THIS
NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW CAREFULLY.
A federal regulation known as the "HIPAA Privacy Rule" requires us to maintain the privacy of your "protected health information" and to provide you with this notice of our legal duties and privacy practices concerning your protected health information. Your protected health information includes any information which (a) relates to your past, present or future physical or mental health or condition, the provision of health care to you, or payment for health care provided to you; and (b) individually identifies you or can be reasonably used to identify you. We are required to comply with the terms of this notice, or any future notice that replaces this notice.
This notice applies to all the programs and
facilities of Ephrata Area Rehab. Services, that are referred to as EARS. Our
facilities include EARS, Cloister Avenue, Ephrata; EARS, Fulton Street; EARS of
Lebanon, Lehman Street, Lebanon. The
programs include the Specialized Services Unit of Ephrata and Lebanon, the
Vocational Units of Ephrata and Lebanon, the Mobile Work Crews of Ephrata and
Lebanon, the Advanced Training Unit, the EARS Transit System and EARS/ODC.
This
notice also applies to all of the people that make up Ephrata Area Rehab.
Services,
including
our staff and employees.
Whenever
the words "we" or "us" are used in this notice, they are
intended to include the
employees
and staff of EARS.
If
you have any questions, or would like additional information about this notice,
you may contact our Privacy Officer, Bill Trowbridge at (717) 626-1900, or
e-mail him at earsbt@dejazzd.com.
I.
HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH
INFORMATION
We may use and disclose your protected health information
for treatment, payment, and health care operations without obtaining your
authorization. The following section contains some examples of ways we may use
and disclose your protected health information for treatment, payment and
health care operations. These examples do not list every possible use or disclosure
for treatment, payment, and health care operations.
1.
Treatment
We may use and disclose your protected health
information for our program development purposes as well as the treatment
purposes of other health care providers who treat you. Treatment includes the
provision, coordination, and management of health care services provided to you
by one or more health care providers. Treatment also includes consultations
with other health care providers.
Some
examples of treatment uses and disclosures include:
• Disclosure of your protected
health information to a physician who will be
providing treatment to you.
• Disclosure of your protected
health information to a hospital or other health
care facility that will be
providing treatment to you.
• Disclosure of your protected
health information to residential
program providing care to you.
2.
Payment
We
may use and disclose your protected health information for the purpose of
allowing us to secure payment for treatment provided to you. We may also
disclose your protected health information to another health care provider for
the payment activities of that health care provider.
Some
examples of payment uses and disclosures include:
• Disclosing information to
Medicare or Medicaid to determine whether you are
eligible for coverage or
whether proposed treatment is a covered service or
medically necessary.
• Disclosing information to
local, state or federal agencies to secure funding or
payment in connection with
services provided to you.
3.
Program Operations
We
may use and disclose your protected health information for conducting our
program
operations. If another provider has treated you, we may
disclose protected health
information
about you for certain health care/program operations of that health care
provider.
Some
examples of our health care operations include:
• Quality assessment activities
designed to assist us in determining how to
improve the treatment we
provide.
• Legal, accounting and
auditing functions.
• Training programs for
students, trainees, health care providers or business
personnel.
• Accreditation, certification
and licensing activities.
• Other business management
activities, such as compliance activities related
to state and federal laws.
• Solicitation by us or by the
EARS Foundation, which is related to us, for the
purpose of raising funds for our organization.
B.
Other Uses and Disclosures We Can Make Without Your Written Authorization
Or
Opportunity to Agree or Object.
We may use and disclose protected health
information about you in the following circumstances without your authorization
or opportunity to agree or object, subject to certain conditions that may
apply:
We may use and disclose protected health
information when required by federal,
state,
or local law.
We may use and disclose protected health
information to public health authorities or
Other persons authorized to carry out
certain activities related to public health. These
disclosures may include, for example,
FDA-related reports and disclosures related to
problems with products or services.
We may contact you to provide information
about program
alternatives or services that may be of interest to you.
We may use and disclose protected health
information for purposes of reporting
abuse,
neglect or domestic violence, as for example, reports of elder abuse.
We may use and disclose protected health
information for purposes of oversight
activities authorized by law. These
activities could include audits, inspections,
investigations, licensure actions, or legal
proceedings conducted by health oversight
agencies.
We
may use and disclose protected health information in judicial and
administrative
proceedings in response to a court order, subpoena, discovery request or
other lawful
process.
We may use and disclose protected health
information for certain law enforcement
purposes.
These purposes may include, for example, complying with a search
warrant
or other authorized legal
process, responding to a request for information
about a crime victim, or providing
information regarding a crime on our premises.
We may use and disclose protected health
information for purposes of providing
information to a coroner or medical
examiner for the purpose of identifying a
deceased individual, determining a cause
of death, or facilitating their performance of
other duties required by law.
We may use and disclose protected health
information for purposes of providing
information to funeral directors as
necessary to carry out their duties.
We may use and disclose protected health
information for research purposes under
certain limited circumstances. We must
obtain a written authorization to use and
disclose protected health information
for research purposes, except in situations
where a research project meets specific
criteria established by the HIPAA Privacy
Rule to insure the privacy of protected
health information.
We may use and disclose protected health
information in limited circumstances when
necessary to prevent a threat to the
health or safety of a person or to the public.
We may use and disclose protected health
information for purposes involving
specialized governmental functions such
as military and veterans activities, national
security and intelligence, protective
services for the President and others, medical
suitability determinations for the
Department of State, and correctional institutions
and other law enforcement custodial
situations.
We may use and disclose protected
health information as authorized by and to the
extent necessary to comply with laws
relating to workers' compensation or similar
programs that provide benefits for
work-related injuries or illness without regard to
fault.
Some of our functions and operations
involving protected health information are
performed by business associates, such
as accounting and law firms. We may
disclose protected health information to
our business associates and allow them to
create and receive protected health
information on our behalf.
We may use protected health information
in the process of de-identifying that
information so that the de-identified
information can be disclosed to a third without
your authorization. We may also exclude
certain direct identifiers in your protected
health information to create information
known as a limited data set to be used or
disclosed for the purpose of research,
health care operations or public health
activities.
We are required to disclose protected
health information to the Secretary of the
United States Department of Health and
Human Services when requested by the
Secretary to review our compliance with
the HIPAA Privacy Rule.
C.
Uses and Disclosures for Which You Have the Opportunity to Agree or Object
In
some situations you may have the opportunity to agree or object to certain uses
and
disclosures
of protected health information about you. If you agree or do not object, then
we
may make these types of uses and disclosures of protected health information in
the following circumstances:
Disclosure
to Family, Close Friends or Others.
We
may use and disclose protected health information about you in connection with
notifications to individuals involved in your care or payment for your care. We
may disclose protected health information about you to your family members,
close friends or any other persons identified by you if that information is
directly relevant to the person's involvement in your care or payment for your
care. If you are present and able to consent or object (or if you are available
in advance), then we may only use or disclose your protected health information
if you agree to the use or disclosure or do not object after you have been
informed of your opportunity to object. If you are not present or if you are
unable to consent or object, we may exercise professional judgment in
determining whether the use or disclosure of protected health information is in
your best interest. We may also use and disclose protected health information
to notify your family members or close friends of your location, general
condition or death.
D.
Confidentiality of Certain Medical Records
The
confidentiality of drug and alcohol treatment records, HIV related information
and mental health records maintained by us is specially protected by
Pennsylvania law. We will only disclose such information if you consent in
writing, or if the disclosure is allowed by a court order, or if other limited
circumstances apply.
E.
Other Uses and Disclosures of Protected Health Information Require Your
Authorization
All
other uses and disclosures of protected health information which do not fit
into one of the above categories will only be made with your written
authorization. If you have authorized us to use or disclose protected health
information about you, you may revoke your authorization at any time, except to
the extent that we have already taken action based on your authorization.
II.
YOUR PRIVACY RIGHTS
A.
Further Restriction on Use or Disclosure
You
have a right to request additional restrictions on the use and disclosure of
your protected health information to carry out treatment, payment or health
care operations. You may also request additional restrictions on our disclosure
of protected health information to persons involved in your care or the payment
for your care. We are not required to agree to a request for a further
restriction. If we do agree to your request, we are required to comply with our
agreement, except in certain cases, including treatment of you in an emergency.
To request a further restriction, you must submit a written request to our
Privacy Officer specifying what information you want restricted; how you want
the information restricted; and to whom you want the restriction to apply.
B.
Confidential Communication
You
have the right to request that we communicate your protected health information
to you by a certain means or at a certain location. For example, you might
request that we only contact you at home, rather than at work. We are required
to accommodate requests for confidential communications that are reasonable. To
make a request for confidential communications, you must submit a written
request to our Privacy Officer specifying how or where you want to be
contacted.
C.
Accounting of Disclosures
You
have the right to request an accounting of certain disclosures that we have
made of your protected health information. This accounting would be a list of
disclosures made by us during a specified period of up to six years, other than
disclosures made for the following purposes:
• For treatment, payment and health care
operations.
• For use in or related to a facility
directory.
• To family members or friends involved
in your care.
• To you directly.
• Pursuant to an authorization by you or
your personal representative.
• For certain notification purposes,
including national security, intelligence,
correctional and law enforcement
purposes.
• For disclosures made before April 14,
2003.
To
request an accounting of disclosures, you must submit a written request to our
Privacy Officer. The first list that you request in a 12 month period will be
free, but we may charge you for our reasonable costs of providing additional
lists in the same 12 month period. We will tell you about these costs, and you
may choose to cancel your request at any time before costs are incurred.
D.
Right to Inspect and Copy
You have a right to request an
opportunity to inspect and receive a copy of your
protected health information in certain
records that we maintain. This includes your
medical and billing records, but does not
include psychotherapy notes or information
gathered or prepared for a civil,
criminal or administrative proceeding. We may deny
your request to inspect and copy
protected health information only in certain limited
circumstances. If you request a copy of
your protected health information, we may
charge you a reasonable fee as allowed by
Pennsylvania law. To exercise your right
of access, you must submit a written
request to our Privacy Officer.
E.
Right to Request an Amendment
You may request that your protected
health information be amended. Your request
may be denied if the information in
question is accurate and complete. Your request
may also be denied if the information in
question was not created by us (unless the
original source of the information is no
longer available), is not part of our records, or
is not the type of information that
would be available to you for inspection or
copying. If your request to amend your
health information is denied, you may submit
a written statement disagreeing with our
denial, which we will keep on file and
distribute with all future disclosures
of the information to which it relates. To request
an amendment, you must submit a written
request to our Privacy Officer specifying
the change that you want and the reasons
for the requested change.
F.
Paper Copy of Privacy Notice
You have a right to receive, upon
request, a paper copy of this notice at any time. To
obtain a paper copy, please contact our
Privacy Officer.
III.
CHANGES TO THIS NOTICE
We may change this notice at any time.
We may make any change effective for all
Protected health information that we
maintain at the time of the change, including
information that we created or received
prior to the effective date of the change. We
will post a copy of our current notice
in our reception area. You may also get a copy
of our current notice from our Privacy
Officer.
IV.
COMPLAINTS
If you believe that we have violated
your privacy rights, you may submit a complaint
to us or to the Secretary of Health and
Human Services. To file a complaint with us,
submit the complaint in writing to our
Privacy Officer. We will not retaliate against
you for filing a complaint.
V.
LEGAL EFFECT OF THIS NOTICE
This
notice is not intended to create contractual or other rights independent of
those created in the HIPAA Privacy Rule.
VI.
EFFECTIVE DATE
This
notice was first effective on April 14, 2003.