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THIS
NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE
USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
WHO WILL FOLLOW THIS NOTICE
This notice describes how the Fresno-Madera Area Agency on
Aging (FMAAA) may use and disclose your protected health information
(PHI) in order to carry out treatment, payment and health
care operations and for other purposes permitted or required
by law. Your PHI is any information that identifies you (such
as your name or address or social security number) that relates
to your past, present or future physical or mental health
or condition, any health care you receive, or to the past,
present or future payment for your health care.
OUR PLEDGE REGARDING PROTECTED HEALTH INFORMATION
We understand that the PHI about you is personal. We are committed
to protecting the PHI about you. We create a record of the
care and services you received from the FMAAA. We need this
record to provide you with quality care and to comply with
certain legal requirements. This notice applies to all of
the records of your care. This notice will tell you about
the way in which we may use and disclose the PHI about you.
We also describe your rights and certain obligations we have
regarding the use and disclosure of your PHI.
We are required by law to: Make sure that the PHI that
identifies you is kept private (with certain exceptions that
will be described), give you this notice of our legal duties
and privacy practices with respect to the PHI about you; and
follow the terms of the notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE THE PHI ABOUT YOU
Except as provided in this notice, the Fresno-Madera Area
Agency on Aging (FMAAA) will disclose PHI only with your written
permission (authorization). However, there are situations
that require or allow disclosures without your authorization.
The following categories describe different ways that the
FMAAA uses and discloses PHI without your authorization. Not
every use or disclosure in a category is listed; however,
all of the ways we are permitted to use and disclose information
will fall within one of the categories. When the FMAAA discloses
your information, we will release only the minimum necessary
to accomplish the purpose for which it is requested.
For Treatment: We may use PHI about you to assist you
with obtaining medical treatment or services. We may disclose
PHI about you to doctors, nurses, technicians, medical students,
interns or other personnel who are involved in taking care
of you. Your treatment team may share your PHI in order to
coordinate the different things you need, such as prescriptions,
regular blood pressure checks, lab work or an EKG. We also
may disclose PHI about you to people outside the FMAAA who
may be involved in your medical care, such as home health
agencies or other third parties for coordination and management
of your health care.
For Payment and Authorization: We use and disclose
your PHI to obtain or provide authorization for services.
Your PHI will also be used and disclosed in order to receive
payment or pay for services provided to you. For example,
insurance companies require PHI to authorize treatment and
for payment of services. We will only disclose the minimum
necessary information to accomplish these purposes.
For Health Care Operations: We may use and disclose
PHI about you for health care operations. These uses and disclosures
are necessary to run the agency and make sure that all of
our clients receive quality care. For example, we may use
your PHI to review our treatment and services and to evaluate
the performance of our staff in caring for you. We may also
disclose information to doctors, nurses, technicians, medical
students, interns and other personnel for review and learning
purposes.
Appointment Reminders: We may use and disclose your
PHI to contact you as a reminder that you have an appointment
for treatment or medical care.
Individuals Involved in Your Care or Payment for Your Care:
We may release your PHI to a family member, another relative,
a close personal friend, or any other person you identify
relevant to that person's involvement in your care or payment
related to your care.
Research: We may use and disclose PHI about you for
research purposes. A research project may involve comparing
the health and recovery of all clients who received one medication
to those who received another, for the same condition. All
research projects are subject to a special approval process.
This process evaluates a proposed research project and its
use of PHI, trying to balance the research needs with clients'
need for privacy of their PHI. Before we use or disclose PHI
for research, the project will have been approved through
this research approval process. We may, however, disclose
PHI about you to people preparing to conduct a research project,
for example, to help them look for clients with specific medical
needs, so long as the PHI they review does not leave the agency.
We will ask for your specific permission if the researcher
will have access to your name, address, or other information
that reveals who you are or will be involved in your care.
As Required By Law: We will disclose PHI about you
when required to do so by federal, state or local law.
To Avert a Serious Threat to Health or Safety: We may
use and disclose PHI about you when necessary to prevent a
serious threat to your health and safety or the health and
safety of the public or another person.
Military and Veterans: If you are a member of the armed
forces, we may release PHI about you as required by military
command authorities. We may also release PHI about foreign
military personnel to the appropriate foreign military authority.
Organ and Tissue Donation: We may release your PHI
to organizations that handle organ procurement or organ, eye
or tissue transplantation or to an organ donation bank.
Workers' Compensation: We may release PHI about you
for workers' compensation or similar programs.
Health Oversight Activities: We may disclose your PHI
to a health oversight agency for activities authorized by
law. These oversight activities include audits, investigations,
inspections, and licensure.
Public Health and Safety: We may disclose PHI about
you for public health and safety activities when such disclosures
are required by law. Public Health and Safety activities generally
include the following: preventing or controlling disease,
injury or disability; reporting births and deaths; reporting
abuse or neglect of children, elders and dependent adults,
including domestic violence that may place a child, elder
or dependent adult at risk; reporting reactions to medications
or problems with products; notifying people of recalls of
products they may be using; notifying a person who may have
been exposed to a disease or may be at risk for contracting
or spreading a disease or condition.
Legal and Administrative Actions: If you are involved
in a criminal court case, a civil lawsuit or an administrative
action, we may disclose PHI about you in a response to a court
or administrative order, subpoena, discovery request, or other
lawful process.
Law Enforcement: We may release your PHI to law enforcement
if required by law.
Coroner, Medical Examiners and Funeral Directors: We
may release PHI to a coroner or medical examiner. This may
be necessary, for example, to identify a deceased person or
determine the cause of death. We may also release PHI about
clients of the FMAAA to funeral directors as necessary to
carry out their duties.
National Security and Intelligence
Activities: We may release PHI about you to authorized
federal officials for intelligence, counterintelligence, and
other national security activities as required by law.
Protective Services for
the President and Others: We may disclose PHI about you
to authorized federal officials so they may provide protection
to the President, other authorized persons or foreign heads
of state or conduct special investigations.
Inmates: If you are
an inmate of a correctional institution or under the custody
of a law enforcement official, we may release PHI about you
to the correctional institution or law enforcement official.
This release would be necessary (1) for the institution to
provide you with healthcare; (2) to protect your health and
safety or the health and safety of others; or (3) for the
safety and security of the correctional institution.
Secretary of the U.S. Department of
Health and Human Services: We may release PHI about you
to the Secretary to investigate or determine the agency's
compliance with the HIPAA privacy rule.
YOUR RIGHTS REGARDING PHI ABOUT YOU
Right to Inspect and Copy: You have the right to inspect and
copy PHI that may be used to make decisions about your care.
Usually, this includes medical and billing records, but may
not include some mental health information. You must make
your request for access in writing.
If you request a copy of the PHI the FMAAA
has about you we may charge a fee for the costs of copying,
mailing or other supplies associated with your request.
We may deny your request to inspect and copy
in certain very limited circumstances. If you are denied access
to your PHI, you may request that the denial be reviewed.
A licensed health care professional, chosen by the FMAAA,
will review your request and the denial. The licensed health
care professional conducting the review will not be the person
who denied your request. We will comply with the outcome of
the review.
Right to Amend: If you feel that PHI we have
about you is incorrect or incomplete, you may ask us to amend
the information. You have the right to request an amendment
for as long as the information is kept by the FMAAA. Your
request must be in writing. You must provide a reason that
supports your request.
We may deny your request if it is not in writing
or does not include a reason to support the request. We may
deny your request if you ask us to amend information that:
Was not created by us, unless the person or
entity that created the information is no longer available
to make the amendment;
Is not part of the PHI kept by or for the FMAAA
Is not part of the information which you would be permitted
to inspect and copy; or Is accurate and complete.
If we deny your request for
amendment, you have the right to submit a written addendum,
not to exceed 250 words, with respect to any item or statement
in your record you believe is incomplete or incorrect. If
you clearly indicate in writing that you want the addendum
to be made part of your PHI we will attach it to your records
and include it whenever we make a disclosure of the item or
statement you believe to be incomplete or incorrect.
Right to Request Confidential
Communications: You have the right to request that we
communicate with you about medical matters in a certain way
or at a certain location. For example, you can ask that we
only contact you at work rather than at home. We will not
ask you the reason for your request. We will accommodate all
reasonable requests. Your request must specify how or where
you wish to be contacted.
Right to Request Restrictions:
You have the right to request a restriction or limitation
on the PHI we use or disclose about you for treatment, payment
or health care operations. You also have the right to request
a limit on the PHI we disclose about you to someone who is
involved in your care or the payment for your care, like a
family member or friend. For example, you could ask that we
not use or disclose information about a service you had.
We are not required to agree
to your request. If we do agree, we will comply with your
request until we are notified from you that you no longer
want the restriction to apply (except as required by law or
in emergency situations).
In your request, you must tell
us (1) what information you want to limit; (2) whether you
want to limit our use, disclosure or both; and (3) to whom
you want the limits to apply, for example, disclosures to
your spouse.
Right to an Accounting of
Disclosures: You have the right to request an "accounting
of disclosures." This is a list of the disclosures we
made of PHI about you other than disclosures: made to you;
made based on your authorization, for treatment, payment and
health care operations (as those functions are described above);
to persons involved in your care; for national security or
intelligence purposes; to correctional institutions; to law
enforcement (as required by law); or that occurred prior to
April 14, 2003.
Your request must state a time
period, which may not be longer than six years and may not
include dates before April 14, 2003. Your request should indicate
in what form you want the list, i.e., paper copy, electronically.
The first list you request within a 12-month period is free.
For additional lists, we may charge you for the costs of providing
the list. We will notify you of the cost involved and you
may choose to withdraw or modify your request at that time
before any costs are incurred.
TO INSPECT AND COPY PHI
THAT MAY BE USED TO MAKE DECISIONS ABOUT YOU, TO REQUEST AN
AMENDMENT, TO REQUEST A LIST OR ACCOUNTING OF DISCLOSURES,
TO REQUEST RESTRICTIONS, OR TO REQUEST CONFIDENTIAL COMMUNICATIONS:
You must make your request in writing to: Fresno-Madera Agency on Aging
Care Management Services
2085 East Dakota Avenue
Fresno, CA 93726
Right to a Paper Copy of This Notice: Even if you have agreed
to receive this notice electronically, you are still entitled
to a paper copy of this notice. You may ask us to give you
a copy of this notice at any time. You may obtain a copy of this notice at our
website: http://www.fmaaa.org
To obtain
a paper copy of this notice contact the Fresno-Madera Agency
on Aging.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the
right to make the revised or changed notice effective for
PHI we already have about you as well as any information we
receive in the future. We will post a copy of the current
notice at the FMAAA. All clients will be informed of changes
to this notice.
COMPLAINTS
If you believe your privacy rights have
been violated, you may complain either verbally or in writing
to:
Privacy Officer
Fresno-Madera Agency on Aging
2085 East Dakota Avenue
Fresno, CA, 93726
(559) 453-4405
(559) 453-5111 (fax)
Or you may file a complaint directly to the
Secretary, U.S. Department of Health and Human Services, at:
Region IX, Office for Civil
Rights
U.S. Department of Health and Human Services
50 United Nations Plaza Room 322
San Francisco, CA 94102
Fax number: (415) 437-8329
E-mail address: OCRComplaint@hhs.gov
The complaint to the Office
for Civil Rights must be submitted in written or electronic
form and must be filed within 180 days of when the incident
occurred or was known to have occurred. You will not be retaliated
against for filing a complaint.
OTHER USES OF PHI
Other uses and disclosures of your PHI not covered by this
notice or the laws that apply to us will be made only with
your written permission (authorization). If you provide us
permission to use or disclose PHI about you, you may revoke
that permission, in writing, at any time. If you revoke your
permission, this will stop any further use or disclosure of
your PHI for the purposes covered by your written authorization,
except if we have already acted in reliance on your permission.
We are unable to take back any disclosures we have already
made with your permission, and we are required to retain our
records of the care that we provided to you.
HOW TO CONTACT US
If you have any comments or questions about this notice, please
contact:
Privacy Officer
Fresno-Madera Agency on Aging
Care Management Services
2085 East Dakota Avenue
Fresno, CA 93726
(559) 453-4405
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