NOTICE OF USE OF PRIVACY RIGHTS
Effective date April 3, 2003
For your Protection
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION
Private Application Information
If you are applying for Government programs that provide money or services i.e., Medicaid, you need to give them personal information about you. The laws say that:
- They must keep your health information from others who do not need to know it.
- You can tell them if there is some health information you do not want them to share.
In some cases, they may not be able to agree to your request.
Who sees and Shares my Medical Information? Permitted uses and disclosure
Your private medical information may be used by healthcare providers who take care of you. This may cover healthcare you had before now, or may have later on. We may also use your information to contact you about appointment reminders or to tell you about treatment alternatives. We only share the minimum necessary information about you that is needed at that time by that provider or agency to do their job. You have the right to restrict certain disclosures of your protected health information to a health plan if you pay for the healthcare services out-of-pocket.
In the unlikely event of a breach of your protected health information, we are obligated to notify you of such breach and all corrective measures we have taken to minimize the use of such protected health information by the unauthorized user including notifying the authorities.
How is Payment Made?
Your healthcare provider sends a bill to an insurance company or to a Government program to get paid. This bill has all the information about what services you had. Claims (bills) are Reviewed to make sure that you get the quality healthcare every person deserves, and that all laws about medical care are being met.
May I see My Medical Information?
You are allowed to see your medical information unless it is the private notes taken by a mental health provider, is part of a legal case, or if your healthcare provider decides it would be harmful for you to see the information. Most of the time you can receive a copy if you ask. You may be charged a small amount for the copying costs. If you think some of the information is wrong, you may ask in writing that it be changed or new information added. You may ask that the changes be sent to others who have received your health information from us. You can get a list of where your medical information has been sent, unless it was sent as part of your provider’s care, to be sure that you received quality care, or to make sure the laws are being followed.
What if my Medical Information needs To go somewhere Else?
You will be asked to sign a separate form, called an authorization form, allowing you’re medical information to be sent somewhere else. This would be used if your healthcare provider needs to sent it to another place or if you want us to send it to another person or healthcare provider for you. The form tells us what, where and to whom this information must be sent. Your Authorization is good for six (6) months or until the date you put on the form (not more than one year). You can cancel or limit the amount of information sent at any time by letting us know in writing. You may be charged a small amount for the copying costs.
NOTE: If you are less than 18 years old, your parents or guardians will receive your medical information, unless, by law, you are able to consent for your own healthcare. If you are, then it will not be shared with them unless your sign an authorization form.
Could my Medical Information be Released Without my Authorization?
We follow laws that tell us when we must share your medical information, even if you do not sign an authorization form. We always report:
- contagious diseases;
- reactions and problems with medicines;
- to the police when required by law or when the courts order us to;
- to the government to review how our programs are working;
- to a provider or insurance company who needs to know if you are enrolled in one of our programs.
- to Worker’s Compensation for work related injuries;
- birth, death and immunization information;
- to the federal government when they are investigating something important to protect Our country, the President and other government workers.
May I have a copy of this notice?
This notice is yours. If anything changes, you will get a new one. If you have questions about this notice, please ask the person who gave or sent it to you. If this person cannon answer your questions, call our Privacy Official at 305-591-9975. You can also complain to the federal government Secretary of Health and Human Services by Writing to 200 Independence Ave. SW, Washington, D.C. 20201. This needs to be done within 180 days of when the problem happened. You can also complain to the Office for Civil Rights by Calling 866-627-7748.
Your care will not be affected by a complain made to our Privacy Official or to the Secretary of Health and Human Services.
NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION