PROJECT SAMARITAN
AIDS SERVICES INC.
NOTICE OF PRIVACY
PRACTICES
(Effective April 14,
2003)
THIS NOTICE
DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN
GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
At PROJECT SAMARITAN AIDS
SERVICES, Inc. (PSAS) we are committed to protect your health
information. This Notice, which is required by the Federal Health Insurance
Portability and Accountability Act (HIPAA), informs you of our privacy
practices. It also describes your rights as they relate to your protected
health information. This Notice is effective April 14, 2003 and applies to all
protected health information as defined by federal regulations.
Project Samaritan AIDS
Services, Inc. is required to:
·
Maintain the privacy of your health information,
·
Provide you with this notice as to our legal duties and privacy
practices with respect to protected health information,
·
Abide by the terms of this notice,
·
Notify you if we are unable to agree to a requested restriction,
·
Notify you if we are unable to provide you with access to your
protected health information,
·
Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations,
·
Reserve the right to
change the terms of this Notice.
If PSAS
changes the terms of this notice, we will
provide
you with a paper copy of the revised Notice
within 60
days of the revision. The revised Notice will
be
distributed as follows:
Residential Health Care
Facility:
Hand delivered by PSAS staff to residents.
Adult Day Health Care
Centers and COBRA
programs: You will receive this at the time of your next visit. If the visit is not scheduled within the
60-day time frame the Notice will be mailed to you.
How We Use and Disclose Your Health Information
We
will not use or disclose your individually
identifiable health information
without authorization, except as permitted by this Notice.
Treatment: All entries in your health record
are deemed protected health information (PHI). This includes information
regarding your diagnosis, treatment, procedures and results of tests done. We
may release such health information to other health care providers in order to
provide you with quality care and to ensure the appropriate and timely
provision of care and services.
Payment.
In order to receive payment for the care and treatment that we
provide for you we must submit a bill to you or your insurance company. The
bill will include information regarding your diagnosis, procedures done and
treatments rendered.
Health
Care Operations: Members of
the PSAS staff, may use information in your health record for other purposes
which includes but is not limited to: improve the quality and effectiveness of
the healthcare and services we provide, staff training, evaluating staff
performance, auditing functions, strategic planning.
Special Protections for Health
Information:
Additional protections apply under the Public Health Laws governing release of
HIV related information and Federal law, 42 CFR Part 2, governing release of
information for substance abuse treatment. PSAS will comply with these
regulations.
·
Be provided with the paper copy of this Notice, even
if it was sent electronically.
·
Inspect and request a copy of your health record,
·
Request an amendment to your health record in accordance with PSAS
procedures,
·
Obtain an accounting of certain disclosures of your health
information,
·
The right to request restriction on certain uses and disclosures
of your protected health information.
However, PSAS is not obligated to agree to all such requests.
·
Request communications of your health information by reasonable
alternative means or at alternative locations, such as, you can request that we
contact you at work rather than home, by cell phone rather than home phone.
·
Revoke an authorization
to use or disclose health information, unless that action has already been
taken or the action is required by law.
Family
Members/Relatives/Friends: PSAS
staff may disclose to a family member, other relative, close personal friend or
any other person you identify, health information relevant to that person’s
involvement in your care or payment related to your care. When communicated to us, PSAS will comply with your requests for restrictions
on disclosures to any of these persons.
Appointment Reminders: We may also contact you to
provide appointment reminders. If you wish to be notified by alternative means
at addresses or telephone numbers not on file please notify PSAS staff of any
restrictions on such notifications and alternate contact information.
Marketing/Treatment Alternatives: We may contact you with information about treatment alternatives or other health-related benefits and services that may be of interest to you
Research: We may
disclose information to researchers when an institutional review board has
reviewed and approved the research proposal and has established protocols to
ensure the privacy of your health information.
Funeral
Directors/Coroners: We may disclose health information
to these persons, consistent with applicable law, to carry out their duties.
Organ
Procurement Organizations: Consistent with applicable
law, we may disclose health information to organ procurement organizations or
other entities engaged in the procurement, banking, or transplantation of
organs for the purpose of tissue donation and transplant.
Fund
raising: We may contact you as part of a PSAS fund-raising effort but will
not use information regarding your health care or treatment for any fund
raising purposes.
Workers
Compensation: We may disclose health information to the extent authorized by
and to the extent necessary to comply with laws relating to workers
compensation or other similar programs established by law.
Law Enforcement: We may disclose health information
to correctional institutions and for law enforcement purposes, as defined by
law or in response to a valid subpoena.
Oversight Agencies: Federal law also makes
provision for your health information to be released to public health,
regulatory and governmental authorities for the purposes of:
·
Investigating
unlawful conduct and/or violations of professional or clinical standards that
may potentially endanger patients, workers or the public.
·
Reporting
cases of child abuse or neglect, domestic violence, elder abuse.
·
Preventing
serious threats to public health and safety.
·
Reporting
diseases that may pose a threat to the public.
·
Legal
proceedings, as required by law.
If
you require additional information regarding this Notice and/ or believe your
privacy rights have been violated, you can file a complaint with PSAS Privacy
Contact person, as noted below.
Title: Sr. Vice
President/Administrator RHCF
Telephone: (718) 681-8700, Ext. 2116
You may file a complaint with the Office for Civil Rights, U.S. Department of Health and Human Services.
The address is:
Office
for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201
There will be no retaliation for
filing a complaint with either the PSAS Privacy contact person or the Office
for Civil Rights.