Blair Senior Services, Inc.
NOTICE OF PRIVACY PRACTICES
Effective Date: April 14, 2003
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.
I. How Blair Senior Services Uses and Discloses Your Health Information:
Blair Senior Services, Inc. provides a broad range of services through a wide variety of health and human services programs. If you receive services from Blair Senior Services, the Agency may use your protected health information and disclose it to other health and human service programs, to:
a) plan and provide your care and services
b) communicate with health care professionals who care for you
c) describe the care you receive
d) obtain reimbursement from private insurers or other government programs
e) verify that services billed were actually provided
f) educate health professionals
g) inform public health officials charged with improving healthcare
h) help to administer other Commonwealth programs which provide public benefits, and/or health or human services
i) assess and improve the services provided and the outcome achieved
j) pay for services you receive
k) inform you about other public programs and services
Blair Senior Services, Inc. and its programs will not use or disclose your protected health information except as described in this notice, or otherwise authorized by law.
II. Your Health Information Rights:
You have the right to:
a) obtain a paper copy of this Notice of Privacy Practices upon request.
You have the right to a copy of this Notice of Privacy Practices. Contact Blair Senior Services, Inc.'s Privacy Department at 1320 12th Avenue, Altoona, PA 16601-3308, or call (814) 946-1235 or 1-800-245-3282 for a written copy of this notice. Hereinafter, all written communication regarding this Notice of Privacy Practice should be directed to Blair Senior Services' Privacy Department.
b) request a restriction on certain uses and disclosures of your protected health information.
You have the right to request a restriction on the protected health information we use or disclose about you for treatment, payment or health care operations. Your request to us must be in writing. We are not required to agree to these additional restrictions but, if we do, we will abide by our agreement unless the information is needed to provide emergency treatment to you. Any agreement we may make to a request for additional restrictions must be signed by a person authorized to make such an agreement on our behalf. We will not be bound unless our agreement is in writing and signed by both parties.
You may request a restriction by contacting Blair Senior Services, Inc. at 1320 12th Avenue, Altoona, PA 16601-3308. In your request, tell us: your name, address, phone number, the information whose disclosure you want to limit; and, how you want to limit our use and/or disclosure of the information.
c) inspect and copy your protected health information.
You have the right to look at or receive copies of your protected health information in a designated record set. Generally, a "designated record set" contains referral and medical information, as well as other records that are used to make decisions about your services. You may inspect notes or certain other information that is authorized by Blair Senior Services, Inc.
You may request that we provide copies in a format other than photocopies. We will use the format you request, unless we cannot practicably do so.
To inspect and/or copy your protected health information, you must make this request, in writing, and send it to Blair Senior Services, Inc. at 1320 12th Avenue, Altoona, PA 16601-3308. We reserve the right to charge you a reasonable fee for this and subsequent requests.
We may deny your request to inspect and copy your protected health information in certain limited circumstances. If you are denied access to your information, you may request that the denial be reviewed. To file a complaint see Section II, h.
d) request amendments to your protected health information.
If you believe that your protected health information is incorrect or incomplete, you have the right to request that we amend your protected health information. Your request must be in writing and sent to Blair Senior Services, Inc., 1320 12th Avenue, Altoona, PA 16601-3308. It must explain what should be amended and why the information should be amended.
We may deny your request if we did not create the information you want amended, or for certain other reasons. If we deny your request, we will provide you a written explanation. You may respond with a statement of disagreement to be added to the information you wanted amended. If we accept your request to amend the information, we will make reasonable efforts to inform others, including people you name, of the amendment and to include the changes in any future disclosures of that information
e) obtain an accounting of disclosures of your protected health information.
You have a right to an accounting of certain disclosures of your protected health information that are for reasons other than treatment, payment, or health care operations. There are certain other exceptions as well. An accounting, if required, will include the date(s) of the disclosure, to whom we made the disclosure, a brief description of the information disclosed, and the purpose for the disclosure.
You may request, in writing, an accounting of disclosures. It must be sent to Blair Senior Services, Inc. at 1320 12th Avenue, Altoona, PA 16601-3308.
We reserve the right to charge you a reasonable fee for responding to this and subsequent requests.
f) request communications of your protected health information by
alternative means or to an alternative address.
You have the right to request that we communicate with you in confidence about your protected health information by alternative means or to an alternative location. For example, you may ask that we contact you only at your post office address.
You must request in writing the alternative means and/or the alternative location you want. We will accommodate your request if it is reasonable. Alternative means that incur a cost to Blair Senior Services, Inc. may be passed on to you.
g) revoke your consent to use or disclose protected health information to the
extent that it has not already been relied upon.
If you wish to revoke your written consent to use or disclose protected health information, you may do so, in writing, to Blair Senior Services, Inc., 1320 12th Avenue, Altoona, PA 16601-3308.
However, you should know that this revocation can only be done to the extent that it has not already been relied upon to render services to you, or on your behalf.
h) file a complaint to Blair Senior Services, Inc. and/or the Secretary of
the U.S. Department of Health and Human Services if you believe your privacy rights have been violated.
If you want more information about our privacy policies or practices, or have questions or concerns, please contact us at: Privacy Department, Blair Senior Services, Inc., 1320 12th Avenue, Altoona, PA 16601-3308, or call (814) 946-1235 or 1-800-245-3282, Fax: (814) 949-4857.
If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your protected health information, or in response to a request you made to amend or restrict the use or disclosure of your protected health information, or to have us communicate with you in confidence by alternative means or at an alternative location, you may complain to us using the contact information listed above.
You may also submit a written complaint to the U.S. Department of Health and Human Services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request.
We support your right to protect the privacy of your protected health information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.
III. Blair Senior Services' Privacy Rule Duties:
Blair Senior Services’ health and human service programs have a duty to:
a) maintain the privacy of your protected health information
b) provide you with a notice as to our legal duties and privacy practices with respect to protected health information we collect and maintain about you
c) abide by the terms of the privacy notice currently in effect
d) notify you if we are unable to agree to a requested restriction
e) accommodate reasonable requests you may have to communicate health information by alternative means or at alternative addresses
f) provide an accounting of disclosures of your protected health information, upon request
Blair Senior Services, Inc. and its health and human service programs may change its privacy practices and make the new privacy practices effective for all protected health information we maintain. Should our privacy practices change while you are an active consumer of the Agency, we will mail a revised notice to the address you have supplied us.
IV. Examples of Disclosures for Treatment, Payment and Health Operations:
In order to administer our health and human service programs effectively, we will collect, use and disclose protected health information for certain activities including for treatment, payment and health operation purposes.
The following are examples as to how we may use and/or disclose protected health information about you for treatment, payment and health care operations.
We will use your health information for treatment.
For example: Care Managers disclose your health information to in-home service providers to assist with your care. Information as to your diagnosis, medications and functional abilities may be disclosed in order to provide care and recognize problems.
We will disclose health information for emergency treatment.
For example: Senior Center Personnel disclose your health information to emergency personnel to render treatment, as needed.
We will use your health information for payment.
For example: Through the PDA Waiver Program, medical and financial information will be disclosed to the Department of Public Welfare for reimbursement to providers for services.
We will use your health information for regular health operations.
For example: Health information will be disclosed to the Pennsylvania Department of Aging to assure proper utilization of funds and to project areas of need.
V. Others who may receive your health information:
Business Associates: there are some services provided in our organization through contracts with business associates. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve asked them to do. However, we require the business associate to appropriately safeguard your information.
Research: We may disclose information to researchers when the information is de-identified or when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.
Coroners, Medical Examiners and Funeral Directors: We may disclose health information to coroners, medical examiners, or to funeral directors to carry out their duties as required by law.
Public Health: We may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability, or to lessen a serious and imminent threat to the health or safety of a person or the public.
Correctional institution: Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof any health information necessary for your health and the health and safety of other individuals, or for the administration of the institution.
Law Enforcement/Legal Proceedings: We may disclose health information to law enforcement officials, a court of law in connection with a legal proceeding, or in administrative proceedings.