The
Seniors’ Resource Center provides non-medical
services to our customers. In order to provide service, however,
it is frequently necessary for us to have access to health information.
The Health Insurance Portability and Accountability Act,
(HIPAA), guidelines require specific language be used in our notice
of privacy practices. Therefore, referrals will be made to ‘treatment’
within this notice even though we are not a direct provider of
what we consider medical treatment.
For
purposes this and other HIPAA-related documents from SRC, the
term “treatment” will be defined for SRC purposes
as non-medical services received from one of the Center’s
programs including but not limited to: Adult Day and Respite
Services, Homemaker and Personal Care Program Services, Transportation
Services, Case Management Services, Nutrition Services and Volunteer
Services.
WHO WILL FOLLOW THIS NOTICE
This notice describes the information
privacy practices followed by our employees and other office personnel.
The practices described in this notice will also be followed by
staff members that you may consult with by telephone.
YOUR HEALTH INFORMATION
This
notice applies to the information and records we have about your
health, health status, and the health care and services you receive
from Seniors’ Resource Center, Incorporated.
We
are required by law to give you this notice. It will tell you
about the ways in which we may use and disclose health information
about you and describes your rights and our obligations regarding
the use and disclosure of that information.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
For
Treatment
or provision of Services:
We may use health information about you to provide you with treatment
or services. We may disclose health information about you to doctors,
nurses, technicians, office staff or other personnel or entities
who are involved in taking care of you and your health.
For
example, your doctor may be treating you for a heart condition
and may need to know if you have other health problems that could
complicate your treatment. The doctor may use your medical history
to decide what treatment is best for you. The doctor may also
tell another doctor about your condition so that doctor can help
determine the most appropriate care for you. Your doctor could
also contact us about information that may be related to your
health status in order to further determine treatment measures
for you. We may also contact your doctor or members of his/her
staff in order to acquire information that will allow us to better
create a plan of care or to determine what services will be required
to best meet your needs.
Different
personnel in our office may share information about you and disclose
information to people who do not work in our office in order to
coordinate your care, such as helping you to set up doctor, treatment,
or therapy appointments, scheduling lab work or assisting you
in coordinating transportation. Family members and other health
care providers may be part of your medical care outside this office
and may require information about you from us. We may also request
information from them if it is believed to be in your best interest.
For
Payment We may use and disclose health information
about you so that the services you receive from the Seniors’
Resource Center may be billed to and payment may be collected
from you, an insurance company or a third party. For example,
we may need to give your health plan information about a service
you received from the Center so that we will be paid or so that
you may be reimbursed for the service. We may also tell your health
plan about a treatment you are going to receive to obtain prior
approval, or to determine whether your plan will cover the treatment.
For
Health Care Operations We may use and disclose health
information about you in order to run the office and make sure
that you and our other customers receive quality care. For example,
we may use your health information to evaluate the performance
of our staff in caring for you. We may also use health information
about all or many of our customers to help us decide what additional
services we should offer, how we can become more efficient, or
whether certain new services are effective.
Appointment
Reminders We may contact you as a reminder that
you have an appointment for service.
Service
Alternatives We may tell you about or recommend
possible service options or alternatives that may be of interest
to you.
Health-Related
Products and Services We may tell you about health-related
products or services that may be of interest to you.
Please
notify us if you do not wish to be contacted for appointment reminders,
or if you do not wish to receive communications about service
or treatment alternatives or health-related products and services.
If you advise us in writing (at the address listed at the top
of this Notice) that you do not wish to receive such communications,
we will not use or disclose your information for these purposes.
You
may revoke your Consent at any time by giving us written
notice. Your revocation will be
effective when we receive it, but it will not apply to any uses
and disclosures which occurred before that time.
If
you do revoke your Consent, we will not be permitted to
use or disclose information for purposes of service, payment or
health care operations, and we
may therefore choose to discontinue providing you with health
care service and services.
SPECIAL SITUATIONS
We
may use or disclose health information about you without your
permission for the following purposes, subject to all applicable
legal requirements and limitations:
To
Avert a Serious Threat to Health or Safety
We may use and disclose health
information 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.
Required
By Law We will disclose health information about
you when required to do so by federal, state or local law.
Research
We may use and disclose health information about you for research
projects that are subject to a special approval process. We will
ask you for your 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 at the office.
Organ
and Tissue Donation
If you are an organ donor, we may release health information
to organizations that handle organ procurement or organ, eye or
tissue transplantation or to an organ donation bank, as necessary
to facilitate such donation and transplantation.
Military,
Veterans, National Security and Intelligence If
you are or were a member of the armed forces, or part of the national
security or intelligence communities, we may be required by military
command or other government authorities to release health information
about you. We may also release information about foreign military
personnel to the appropriate foreign military authority.
Workers'
Compensation We may release health information about
you for workers' compensation or similar programs. These programs
provide benefits for work-related injuries or illness.
Public
Health Risks We may disclose health information
about you for public health reasons in order to prevent or control
disease, injury or disability; or report births, deaths, suspected
abuse or neglect, non-accidental physical injuries, reactions
to medications or problems with products.
Health
Oversight Activities We may disclose health information
to a health oversight agency for audits, investigations, inspections,
or licensing purposes. These disclosures may be necessary for
certain state and federal agencies to monitor the health care
system, government programs, and compliance with civil rights
laws.
Lawsuits
and Disputes If you are involved in a lawsuit or
a dispute, we may disclose health information about you in response
to a court or administrative order. Subject to all applicable
legal requirements, we may also disclose health information about
you in response to a subpoena.
Law
Enforcement We may release health information if
asked to do so by a law enforcement official in response to a
court order, subpoena, warrant, summons or similar process, subject
to all applicable legal requirements.
Coroners,
Medical Examiners and Funeral Directors We may release
health information to a coroner or medical examiner. This may
be necessary, for example, to identify a deceased person or determine
the cause of death.
Information
Not Personally Identifiable
We may use or disclose health information about you in a way that
does not personally identify you or reveal who you are.
Family
and Friends We may disclose health information about
you to your family members or friends if we obtain your verbal
agreement to do so or if we give you an opportunity to object
to such a disclosure and you do not raise an objection. We
may also disclose health information to your family or friends
if we can infer from the circumstances, based on our professional
judgment, that you would not object. For example, we may assume
you agree to our disclosure of your personal health information
to your family or friend when you have another person in the room
with you when we meet with you or when you receive services from
one of our staff or volunteers.
In
situations where you are not capable of giving consent (because
you are not present or due to your incapacity or medical emergency),
we may, using our professional judgment, determine that a disclosure
to your family member, friend, or care-giver is in your best interest.
In that situation, we will disclose only health information relevant
to the person's involvement in your care. For example, we may
inform the person who followed you to the emergency room that
you appeared to suffer an acute health situation requiring us
to assist you in receiving medical care. We may also use our professional
judgment and experience to make reasonable inferences that it
is in your best interest to allow another person to act on your
behalf to pick up, for example, filled prescriptions, medical
supplies, etc.
OTHER
USES AND DISCLOSURES OF HEALTH INFORMATION
We
will not use or disclose your health information for any purpose
other than those identified in the previous sections without your
specific, written Authorization. We must obtain your Authorization
separate from any Consent we may have obtained from
you. If you give us Authorization to use or disclose health
information about you, you may revoke that Authorization, in
writing, at any time. If you revoke your Authorization, we
will no longer use or disclose information about you for the reasons
covered by your written Authorization, but we cannot take
back any uses or disclosures already made with your permission.
If
we have HIV or substance
abuse information about you, we cannot release that information
without a special signed, written authorization (different than
the Authorization and Consent mentioned above) from
you. In order to disclose these types of records for purposes
of service, payment or health care operations, we will have to
have both your signed Consent and a special written Authorization
that complies with the law governing HIV
or substance abuse records.
SRC
may use demographic information contained in a client/customer’s
file (such as names and addresses) for fund-raising purposes for
the Center and its services. You may elect to decline to participate
in these processes by notifying: Development, Seniors’ Resource
Center, 3227 Chase Street, Denver, CO 80212.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
You have the following rights regarding health information we
maintain about you:
Right
to Inspect and Copy
You have the right to inspect and copy your health information,
such as medical and billing records, that we use to make decisions
about your care. You must submit a written request to Terri
Wager, Director of Human Resources] in order to inspect
and/or copy your health information. If you request a copy of
the information, we may charge a fee for the costs of copying,
mailing or other associated supplies. We may deny your request
to inspect and/or copy in certain limited circumstances. If you
are denied access to your health information, you may ask that
the denial be reviewed. If such a review is required by law, we
will select a licensed health care professional to review your
request and our denial. The person conducting the review will
not be the person who denied your request, and we will comply
with the outcome of the review.
Right
to Amend
If
you believe health information we have about you is incorrect
or incomplete, you may ask us to amend the information. You have
the right to request an amendment as long as the information is
kept by this office.
To
request an amendment, complete and submit a Medical Record Amendment/Correction
Form to Terri Wager, Director of Human Resources We may deny your
request for an amendment if it is not in writing or does not include
a reason to support the request. In addition, we may deny your
request if you ask us to amend information that:
a)
We did not create, unless the person or entity that created the
information is no longer available to make the amendment.
b)
Is not part of the health information that we keep.
c)
You would not be permitted to inspect and copy.
d)
Is accurate and complete.
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 medical information about
you for purposes other than service, payment and health care operations.
To obtain this list, you must submit your request in writing to
Terri Wager, Director of Human
Resources]. It 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 (for
example, on paper, electronically). 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.
Right
to Request Restrictions
You
have the right
to request a restriction or limitation on the health information
we use or disclose about you for service, payment or health care
operations. You also have the right to request a limit on the
health information we disclose about you to someone who is involved
in your care or the payment for it, like a family member or friend.
For example, you could ask that we not use or disclose information
about a surgery you had.
We
are Not Required to Agree to Your Request
If
we do agree, we will comply with your request unless the information
is needed to provide you emergency service. We may also agree
to a modified version of your request and will inform you of what
information we will agree NOT to disclose.
To
request restrictions, you may complete and submit the Request
For Restriction On Use/Disclosure Of Medical Information to
Terri Wager, Director of Human Resources
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 or by mail.
To
request confidential communications, you may complete and submit
the Request For Restriction On Use/Disclosure Of Medical Information
And/Or Confidential Communication to Terri Wager, Director
of Human Resources We will not ask you the reason for your request.
We will accommodate all reasonable
requests. Your request must clearly specify how or where
you wish to be contacted.
Right
to a Paper Copy of This Notice You have the right to a
paper copy of this notice. You may ask us to give you a copy of
this notice at any time. Even if you have agreed to receive it
electronically, you are still entitled to a paper copy. To obtain
such a copy, contact Terri Wager, Director of Human Resources
CHANGES
TO THIS NOTICE
We
reserve the right to change this notice, and to make the revised
or changed notice effective for medical information we already
have about you as well as any information we receive in the future.
We will post a summary of the current notice in the office with
its effective date in the top right hand corner. You are entitled
to a copy of the notice currently in effect.
COMPLAINTS
If
you believe your privacy rights have been violated, you may file
a complaint with our office or with the Secretary of the Department
of Health and Human Services. To file a complaint with our office,
contact Terri Wager, Director
of Human Resources, Seniors’ Resource Center, 3227 Chase
Street, Denver, CO 80212. You may also contact Ms. Wager at (303)
238-8151 but we request that you also follow-up your phone contact
with a written complaint to insure that all information is communicated
clearly and we can address all of your concerns in a timely manner.
You will not be penalized for filing a complaint.
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