Notice of Privacy Practices

Please Review Carefully

This notice describes the privacy practices followed by our employees, staff and other office personnel effective 4/14/2001. The practices described in this notice will also be followed by health care providers you consult with by telephone when your regular health care provider from our office is not available. If you have any questions about this notice, please contact the CSP (Compliance/Security/Privacy) Officer at our Corporate Office, 315-853-1280, Upstate HomeCare, 7506 State Route 5, Clinton, NY 13323.

Your Health Information

This notice applies to the information and records we have about your health, health status, and the health care services you receive from us. 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 such disclosures.

How We May Use and Disclose Health Information About You

We will request your signed acknowledgment and related consent to use and disclose health information for the following purposes:

For Treatment

We may use health information about you to provide you with medical treatment/services. We may disclose health information about you to doctors, therapists, technicians, office staff, or other personnel who are involved in taking care of your health 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 phoning in an order or coordinating services with another provider. Family members and other health care providers may be part of your medical care and may require information about you that we have.

For Payment

We may use and disclose health information about you so that the treatment and services you receive from us 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 here so your health plan will pay us or reimburse you 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/service.

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 patients receive quality care. For example, we may use your health information to evaluate the performance of our staff in caring for you.

For Communications

We, nor will any of our Business Associates, will neither make any communication to you about a product or service which encourages purchasing of that product or service nor use your PHI for marketing purposes without your prior written authorization.

For Consent

You may revoke your Consent at any time by giving us written 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 treatment, payment or health care operations and we may therefore choose to discontinue providing you with health care 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 another.

Required By Law

We will disclose health information about you when required to do so by federal, state or local

Research

We may use and disclose health information about you for research projects that are subject to a special approval process. We will ask 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 this office.

Organ and Tissue Donation

If you are an organ donor, we may release health information to organizations that handle organ procurement or organ transplantation or to an organ donation bank, as necessary, to facilitate such donation.

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 that provide benefits for work-related injuries or illnesses.

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. This could include the HHS for HIPAA compliance and enforcement purposes.

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 your health information 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 spouse when he/she is present when we provide 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 or friend is in your best interest. In that situation, we will disclose only health information relevant to the person’s involvement in your care. We may use our professional judgment 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, supplies.

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, 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 treatment, payment or health care operations, we will have to have both your initialed consent and a special written authorization that complies with the law governing HIV or substance abuse records.

Your Rights Regarding Health Information 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 the CSP Officer at the address on this Notice in order to inspect and/or copy your health information. If you request a copy of the information, we will 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 the law requires such a review, we will select a licensed healthcare professional to review your request and our 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 the 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 Upstate HomeCare. To request an amendment, you will need to complete and submit a Medical Record Amendment/Correction form to the CSP Officer at the address on this notice. 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: (1) We did not create unless the person or entity that created the information is no longer available to make the amendment; (2) Is not part of the health information that we keep; (3) You would not be permitted to inspect and copy; (4) 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 treatment, payment and healthcare operations. To obtain this list, you must submit your request in writing to the CSP Officer at the address on this notice. 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 or 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 treatment, payment or health care 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. To request restrictions or limitations, you may complete and submit the Request for Restriction on Use/Disclosure of Medical Information And/Or Confidential Communication to the CSP Officer at the address on this notice. 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 with emergency treatment.

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 the CSP Officer at the address on this notice. 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 Receive Paper and/or Electronic Copies of Your PHI

You have the right to receive a paper and/or electric copy(s) of your PHI within thirty days of the request, which may include the cost of supplies. You also have the right to request that your PHI be directly sent to another individual if such a request is made in writing and signed by you.

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. To obtain such a copy, contact the CSP Officer at the address on this notice.

Right to be Notified

You have the right to be notified according to the requirements specified in the HIPAA Privacy Rule regarding any breach or presumption of breach in your PHI unless it can be demonstrated that there is a low probability that the PHI has been compromised.

Changes To This Notice

We reserve the right to change this notice and 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 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.

Reproductive Rights covered per Title 45 Subtitle A Subchapter C Part 164.502

Complaints

If you believe your privacy rights have been violated, you may file a complaint with our office or the Secretary of the Department of Health and Human Services. To file a complaint with our office, contact the Chief Operations Officer at 315-853-1280. You will be requested to submit your complaint in writing. You will not be penalized for filing a complaint.

If Your PHI is Compromised

If Upstate HomeCare suspects or knows that your PHI has been or is potentially at risk of being exposed due to theft, negligence, or error, Upstate HomeCare will follow its Violation Response Policy which includes notifying the patient immediately by 1^st class mail of the unauthorized disclosure including a brief description of what happened including the date of the breach and date of discovery, a description of the type of PHI involved, any steps the individual should take to protect themselves, a brief description of what UHC is doing to investigate and mitigate the harm and to protect against future breaches and contact information for further questions If the patient is deceased the notice will be sent, if known, to the last known address of the next of kin. Depending on the scope of the breach, other notifications may be made pursuant to Policy #6216.