NOTICE OF INFORMATION PRACTICES

Protected Information. While receiving care from our organization, information regarding your medical history, treatment, and payment for your health care may be originated and/or received by us. Information which can be used to identify you and which relates to your medical care or your payment for medical care is protected by state and federal law (“Protected Information”).

Your Rights. Federal law grants you certain rights with respect to your Protected Information. Specifically, you have the right to:

Receive notice of our policies and procedures used to protect your Protected Information; Request that certain uses and disclosures of your Protected Information be restricted; provided, however, if we may release the information without your consent of authorization, we have the right to refuse your request; Access to your Protected Information; provided, however, the request must be in writing and may be denied in certain limited situations; Request that your Protected Information be amended; Obtain an accounting of certain disclosures by us of your Protected Information for the past six years; Revoke any prior authorizations or consents for use or disclosure of Protected Information, except to the extent that action has already been taken; and Request communications of your Protected Information are done by alternative means or at alternative locations.e

Our Responsibilities. Federal law also imposes certain obligations and duties upon us with respect to your Protected Information. Specifically, we are required to:

Provide you with notice of our legal duties and our facility’s policies regarding the use and disclosure of your Protected Information; Maintain the confidentiality of your Protected Information in accordance with state and federal law; Honor your requested restrictions regarding the use and disclosure of your Protected Information without your authorization or consent, in which case you will be notified within a reasonable period of time; Allow you to inspect and copy, at your expense, your Protected Information during our regular business hours; Act on your request to amend Protected Information within sixty (60) days and notify you of any delay which would require us to extend the deadline by the permitted thirty (30) day extension; Accommodate reasonable requests to communicate Protected Information by alternative means or methods; and Abide by the terms of this notice.

How Your Protected Information May be used and Disclosed. Generally, your Protected Information may be used and disclosed by us only with your express written authorization. However, there will be some exceptions to this general rule.

1. Treatment Purposes. We may use or disclose your Protected Information for treatment purposes, provided, however, we must first obtain your consent to do so. During your care from our agency, it may be necessary for various personnel, including, but not limited to physicians, nurses, lab technicians, physical therapists, occupational therapists, speech therapists, medical students, nursing students, home health aides, and homemakers involved in your care to have access to your Protected Information in order to provide you with quality care. For example, your physician may need to know which medications you are currently taking before prescribing additional medications. It may be necessary for the physician to inform the nurses on staff of the medications you are taking so they can administer the medications and monitor any possible side effects.

Situation may also arise when it is necessary to disclose your Protected Information to individuals outside our agency who may also be involved in your care. For example, if you are a resident in a nursing facility, it may be necessary for your physician to disclose medications prescribed by him/her so that they can be appropriately administered by the nursing facility and side effects may be monitored.

2. Payment Purposes. Your Protected Information may also be used or disclosed with your consent for payment purposes. It is necessary for us to use or disclose Protected Information so that treatment and services provided by us may be billed and collected from you, your insurance company, or other third party payor. Bills requesting payment will usually include information which identifies you, your diagnosis, and any procedures or supplies used. It may also be necessary to release Protected Information to obtain prior approval from your health insurance.

3. Health Care Operations. With your consent, your Protected Information may be used for agency operations, which are necessary to ensure our agency provides the highest quality care. For example, your Protected Information may be used for learning or quality assurance purposes. We may also remove information that could identify you from your record so as to prevent others from learning who the specific patients are.

Although your consent is needed before we use or disclose Protected Information for treatment, payment, or health care operations, if an emergency situation exists, and obtaining your consent is not practicable, we may use or disclose Protected Information to the extent necessary during the emergency.

Although you have the right to refuse to consent to the use or disclosure of Protected Information for treatment, payment, or health care operations, or to revoke such a consent at any time, it would be impossible for our agency to render you the highest quality of care without the right to use or disclose your Protected Information in this manner. Therefore, in the absence of an emergency medical condition, we reserve the right to condition your care, on your consent to the use of disclosure of Protected Information for treatment, payment, or health care operations.

Our agency maintains a directory of patient names and their addresses. With your permission, your name, address, general condition, and religious affiliation will be contained in the database and may be disclosed to members of the clergy or other persons who specifically ask for the information by your name. You are not obligated, however, in any way, to consent to the inclusion of your information in the agency database.

Unless you have informed us otherwise, your Protected Information may be used or disclosed by us to notify or assist in notifying a family member or other person responsible for your care. In most cases, Protected Information disclosed for notification purposes will be limited to your name, location and general condition.

With your permission, we will release Protected Information to a family member, relative, or close personal friend who is involved in your care to the extent necessary for them to participate in your care.

We may use your Protected Information for the purpose of contacting you regarding health-related benefits and services we feel may be of interest to you. In addition, you may also be contacted as part of a fund-raising effort. If you do not wish to be contacted for marketing or fundraising activities, you may contact the Office Coordinator at the Visiting Nursing Association at 319-235-6201 to have your name removed from Marketing or fundraising lists.

In some instances, your Protected Information may be used or disclosed for research purposes. All research projects, which use Protected Information, are subject to a special approval process which will, among other things, evaluate the precautions used to protect patient medical information. In many cases, information which identifies you as the patient will be removed.

Situations may arise which warrant us to use or disclose Protected Information without your consent or authorization. The law specifically allows us to use or disclose Protected Information without your consent or authorization in the following special circumstances:

1. Public Health Activities. We are allowed to use or disclose your Protected Information for public health activities and purposes. Examples of public health activities that would warrant the use or disclosure of your Protected Information include:

Preventing or controlling disease, injury, or disability; Reporting births or deaths; Reporting the abuse or neglect of a child or dependent adult; Reporting reactions to medications or problems with products; or Notifying individuals exposed to a disease who may be at risk for contracting or spreading the disease.

2. Health Oversight Activities. Your Protected Information may be used or disclosed to a health oversight agency for activities authorized by law. Examples of health oversight activities include audits, investigation, inspections or judicial/administrative proceedings which you are not the subject of. In most cases, the oversight activity will be for the purpose of overseeing the care rendered by our agency or our agency’s compliance with certain laws and regulations.

3. Judicial and Administrative Proceedings. If you are involved in a lawsuit or other administrative proceeding, we may release your Protected Information in response to a court or administrative order requesting the release. In some instances, we may also release Protected Information pursuant to a subpoena or discovery request but only if efforts have been made by the requestor to provide you with notice of the request and you have failed to object or the objection was resolved in favor of disclosure, or in the alternative, the requestor has obtained a protective order protecting the requested information.

4. Victims of Abuse or Neglect. Other than child and dependent adult abuse which is covered under public health activities, we may use or disclose your Protected Information to a protective services or social services agency or other similar government authority, if we reasonably believe you have been the victim of abuse, neglect or domestic violence as long as you agree to such disclosure and we feel it is necessary to prevent serious harm to you or other individuals. If you are incapacitated and unable to agree to such a disclosure, we may release your Protected Information for this purpose but only if failure to release it would materially and adversely affect a law enforcement activity and the information will not be used, in any way, against you.

5. Law Enforcement. We may also release your Protected Information to a law enforcement official for the following purposes:

Pursuant to a court order, warrant, subpoena/summons, or administrative request; Identifying or locating a suspect, fugitive, material witness or missing person; Regarding a crime victim, but only if the victim consents or the victim is unable to consent due to incapacity and the information is needed to determine if a crime has occurred, non-disclosure would significantly hinder the investigation, and disclosure is in the victim’s best interest. Regarding a deceased individual, to alert law enforcement that the individual’s death was caused by suspected criminal conduct; or By emergency care personnel if the information is necessary to alert law enforcement of a crime, the location of a crime, or characteristics of the perpetrator.

6. Coroner, Medical Examiners, Funeral Homes. Protected Information regarding a deceased individual may be released to a coroner or medical examiner for the purpose of identification, determining cause of death or other duties as authorized by law. Protected Information regarding a deceased individual may also be disclosed to funeral directors if necessary to carry out their duties.

7. Specialized Governmental Functions. Your Protected Information may be used or disclosed for a variety of governmental functions subject to some limitations. These government functions include:

Military and veteran activities; National security and intelligence activities; Protective service of the President and others; Medical suitability determinations for Department of State officials; Correctional institutions and law enforcement custodial situations; or Provision of public benefits.

8. Organ donation. Your Protected Information may be used or disclosed by us to entities engaged in the procurement, banking or transplantation of organs, eyes or tissues for the purpose of facilitation such donation and transplantation.

9. Worker’s Compensation. We are allowed to disclose your Protected Information as authorized and to the extent necessary to comply with laws relating to workers’ compensation or other programs providing benefits for work-related injuries or illness without regard to fault.

Important Contact Information. This notice has been provided to you as a summary of how we will use your Protected Information and your rights with respect to your Protected Information. If you have any questions or want more information regarding your Protected Information, please contact the Visiting Nursing Association at 319-235-6201.

If you believe your privacy rights have been violated, you may file a complaint with our office by contacting the Executive Director at 319-235-6201. You may also file a complaint with the Secretary of Health and Human Services. There will be no retaliation for the filing of a complaint.

Effective Date. This notice became effective on October 14, 2002. Please note, we reserve the right to revise this notice at any time. Should we revise this notice, you will receive notification by a letter sent in the mail. In addition, a current notice of our privacy practices may be obtained from the Executive Director at 2530 University Avenue, Suite 3, Waterloo, Iowa, 50701.