Effective Date of This Notice: April 14, 2003
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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.
We, Visiting Nurse Association of Central Jersey ("VNACJ"), are required by law to maintain the privacy of your health information and to provide you with notice of our legal duties and privacy practices with respect to your protected health information. The term "protected health information," as it is used throughout this notice, means any information that is created or received by VNACJ, including demographic information, that relates to (1) your past, present, or future physical or mental health or condition; (2) the provision of your health care; or (3) the past, present, or future payment for the provision of your health care, which either identifies you or with respect to which there is a reasonable basis to believe the information can be used to identify you.
We are required to abide by the terms of this notice, currently in effect. We reserve the right to change the terms of this notice and to make the new notice provisions effective for all protected health information that our entity maintains at that time. You may send a written request for a revised notice to the name and address at the end of this document. You may also view the current notice on VNACJ's website at www.vnacj.org
I. Permitted Uses and Disclosures of Your Health Information
We are permitted under federal law to make the uses and disclosures of your protected health information as described below. Other uses and disclosures not listed below will only be made if we obtain your written authorization. If you provide us with such authorization, you may revoke the authorization at any time by submitting a written revocation to the name and address at the end of this document. Such revocation, however, will not apply to our actions taken in reliance on the authorization, before the revocation of authorization was received.
Note that the following descriptions and examples are not exhaustive, but are meant to put you on notice with respect to the types of uses and/or disclosures that we are permitted to make.
A. Uses/Disclosures that Do Not Require Your Authorization
We are permitted to use and/or disclose your protected health information without your written authorization as described below:
Treatment - in order to provide, manage, and/or coordinate your health care, such as consultations with, or referrals to, other health care providers regarding your health care. For example, the information in your medical record may be discussed with other health care providers, such as your personal doctor, or nurses or specialists who are involved in the provision of your healthcare, to determine the appropriate steps with regard to your medical treatment.
Payment - for purposes of payment for your health services, which includes, but is not limited to, billing, claims management, and efforts to obtain premiums or reimbursement. For example, a bill, which may include protected health information, such as the medical procedures performed, may be sent to your insurance company in order to obtain reimbursement.
Healthcare Operations - for our "healthcare operations," a term which refers to the daily business practices of the healthcare entity, including, but not limited to, quality assessment and improvement, business planning, customer services, and reviewing the qualifications and competence of staff. For example, we may conduct quality improvement assessments and use the information in your medical record to advance the effectiveness and quality of the healthcare services we provide by analyzing the care in your case.
Contact Purposes - in order to contact you for the following purposes: (1) appointment reminders; (2) information regarding treatment alternatives or other health related benefits; and (3) fundraising for our entity.
Required Disclosures to the Secretary - to the Secretary of the Department of Health and Human Services in order to investigate or determine our compliance with federal privacy regulations.
Business Associates - to "business associates," such as billing services, attorneys, and computer specialists, in order for these entities to assist us in our business activities.
De-Identified Information - to create information that is "de-identified" and not individually identifiable (meaning health information that can not be traced to you).
Personal Representatives - to someone who has the legal authority to act on your behalf as your personal representative.
Required by Law - if uses/disclosures of your protected health information is required by law and if such use or disclosure complies with and is limited to the relevant requirements of the law, such as the reporting of certain types of wounds or other physical injuries.
Public Health Authority - to a public health authority that is authorized by law to collect or receive such information for the purposes of controlling disease, injury, or disability, such as reporting disease or births/deaths.
Victims of Abuse, Neglect, or Domestic Violence - to a proper government authority, under certain limitations, if we reasonably believe you to be a victim of abuse, neglect, or domestic violence.
Food and Drug Administration ("FDA") - to an authorized person with respect to a product or activity regulated by the FDA for the purposes of monitoring quality, safety or effectiveness.
Communicable Disease - to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition.
Employers - to your employer for purposes of an evaluation relating to medical surveillance of the workplace or an evaluation of work-related illnesses and injuries if certain conditions are met.
Health Oversight Activities - to a health oversight agency that is authorized by law to conduct necessary oversight activities regarding the health care system, government benefit programs, and compliance with government regulatory programs and civil rights laws.
Judicial and Administrative Proceedings - for the purposes of any judicial or administrative proceeding in response to an order of a court or and in response to a subpoena, discovery request, or other lawful process.
Law Enforcement - if certain conditions are met, to a law enforcement official for law enforcement purposes including the following: (1) in compliance with a court order or warrant, subpoena, summons, administrative subpoena or other similar administrative request; (2) to report limited information for identification and location purposes; (3) in response to a law enforcement official's request for information about an individual who is or is suspected to be a victim of a crime; (4) to alert law enforcement regarding the death of an individual if we have a suspicion that the death resulted from criminal conduct; (5) to make a report if we believe that criminal conduct has occurred on our premises; (6) to report crime in emergency situations.
Coroners, Medical Examiners, and Funeral Directors - to a (1) coroner or medical examiner for purposes including the identifying of a deceased person or determining a cause of death; or (2) to funeral directors as necessary in order for them to carry out their duties with respect to a decedent.
Organ Donation - to organ procurement organizations or other related entities in order to facilitate organ, eye or tissue donation and transplantation.
Research - for research purposes, provided that certain conditions are met, such as the receipt of proper approval from an Institutional Review Board.
Serious Threat to Health/Safety - if we believe that a use/disclosure is necessary (1) to prevent or lessen a serious and imminent threat to the health or safety of a person or the public or (2) for law enforcement authorities to identify or apprehend an individual.
Specialized Government Functions - (1) if you are Armed Forces or foreign military personnel, (a) for activities deemed necessary by appropriate military command authorities if certain conditions are met, and (b) upon your separation or discharge from the Armed Forces; (2) for national security and intelligence activities, or to authorized federal officials for the provision of protective services to the President and other authorized persons.
Correctional Institutions - information about an inmate to a correctional institution or a law enforcement official if certain conditions are met.
Workers' Compensation - to the extent necessary to comply with laws relating to workers' compensation or other similar programs.
B. Uses/Disclosures That Require You To Have an Opportunity To Object
The following uses and/or disclosures of your protected health information do not require your written authorization. They do, however, require you to have an opportunity to orally agree to or prohibit or restrict the use/disclosure before it is performed, unless there are extenuating circumstances, such as in the event of an emergency or your incapacity.
Involved Person(s) - to a family member, other relative, close personal friend, or any other person identified by you, provided that such information is directly relevant to the person's involvement with your care or the payment for your health care.
Notification - for disaster relief efforts or for the purpose of notifying a family member, personal representative, or other person responsible for your care, of your location, general condition, or death.
II. Your Rights With Regard To Your Protected Health Information
The following discusses your rights with regard to your protected health information:
- Right to Request Restrictions. You have the right to request restrictions on certain uses and disclosures of your protected health information. We are not required to agree to a requested restriction, but if we do agree, we are bound to such a restriction unless there are emergent circumstances.
- Right to Request Confidential Communications. You have the right to request to have your medical matters discussed with you by alternative means or at alternative locations. We will accommodate all reasonable requests.
- Right to Inspect/Copy. You have the right to inspect and copy your protected health information.
- Right to Request Amendments. You have the right to request amendments of your protected health information if, for instance, you feel your records are inaccurate or incomplete.
- Right to Accounting of Disclosures. You have the right upon a written request to receive an accounting of the disclosures of your protected health information that have been made in the six years prior to the request.
- Right to Paper Copy of Notice. You have the right to obtain a paper copy of this notice upon your written request.
If you would like to exercise any of these rights, send a written, detailed request to the address below. Under federal law we may deny particular requests under certain circumstances. If we deny a request, you will receive a written explanation detailing the reason for the denial.
Complaints. Should you believe that your privacy rights have been violated, you may send a written complaint detailing the circumstances of the violation to the following address: Privacy Official, VNACJ, 176 Riverside Avenue, Red Bank, NJ 07701.
You may also send a complaint to the Secretary of the Department of Health and Human Services. You will not be retaliated against for filing such a complaint.
Privacy Contact. Should you require any further information regarding this notice, please contact the VNACJ Compliance Hotline at (732) 224-6893.