The Harrison County Senior
Citizens Center, Inc.
500 West Main Street
Clarksburg, WV 26301
(304) 623-6795
THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
I. UNDERSTANDING YOUR HEALTH RECORD / INFORMATION
Each time you visit a hospital, physician, or other health care provider, a record of your visit is made. Typically, this record contains your symptoms, examination, test results, diagnosis, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:
q Basis for planning your care and treatment
q Means of communication among the many health care professionals who contribute to your care
q Legal document describing the care you receive
q Means by which you or a third –party payer can verify that services billed were actually provided
q A tool in educating health professionals
q A source of data for medical research
q A source of information for public health officials charged with improved the health of the nation
q A source of data for facility planning and marketing
q A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve
Understanding what is in your record and how your health information is used helps you to:
q Ensure its accuracy
q Better understand who, what, when, where, and why others may access your health information
q Make more informed decisions when authorizing disclosure to others
II. WHO WILL FOLLOW THIS NOTICE
This notice describes our senior center’s practices and that of:
q Any health care professional authorized to enter information into your client record
q All departments and units of the senior center
q Any member of a volunteer group we allow to help you or help to maintain our records
q All employees, staff and other senior center personnel
q Any staff of (other subsidiaries, off site, ….) All these entities, sites and locations follow the terms of this notice. In addition, these entities, sites and locations may share medical information with each other for treatment, payment or hospital operations purposes described in this notice.
III. OUR PLEDGE REGARDING MEDICAL INFORMATION
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of care and services you receive while a client of the senior center. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by the senior center, whether made by our personnel or your personal doctor or from your hospital records.. Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your medical information created in the doctor’s office or clinic.
This notice will tell you about he ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
We are required by law to:
q Make sure that medical information that identifies you is kept private;
q Give you this notice of our legal duties and privacy practices with respect to medical information about you; and
q Follow the terms of this notice that is currently in effect
We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will mail a revised notice to the address you’ve supplied us.
We will not use or disclose your health information without your authorization, except as described in this notice.
IV. HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within on of the categories.
For Treatment: We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other personnel who are involved in taking care of you at the hospital, in the home or other settings. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to tell the dietician if you have diabetes so that we can arrange for appropriate meals. Different departments of the senior center also may share medical information about you in order to coordinate the different things you need, such as transportation, prescriptions, lab work and x-rays. We also may disclose medical information about you to people outside the senior center who may be involved in your medical care after you leave the senior center or after our personnel leave your home, such as family members, clergy or others we use to provide services that are part of your care.
For Payment: We may use and disclose medical information about you so that the treatment ands services you receive from the senior 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 care plan information about personal care services that you received from the senior center so your health plan will pay us or reimburse you for these services. We may also tell your health plan about services you are going to receive to obtain prior approval or to determine whether your plan will cover the services.
For Health Care Operations: We may use and disclose medical information about you for senior center operations. These uses and disclosures are necessary to run the senior center and make sure that all of our clients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical information about many senior center clients to decide what additional services the senior center should offer, what services are not needed, and whether certain new services are effective. We may also disclose information to doctors, nurses, technicians, medical students, and other health care personnel for review and learning purposes. We may also combine the medical information we have with medical information from other providers to compare how we are doing and see where we can make improvements in the care and services offer. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific patients are.
Appointment Reminders: We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at the hospital or with other health care providers.
Treatment Alternatives: We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
For Health Related Benefits and Services: We may use and disclose medical information to tell you about health related benefits or services that may be of interest to you.
Fundraising Activities: We may use medical information about you to contact you in an effort to raise money for the senior center and its operations. We may disclose medical information to a foundation related to the hospital so that the foundation may contact you in raising money for the senior center. We only would release contact information, such as your name, address and phone number and the dates you received treatment or services at the senior center. If you do not want the hospital to contact you for fundraising efforts, you must notify HCSC’s Executive Director at 304-623-6795 or in writing.
Senior Center Directory: Unless you direct us not to release your information, we may include certain limited information about you in the senior center directory while you are a client of the senior center. This information may include your name and your general condition (e.g. fair, stable, etc.).
Individuals Involved in Your care or Payment for Your Care: Unless you direct us not to release your information, we may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family or friends your condition and that your are receiving services from the senior center. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.
Research: Except in limited circumstances as required by licensing or accrediting bodies, you will be notified and your consent secured before such disclosures.
As Required By Law: We will disclose medical information about you without your consent or authorization when required to do so by federal, state, or local law.
To Avert a Serious Threat to Health or Safety: We may use or disclose medical 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. Any disclosure, however, would only be to someone able to help prevent the threat.
V. SPECIAL SITUATIONS:
Organ and Tissue Donation: We are required by law to release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Military and Veterans: When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel or veterans (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military service.
Workers Compensation: We may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Public Health Risk: We may disclose medical information about you for public health activities. These activities generally include the following:
q To prevent or control disease, injury or disability;
q To report births and deaths;
q To report child abuse or neglect;
q To report reactions to medications or problems with products;
q To notify people of recalls of products they may be using;
q To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
Health Oversight Activities: We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities, include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil right laws.
Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a subpoena, court or administrative order. We may also disclose medical information
Law Enforcement: We may release medical information if asked to do so by a law enforcement official:
q In response to a court order, subpoena, warrant, summons or similar process;
q To identify or locate a suspect, fugitive, material witness, or missing person;
q About the victim of a crime, if, under certain limited circumstances, we are unable to obtain the person’s agreement;
q About a death or injury we believe may be the result of criminal conduct;
q About criminal conduct at the hospital; and
q In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
Coroners, Medical Examiners and Funeral Directors: We may release medical information to a coroner or medical examiner. This may be necessary for example, to identity a deceased person or determine the cause of death. We may also release medical information about clients of the senior center to funeral directors as necessary to carry out their duties.
National Security and Intelligence: We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Protective Services for the President and Others: We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or to conduct special investigations for those purposes.
Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with heal care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
You have the following rights regarding medical information we maintain about you. Please see the attached CONTACT DIRECTORY for names and addresses for submitting your written requests.
Right to Inspect and Copy: You have the right to inspect and copy medical information that ay be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes.
To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the HCSC Privacy Officer – Executive Director of the Harrison County Senior Center. If you request a copy of the information , we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by the senior center will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Right to Amend: If you feel that medical 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 for as long as the information is kept by or for the hospital.
To request an amendment, you request must be made in writing and submitted to HCSC’s Privacy Officer – Executive Director of the Harrison County Senior Center. In addition, you must provide a reason that supports your request.
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:
q Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
q Is not part of the medical information kept by or for the hospital;
q Is not part of the information which your would be permitted to inspect and copy; or
q Is accurate and complete.
Right to Accounting of Disclosures: You have the right to request an “accounting of disclosure”. This is a list of the disclosures we made of medical information about you.
To request this list or accounting of disclosures in writing to HCSC’s Privacy Officer – Executive Director of the Harrison County Senior Center. Your request must state a time period which may not be longer than six years and may not include dates before February 26, 2003. your request should indication what form you want the list (for example, on paper, electronically). The first list you request within a 12month period will be free. For additional lists, we may charge you’re the full 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 medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your are, like a family member or friend. For example, you could ask that we not use or disclose information about a services you have received.
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 treatment.
To request restrictions, you must make your request in writing to the nurse preparing your care plan or the outreach worker completing your assessment for services or to the Privacy Officer after your assessment or care plan has been completed. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to who you want the limits to apply, for example, disclosure to your spouse.
Right to Request Confidential Communication: 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 home, work or by mail.
To request confidential communications, you must make your request in writing to HCSC’s Privacy Officer – Executive Director of the Harrison County Senior Center.
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 a Paper Copy of This Notice: You have the right to 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 this notice electronically, you are still entitled to a paper copy of this notice.
You may obtain a copy of this notice at our website, www.iolinc.net/harrisoncountyseniorcenter.
To obtain a paper copy of this notice, contact the Administrative Office of Harrison County Senior Center Center.
VII. CHANGES TO THIS NOTICE:
We reserve the right to change this notice. We reserve the right 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 copy of the current notice in the senior center. The notice will contain on the first page, in the top right-hand corner, the effective date.
VIII. COMPLAINTS:
If you believe your privacy rights have been violated, you may file a complaint with the senior center or with the Secretary of the Department of Health and Human Services. To file a complaint with the hospital, see Contact Information attached. All complaints must be submitted in writing.
We support your right to protect the privacy of your medical information. You will not be penalized for filing a complaint. 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.
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. Any revocation must be in writing and directed to HCSC’s Privacy Officer. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You must understand that we are unable to take back any disclosures we have already made with your permission, and are not required to attempt to do so, and that we are required to retain our records of the care that we provided to you.
HARRISON COUINTY SENIOR CITIZENS CENTER, INC.
CONTACT DIRECTORY INFORMATION
Cynthia G. Freeman, CNPA, Executive Director
Harrison County Senior Citizens Center, Inc.
500 West Main Street
Clarksburg, WV 26301
Email: hcsc@clarksburg.com
Phone: 304-623-6795
Fax: 304-623-6798
Carolyn Moschella, Assistant Director/Fiscal Manager
Harrison County Senior Citizens Center, Inc.
500 West Main Street
Clarksburg, WV 26301
Email: hcsc@clarksburg.com
Phone: 304-623-6795
Fax: 304-623-6798
Pam Zirkle, In-Home Services Manager
Harrison County Senior Citizens Center, Inc.
500 West Main Street
Clarksburg, WV 26301
Email: hcsc@clarksburg.com
Phone: 304-623-6795
Fax: 304-623-6798