INDEPENDENCE PLUS, INC. (IPI)
Notice of Privacy Practices
Effective December 18, 2012
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.
IPI is required by law to maintain the privacy of your health information and to provide you with notice of its legal entities and privacy practices with respect to your health information. If you have questions about any part of this notice please contact:
IPI Associate Director (602 484-7610, Ext 209)
A) How IPI may Use or Disclose Your Health Information – Where No Authorization Is Needed
IPI collects health information about you and stores it your individual file. We need this information to provide you with quality services you receive at IPI. IPI is committed to protecting the privacy of your health information. The law permits IPI to use or disclose your health information for the following purposes:
1) Treatment: We may use medical information about you to provide you with medical treatment or services such as those of an occupational, physical, or music therapist. This includes the coordination or management of your health care with a third party who has already obtained your permission to have access to your protected health information. IPI will also disclose protected health information to physicians who may be treating you.
2) Payment: We may disclose medical information about you in the event that any treatment services rendered at IPI were billable to an outside source or to you.
3) Healthcare Operations: IPI may use or disclose, as needed, your protected health information (PHI) for agency operations. These uses and disclosures are necessary to manage the operation and to monitor your quality of care. For example, we may use PHI to evaluate our agency’s services, including the performance of our staff. We may also use PHI for training purposes or to develop new policies, procedures, or programs that may benefit you or other individuals we support. Your medical information may be shared with third party “business associates” that perform various activities (such as residential services, home and community based services).
B) Uses and Disclosures of Protected health Information – Based Upon Your Written
Other uses and disclosures of your PHI will be made only with your written authorization unless otherwise permitted or required by law as described below. You may revoke your authorization, at any time, in writing, except to the extent that your health care provider has taken an action in reliance on the use or disclosure indicated in the authorization.
1) Other Permitted and Required Uses and Disclosures That May Be Made With Your Authorization or Opportunity to Object
IPI may use and disclose your PHI in the following instances. You have the
opportunity to agree or object to the use or disclosure of all or part of your protected health information. If you are not present or able to agree or object to the use or disclosure of the protected health information, IPI, using the professional judgement of its staff, determine whether the disclosure is in your best interest. In this case, only the PHI that is relevant to your health care will be disclosed.
2) Others Involved In Your Healthcare: Unless you object, IPI may disclose to a member of your family, a relative, a close friend or any other person you identify, your PHI that directly relates to that person’s involvement in your health care or payment of your health care (if this were to apply). If you are unable to agree or object to such a disclosure, IPI may disclose such information as necessary if IPI determines that it is in your best interest based on IPI staff’s professional judgment. IPI may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location or general condition. Finally, IPI may use or disclose your PHI to an authorized public or private entity, to assist in disaster relief efforts and to coordinate uses and disclosures to family members or other individuals involved in your health care.
3) Emergencies: IPI may use or disclose your PHI in an emergency treatment situation involving you or for such emergencies as disaster relief.
C) Other Permitted and Required Uses and Disclosure That May Be Made Without Your Authorization or Opportunity to Object
IPI may use or disclose your protected health information in the following situations without your authorization. These situations include:
1. Required By Law: IPI may use or disclose your PHI to the extent that the use or
disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of certain uses or disclosures.
2. Public Health: IPI may disclose your PHI for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury of disability. IPI may also disclose your PHI, if directed by the public health authority, to a foreign
government agency that is collaborating public health authority.
3. Communicable Diseases: IPI may disclose your PHI, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
4. Health Oversight: IPI may disclose PHI to a health oversight agency for activities authorized by law, such as audits, investigations and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil
5. Abuse or Neglect: IPI may disclose your PHI to a public health authority that is authorized by law to receive reports of abuse or neglect. If IPI reasonably believes that you have been a victim of abuse, neglect, or domestic violence, IPI may disclose your PHI to a government authority authorized to receive reports of abuse, neglect or domestic violence. The information will be disclosed when you agree to the release of the information or the disclosure will be made consistent with the requirement of applicable federal and state laws including protections afforded you to prevent serious harm.
6. Criminal Activity: Consistent with applicable federal and state laws, IPI may disclose your protected health information if you are the victim of a crime or IPI believes that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the
health or safety of a person or the public. IPI may also disclose PHI if it is necessary for laws enforcement authorities to identify or apprehend an individual.
7. Law Enforcement: We may disclose your protected health information to a law enforcement official for purposes such as identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena and other law enforcement purposes.
9. Legal Proceedings: IPI may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), and in certain conditions in response to a subpoena, discovery request or other lawful process.
D) Your Rights
The following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.
1. You have the right to inspect and copy your protected health information. This means you may inspect and obtain, upon written request, a copy of your protected health Information that is contained in a designated record set, as defined by federal law, for as long as IPI maintains the protected health information.
Under federal law, however, you may not automatically inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; and protected health information that is subject to law that prohibits access to protected health information. In some circumstances, you may a right to have this decision reviewed. Please contact IPI’s Privacy Officer/ Associate Director if you have questions about access to your records.
2. You have the right to request a restriction of your protected health information. This means you may ask IPI not to use or disclose any part of your protected health information for the purposes of treatment, payment or health care operations. You may also request that any part of your protected health information not be disclosed to family members, relatives or friends who may be involved in your care or payment for your
care or for notification purposes as described in this Notice of Privacy Practices. Your
request must state the specific restriction requested and to whom you want the restriction
3. IPI is not required to agree to a restriction that you may request.
If we believe I it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. If IPI does agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment; even then IPI will request that the information not be further disclosed. With this in mind, please discuss any restriction you wish to request with your support coordinator. You may request a restriction by submitting the result in writing to IPI’s Privacy Officer/ Associate Director at the address designated on page 1 of this document.
4. You have the right to request to receive confidential communications from IPI by alternative means or at an alternative location. IPI will accommodate reasonable requests. We may also condition this accommodation by asking you to specify an alternative address or other method of contact. IPI will not request an explanation from you as to the basis for the request. Please make this request in writing to the Division’s Privacy Officer/ Associate Director.
5. You may have the right to have your protected health information amended. This means you may request an amendment of protected health information about you
IPI created in a designated record set for as long as IPI maintains this information. This statement must provide a reason to support the requested amendment. In certain cases, IPI may deny your request for an amendment. If IPI denies your request for amendment you have the right to file a statement of disagreement with our Privacy Officer/ Associate Director. If IPI continues to deny your request, it may prepare a rebuttal to your statement; IPI will provide you with a copy of any such rebuttal. Please contact our Privacy Officer if you questions about amending your medical records.
6. You have the right to receive an accounting of certain disclosures IPI has made, if any, of your PHI. This right applies to disclosures for purposes other than treatment, payment or health care operations as described in this Notice of Privacy Practices. It excludes disclosures authorized by federal law or required by law. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. You may request a short timeframe. The right to receive this information is subject to certain exceptions, restrictions and limitations.