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.
HHM (an assumed business name for Home Health of Montana, Inc.) is required by law to maintain the privacy of your health information and to provide you with notice of its legal duties and privacy practices with respect to your health information. If you have questions about any part of this notice or if you want more information about the privacy practices at HHM, please contact one of the following:
Privacy Managers Telephone E-mail
Director of Nursing, 406-541-1800, email@example.com
Vice President, 406-541-1800 firstname.lastname@example.org
Overall Privacy Official
Bruce Kramer Vice President 406-541-1700 email@example.com
Home Health of Montana
1903 South Russell
Missoula, MT 59801
Effective Date of This Notice: April 1, 2003
1. How Home Health of Montana (HHM) may Use or Disclose Your Health Information: HHM collects health information from you and stores it in a chart and on a computer. This is your medical record. The medical record is the property of HHM, but the information in the medical record belongs to you. HHM protects the privacy of your health information. The law permits HHM to use or disclose your health information for the following purposes:
a. Treatment . Home health care & related services. Information disclosure includes, but is not limited to, physician notes on treatment plans and pertinent health information from a case manager.
b. Payment . For invoicing and collections activities with private, State, Federal, insurance, and other related & non-related parties. Information that may be shared includes name, date of services, social security number or other personal identifier (like Medicaid number), etc.
c. Regular Health Care Operations . During the provision of home health care services, periodic assessments are made and documented to a patient chart. Other examples include information on the number and nature of visits is further documented to file and into the computer.
d. Information provided to you . Information regarding your medical treatment plan(s), on-going care assessments, etc.
e. Notification and communication with family . We may disclose your health information to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or in the event of your death. If you are able and available to agree or object, we will give you the opportunity to object prior to making this notification. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communication with your family and others.
f. Required by law . As required by law, we may use and disclose your health information.
g. Public health . As required by law, we may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting child abuse or neglect; reporting domestic violence; reporting to the Food and Drug Administration problems with products and reactions to medications; and reporting disease or infection exposure.
h. Health oversight activities . We may disclose your health information to health agencies during the course of audits, investigations, inspections, licensure and other proceedings.
i. Judicial and administrative proceedings . We may disclose your health information in the course of any administrative or judicial proceeding.
j. Law enforcement . We may disclose your health information to a law enforcement official for purposes such as identifying of locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena and other law enforcement purposes.
k. Deceased person information . We may disclose your health information to coroners, medical examiners, and funeral directors.
l. Organ donation . We may disclose your health information to organizations involved in procuring, banking or transplanting organs and tissues.
m. Research . We may disclose your health information to researchers conducting research that has been approved by an Institutional Review Board.
n. Public safety . We may disclose your health information to appropriate persons in order to prevent or lessen a serious and imminent threat to the health or safety of a particular person or the general public.
o. Specialized government functions . We may disclose your health information for military, national security, prisoner and government benefits (only for health plans) purposes.
p. Workers' compensation . We may disclose your health information as necessary to comply with workers' compensation laws.
q. Marketing . We may contact you to provide appointment reminders or to give you information about other treatments or health-related benefits and services that may be of interest to you.
r. Fund-raising . We may contact you to participate in fund-raising activities for HHM.
s. Change of Ownership . In the event that HHM is sold or merged with another organization, your health information/record will become the property of the new owner.
II. When HHM May Not Use or Disclose Your Health Information
Except as described in this Notice of Privacy Practices, HHM will not use or disclose your health information without your written authorization. If you do authorize HHM to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time.
III. Your Health Information Rights
1. You have the right to request restrictions on certain uses and disclosures of your health information. Home of Health of Montana is not required to agree to the restriction that you requested.
2. You have the right to receive your health information through a reasonable alternative means or at an alternative location. Requests for alternate communication methods & means should be submitted in writing specifying the details on the alternative of method. Charges may apply, and if so, will be due in advance of release of the information.
3. You have the right to inspect and copy your health information.
4. You have a right to request that HHM amend your health information that is incorrect or incomplete. HHM is not required to change your health information and will provide you with information about a Home of Health of Montana denial and how you can disagree with the denial.
5. You have a right to receive an accounting of disclosures of your health information made by Home of Health of Montana, except that HHM does not have to account for the disclosures described in parts a.(treatment), b.(payment), c. (health care operations), d. (information provided to you), and o. (certain government functions) of section I of this Notice of Privacy Practices.
6. You have a right to a paper copy of this Notice of Privacy Practices. If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, please contact a HHM Privacy Manager as listed previously.
Note: These rights are not absolute and are subject to some limitations and conditions as required by the Health Information Portability & Accountability Act of 1996.
IV. Changes to this Notice of Privacy Practices
Home of Health of Montana reserves the right to amend this Notice of Privacy Practices at any time in the future, and to make the new provisions effective for all information that it maintains, including information that was created or received prior to the date of such amendment. Until such amendment is made, Home of Health of Montana is required by law to comply with this Notice. Any amendments will be made in writing.
Complaints about this Notice of Privacy Practices or how Home of Health Montana handles your health information should be directed to: HHM Privacy Official , Bruce Kramer.
If you are not satisfied with the manner in which this office handles a complaint, you may submit a formal complaint to:
Department of Health and Human Services
Office of Civil Rights
Hubert H. Humphrey Bldg.
200 Independence Avenue, S.W.
Room 509F HHH Building
Washington, DC 20201
You may also address your compliant to one of the regional Offices for Civil Rights. A list of these offices can be found online at http://www.hhs.gov/ocr/regmail.html.