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Lee County
Central Point of Coordination
NOTICE OF PRIVACY
PRACTICES
Effective: April 14, 2003
Revised: March 22, 2007
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.
This notice will tell you how we may use and disclose
protected health information
about you. Protected
health information means any health information, including
mental health information, about you that identifies
you or for which there is a
reasonable basis to believe the information can be
used to identify you. In this
notice, we call all of that protected health
information, “medical information.”
This notice also
will tell you about your rights and our duties with respect to
medical
information about you. In addition, it will tell you how to complain
to us if you believe
we have violated your privacy rights.
How We May Use and
Disclose Medical Information About You.
We use and disclose medical information about you for
a number of different purposes.
Those purposes are described below.
We may use medical
information about you to provide, coordinate or manage your
health
care and related services by both us and other health care providers. We may
disclose medical
information about you to doctors, nurses, counselors, hospitals,
pharmacies
and other health facilities who become involved in your care. We may
consult with other
health care providers concerning you and as part of the consultation
share your medical
information with them. Similarly, we may
refer you to another
health care provider
and as part of the referral share medical information about you
with
that provider. For example, we may conclude you need to
receive services from
a physician, we also
will contact that physician’s office and provide medical
information about you
to them so they have information they need to provide
services
to you.
We may use and disclose
medical information about you so we can arrange payment
for the services that
were provided to you. This can include
sharing information about
you
to your insurance company, another county, provider, or a third party payer. For
example, we may need
to give a county where you previously lived certain
information about the
health care services provided to you so that a determination
may
be made regarding which county has financial responsibility. We also may
need to provide your
insurance company or a government program, such as Medicare
or Medicaid, with
information about your medical condition and the health care
you need to receive
to determine if you are covered by that insurance or program.
- For Health Care Operations
We
may use and disclose medical information about you for our own health care
operations. These are necessary for us to operate our
office and to maintain
quality health care for our consumers. For example,
we may use medical
information
about you to review the services provided and the performance of our
contract providers in caring for you. We also may
use the information to study
ways
to more effectively manage our organization.
Unless you tell us otherwise
in writing, we may contact you by either telephone or
by
mail at either your home or your workplace. At either
location, we may leave
messages
for you on the answering machine or voice mail. If you want to
request
that we communicate
to you in a certain way or at a certain location, see “Right to
Receive
Confidential Communications” later in this Notice.
·
Appointment
Reminders
We may use and
disclose medical information about you to remind you of an
appointment you have
with us.
·
Treatment
Alternatives
We may use and
disclose medical information about you to contact you about
treatment
alternatives that may be of interest to you.
·
Marketing
Communications.
We may use and
disclose medical information about you to communicate with you
about
a service to encourage you to utilize the service. This may be:
For your
treatment;
For case
management or care coordination for you;
To direct or recommend alternative treatments, therapies, health care
providers,
or settings of care.
All other use and
disclosure of medical information about you by us to make a
communication about a
service to encourage the use of a product or service will be
done
only with your written authorization.
·
Health Related
Benefits and Services
We may use and
disclose medical information about you to contact you about
health related
benefits and services that may be of interest to you.
·
Individuals
Involved in Your Care
We may disclose to a
family member, other relative, a close personal friend, or any
other person
identified by you, medical information about you that is directly
relevant to that
person’s involvement with your care or payment related to your care.
We also may use or
disclose medical information about you to notify, or assist in
notifying,
those persons of your location, general condition, or death. If there is a
family member, other relative, or close personal friend that you do not want us
to
disclose medical
information about you to, please notify the CPC office or your
case
manager.
·
Disaster
Relief
We may use or
disclose medical information about you to a public or private entity
authorized
by law or by its charter to assist in disaster relief efforts. This will be
done to coordinate with
those entities in notifying a family member, other relative,
close personal
friend, or other person identified by you of your location, general
condition
or death.
·
Required by
Law
We may use or
disclose medical information about you when we are required to do
so
by law.
·
Public Health
Activities
We may disclose
medical information about you for public health activities and
purposes. This includes
reporting medical information to a public health authority
that is authorized by
law to collect or receive the information for purposes of
preventing or
controlling disease or one that is authorized to receive reports of child
or dependent adult
abuse and neglect. It also includes
reporting for purposes of
activities related to
the quality, safety, or effectiveness of a United States Food
and Drug
Administration regulated product or activity.
·
Victims of
Abuse, Neglect or Domestic Violence
We may disclose medical information about you to a government authority
authorized by law to receive reports of abuse, neglect, or domestic
violence, if we
believe you are a victim of abuse, neglect, or domestic violence. This will occur
to the extent the disclosure is: (a) required by law; or (b) authorized
by law and
we believe the disclosure is necessary to prevent serious harm to you
or to other
potential victims, or, if you are incapacitated and certain other
conditions
are met, a law enforcement or other public official represents that
immediate
enforcement activity depends on the disclosure.
·
Health
Oversight Activities
We may disclose medical information about you to a health oversight
agency
for activities authorized by law, including audits, investigations,
inspections,
licensure or disciplinary actions. The Lee County
CPC office is operated with
oversight from the Lee County Board of Supervisors, who may review
information
of this office. These and similar types of
activities are necessary for appropriate
oversight of the health care system, government benefit programs, and
entities
subject to various government regulations.
·
Judicial and
Administrative Proceedings
We may disclose medical information about you in the course of any
judicial or
administrative proceedings in response to an order of the court or
administrative
tribunal. We also may disclose medical information
about you in response
to a subpoena, discovery request, or other legal process but only if
efforts have
been made to tell you about the request or to obtain an order protecting
the
information to be disclosed.
·
Disclosures
for Law Enforcement Purposes
We may disclose medical information about you to a law enforcement
official for
law enforcement purposes:
a. As required by law
b. In response to a court, grand jury or administrative
order, warrant or subpoena.
c.
To identify or
locate a suspect, fugitive, material witness or missing person.
d. About an actual or suspected victim of a crime and
that person agrees to the
disclosure. If we are unable to obtain that person’s
agreement, in limited
circumstances, the
information may still be disclosed.
e.
To alert law
enforcement officials to a death if we suspect the death may
have
resulted from criminal conduct.
f.
About crimes that
occur at our facility.
g.
To report a crime
in emergency circumstances.
·
Coroners and
Medical Examiners
We may disclose
medical information about you to a coroner or medical examiner
for
purposes such as identifying a deceased person and determining cause of death.
·
Funeral
Directors
We may disclose
medical information about you to funeral directors as necessary
for
them to carry out their duties.
·
Organ, Eye or
Tissue Donation
To facilitate organ, eye
or tissue donation and transplantation, we may disclose
medical information
about you to organ procurement organizations or other entities
engaged
in the procurement, banking or transplantation of organs, eyes or tissue.
·
Research
Under certain circumstances,
we may use or disclose medical information about
you
for research. Before we disclose medical information for
research, the
research will have
been approved through an approval process that evaluates the
needs of the research
project with your needs for privacy of your medical
information. We may,
however, disclose medical information about you to a
person who is
preparing to conduct research to permit them to prepare for the
project, but no
medical information will leave our organization during that
person’s
review of the information.
·
To Avert
Serious Threat to Health or Safety
We may use or
disclose protected health information about you if we believe the
use or disclosure is
necessary to prevent or lessen a serious or imminent threat to
the
health or safety of a person or the public. We also may
release information
about you if we
believe the disclosure is necessary for law enforcement authorities
to identify or
apprehend an individual who admitted participation in a violent crime
or who is an escapee
from a correctional institution or from lawful custody.
·
National
Security and Intelligence
We may disclose
medical information about you to authorized federal officials for
the conduct of intelligence,
counter-intelligence, and other national security
activities authorized
by law.
·
Protective
Services for the President
We may disclose
medical information about you to authorized federal officials so
they can provide
protection to the President of the United States, certain other
federal officials, or foreign heads of state.
·
Inmates;
Persons in Custody
We may disclose
medical information about you to a correctional institution or law
enforcement
official having custody of you. The disclosure will be made if the
disclosure is
necessary:
(a) to provide health care to you
(b) for the health and safety of others or
(c) the safety, security and good order of the correctional
institution.
·
Workers
Compensation
We may disclose
medical information about you to the extent necessary to comply
with workers’
compensation and similar laws that provide benefits for work-related
injuries
or illness without regard to fault.
·
Other Uses and
Disclosures
Other uses and disclosures
will be made only with your written authorization. You
may revoke such an
authorization at any time by notifying the CPC office in writing
of
your desire to revoke it. However, if you revoke such an authorization,
it will not
have any affect on
actions taken by us in reliance on it.
Your
Rights With Respect to Medical Information About You
You have the
following rights with respect to medical information that we maintain
about
you.
·
Right to
Request Restrictions
You have the right to
request that we restrict the uses or disclosures of medical
information
about you to carry out treatment, payment, or health care operations.
You also have the
right to request that we restrict the uses or disclosures we make
to:
(a) a family member, other relative, a close personal
friend
or any other person
identified by you or
(b) public or private entities for disaster relief
efforts. For
example, you could ask
that we not disclose medical
information
about you to your brother or sister.
To request a
restriction, you may do so at the time you complete your consent
form
or at any time after that time. If you request a restriction after that time,
you should do so in writing
to the CPC office or your case manager and tell us:
(a) what information you want to limit
(b) whether you want to limit use or disclosure or both and
(c) to whom you want the limits to apply (for example,
disclosures
to your spouse).
We are not required
to agree to any requested restriction.
However, if we do
agree, we will follow
that restriction unless the information is needed to provide
emergency
treatment. Even if we agree to a restriction, either you
or we can later
terminate the
restriction.
·
Right to
Receive Confidential Communications
You have the right to
request that we communicate medical information about
you
to you in a certain way or at a certain location. For example,
you can ask that
we only contact you
by mail or at work. We will not require
you to tell us why you
are
asking for the confidential communication.
If you want to
request confidential communication, you must do so in writing to the
CPC
office or your case manager. Your request must state how or where you can
be contacted.
We will accommodate
your request. However, we may, when
appropriate, require
information
from you concerning how payment will be handled. We may also
require an alternate
address or other method to contact you.
·
Right to Inspect
and Copy
With a few very
limited exceptions, such as psychotherapy notes, you have the right
to
inspect and obtain a copy of medical information about you.
To inspect or copy
medical information about you, you must submit your request in
writing
to the CPC office or your case manager. Your request should state
specifically what
medical information you want to inspect or copy. If you request
a copy of the
information, we may charge a fee for the costs of copying and, if you
ask that it be mailed
to you, the cost of mailing.
We will act on your
request within thirty (30) calendar days after we receive your
request. If we grant
your request, in whole or in part, we will inform you of our
acceptance of your
request and provide access and copies.
We may deny your
request to inspect and copy medical information if the medical
information involved
is:
a. Psychotherapy notes;
b. Information compiled in anticipation of, or use in, a
civil, criminal or
administrative action or proceeding;
c.
“Protected health
information subject to the Clinical Laboratory Improvements
Amendments of 1988
(CLIA).
42 U.S.C. 263a, to the extent the provision of access to the individual
would
be prohibited by law.”
If we deny your request,
we will inform you of the basis for the denial, how you
may have our denial
reviewed, and how you may complain. If
you request a review
of our denial, it
will be conducted by a licensed health care professional designated
by us who was not directly
involved in the denial. We will comply
with the outcome
of
that review.
·
Right to Amend
You have the right to
ask us to amend medical information about you.
You have
this right for so
long as the medical information is maintained by us.
To request an
amendment, you must submit your request in writing to your case
manager. Your request
must state the amendment desired and provide a reason in
support
of that amendment.
We will act on your
request within sixty (60) calendar days after we receive your
request. If we grant
your request, in whole or in part, we will inform you of our
acceptance of your
request and provide access and copying.
If we grant the
request, in whole or in part, we will seek your identification of and
agreement
to share the amendment with relevant other persons. We also will
make
the appropriate
amendment to the medical information by appending or otherwise
providing
a link to the amendment.
We may deny your
request to amend medical information about you.
We may deny
your request if it is
not in writing and does not provide a reason in support of the
amendment. In addition,
we may deny your request to amend medical information
if we determine that
the information:
a. Was not created by us, unless the person or entity
that created the
Information is no longer available to act on the requested amendment;
b. Is not part of the medical information maintained by
us;
c.
Would not be
available for you to inspect or copy; or,
d. Is accurate and complete
If we deny your
request, we will inform you of the basis for the denial. You will
have the right to
submit a statement of disagreeing with our denial. Your statement
may
not exceed 1 page. We may prepare a rebuttal to that statement. Your request
for amendment, our
denial of the request, your statement of disagreement, if any,
and our rebuttal, if
any, will then be appended to the medical information involved
or
otherwise linked to it. All of that will then be included with any
subsequent
disclosure of the
information, or, at our election, we may include a summary of any
of
that information.
If you do not submit
a statement of disagreement, you may ask that we include your
request for amendment
and our denial with any future disclosures of the information.
We will include your
request for amendment and our denial (or summary of that
information)
with any subsequent disclosure of the medical information involved.
You also will have
the right to complain about our denial of your request.
·
Right to an
Accounting of Disclosures
You have the right to
receive an accounting of disclosures of medical information
about
you. The accounting may be for up to six (6) years
prior to the date on which
you request the accounting but not
before April 14, 2003.
Certain types of
disclosures are not included in such an accounting:
a. Disclosures to carry out treatment, payment and health
care operations;
b. Disclosures of your medical information made to you;
c.
Disclosures that
are incident to another use or disclosure;
d. Disclosures that you have authorized;
e.
Disclosures for
our facility or to persons involved in your care;
f.
Disclosures for
disaster relief purposes;
g.
Disclosures for
national security or intelligence purposes;
h. Disclosures to correctional institutions or law
enforcement officials having
custody of you’
i.
Disclosures that
are part of a limited data set for purposes of research,
public health, or health
care operations (a limited data set is where things
that would
directly identify you have been removed.)
j.
Disclosures made
prior to April 14, 2003.
Under certain circumstances your right to an accounting of disclosures
to a law
enforcement official
or a health oversight agency may be suspended. Should you
request an accounting during the period of time your right is
suspended, the
accounting would not include the disclosure or disclosures to a law enforcement
official to a health oversight agency.
To request an accounting of disclosures, you must submit your request
in
writing to the Lee County CPC office. Your request
must state a time period
for the disclosures. It may be no
longer that six (6) years from the date we
receive your request and may not include dates before April 14, 2003.
Usually, we will act on your request within sixty (60) calendar days
after we
receive your request. Within
that time, we will either provide the accounting
of disclosures to you or give you a written statement of when we will
provide
that accounting and why the delay is necessary.
There is no charge for the first accounting we provide to you in any
twelve
(12) month period. For
additional accountings, we may charge you for the cost
of providing the list. If there will
be a charge, we will notify you of the cost
involved and give you an opportunity to withdraw or modify your request
to
avoid or reduce the fee.
·
Right to Copy
of this Notice
This is your paper
copy of our Notice of Privacy Practices.
Our Duties
·
Generally
We are required by
law to maintain the privacy of medical information about you
and to provide
individuals with notice of our legal duties and privacy practices with
respect to medical
information. We are required to abide by
the terms of our
Notice
of Privacy Practices in effect at the time.
·
Our Right to
Change Notice of Privacy Practices
We reserve the right
to change this Notice of Privacy Practices.
We reserve the
right to make the new
notice’s provisions effective for all medical information that
we maintain,
including that created or received by us prior to the effective date of
the
new notice.
·
Availability
of Notice of Privacy Practices
A copy of our current
Notice of Privacy Practices will be posted at
www.leecounty.org. In addition, upon the completion of the
initial application,
a copy of the HIPAA
Brochure will be provided to the applicant, by the provider
assisting
you with the completion of the application.
·
Effective Date
of Notice
The effective date of
the notice will be stated on the first page of the application.
·
Complaints
You may complain to
us and to the United States Secretary of Health and Human
Services if you
believe your privacy rights have been violated by us.
To file a complaint
with us, contact the CPC Administrator.
All complaints should
be submitted in
writing.
To file a complaint
with the United States Secretary of Health and Human Services,
send your complaint
to him or her in care of: Office for Civil
Rights, U.S.
Department of Health
and Human Services, 200
Independence Avenue SW,
Washington, D.C.
You will not be
retaliated against for filing a complaint.
·
Questions and
Information
If you have any
questions or want more information concerning this Notice of
Privacy Practices,
please contact Ryanne Wood.
Lee County
Central Point of Coordination
933 Avenue H
Post Office Box 190
Fort Madison, IA 52627
Phone: 1-319-372-5681 or 1-319-0042
or
1-866-218-7574
(toll free)
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