Notice of Privacy Practices
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 privacy notice is required by new federal regulation, signed into law in 1996 known as the Health Insurance Portability and Accountability Act (HIPAA). 45 CFR §164.520 (B) (1) (I)
This notice will tell you how Foothills Gateway, Inc. (FGI) may use and disclose protected health information about you. Protected Health Information (PHI) means any 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 the header above, PHI information is referred to as “medical information.” In this notice, all protected health information will be called “health information, or PHI.”
This notice also will tell you about your rights and FGI’s duties with respect to health information about you. In addition, it will tell you how to complain to FGI if you believe we have violated your privacy rights.
Right to Change Notice of Privacy Practices.
FGI reserves the right to change this Notice of Privacy Practices. FGI reserves the right to make the new notice’s provisions effective for all health information that FGI maintains, including information created or received by FGI prior to the effective date of the new notice.
45 CFR §164.520(b)(v)(C)
HOW FOOTHILLS GATEWAY, INC. MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
FGI has policies in effect concerning Confidential Information, Master Records and Access to Information. These policies outline practices that will continue in addition to this Privacy Notice.
The law requires FGI to have your written authorization for some uses and disclosures. In other circumstances, the law allows FGI to use and disclose PHI without your written authorization.
FGI may use or disclose PHI without your authorization for the purposes of treatment, payment or health care operations
FGI uses health information about you to provide, coordinate, or manage the services, supports, and health care you receive from FGI and other Program Approved Service Agencies. FGI may disclose health information about you to doctors, nurses, psychologists, social workers, agency staff, consultants, volunteers and other persons who are involved in supporting you or providing care or treatment. FGI may consult with other health care providers, and as part of the consultation share your health information with them. FGI staff may discuss your PHI to develop and carry out your service plan. FGI staff may share information to coordinate needed services such as medical tests, transportation to a doctor or therapy. FGI staff may need to disclose health information to entities outside FGI (for example, another provider or a state or local agency) to obtain new services for you.
FGI may use and disclose PHI about you so we can be paid for the services FGI provides. This can include billing a third party payor, such as Medicaid or other state agency (for example, Division for Developmental Disabilities). FGI needs to provide the state Medicaid program and billing agent information about the services FGI provides to you so we will be reimbursed for those services. FGI also may need to provide the state Medicaid program with information to ensure you are eligible for the medical assistance program.
For Health Care Operations
FGI uses and discloses health information about you for our own operations. This is necessary for us to operate FGI and to maintain quality for our clients. For example, FGI may use PHI about you to review the services provided and the performance of our employees supporting you. FGI may disclose PHI about you to train staff and volunteers. FGI may use the information to study ways to more efficiently manage the organization, for accreditation or licensing activities, or for the quality assurance survey process.
Certain Uses and Disclosures Do Not Require Your Written Authorization
The law allows FGI to disclose PHI without written authorization in the following circumstances. The amount of information disclosed will be restricted to the minimum amount necessary to accomplish the intended purpose of the disclosure.
When Required by Law
FGI discloses PHI when required to do so by federal, state or local law.
To Law Enforcement
FGI may release PHI (a) in response to a court order, subpoena, warrant, summons, or similar process, (b) to identify or locate a suspect, fugitive, material witness, or missing person, (c) about the victim of a crime if we are unable to obtain the person’s authorization, (d) about a death that may be due to criminal conduct, (e) about criminal conduct at the facility, (f) and in emergency circumstances, to report a crime, its location or victims, or the identity, description or location of the person who committed the crime.
Victims of Abuse, Neglect, Domestic Violence
FGI may disclose PHI about you to a government authority authorized by law to receive reports of abuse, neglect or domestic violence. This disclosure will occur as required by law or regulations for entities serving developmentally disabled individuals.
For Public Health Activities
FGI discloses PHI to report suspected abuse, the occurrence of certain diseases, or adverse reactions to a drug or medical device.
To Health Oversight Agencies
FGI will provide PHI as requested to regulatory agencies with the authority to audit or investigate our operations. Documentation of a review of records is noted in the master record for each individual.
For Lawsuits and Disputes
If you are involved in a lawsuit or dispute, FGI may disclose your PHI in response to a subpoena or other lawful request, but only if efforts have been made to tell you about the request or to obtain a court order that will protect the PHI requested.
To Coroners, Medical Examiners and Funeral Directors
FGI may disclose PHI about you to a coroner, or medical examiner for purposes or identifying a deceased person, determining a cause of death, or to a funeral director as necessary to facilitate their duties.
By current policy, FGI does not disclose PHI for research purposes.
To Avert a Serious Threat to Health and Safety
FGI may disclose your PHI to someone who can help prevent a serious threat to your health and safety or the health and safety of another person or the public.
Uses and Disclosures that Require Foothills Gateway, Inc. to Give You the Opportunity to Object.
How FGI will Contact You
Unless you indicate otherwise, FGI will contact you either by mail or telephone at your home or workplace. At either location, FGI may leave messages on the answering machine or voice mail. If you wish for FGI to communicate with you in a certain way, or at a certain location, you should complete a Request for Confidential Communications form available from your Case Manager.
FGI uses and discloses PHI about you to contact you to remind you of an appointment for treatment or services.
Treatment and Service Alternatives
FGI uses your PHI to contact you about treatment and service alternatives that may be of interest or benefit to you.
Health Related Benefits and Services
FGI may use and disclose PHI about you to contact you about health related benefits and services.
Public Information and Communications
FGI will not use or disclose PHI about you for the purposes of public information without your prior authorization.
FGI will not use or disclose PHI about you in order to promote public awareness, support and funding without your prior authorization.
Disclosures to Family and Others
With written authorization, FGI will disclose PHI about you to parents, family members, relatives or any other person identified by you. The information disclosed will be relevant to that persons involvement with the services and supports you receive or payment for those services and supports.
Sale of Protected Health Information
FGI will not sell or receive remuneration of any kind in exchange for your PHI.
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 your Case Manager in writing of your desire to withdraw the authorization.
YOUR RIGHTS RELATED TO YOUR PROTECTED HEALTH INFORMATION
Right to Request Restrictions
You have the right to ask FGI to limit how we use and disclose your Protected Health Information, for treatment, payment, or health care operations as long as you are not asking FGI to limit uses and disclosures that FGI is required or authorized to make, or to place limits on any of the disclosures described above. Requests for restrictions must be submitted in writing to the Privacy Officer at FGI. FGI is not required to agree with your request. If FGI agrees, we will acknowledge the request in writing and abide by the agreement except when you require emergency treatment.
Right to Choose How We Communicate With You
You have the right to ask that FGI send information to you at a specific address, (at your workplace rather than at home) or in a specific manner (for example: regular mail, or never by telephone). FGI will agree to your request as long as it would not be disruptive to our operations to do so. You must make any such request in writing, addressed to the Privacy Officer.
Right to See and Obtain a Copy of your Protected Health Information
Except for limited circumstances, you may look at and copy your PHI. Your case manager will assist you in this process. If you ask FGI to copy your PHI, we will charge you $.05 for each page.
Right to Amend or Update your Protected Health Information
If you believe the Protected Health Information FGI has about you is incomplete or incorrect, you may ask FGI to amend it. Any such request must be made in writing addressed to the Privacy Officer. You must tell FGI why you think the amendment is appropriate. FGI will act on your request with 60 days and will inform you in writing as to whether the amendment will be made or denied. If we agree to the amendment, FGI will ask you who needs to be notified of the amendment. FGI will deny your request if you ask to amend information that (a) was not created by FGI, (b) is not part of the PHI FGI keeps about you, (c) is not part of the PHI you are allowed to see and copy, or (d) is determined by FGI to be accurate and complete. If FGI denies the requested amendment, FGI will notify you in writing and include information on how to submit a statement of disagreement or complaint, or how to request inclusion of your original amendment request in your PHI.
Right to be Notified of a Breach of Unsecured PHI
In the event of any impermissible use or disclosure of your PHI, you will be notified and FGI will takes steps to mitigate any possible harm that could result from the action.
Right to An Accounting of the Disclosures.
You have the right to receive an accounting of disclosures of PHI about you. The accounting may be 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:
- Disclosures to carry out treatment, payment and health care operations.
- Disclosures of your health information made to you.
- Disclosures you have authorized.
- Disclosures for disaster relief purposes.
- Disclosures for national security or intelligence purposes.
- Disclosures to correctional institutions or law enforcement officials.
- Disclosures made prior to April 14, 2003.
To request an accounting of disclosures, you must submit your request in writing to the Privacy Officer at FGI. Your request must state a time period for the disclosures. FGI will act upon your request within 60 days.
Right to a Copy of FGI Notice of Privacy Practices. You have a right to obtain a paper copy of the FGI Notice of Privacy Practices. You may request a copy of our Notice of Privacy Practices at any time by contacting the Privacy Officer at FGI. You may obtain a copy of the FGI Notice of Privacy practices over the Internet at our website www.foothillsgateway.org.
FOOTHILLS GATEWAY INC. DUTIES
FGI is required by law to maintain the privacy of health information about you and to provide individuals with notice of our legal duties and privacy practices with respect to health information.
You may complain to FGI and to the United States Secretary of Health and Human Services if you believe your privacy rights have been violated by FGI.
To file a complaint with FGI, contact the Complaint Officer, at Foothills Gateway, 301 W. Skyway Drive, Fort Collins, CO 80525. Phone (970) 226-2345. All complaints should be submitted in writing.
To file a complaint with the United States Secretary of Health and Human Services, send your written 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. 20201.
You will not be retaliated against for filing a complaint.
Questions and Information
If you have questions or want more information concerning this Notice of Privacy Practices, please contact the Privacy Officer at Foothills Gateway.