DISCLAIMER: WE ARE NOT A MEDICAL PROVIDER. HOWEVER DUE TO OUR CLOSE INVOLVEMENT WITH OUR CLIENTS AND THE NEED TO SOMETIMES COMMUNICATE WITH HEALTH CARE PROVIDERS, WE WILL HAVE SOME ACCESS TO YOUR MEDICAL INFORMATION. WE DO NOT MAINTAIN A MEDICAL RECORD FOR OUR CLIENTS.
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.
Our agency uses your information to determine service, to obtain payment for our services and for our operational purposes, such as improving the quality of service we provide to you. We are committed to maintaining your confidentiality and protecting your information. We are required by law to provide you with this notice which describes our information privacy practices and those of our affiliated providers. This notice applies to all information and records related to your service that our agency workforce members and business associates (described below) have received or created. It also applies to other professionals, such as physicians, and organizations that provide service to you. It informs you about the possible uses and disclosures of your information and describes your rights and our obligations regarding your information. We will maintain the privacy of your information; provide to you this detailed notice of privacy practices relating to your information; and abide by the terms of the notice that are currently in effect. We reserve the right to change the terms of this notice, and will notify you or your personal representative by letter if we make any material changes to the notice.
WITH YOUR CONSENT WE MAY USE AND DISCLOSE INFORMATION FOR PAYMENT AND SERVICE
You will be asked to sign a consent allowing us to use and disclose your information to others to provide you with service and obtain payment for our services. Here are examples of how we may use and disclose your information.
For Payment. Our agency may use and disclose your information to others in order for the agency to bill for your services and receive payment. For example, we may include your information in our claim to a payor in order to receive payment for services provided to you.
For Business Operations. We may use and disclose your information to others for our agency’s business operations. For example, we may use information to evaluate our agency’s services, including the performance of our staff, and to educate our staff. We may share your information with our vendors and agents who help us with obtaining payment or carrying out our business functions. For example, we may give your information to a billing company to assist us with our billing for services, or to a law firm or an accounting firm that assists us in complying with the law and or improving our services.
Family and Friends Involved in Your Service. Unless you object, we may disclose your information to a family member or close personal friend, including clergy, who is involved in your service or payment for that service.
Disaster Relief. We may disclose your information to an organization assisting in a disaster relief effort.
Reporting Victims of Abuse, Neglect or Domestic Violence. If we have reason to believe that you have been a victim of abuse, neglect or domestic violence, we may use and disclose your information to notify a government authority if required or authorized by law, or if you agree to the report.
Law Enforcement. We may disclose your information for certain law enforcement purposes or other specialized governmental functions.
Judicial and Administrative Proceedings. We may disclose your information in the course of certain judicial or administrative proceedings.
Research. In general, we will request that you sign a written authorization before using your information or disclosing it to others for research purposes. However, we may use or disclose your information without your written authorization for research purposes provided that the research has been reviewed and approved by a special Privacy Board or Institutional Review Board.
Coroners, Medical Examiners, Funeral Directors, Organ Procurement Organizations. We may release your information to a coroner, medical examiner, and funeral director or, if you are an organ donor, to an organization involved in the donation of organs and tissue.
To Avert a Serious Threat to Health or Safety. We may use and disclose your information when necessary to prevent a serious threat to your health or safety or the health or safety of the public or another person. However, any disclosure would be made only to someone able to help prevent the threat.
Military and Veterans. If you are a member of the armed forces, we may use and disclose your information as required by military command authorities. We may also use and disclose information about foreign military personnel as required by the appropriate foreign military authority.
Workers’ Compensation. We may use or disclose your information to comply with laws relating to workers’ compensation or similar programs.
National Security and Intelligence Activities; Protective Services. We may disclose information to authorized federal officials who are conducting national security and intelligence activities or as needed to provide protection to the President of the United States, or other important officials.
As Required By Law. We will disclose your information when required by law to do so.
YOUR AUTHORIZATION IS REQUIRED FOR OTHER USES OF YOUR INFORMATION
We will use and disclose your information other than as described in this notice or required by law only with your written authorization. You may revoke your authorization to use or disclose information in writing, at any time. To revoke your authorization, contact office management personnel. If you revoke your authorization, we will no longer use or disclose your information for the purposes covered by the authorization, except where we have already relied on the authorization.
YOUR RIGHTS REGARDING YOUR INFORMATION
You have the following rights with respect to your information. If you wish to exercise any of these rights, you should make your request to an Office Management Personnel.
Right to Request Restrictions. You have the right to request restrictions on the way we use and disclose your information for our services, payment or other business operation. You also have the right to restrict your information that we disclose to a family member, friend or other person who is involved in your service or the payment for your service. We are not required to agree to your requested restriction, and in some cases, the law may not permit us to accept your restriction. However, if we do agree to accept your restriction, we will comply with your restriction except if you are being transferred to another company, the release of records is required by law.
Right to a Paper Copy of This Notice. You have the right to obtain a paper copy of this notice, even if you have agreed to receive this notice electronically. You may request a copy of this notice at any time.
Right to Request Confidential Communications. You have the right to request that we communicate with you concerning personal matters in a certain manner or at a certain location. For example, you can request that we speak to you only at a private location in your home. We will accommodate your reasonable requests.
If you believe that your privacy rights have been violated, you may file a complaint in writing to: Tender Loving Family Care, Inc. 97 West Avenue, Brockport, NY 14420 or call the agency president, Annika T. D’Andrea at 585-637-0333. No one will retaliate or take action against you for filing a complaint.
CHANGES TO THIS NOTICE
We will promptly revise and distribute this notice whenever there is a material change to the uses or disclosures, or your individual rights. We reserve the right to change this notice and to make the revised or new notice provisions effective for all information already received and maintained by the agency as well as for all information we receive in the future. We will post a copy of the current notice in the agency. In addition, we will provide a copy of the revised notice to all clients by mailing or hand-delivering a hard copy to them or their personal representatives.