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Alternative Choices, LLC
NOTICE OF PRIVACY PRACTICES
Effective: April 14th, 2003
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 applies to the privacy practices of this agency that may share
your Protected Health Information as needed for treatment, payment, and
health care operations.
This
notice will tell you how we may use and disclose protected health
information about you.
Protected health information 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 this notice we call all of that protected health information
“medical information.”
This
notice will also tell you about your rights and our duties with respect
to medical information about you.
In addition, it will tell you how to file a complaint if you
believe we have violated your privacy rights.
How
We May Use and Disclose Medical Information About You
·
For
Treatment.
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 other health care providers (doctors,
nurses, hospitals, dentists, and other caregivers) 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 with a
particular specialty. When
we refer you to that physician, we will also contact that physician’s
office and provide medical information about you to them, so that they
have the information they need to provide services for you.
·
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 and to maintain quality health care for our
consumers. For example:
o
To
review the services we provide, and the performance of our employees in
caring for you.
o
To
train our staff or volunteers.
o
In
conducting quality assessment and improvement activities, including peer
review, credentialing of providers, and accreditation.
o
In
preventing, detecting, and investigating fraud and abuse.
o
In
coordinating case and disease management activities.
·
For
Payment.
We
may use and disclose medical information about you so we can be paid for
the services we provide to you.
We may need to provide a third-party payer, our funding source,
or a government program, such as Medicare or Medicaid, with information
about your medical condition, as well as the health care you need to
receive.
·
How
We Will Contact You.
Unless you tell us otherwise in writing, we may contact you by either
telephone or mail, at either your home or workplace.
At either location, we may leave messages for you on the
answering machine or voicemail.
If you want to request that we communicate to you in a certain
way or at a certain location, please see “Right to Receive Confidential
Communications” as part of this Notice.
·
Marketing Communications.
We
may use and disclose medical information about you to communicate with
you about a product or service, to encourage you to purchase the product
or service. This may be:
o
To
describe a health-related product or service that is provided by us.
o
For
your treatment.
o
For
case management or care-coordination for you.
o
To
direct or recommend alternative treatments, therapies, or health care
providers.
We
may communicate to you about products and services in a face-to-face
communication by us to you.
We may also communicate about products or services in the form of a
promotional gift of nominal value.
All
other use and disclosure of medical information about you, by us, to
make a communication about a product or service, to encourage the
purchase or use of a product or service, will be done only with your
written authorization.
·
Fundraising.
We
may use and disclose medical information about you to contact you to
raise funds for our company.
We may disclose medical information to a business associate or a
foundation related to our company, so that business associate or
foundation may contact you to raise money for the benefit of our
company. We will only
release demographic information, such as your name and address, and the
dates you received treatment or services from us.
If you do not want our company or its foundation to contact you
for fundraising, you must notify the program manager in writing.
·
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 to
whom you do not want us to disclose medical information about you,
please notify the program manager, or tell our staff member who is
providing care to you.
·
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.
·
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
providing or controlling disease, or one that is authorized to receive
reports of abuse and neglect.
It
also includes reporting for purposes of activities relating 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 government authorities,
including social services or protective service agencies, if we
reasonably believe you are a victim of abuse, neglect, or domestic
violence. This will occur to
the extent that the disclosure is: (a) required by law, (b) agreed to by
you, or (c) 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.
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 proceeding in response to an order of the court or
administrative tribunal. We
may also 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:
o
As
required by law.
o
In
response to a court, grand jury, administrative order, warrant, or
subpoena.
o
To
identify or locate a material witness or missing person.
o
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.
o
To
alert law enforcement officials to a death if we suspect the death may
have resulted from criminal conduct.
o
About
crimes that occur at our facility.
o
About
medical emergencies, if the disclosure is necessary to alert law
enforcement about the commission and nature of a crime, the location of
victims, or the perpetrator of such crime.
·
Coroners and Medical Examiners.
We
may disclose medical information about you to a coroner or medical
examiner for purposes such as identification 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.
We
may use or disclose medical information about you for research, provided
that certain conditions are met.
·
To
Avert Serious Threat to Health or Safety.
We
may use or disclose protected health information about you if we believe
that 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,
who is an escapee from a correctional institution, or from lawful
custody.
·
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.
·
Specialized Government Functions.
We
may use or disclose medical information about you if you are a member of
the Armed Forces or foreign military personal, if appropriate notice has
been filed in the Federal Register.
We
may disclose medical information about you to authorized federal
officials for the conduct of lawful intelligence, counter-intelligence,
and other national security activities, or for federal protective
services and investigations, to the extent authorized by law.
·
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
program manager 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) to public or private
entities for disaster relief efforts.
To
request a restriction, you may do so at any time.
If you request a restriction, you should do so to the program
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 parent).
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.
·
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 confidential communication.
If
you want to request confidential communication, you must do so in
writing, to the program manager.
We may condition our acceptance of this accommodation upon
obtaining appropriate information regarding payment, and upon receiving
an alternative method to contact you.
·
Right
to Access Protected Health Information.
You
have a right to request access to inspect or obtain a copy of your
medical information that is contained in a designated record set.
You must make such request in writing to the program manager at
your facility. If we deny
your request, we will provide a basis for the denial in writing.
If your request is denied, under certain circumstances, you have
the right to have your request reviewed by a licensed health care
professional, designated by us.
We may charge you for the reasonable copy and postage costs if
you request a copy of the records.
·
Right
to Amend.
You
have the right to ask us to amend medical information about you.
You have this right for so long as we maintain the medical
information. If we deny your
request, we will provide you a written explanation.
If you disagree, you may have a statement of your disagreement
placed in our records. If we
accept your request to amend the information, we will make reasonable
efforts to inform others, including individuals you name, of the
amendment.
To
request an amendment, you must submit your request in writing to the
program manager. Your
request must state the amendment desired and provide a reason in support
of that amendment.
·
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.
Our
Rights, Questions, and Complaints
We
are required to maintain the privacy of protected health information and
to provide individuals with notice of our legal duties and privacy
practices, with respect to protected health information.
We are required to abide by the terms of this Notice of Privacy
Practices currently in effect.
We reserve the right to change the terms of this Notice and to
make the new Notice provisions effective for all protected health
information that we maintain.
·
Availability of Notice of Privacy Practices.
A
copy of our current Notice of Privacy Practices will be posted on the
“consumer information” bulletin board.
A copy of the current notice will also be posted on our web site.
At any time, you may obtain a copy of the current Notice of
Privacy Practices by contacting the program manager.
·
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.
Office for Civil Rights,
To
file a complaint with us, write or call:
Privacy Officer at
All
complaints should be submitted in writing.
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, you can write or call:
Privacy Officer at
Telephone: 248-641-7200.
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