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 this notice carefully.

We understand the importance and the personal nature of your medical information and are committed to protecting it. Your protected health information (PHI) includes all medical history and/or financial information obtained.

Where did we obtain your Personal Health Information?

You provided us with most of your personal health information on your application for health care services. We may also have obtained your personal health information from a provider, such as hospital or insurance company when we obtained your medical records in order to process your medical bills.

Use and Disclosure of Health Information

Alliance Home Health Care Agency,  may use your health information, information that constitutes protected health information as defined in the Privacy Rule of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act (HIPAA) of 1996, for purposes of providing you treatment, obtaining payment for your care and conducting health care operations. We have established policies to guard against unnecessary disclosure of your health information.

The Notice covers:

Uses and disclosures of your PHI which require your written authorization.

  • Your rights as a patient regarding privacy of your health information.
  • Our duties in protecting your health information.
  • Complaints, contact person, effective date and acknowledgement.

Uses and disclosures of your PHI which do not require your written authorization.

  • Treatment, payment and health care operations.
  • Uses and disclosures of your health information to which you may object.
  • Uses and disclosures required or permitted by law.

Uses and disclosures which do not require your written authorization.

The confidential health information that we collect as we deliver care or services to you is called “protected health information”. We can use and disclose your protected health information:

  • To provide treatment: We may use your information to help us coordinate care, as family members, your pharmacist, suppliers of medical equipment and your physician, or to notify you of a service such as availability of flu shot.
  • To obtain payment: We may use your health information to prepare documentation required by your insurer. We may also need to obtain prior approval from your insurer to explain your need for home care services and the care or services that we will provide you.
  • For health care operation: We may use your protected health information to evaluate and improve the quality of our services or to write new guidelines to provide more effective nursing care to patients, to evaluate staff performance or for business management and general administrative activities.

Uses and Disclosures Required or Permitted By Law

The following is a summary of the circumstances under which and purposes for which your health information may also be used and disclosed when legally required:

  • Federal government investigation, when required by the Secretary of Health and Human services to investigate or determine our compliance with federal regulations regarding privacy of health information.
  • Federal, state or local law requirements.
  • Public health activities, for example to report communicable diseases or death; or for matters involving the Food and drug Administration.
  • To report abuse, neglect or domestic violence.
  • To conduct health oversight activities.
  • For law enforcement purposes – to report certain types of wounds or other physical injuries or to identify or locate a suspect, fugitive, material witness or missing person.
  • Use by coroners, medical examiners or funeral directors.
  • To facilitate organ, eye or tissue donation.
  • Workers’ Compensation.
  • For specific government functions.
  • Serious threat to health and safety.

Your Rights With Respect to Your Health Information

  • Right to request restrictions. You have the right to request a limit on the disclosure of your health information; however we are not required to agree to your request.
  • Right to request confidential communications. You have the right to request that we communicate with you in a certain way. For example, to communicate your health information to you in private with no family member present. Your request has to be in writing. We may deny your request and, if so, you may be entitled to request a review of the denial. However, we will make every attempt to honor your request.
  • Right to request and copy your health information. You have the right to inspect and copy your health information, including billing records. A request to inspect your records must be in writing. If you request a copy of your health information, we may charge reasonable fees for copying and assembling costs associated with your request.
  • Right to amend health care information. You or your representative has the right to request that we amend your records, if you believe that your health information is incorrect or incomplete. Your request must be in writing and must provide reason for the amendment. We may deny your request, and if so, you may submit a statement of disagreement. However, we will make every attempt to honor your request.
  • Right to an accounting. You or your representative has the right to request an accounting of disclosures of your health information made by us for certain reasons, including reasons related to public purposes authorized by law and certain research. Your request must be in writing. We are not required to provide an accounting for disclosures before April 14, 2003 or for more than six (6) years prior to the date of your request.
  • Right to a paper copy of this Notice. You or your representative has the right to obtain a separate paper copy of this notice at any time even if you or your representative have received this Notice previously.

To exercise any of these rights, please write or telephone Privacy Officer.

Duties of the Agency

  • We are required by law to maintain the privacy of your health information.
  • To provide you and your representative this Notice of its duties and privacy practices.
  • We are required to abide by the terms of this Notice as may be amended from time to time.
  • We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all health information that it maintains.
  • If we change this Notice, we will provide a copy of the revised Notice to you or your appointed representative.

Complaints

You or your personal representative has the right to express complaints to us and to the Secretary of Department of Health and Human Services. However, we ask that you provide us with the necessary information to follow up on your concerns/complaints so that we may address them in the most proactive and effective manner.

  • You may file a complaint with our agency by either writing or calling the Privacy Officer.Privacy Officer
    Alliance Home Health Care
    214 W Kenosha St Ste. 214
    Broken Arrow, OK  74012
    918-286-6276
  • You may file a complaint with the Secretary of Health and Human Services by writing to:Medical Privacy
    Complain Division, Office of Civil Rights
    U. S. Department of Health and Human Services
    200 Independence Avenue, S.W., Room 509F
    HHH Building
    Washington, D.C. 20201
    Hotline Number: 800-368-1019
    (Source: www.hhs.gov/ocr)
  • This notice is effective October 5, 2017