Use & Disclosure of Protected Health Information

Notice Effective: March 01, 2003

NOTICE

USE & DISCLOSURE OF PROTECTED HEALTH INFORMATION

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.

New Milford VNA is required by law to maintain the privacy of protected health information and to provide you with notice of its legal duties and privacy practices. New Milford VNA must abide by the terms of the notice currently in effect; however New Milford VNA reserves the right to change the terms of this notice as well as make the new provisions effective for all protected health information maintained. If there is a change, New Milford VNA will inform you of this change at your next scheduled appointment or upon your request. In addition, a copy of the effective notice will be posted at all times in the office, with a date notifying you of the most recent update.

New Milford VNA IS NOT REQUIRED TO OBTAIN CONSENT OR AUTHORIZATION TO USE AND DISCLOSE INFORMATION ABOUT YOU UNDER THE FOLLOWING CIRCUMSTANCES:

For purposes of treatment, payment and healthcare operations, including the release of information to:
An insurance company, Medicare, Medicaid
Any person or entity affiliated with billing and quality and risk management
Any hospital, nursing home, or other health care facility in which you may be admitted
Any assisted living or personal care facility
Any physician providing you care
Any business associate of New Milford VNA
Licensing and accrediting bodies
When New Milford VNA is required by law
For certain public health activities or health care oversight activities
When New Milford VNA reasonably believes that you are a victim of abuse, neglect or domestic violence
In certain judicial administrative hearings
In certain circumstances, to coroners, medical examiners and funeral directors
For certain law enforcement purposes
For cadaveric organ, eye or tissue donation purposes
For certain research purposes
For workers' compensation purposes
For specialized government functions, including military and veterans' activities, national security and intelligence activities, medical suitability determinations, correctional institution and custodial situations

New Milford VNA IS ONLY REQUIRED TO INFORM YOU IN ADVANCE AND ALLOW YOU TO OBJECT TO THE USE AND DISCLOSURE OF INFORMATION ABOUT YOU UNDER THE FOLLOWING CIRCUMSTANCES:

For use in a directory of individuals served by New Milford VNA
To a family member, other close relative, close personal friend, or other identified person involved in your care
To a public or private entity authorized by law or charter to assist in disaster relief efforts

USES AND DISCLOSURES NOT SPECIFICALLY ADDRESSED IN THIS NOTICE WILL BE MADE ONLY WITH YOUR WRITTEN AUTHORIZATION, INCLUDING:

Psychotherapy notes (notwithstanding the provisions allowing uses)
Marketing, except face-to-face communications and promotional gifts of nominal value

YOUR RIGHTS

Subject to certain conditions, you have the right under the law, to:

Request restrictions on certain uses and disclosure of information about you (although the New Milford VNA is not required to agree with the request)
Receive confidential communication of protected health information
Inspect and copy protected health information
Amend protected health information
Receive an accounting of disclosures
Obtain a paper copy of this notice

COMPLAINTS

If you believe your privacy rights have been violated, you may complain to New Milford VNA and the Secretary of the U.S. Department of Health and Human Services. There will be no retaliation for complaints filed. For further information or to make a complaint, contact:

PRIVACY OFFICER AT 860-354-2216

- OR -

The U.S. Department of Health and Human Services, Office of the Secretary

200 Independence Avenue S.W., Washington, D.C. 20201

(202) 619-0257 OR Toll Free: 1-877-696-6775