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.
THE EFFECTIVE DATE OF THIS NOTICE IS MARCH _20th_, 2014.
Bradford Health Services (“Facilities”, “us” or “we”) is part of an organized health care arrangement (“OHCA”) that is made up of those persons and entities listed on the last page of this Notice. This Notice is a joint notice that covers the functions of the OHCA and any health care professional working within the Facilities.
We are required under the federal health care privacy rules (the “Privacy Rules”) to protect the privacy of your health information, which includes information about your health history, symptoms, test results, diagnoses, treatment, and claims and payment history (collectively, “Health Information”). We are also required to provide you with this Notice regarding our legal duties, policies and procedures to protect and maintain the privacy of your Health Information. We are required to follow the terms of this Notice unless (and until) it is revised. We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for the Health Information that we maintain and use, as well as for any Health Information that we may receive in the future. Should the terms of this Notice change, we will make a revised copy of the Notice available to you. This Notice will be available at our Facilities for individuals to take with them and we will post a copy of this Notice in a prominent location in our Facilities. This Notice will also be posted and made available electronically on our website.
Permitted Uses and Disclosures of Your Health Information.
1. General Uses and Disclosures. Under applicable law, we are permitted to use and disclose your Health Information for the following purposes, without obtaining your permission or Authorization:
Treatment. We are permitted to use and disclose your Health Information in the provision and coordination of your health care. For example, we may disclose your Health Information to your primary health care provider, consulting providers, and to other health care personnel who have a need for such information for your care and treatment.
Payment. We may use and disclose your Health Information so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company or other third party, including determining the applicability of any health insurance coverage. For example, a bill sent to your insurance company may include information that identifies you and your medical information.
Health Care Operations. We are permitted to use and disclose your Health Information for certain administrative, legal and quality improvement activities that are necessary for us to operate our Facilities and to support our functions of treatment and payment, including, but not limited to, quality assurance, auditing, licensing or credentialing activities, and for educational purposes. For example, we can use your Health Information to assess our quality of care provided to patients.
Uses and Disclosures Related to OHCA Functions. The health care providers and entities participating in the OHCA and listed below in this Notice will share your Health Information with each other, as necessary, to carry out treatment, payment and health care operations relating to the OHCA.
Uses and Disclosures Required by Law. We may use and disclose your Health Information when required to do so by law, including, but not limited to, in response to judicial and administrative proceedings, in responding to a law enforcement request for information, in order to alert law enforcement to criminal conduct on our premises, in response to an order of a court, or in response to a subpoena, summons, warrant, discovery request, or similar legal request.
Public Health Activities. We may disclose your Health Information for public health reporting, including, but not limited to, reporting communicable diseases and vital statistics, product recalls and adverse events, or notifying person(s) who may have been exposed to a disease or are at risk of contracting or spreading a disease or condition.
Abuse and Neglect. We may disclose your Health Information to a local, state, or federal government authority, including social services or a protective services agency authorized by law to receive such reports, if we have a reasonable belief of abuse, neglect or domestic violence.
Regulatory Agencies. We may disclose your Health Information to a health care oversight agency for activities authorized by law, including, but not limited to, licensure, investigations and inspections. These activities are necessary for the government and certain private health oversight agencies to monitor the health care system, government programs, and compliance with civil rights.
Coroners, Medical Examiners, Funeral Directors. We may disclose your Health Information to a coroner or medical examiner. This may be necessary, for example, to determine a cause of death. We may also disclose your Health Information to funeral directors, as necessary, to carry out their duties.
Threats to Health and Safety. We may use or disclose your Health Information if we believe, in good faith, 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, or is necessary for law enforcement to identify or apprehend an individual.
Specialized Government Functions. If you are a member of the U.S. Armed Forces, we may disclose your Health Information as required by military command authorities. We may also disclose your Health Information to authorized federal officials for national security reasons and the Department of State for medical suitability determinations.
Workers’ Compensation. We may disclose your Health Information as authorized by and to the extent necessary to comply with State laws relating to workers’ compensation or other similar programs.
Fundraising. We may use or disclose your Health Information to make a fundraising communication to you, for the purpose of raising funds for our own benefit. With each fundraising communication, we will provide you with an opportunity to elect not to receive any further fundraising communication. We will also make reasonable efforts to ensure that if you opt out of such communications you are not sent future fundraising communications. We may also use or disclose to a business associate or to an institutionally related foundation, the following Health Information for the purpose of raising funds for our own benefit: (a) demographic information relating to you, including your name, address, other contact information, age, gender, and date of birth, (b) the dates of health care provided to you, (c) the department or area of service that provided you treatment, (d) your treating physician, (e) outcome information, and (f) your health insurance status.
Care Coordination, Refill Reminders, Alternative Therapies. We may provide you with refill reminders about a drug or biologic that is currently being prescribed for you, but only if any financial remuneration received by us in exchange for making the communication is reasonably related to our cost of making the communication. Except where we receive financial remuneration in exchange for making the communication, we may also communicate with you for the following treatment and health care operations purposes: (a) for your treatment, including case management or care coordination, or to direct or recommend alternative treatments, therapies, health care providers, or settings of care, (b) to describe a health-related product or service (or payment for such product or service) that is provided by, or included in a plan of benefits, including communications about a health care provider network or health plan network, replacement of, or enhancements to, a health plan, and/or (c) for case management or care coordination, contacting of individuals with information about treatment alternatives, and related functions to the extent these activities are not considered treatment.
Marketing. We may use or disclose your Health Information to make a marketing communication to you that occurs in a face-to-face encounter with us or which concerns a promotional gift of nominal value provided by us.
Business Associates. We may disclose your Health Information to business associates who provide services to us pursuant to a written agreement that contains terms regarding protection of your Health Information.
Other Uses and Disclosures. In addition to the items outlined above, we may use and disclose your Health Information for other purposes permitted by the Privacy Rules.
2. Uses and Disclosures Which Require Your Opportunity to Verbally Agree or Object. Under the Privacy Rules, we are permitted to use and disclose your Health Information: (a) for the creation of facility directories, (b) to disaster relief agencies, and (c) to family members, close personal friends or any other person identified by you, if the information is directly relevant to that person’s involvement in your care or treatment. Except in emergency situations, you will be notified in advance and have the opportunity to verbally agree or object to this use and disclosure of your Health Information.
3. Uses and Disclosures Which Require Your Written Authorization. As required by applicable law, all other uses and disclosures of your Health Information (not described above) will be made only with your written permission, which is called an Authorization. You may revoke your Authorization in writing at any time. The revocation of your Authorization will be effective immediately, except to the extent that: we have relied upon it previously for the use and disclosure of your Health Information, if the Authorization was obtained as a condition of obtaining insurance coverage where other law provides the insurer with the right to contest a claim under the policy, or where your Health Information was obtained as part of a research study and is necessary to maintain the integrity of the study.
You have the following rights concerning your Health Information:
1. Right to Receive Written Notification of a Breach of Your Unsecured Health Information. You have the right to receive written notification of a breach of your unsecured Health Information if it has been accessed, used, acquired, or disclosed in a manner not permitted by the Privacy Rules. We will provide this notification by first-class mail or, if necessary, by such other substituted forms of communication allowable by law or you may request in writing to receive a notification of a breach by email.
2. Right to Inspect and/or Copy Your Health Information. Upon written request, you have the right to inspect and copy your own Health Information contained in a designated record set which is maintained by or for the Facilities. A “designated record set” contains medical and billing records and any other records that we use for making decisions about you. However, we are not required to provide you access to all the Health Information that we maintain. For example, this right of access does not extend to psychotherapy notes or information compiled in reasonable anticipation of, or for use in, a civil, criminal or administrative proceeding. Where permitted by the Privacy Rules, you may request that we review certain denials to inspect and copy your Health Information. Instead of copies, we can provide you with a summary of your Health Information if you agree to the form and cost of such summary. If you request a paper copy or summary explanation of your Health Information, we may charge you a reasonable fee for copying costs, postage, and any other costs associated with preparing the summary or explanation. Instead of paper copies, if your Health Information is maintained in an electronic health record, you may request that we provide the information in electronic form to either you or to a designated third-party if such designation is clear, conspicuous, and specific. We may charge you a reasonable cost-based fee for an electronic copy, which shall not exceed our labor costs in responding to the request. We may, in some cases, deny your request to inspect and copy your Health Information and will notify you in writing of the reasons for our denial and provide you with information regarding your rights to have our denial reviewed.
3. Right to Request Restrictions on the Use and Disclosure of Your Health Information. You have the right to request restrictions on the use and disclosure of your Health Information for treatment, payment and health care operations. We will consider, but do not have to agree to, such requests. However,we must agree to restrict the disclosure of your Health Information to a health plan if: (a) the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law, and (b) the Health Information pertains solely to a health care item or service for which you, or someone other than the health plan on your behalf, has paid in full.
4. Right to Request an Amendment of Your Health Information. You have the right to request an amendment of your Health Information maintained by us. We may deny your request if we determine that you have asked us to amend information that: was not created by us, unless the person or entity that created the information is no longer available, is not Health Information maintained by or for us, is Health Information that you are not permitted to inspect or copy, or we determine that the information is accurate and complete. If we disagree with your requested amendment, we will provide you with a written explanation of the reasons for the denial, an opportunity to submit a statement of disagreement, and a description of how you may file a complaint.
5. Right to an Accounting of Disclosures of Your Health Information. You have the right to receive an accounting of disclosures of your Health Information made by us. With respect to Health Information contained in paper form, our accounting will not include: disclosures related to treatment, payment or health care operations, disclosures to you, disclosures based upon your Authorization, disclosures to individuals involved in your care, incidental disclosures, disclosures to correctional institutions or law enforcement officials, disclosures for facility directories, disclosures that are part of a Limited Data Set (as defined by the Privacy Rules), or disclosures that occurred prior to April 14, 2003 or as otherwise allowed by the Privacy Rules. With respect to Health Information contained in an electronic health record, unless otherwise specified by law, the accounting will contain disclosures made to you, based upon your Authorization, to individuals involved in your care, or as allowed by law. You may request an accounting of applicable disclosures made by us within six (6) years prior to the date of your request for Health Information stored in paper form and within three (3) years prior to the date of your request (but not for any disclosures made prior to Implementation of our electronic health records system) for Health Information stored in an electronic health record. If you request an accounting more than once in a 12-month period, we may charge you a reasonable cost-based fee to comply with your additional request.
6. Right to Alternative Communications From The Facilities. You have the right to receive confidential communications of your Health Information by a different means or at a different location than currently provided. For example, you may request that we only contact you at home or by mail. Such requests must be made in writing.
7. Right to Receive a Paper Copy of this Notice. You have the right to receive a paper copy of this Notice upon request, even if you have agreed to receive this Notice electronically.
Contact Information and How to Report a Privacy Rights Violation.
If you want to exercise any of these rights, have any questions, or feel that your privacy rights have been violated, please contact us. All requests must be submitted to us in writing and sent to the address below.
Bradford Health Services
Attn: HIPAA Privacy Officer
2101 Magnolia Avenue, Suite 518
Birmingham, Alabama 35205
Telephone: (205) 251-7753
If you believe that your privacy rights have been violated or that we have violated our own privacy practices, you may file a complaint with our Privacy Officer. You may also file a complaint with the Office of Civil Rights, U.S. Department of Health and Human Services. Our Privacy Officer can provide you with the address.
The following health care providers may provide services to you at our Facilities as part of our organized health care arrangement (OHCA) and are covered by this Notice: Physicians, Allied Health Professionals, Counselors, Therapists, Dietary Consultants, Nurses, Psychologists, Social Workers, Recreational Therapists, Pharmacists, Medical Equipment Suppliers, Diagnostic Providers, Physician Assistants, Lab Technicians and other health care providers working in the Facilities. These individuals may not be employees of Bradford Health Services.
The following Bradford Health Services locations are part of this organized health care arrangement (OHCA) and are covered by this Notice:
Bradford Health Services: Madison, AL
Bradford Health Services: Warrior, AL
Bradford Health Services: Anniston, AL
Bradford Health Services: Augusta, GA
Bradford Health Services: Birmingham, AL
Bradford Health Services: Boaz, AL
Bradford Health Services: Chattanooga, TN
Bradford Health Services: Clarksville, TN
Bradford Health Services: Columbus, GA
Bradford Health Services: Cookeville, TN
Bradford Health Services: Dothan, AL
Bradford Health Services: Florence, AL
Bradford Health Services: Franklin, TN
Bradford Health Services: Huntsville, AL
Bradford Health Services: Knoxville, TN
Bradford at Innerview: Louisville, KY
Bradford Health Services: Manchester, TN
Bradford Health Services: Memphis, TN
Bradford Health Services: Mobile, AL
Bradford Health Services: Montgomery, AL
Bradford Health Services: Nashville, TN
Bradford Health Services: Pensacola, FL
The Reprieve: Opelika, AL
Bradford Health Services: Alabaster, AL
Bradford Health Services: Tuscaloosa, AL