THIS NOTICE DESCRIBES HOW IDENTIFIABLE HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
At LifeSong Inc, we understand that information about you and your family is personal. We are committed to protecting your privacy and sharing information only with those persons who need to know and are allowed to see the information. This notice tells you how LifeSong Inc uses and discloses information about you. It describes your rights and what our responsibilities are concerning information about you.
If you have any questions about this notice, please contact Philip Catchpole at (518) 406-5157 extension #301.
Who will follow this notice?
All people who work for LifeSong Inc in our non-residential service programs and in our administrative offices will follow this notice. This includes employees and contractors who are authorized to enter information in your clinical record or need to review your record in order to provide services to you, and volunteers or interns that we allow to assist you.
What information is protected?
All information that we create or keep that relates to your health or care and treatment, including your name, address, birth date, social security number, your medical information, your individualized service plan and other information about your care in our programs.
Your Clinical Information Rights
You have the following rights concerning your clinical information. When we use the word “you” in this notice we also mean your personal representative. Depending on your circumstances and in accordance with state law, this may be your guardian, your health care proxy, or your involved parent, spouse or adult child.
- You have a right to see or inspect your clinical information and obtain a copy. Some exceptions apply, such as records regarding incident reports and investigations, and information compiled for use in court or administration proceedings. NOTE: LifeSong Inc. may require you to make your request for records in writing.
- If we deny your request to see your clinical information, you have the right to request a review of that denial. Professionals chosen by LifeSong Inc. who were not involved in denying your request will review the record and decide if you may have access to the record.
- You have the right to ask LifeSong Inc. to change or amend clinical information that you believe is incorrect or incomplete. We may deny your request in some cases, for example, if the record was not created by LifeSong Inc. or if after reviewing your request, we believe the record is accurate and complete.
- You have a right to request a list of disclosures that LifeSong Inc. has made of your clinical information. The list, however, does not include certain disclosures such as those made to you or made to others with your permission.
- You have the right to request a restriction on uses or disclosures of your health information related to treatment, payment, health care operations and disclosures to involved family. LifeSong Inc., however, is not required to agree to your request.
- You have the right to request that LifeSong Inc. communicates with you in a way that will help keep your information confidential.
- You have the right to receive a paper copy of this notice. You may ask LifeSong Inc. staff to give you another copy.
- To request access to your clinical information or to request any of the rights listed here, you may contact Philip Catchpole at (518) 406-5157 ext. #301.
LifeSong Inc. Responsibility for Your Clinical Information
It is the responsibility of LifeSong Inc. with regards to your clinical information to:
- Maintain the privacy of your information in accordance with federal and state laws.
- Give you this notice of our legal duties and practices concerning the clinical information we have about you.
- Follow the rules in this notice. LifeSong Inc. will use or share information about you only with your permission except for the reasons explained in this notice.
- Tell you if we make changes to our privacy practices in the future. If changes are made that affect the use and disclosure of your protected health information, your rights, our duties, or our privacy practices, LifeSong Inc. will notify you.
LifeSong Inc. Use & Disclosure of Clinical Information
LifeSong Inc. may use and disclose clinical information without your permission for the purposes described below. For each of the categories of uses and disclosures, we explain what we mean and offer an example. Not every use or disclosure is described, however, all of the ways we will use or disclose information will fall within these categories.
- Treatment: LifeSong Inc. will use your clinical information to provide you with treatment and services. We may disclose clinical information to doctors, nurses, psychologists, social workers, qualified mental retardation professionals (QMRP), developmental specialist, and other LifeSong Inc. personnel, volunteers or interns who are involved in providing your care. For example, involved staff may discuss your clinical information to develop and carry out your individualized service plan (ISP). Other agency staff may share your clinical information to coordinate different services you need, such as medical tests, respite care, transportation, etc. We may also need to disclose your clinical information to your service coordinator and other providers outside of LifeSong Inc. who are responsible for providing you with the services identified in your ISP or to obtain new services for you.
- Payment: LifeSong Inc. will use your clinical information so that we can bill and collect payment from you, a third party, an insurance company, Medicare or Medicaid or other government agencies. For example, we may need to provide the NYS Department of Health (Medicaid) with information about the services you received through one of our HCBS waiver programs so they will pay us for services rendered. In addition, we may disclose your clinical information to receive prior approval for payment for services you may need. Also, we may disclose your clinical information to the US Social Security Administration, or the department of health to determine your eligibility for coverage or your ability to pay for services.
- Health Care Operations: LifeSong Inc. will use clinical information for health care operations. These uses and disclosures are necessary to operate agency programs and to make sure all participants receive appropriate, quality care. For example, we may use clinical information for quality improvement to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also disclose information to clinicians and other personnel for on-the-job training. We will share your clinical information with other LifeSong Inc. staff for the purposes of obtaining legal services through our Counsel’s office, conducting fiscal audits, and for fraud and abuse detection and compliance. We will also share your clinical information with LifeSong Inc. staff to resolve complaints or objections to your services. We may also disclose clinical information to our business associates who need access to the information in order to perform administrative or professional services on our behalf. (example: agency attorney or independent auditors)
Uses and Disclosures that Require Your Agreement
LifeSong Inc. may disclose clinical information to the following persons if we tell you we are going to use or disclose it and you agree or do not object:
- To family members and personal representatives who are involved in your care if the information is relevant to their involvement and to notify them of your condition and location; or
- To disaster relief organizations that need to notify your family about your condition and location should a disaster occur.
Other Uses and Disclosures that Do Not Require Your Permission
In addition to treatment, payment and health care operations, LifeSong Inc. may use your clinical information without your permission for the following reasons:
- To tell you directly about possible alternatives or health-related benefits or services that may be of interest to you.
- When we are required to do so by federal or state law.
- For public health reasons, including prevention and control of disease, injury or disability, reporting births and deaths, reporting child abuse or neglect, reporting reactions to medication or problems with medical devices or products, and to notify people who may have been exposed to a disease or are at risk of spreading the disease.
- To report domestic violence and adult abuse or neglect to government authorities if you agree or if necessary to prevent serious harm in accordance with the law.
- For health oversight activities, including audits, investigations, surveys and inspections, and licensure. These activities are necessary for government to monitor the health care system, government programs, and compliance with civil rights laws. Health oversight activities do not include investigations that are not related to the receipt of health care or receipt of government benefits in which you are the subject.
- For judicial and administrative proceedings, including hearings and disputes. If you are involved in a court or administrative proceeding we will disclose clinical information if the judge or presiding officer orders us to share the information.
- For law enforcement purposes, in response to a court order or subpoena, to report a possible crime, to identify a suspect or witness or missing person, to provide identifying data in connection with a criminal investigation and to the district attorney in furtherance of a criminal investigation of client abuse.
- In the event of your death, to coroners or medical examiners for identification purposes or to determine cause of death, and to funeral directors to allow them to carry out their duties.
- To organ procurement organizations to accomplish cadaver, eye, tissue, or organ donations in compliance with state law.
- For research purposes when you have agreed to participate in the research an Institutional Review Board or Privacy Committee has approved the use of the clinical information for the research purpose.
- To prevent or lesson a serious imminent threat to your health and safety or someone else’s where permitted by law.
- To authorize federal officials for intelligence and other national security activities authorized by law or to provide protective services to the president and other officials.
- To correctional institutions or law enforcement officials if you are an inmate and the information is necessary to provide you with health care, protect your health and safety or that of others, or for the safety of the correctional institution.
- To government agencies that administer public benefits if necessary to coordinate the covered functions of the programs.
- Fundraising. We may use your name and address, or the name of your involved family members, in order to make contact as part of a fund-raising effort. If you do not want to be contacted for fundraising efforts, please write to: Mr. Philip Catchpole, Executive Director at 1536 Crescent Road, Clifton Park, New York 12065 or call at (518) 406-5157 extension #301.
- Appointment reminders and follow-up calls. We may use and disclose protected health information to contact you with a reminder that you have an appointment for treatment or medical care. We may also call to follow-up on care you received with us, to tell you of test results, or to confirm an appointment with us or another health care provider.
Authorization Required for All Other Uses and Disclosures
For all other types of uses and disclosures not described in this notice, LifeSong Inc. will use or disclose clinical information only with a written authorization signed by you that states who may receive the information, what information is to be shared, the purpose of the use or disclosure and an expiration for the authorization. Written authorizations are always required for use and disclosure of psychotherapy notes and for certain marketing purposes.
NOTE: If you cannot give permission due to an emergency, LifeSong Inc. may release clinical information in your best interest. We must tell you as soon as possible after releasing the information.
You may revoke your authorization at any time. If you revoke your authorization in writing, we will no longer use or disclose your clinical information for the reasons stated in your authorization. We cannot, however, take back disclosures we made before you revoked and we must retain clinical information that indicates the services we have provided to you.
Changes to this Notice
We reserve the right to change this notice. We reserve the right to make changes to terms described in this notice and to make the new notice terms effective to all clinical information that LifeSong Inc. maintains. We will place the new notice with the effective date in our agency administrative office binder. In addition, we will offer you a copy of the revised notice at your next scheduled service planning meeting.
If you believe your privacy rights have been violated you are entitled take the following action:
- You may file a complaint with the agency at 1536 Crescent Road, Clifton Park, NY 12065 (518) 406-5157 ext. #301. Or,
- You may contact the Secretary of the Department of Health and Human Services. You may call them at (877) 696-6775 or write them at 200 Independence Ave S.W., HHH Building, Room 509H, Washington DC, 20201.
- You may file a grievance with the Office of Civil Rights by calling 866-OCR-PRIV or (866) 627-7748, or (TTY)(886)788-4989, or by e-mail at www.hhs.gov.ocr
All complaints must be submitted in writing. You will not be penalized for filing a complaint.