VIP
HEALTH CARE SERVICES
PRIVACY NOTICE
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
n
Your Right to Privacy
Protection
In
order to provide you with health care services, VIP Health Care Services
(hereafter “VIP”) acquires personally identifiable health information (hereafter
“Protected Health Information”) about you, and it is required by a federal law
known as the Health Insurance Portability and Accountability Act (hereafter
“HIPAA”), and by state law, to maintain the privacy of your Protected Health
Information. The federal
requirements, called the “Privacy Rule,” are spelled out in detailed regulations
that may be found in volume 45 of the Code of Federal Regulations (“CFR”), Parts
160 and 164.
In
addition, under HIPAA and the Privacy Rule, VIP is required to provide you with
this notice of its legal duties and privacy practices with respect to that
Protected Health Information. This
notice explains how VIP provides that protection. VIP reserves the right to change its
privacy practices, but when it does, it will provide you with a written copy of
any material change within 60 days after such a change becomes effective.
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Your Right to Complain About
Violations of Your Right to Privacy Protection
If
you believe that your privacy rights have been violated, you may complain to
Sandra Sieratzki, Privacy Officer, either in writing addressed to
There will be no retaliation
if you file any such complaint.
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Effective Date of This
Notice
The
effective date of this notice is
VIP
may acquire Protected Health Information about you for purposes of your
treatment, payment of benefits or provisions of health care services, or for
overall health care operations.
This Protected Health
Information will not be disclosed to anyone without your express written
authorization, except as follows:
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Disclosure for Treatment,
Payment and Health Care Operations
Your Protected Health
Information will be disclosed, without your written consent or authorization, to
covered entities, which include:
1.
VIP staff and
administration.
2.
The insurer or administrator
of the plan under which your services are provided.
3.
Your health care
provider.
4.
Other insurers or
administrators of any plan that provides additional services to
you.
5.
Any health care
clearinghouse.
6.
Any Business Associate of
VIP or any other Covered Entity.
A
“Business Associate” is an entity that provides related services to VIP
or any Covered Entity and that has entered into a contract under which it agrees
to abide by the rules and regulations established pursuant to federal law and
regulations to protect the privacy of your Protected Health
Information.
Examples of the disclosures
that will be made to any of the Covered Entities described in this paragraph
include, but are not limited to:
1.
Treatment:
• VIP discloses symptoms
identified in the course of your care to your physician so that your physician
can provide adequate health care services.
• VIP contacts you to
provide information about treatment alternatives that may be of interest to
you.
2.
Payment:
• VIP contacts your Health
Plan in order to determine that you are eligible for
coverage.
• VIP discloses your
Protected Health Information to any other Covered Entity or Business Associate
in order to process, or expedite the process of, your claims for benefits or
request for health care services.
3.
Health Care
Operations:
• Review or audit of VIP
services, with respect to quality, timeliness, accuracy, and/or compliance with
laws and regulations.
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Additional Disclosures and
Contacts Without Authorization
1.
A Covered Entity that is a
health care provider may contact you to raise funds for its
operations.
2.
A group health plan or its
health insurer, HMO, or third party administrator may disclose Protected Health
Information to VIP, but that information must be used only for the purposes of
health care operations.
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Disclosures Required by
Law
Your Protected Health
Information will be disclosed, without your written consent or authorization,
when required by law. This may
include disclosure for any of the following purposes (with examples of
each):
1.
Public Health
Activities
(when the law requires disclosure that you were exposed to a communicable
disease).
2.
Abuse, Neglect or Domestic
Violence (when the law requires
disclosure if the circumstances indicate that might have
occurred).
3.
Law Enforcement Purposes
(if you are
treated for gunshot or other types of wounds or if the information may help in
apprehension of someone other than you who is suspected of a
crime).
4.
Requests From a Coroner or
Medical Examiner (to identify a deceased
person or determine the cause of death).
5.
Requests From a Funeral
Director (to help carry out his or
her duties).
6.
Subpoenas or Requests For Discovery issued by any court or
government agency. To the extent it
is reasonably possible, VIP will attempt to provide you with notice of its
receipt of any such subpoena, but it must be clearly understood that VIP will
not be responsible if it is unable to or fails to provide you with such
notice.
7.
Compliance With Worker’s
Compensation Laws (to administer the
program).
8.
Oversight of Activities
Authorized by Law (including government
investigations of possible crime or fraud).
VIP
is also required by law to provide all Protected Health Information to the
Secretary of Health and Human Resources for enforcement
purposes.
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All Other Uses and
Disclosures
All
other uses and disclosures of your Protected Health Information, including but
not limited to medical research, will only be made with your written
authorization which you may revoke at any time.
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Restriction on the Use of
Protected Health Information
You
have the right to request that VIP or any other Covered Entity restrict the uses
and disclosures of your Protected Health Information to carry out treatment,
payment and health care operations described above, or to a member of your
family, other relative or close personal friend who is directly involved with or
responsible for your care or payment for that care.
However, VIP or other
Covered Entity is not required to agree to any such restrictions, and VIP will
not do so. As a result, if you make
such a request, VIP will refuse to honor it. So if you do not provide any Protected
Health Information that VIP determines is necessary to process your request for
health care services, your request will be denied.
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Confidential
Communications
You
have the right to request in writing that we communicate with you about your
Protected Health Information in a certain way or at a certain location if you
tell us that communication in another manner may endanger you. VIP will make those reasonable
accommodations that it deems appropriate.
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Inspection of Your Protected
Health Information
You
have the right to inspect and copy your Protected Health Information maintained
in VIP’s files, except for:
1.
Psychotherapy
notes.
2.
Information compiled in
reasonable anticipation of, or for use in, a civil, criminal, or administrative
action or proceeding.
3.
Information maintained by a
Covered Entity pursuant to the Clinical Laboratory Improvements Amendments of
1988, to the extent applicable under that law.
If
your access to such Protected Health Information is denied, you may have a right
to have that denial reviewed, but only under the following
circumstances:
1.
A licensed health care
provider has determined that the access requested is likely to endanger your
life or physical safety.
2.
That information refers to
another person and a licensed health care provider has determined that the
access requested is likely to endanger that person’s life or physical
safety.
3.
The request is made by your
authorized personal representative and a health care provider has determined
that the access requested is reasonably likely to cause substantial harm to you
or another person.
The
following administrative procedures will apply:
1.
All requests for inspection
and copying of one’s medical records must be in writing. Requests must be addressed to the
Director of Licensed Services.
2.
VIP will act upon your
request within 30 days of its receipt, or within an
additional 30 days if it cannot do so within that 30-day
period.
3.
You may be charged the
reasonable costs for copying the Protected Health Information, postage or other
charges incurred in mailing or sending that information to you, and preparation
of any requested explanation or summary of that
information.
4.
You will be advised of your
right to appeal a denial of that information if you have such a right, or that
you have no such right if it is not available.
5.
If VIP does not maintain
that information and knows where that information is maintained, you will be
advised where to direct your request for access to it.
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Amendment of Your Protected
Health Information
You
have the right to request an amendment of your Protected Health Information,
however, that information may not be amended if it:
1.
Was not created by VIP and
the creator of that information is available to act on your request to amend
that information.
2.
Is not part of VIP’s records.
3.
Would not be available for
your inspection, as indicated above.
4.
Is accurate and
complete.
The
following administrative procedures will apply:
1.
All requests for amendment
of medical records must be in a notarized written form, addressed to the
Director of Licensed Services.
2.
All requests must include a
reason to support the requested amendment.
3.
VIP will act on your request
within 60 days after it is received, or within an
additional 30 days if it cannot do so within the 60-day
period.
4.
VIP will inform you when
that amendment is made, and will provide a copy of it to anyone else who previously received the unedited Protected Health
Information and/or may have relied, or could have relied, on it to your
detriment, and thus needs to have that amendment.
5.
If the request is denied,
you will be informed of the reason for the denial, and you will be advised of
your rights to file a statement of disagreement and/or to seek further relief
from that denial.
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Receipt of an Accounting of
Disclosure
You
have the right to receive a six-year accounting of disclosures of your Protected
Health Information, except for disclosures:
1.
That occurred before
2.
To carry out treatment,
payment and/or health care operations, as described above.
3.
Of Protected Health
Information about other individuals.
4.
To
you.
5.
Permitted or otherwise
required by applicable law or regulation.
6.
Pursuant to written
authorization by you or by your authorized representative.
7.
For national security or
intelligence purposes, as required by applicable law or
regulation.
8.
To correctional institutions
or law enforcement officials, as required by applicable law or
regulation.
The
following administrative procedures will apply:
1.
All requests for an
accounting of disclosures must be in writing, addressed to the Director of
Licensed Services.
2.
VIP will act on your request
within 60 days after it is received, or within an
additional 30 days if it cannot do so within that 60-day
period.
3.
You may be charged the
reasonable costs for copying the Protected Health Information, postage or other
charges incurred in mailing or sending that information to you, but no charge
will be made for the first accounting you request within any 12-month
period. If you do not consent to
paying any such charges, your request will be considered to have been
withdrawn.
4.
The accounting will
include:
a.
The date of each
disclosure.
b.
The name and, if known, the
address of each recipient.
c.
A brief description of the
information provided.
d.
A brief statement of the
purpose of the disclosure, or a copy of the written request for that
disclosure.
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Additional
Information
If
you have any questions about this notice, the Privacy Rule, or your rights as
applied to your individual circumstances, contact Sandra Sieratzki, Privacy
Officer, either in writing addressed to VIP Health Care Services,