(To be provided to all patients upon admission.)
1. Achieve Rehab & Home Health responsibly safeguards the privacy of health information entrusted to us. We do so by:
a. Maintaining the privacy and confidentiality of an individual's health information to the fullest extent of the law at all times;
b. Providing individuals with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about the individual;
c. Abiding by the terms of this Notice;
d. Notifying individuals if we are unable to agree to a requested restriction;
e. Accommodating reasonable requests to communicate health information by alternative means.
2. Achieve reserves the right to change our practices and to make new provisions effective for all protected health information that we maintain. Should our protected health information practices change; a revised notice will be posted on our website and furnished to you upon request.
3. Achieve, will not use or disclose the individual's health information without his/her authorization, except as described in this notice.
4. Questions or complaints about the privacy practices of Achieve Rehab & Home Health may be directed to the Agency's Chief Privacy Officer at (513) 794-0555.
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW
5. WHAT IS PROTECTED?
The policies outline in this Notice apply to all of your health information generated or maintained by Achieve -
both medical records and billing records. This also includes information recorded in your medical record,
invoices, payment forms, etc. Similarly, these policies apply to health information gathered for Achieve from other organizations by any health care professional, or employees, who participates in your care.
6. USE & DISCLOSURES OF YOUR HEALTH INFORMATION
In some circumstances, we are legally permitted to use or disclose your health information without obtaining your prior authorization and without offering you the opportunity to object. These circumstances include:
a. Treatment - We may use and/or disclose your health information for the purpose of providing, or allowing others to provide, treatment for you. For example, we may disclose information about you to your treating physician who is overseeing your plan of care. Also, we may contact you with appointment reminders and other health care-related services.
b. Payment - We may use and/or disclose your health information for the purpose of allowing us, as well as other entities, to secure payment for the health care services provided to you. For example, we may inform your health insurance company of your diagnosis and treatment in order to assist the insurer in processing claims for the services provided to you.
c. Operations - We may use and/or disclose your health information for the purposes of our day-to-day operations and functions. For example, we may use or disclose your information to monitor the quality of health care that we provide.
d. Notifications - We may disclose to your family or representatives information directly related to those persons' involvement in the provision of, or payment for, your care.
e. Other Circumstances where we can use/disclose your health information include:
Other Circumstances where we can use/disclose your health information include:
- Where required by law.
- For public health purposes.
- To report abuse, neglect, or domestic violence.
- For health oversight activities (such as audits and investigations).
- For administrative or judicial proceedings.
- For law enforcement purposes.
- To assist coroners, medical examiners, and funeral directors with their official duties.
- To facilitate organ donation.
- For limited, approved research projects.
- To avert a serious threat to health or safety.
- For governmental functions.
- For purposes of workers' compensation, as permitted by law.
Except as described above, disclosures of your health information will be made only with your
written authorization. You may also revoke your authorization, in writing, at any time.
7. YOUR PRIVACY RIGHTS:
a. To Request Restrictions. You have the right to request restrictions on the use and disclosure of your health information for treatment, payment, operations, or notification purposes. In most cases, however, we are not required to agree to your request. If we do agree to a requested restriction, we will abide by that description unless you are in need of emergency treatment. To request a restriction, please submit a written request to the Contact listed below.
b. To Limit Communications. You have the right to receive confidential communications about your own health information at alternative locations or by alternative means. To request alternative or limited communications, you must submit a written request to the Contact listed below.
c. To Access and Copy Your Health Information. Subject to certain exceptions, you have the right to inspect and copy any health information about you. To arrange for access to your records or to receive a copy of your records, you should submit a written request to the Contact listed below. Please note - if you request copies, you may be charged a copying fee.
d. To Request Amendments. You may request that your health information be amended. Your request, however, may be denied if the information: (a) was not created by Achieve; (b) is not part of our records; (c) is not the type of information available to you for inspection; or (d) is accurate and complete. You will be notified if we accept or reject your request for Amendment. If you disagree with a denial, you may submit a written statement of disagreement, which will be kept on file and distributed with all future disclosures. Requests to amend health information should be submitted, in writing, to the Contact listed below.
e. To an Accounting of Disclosures. You have the right to obtain an accounting of any disclosures of your health information made during the preceding 6 years. However, some disclosures are exempted by law, and will not be accounted for, including: (1.) disclosures made for purposes of treatment, payment, operations, notification; (2.) disclosures made to you; (3.) disclosures to law enforcement or for national security or intelligence purposes; (4.) disclosures that occurred prior to April 14, 2003; (5.) disclosures made pursuant to an authorization signed by you. This accounting will include the date of disclosure, the name of the entity to whom disclosure was made, and a description of the information disclosed. To request an accounting of disclosures, you must submit a written request to the Contact listed below.
To a Paper Copy of this Notice. You have a right to a paper copy of this notice, even if you have agreed to
receive a copy by e-mail.
IMPORTANT PRIVACY OBLIGATION. Home health patients should be aware that their
treatment requires that a copy of their clinical record, containing protected health information, be
kept in their home. It is the patientís responsibility to protect this information from unauthorized
use and disclosure.
8. OUR PRIVACY OBLIGATIONS:
(1.) We are required by law to maintain the privacy of your health information.
(2.) We are required by law to provide you with this Notice of our legal duties and privacy practices.
(3.) We are required by law to abide by the terms of this Notice. However, we reserve the right to change the
terms of this Notice and make those changes applicable to all health information that we maintain.
9. PRIVACY COMPLAINTS
You can complain to us or to the Secretary of the U.S. Department of Health and Human Services if you believe
that your privacy rights have been violated. To lodge a complaint with us, please file a written complaint:
Achieve Rehab & Home Health
Chief Privacy Officer
5150 East Galbraith Road
Cincinnati, Ohio 45236-2872
10. Our Chief Privacy Officer can also provide you with further information about our privacy policies upon
request. No retaliatory action will be taken against you for filing a complaint.