NYCNHCS NOTICE OF PRIVACY PRACTICES:

This "NOTICE OF PRIVACY PRACTICES" describes how ANNETTE PISANO-HIGLEY, RN, GCM, Director of NEW YORK CITY NURSING HOMECONSULTANT AND GERIATRIC CARE MANAGEMENT SERVICES (hereafter referred to as NYCNHCS), a private health care referral, counseling, service arrangement, placement and care management service, may use and disclose your protected health information to carry out referral, access treatment, payment or health care operations and for other purposes that are permitted or required by law.  Protected health information is information about you, including demographic information, that may identify you and that relates to your past, present or future physical mental health or condition and related health care services.

OUR PLEDGE REGARDING MEDICAL INFORMATION:

We understand that medical information about you and your health is personal.  We are committed to protecting medical information about you.  We create a record of the care and services you receive.  We need this record to provide you with quality care and to comply with certain legal requirements.  This notice applies to all of the records of your care generated by NYCNHCS. This notice will tell you about the ways in which we may use and disclose medical information about you.  We also describe your rights and certain obligations we have regarding the use and disclosure of medical information. 

We are required by law to:

1) make sure that medical information that identifies you is kept private; 2) give you this notice of our legal duties and privacy practices with respect to medical information about you; and 3) follow the terms of the notice that is currently in effect.

We may change the terms of our notice at any time.  The new notice will be effective for all protected health information that we maintain at that time.  You can request a copy of our notice at any time by email to annettehigley@ahigley.com.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU:

The following categories describe different ways that we use and disclose medical information.  For each category of uses or disclosures we will explain what we mean and try to give some examples.  Not every use or disclosure in a category will be listed.  However, all of the ways we are permitted to use and disclose information will fall within one of the categories. 

1. For Health Care Operations: Assessment/Referral/Counseling/Treatment/Arrangement of Services/Placement.  As a private health care management assessment, referral, counseling, service arrangement and placement service, NYCNHCS may use medical information and insurance or financial information about you to facilitate access of appropriate medical treatment or services for you at home or at the extended-care facilities/agencies of your choice.  We may disclose medical information and insurance or financial information about you to your preferred Homecare Agencies/Durable Medical Equipment Vendors, Transport Companies and Day Care Center, Dementia Care Center, Assisted Living Facility, or Skilled-Nursing Facility admissions/intake staff or medical staff.  For example, a doctor in a Skilled-Nursing facility who will be treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process.  In addition, the doctor may need to tell the dietitian if you have diabetes so that appropriate meals can be arranged for you. Different departments of the extended-care facilities or homecare agencies/DME vendors also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work and x-rays.  We also may disclose medical information about you to people outside the extended-care facilities/agencies who may be involved in your medical care after you return home, such as family members, clergy or others who will provide services that are part of your care, if you contract with us to arrange those services.

2. For Payment.  We may use and disclose medical information about you so that the care, treatment, services, and equipment you receive at your care-facilities/agencies/vendors/transport companies may be billed to and payment may be collected from you, your insurance company or a third party.  For example, we may need to give your health care information about treatment you received at the Hospital or Skilled-Nursing Facility to your health plan so that they will authorize payment to these facilities or to you for the care you received.  We may also consult with your health plan about your benefits and initial authorization for services, to obtain prior approval or to determine whether your plan will cover the treatment.  NYCNHCS does not accept insurance reimbursement of any kind for services rendered.  Payment for all services and reimbursement for any pertinent service-related travel &/or communication costs is due from the client (or clients' contracted Legal Guardian, Representative or Durable Power of Attorney) per contract in full at time of service delivery by cash, personal or certified check, money order.

Any other uses or disclosures of your protected health information will be made only with your written authorization.  You may revoke authorization at any time, in writing, except to the extent that we have taken an action in reliance on the use or disclosure indicated in the authorization.

We may use or disclose identifiable health information about you without your authorization for other reasons.  Subject to certain requirements, we may disclose protected health information without your consent or authorization for public health purposes, for auditing purposes, and for emergencies.  We also provide protected health information when otherwise required by law, or for law enforcement purposes, legal proceedings, military activity and national security, to a coroner, funeral director, or medical examiner, and when required by the Secretary of the Department of Health and Human Services.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU:

Although your health record is the physical property of NYCNHCS, the information belongs to you, and you retain the following rights by law:

Right to Inspect and Copy (as provided for in 45CFR 164.524).  You have the right to inspect and copy medical information that may be used to make decisions about your care, for as long as it is maintained by us.  Usually, this includes medical and billing records, but federal law prohibits inspection or copying of the following records:  psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; and protected health information that is subject to law that prohibits access to protected health information.  To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing, by letter, to ANNETTE PISANO-HIGLEY, RN, GCM.  If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances.  If you are denied access to medical information, you may request that the denial be reviewed.  Another licensed health care professional chosen by NYCNHCS will review your request and the denial.  The person conducting the review will not be the person who denied your request.  We will comply with the outcome of the review. 

Right to Amend (as provided in 45 CFR 164.528). If you feel that the protected medical information we have about you is incorrect or incomplete, you may ask us to amend the information.  You have the right to request an amendment for as long as the information is kept by us. To request an amendment, your request must be made in writing, by letter to ANNETTE PISANO-HIGLEY, RN, GCM.  In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request.  In addition, we may deny your request if you ask us to amend information that:  1) was not created by us; 2) is not part of the medical information kept by or for NYCNHCS; 3) is not part of the information which you would be permitted to inspect and copy; or 4) is accurate and complete.  In such cases, you have the right to file a statement of disagreement with us.  We will provide you with a copy of any rebuttal/denial that we may make to your statement.

Right to an Accounting of Disclosures (as provided for in 45 CFR 164.528).  You have the right to request an "accounting of disclosures."  This is a list of the disclosures we made, if any, of medical information about you.  This right applies to disclosures for purposes other than treatment, payment, or healthcare operations as described in this Notice of Privacy Practices.  It excludes disclosures we may have made to you, to family members or friends, or for notification purposes.  To request this list or accounting of disclosures, you must submit your request in writing, by letter to ANNETTE PISANO-HIGLEY, RN, GCM.  Your request must state a time period, and may not include dates before April 1, 2003.  Your request should indicate in what form you want the list (for example, on paper, electronically).  The first list you request within a 12-month period will be free.  For additional lists, we may charge you for the costs of providing the list.  We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred. 

Right to Request Restrictions (as provided by 45 CFR 164.522).  You have the right to request a restriction or limitation on certain uses and disclosures of your information. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend.  For example, you could ask that we not use or disclose information about transportation you had. We are not required to agree to your request.  If we do agree, we will be bound to honor your request. To request restrictions, you must make your request in writing, by letter to ANNETTE PISANO-HIGLEY, RN, GCM.  In your request, you must tell us 1) what information you want to limit; 2) whether you want to limit our use, disclosure or both; and 3) to whom you want the limits to apply, for example, disclosures to your spouse.

Right to Request Confidential Communications.  You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.  For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing, by letter to ANNETTE PISANO-HIGLEY, RN, GCM.  We will not ask you the reason for your request.  We will accommodate all reasonable requests.   Your request must specify how or where you wish to be contacted.

Right to Revoke Your Authorization To Use Or Disclose Protected Health Information Except To The Extent That Action Has Already Been Taken.  You have the right to revoke any and all authorizations, at any time, by submitting a written request by letter to ANNETTE PISANO-HIGLEY, RN, GCM, except to the extent that we have taken an action in reliance on the use or disclosure indicated in the prior authorization.

Right to a Paper Copy of This Notice.  You have the right to a paper copy of this notice.  You may ask us to give you a copy of this notice at any time.  Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain an email or paper copy of this notice by email request to annettehigley@ahigley.com.  Please indicate your transmittal preference and mailing address and/or fax number so that we can comply with your request. 

CHANGES TO THIS NOTICE.

We reserve the right to change this notice.  We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future.  We will email or mail (at your request) to you a copy of the current notice which will contain on the first page, in the top right-hand corner, the effective date.  In addition, each time you contract for NYCNHCS services, you will receive by email or mail (at your request) a copy of the current notice in effect. 

COMPLAINTS.

If you believe your privacy rights have been violated, you may file a complaint with NYCNHCS or with the Secretary of the Department of Health and Human Services.  To file a complaint with NYCNHCS, contact:  NEW YORK CITY NURSING HOME CONSULTANT & GERIATRIC CARE MANAGEMENT SERVICES annettehigley@ahigley.com.  All complaints must be submitted in writing.

You will not be penalized for filing a complaint.

OTHER USES OF MEDICAL INFORMATION.

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission.  If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time.  If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization.  You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you. 

1)  Under the Federal Substance Abuse Confidentiality Requirements, an authorization must include the purpose of the disclosure of substance abuse information even if you, as a client of NYCNHCS, request the disclosure.  However, the recipient may be prohibited from disclosing substance abuse information under the Federal Substance Abuse Confidentiality Requirements.

2) Under N.Y.S. law, no disclosure of HIV related information is permissible without authorization in writing and signed in ink by the protected individual or, if the individual lacks capacity, by a person authorized by law to consent for health care for the individual.  If NYCNHCS is requested for disclosure of HIV-related information about you by any agencies, institutions, organizations or people who will be providing health care services to you as listed in this Notice of Privacy Practices, we will contact you to obtain your authorization before any information is transmitted.   According to law, the authorization will be dated and will specify:  a) to whom disclosure is authorized; b) the purpose for the disclosure; c) the time period during which the release is to be effective; d) reference to the fact that it is intended to authorize the release of HIV related information and be recorded on N.Y.S. D.O.H. approved form DOH 2557 6/00, DOH 3507 6/00, or on a form that has been approved by the N.Y.S. Department of Health.  You, as the protected person, have the right to withhold information by indicating in the authorization what information is to be released.  The cover letter we use for transmission to the requestor of such partial information will then indicate that some information has been withheld.  Recording of HIV related information in your NYCNHCS records is confidential and accessible only to ANNETTE PISANO-HIGLEY, RN, GCM.

However, confidential HIV related information may be disclosed without use of the State approved authorization form to:  a) the protected individual or, when the protected individual lacks capacity to consent, a person authorized by law to consent to health care for the individual; b) an agent or employee of a health facility or healthcare provider if the agent or employee is permitted to access medical records; the health facility or health care provider itself is authorized to obtain the HIV related information and ; the agent or employee provides health care to the protected individual, or maintains or processes medical records for billing or reimbursement; c) a health facility or health care provider , when the information is needed to provide the appropriate care or treatment to the protected individual; d) a federal, state, city or local health officer when disclosure is mandated by federal or state law; e) an authorized agency in connection with foster care, adoption of a child or child abuse.  Such agency shall be authorized to redisclose such information according to these guidelines of Section 373a of the N.Y.S Social Services law; f) insurance institutions (including HMOs) for purposes other than reimbursement for health services, if proper authorization is obtained from the protected individual; g) any person to whom disclosure is ordered by a court of competent jurisdiction; an employee or agent of the Commission of Correction, the Division of Probation or Parole, or a medical director of a local correctional facility to the extent such agent or employee is authorized to access records containing such information and the information is needed to carry out their official functions and duties; h) a health care provider to a facility that is  authorized to procure, process, and/or distribute the protected persons organs for use in medical education, research, therapy or transplantation; i) a funeral director taking care of the protected persons remains when the director has access to HIV related information on the death certificate.

When information is released that contains confidential HIV related information, all copied material will be marked prohibiting redisclosure of this information to any but the authorized party, by the following disclosure statement:

"The accompanying information has been disclosed to you from confidential records which are protected by state law that prohibits you from redisclosure without written consent form the person to whom it pertains, or as otherwise permitted by law.   A general authorization for release of medical or other information is NOT sufficient authorization to you for further disclosure of confidential HIV related information, and such disclosure is in violation of state law and may result in a fine or jail sentence or both.  Please destroy this confidential information record after its stated purpose has been fulfilled."  If we make an oral disclosure of HIV-related information, this disclosure statement will follow in writing within ten days.

This notice was published and becomes effective on March 5, 2004.