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.
If you have any questions, about this notice, please contact Pleasant Hills Apothecary at 412-653-7566, 25 Gill Hall Road, Jefferson Hills, PA 15025.
WHO WILL FOLLOW THIS NOTICE
All employees, management and any personnel who provide services for Pleasant Hills Apothecary., and Home Health Care Center will follow the practices.
YOUR HEALTH INFORMATION
This notice applies to the information and records we have about your health and the items and/or service you receive at this facility.
There are laws in place to protect the privacy of your medical information. We are providing you with this notice, which will tell you about the ways in which we may use and disclose health information about you and describes your rights and our obligations regarding the use and disclosure of that information.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
At the time of service, we may request your written, signed Consent to use and disclose health information for the following purposes: payment and health care operations. At any time, you have the right to revoke your Consent regarding payment and health care operations; however, the request must be in writing and will become effective when our facility receives it. As a result, we may choose to discontinue providing items and/or service to you.
Payment means such activities as obtaining reimbursement for services, confirming coverage, billing or collection activities and utilization review. For example, we would be sending a bill for the brace to your insurance company for payment.
Health Care Operations include the business aspects of running our facility, such as conducting quality assessment and improvement activities, auditing functions (JCAHO), cost management analysis and customer service. For example, we may use your health information to evaluate the performance of our staff in caring for you.
SPECIAL SITUATIONS
We may use or disclose health information about you without your permission for the following purposes, subject to all applicable legal requirements and limitations:
To Avert a Serious Threat to Health or Safety We may use and disclose health information about you when necessary to prevent a serious threat to your health and safety or health and safety of the public or another individual.
Required by Law We will disclose health information about you when required to do so by federal, state, or local law.
Workman's Compensation/Automobile Injury We may release health information about you for workers' compensation or similar programs.
Public Health Risks Under certain circumstances, we may be required to disclose health information about you for public health reasons in order to prevent or control disease.
Health Oversight Activities We may disclose health information to a health oversight agency for audits, investigations, inspections, or licensing purposes. These disclosures may be necessary for certain agencies to monitor the health care system, government programs and compliance with civil rights laws.
Lawsuits and Disputes If you are involved in a lawsuit or dispute, we may disclose information about you in response to a court or administrative order or a subpoena. These disclosures are subject to all applicable legal requirements.
Law Enforcement We may release health information if asked to do so by a law enforcement official in response to a court order, subpoena, summons or similar process, subject to all applicable legal requirements.
Information Not Personally Identifiable We may use or disclose health information about you in a way that does not personally identify you.
Family and Friends We may disclose health information to your family or friends if we can infer from the circumstances, based on our professional judgment that you would not object.
In situations where you are not capable of giving consent (because you are not present or due to your incapacity or medical emergency), we may, using our professional judgment, determine that a disclosure to your family member or friend is in your best interest. In these situations, we will only disclose information relevant to the person's involvement in your care. We may use our discretion and experience to make reasonable inferences that it is in your best interest to allow another person to act on your behalf to pick up, for example, a prescription.
OTHER USES AND DISCLOSURES OF HEALTH INFORMATION
We will not use or disclose your health information for any purpose other than those identified in the previous sections without your specific, written Authorization. The Authorization is in addition to any Consent we may have obtained from you. At any time, you have the right to revoke your Authorization. The request must be in writing and will not pertain to any prior disclosures covered under that Authorization.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
You have the following rights regarding health information we maintain about you:
You have the right to inspect and copy your health information, such as medical and billing records. You must submit a written request to our privacy officer in order to inspect and/or copy your health information. We may charge a fee for the costs incurred in granting this request. If your request is denied, you have the right to appeal the denial. If the law requires a review, an independent licensed professional will be selected to review the request and we will comply with the decision.
You have the right to update your personal information at any time. Your request must be in writing and must remain with your records at Pleasant Hills Apothecary. We suggest that you request a Medical Record Amendment/Correction Form from our office and forward to our privacy officer.
You have the right to request an "accounting of disclosures." This list represents all the disclosures we made regarding your medical information for purposes other than payment and health care operations. The request must be submitted in writing to our privacy officer. The request must specify a time frame no greater than 6 years and may not include dates prior to April 14, 2003, and should specify what form you want the list (for example, on paper, electronically). We may charge you for the costs of providing the list. We will notify you of the fees prior to the completion of your request.
You have the right to request a restriction or limitation on the health information we use or disclose about you for payment or health care options. For example, you could ask that we not use or disclose information about an orthosis you received.
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. The request must be made in writing to our privacy officer and specify how or where you wish to be contacted. We will accommodate all reasonable requests.
Right to a Paper Copy of This Notice At any time, you have the right to a paper copy of this notice even if you received it electronically.
CHANGES TO THIS NOTICE
We reserve the right to change this notice at any time. We will post a summary of the current notice in our facility with its effective date in the top right hand corner. You are entitled to a copy of the notice currently in effect.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a compliant with our office, please contact Ken Evancic, privacy officer at 412-653-7566. You will not be penalized for filing a complaint.
