HIPAA Privacy Notice

The following legally separate covered entities are affiliated through common ownership and control and are designated as a single affiliated covered entity under 45 C.F.R. § 164.504(d):

A PINEYWOODS HOME HEALTH CARE, INC.

A PINEYWOODS HOME SERVICES, INC.

NOTICE OF HOME CARE PRIVACY PRACTICES

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.

UNDERSTANDING YOUR PROTECTED HEALTH INFORMATION

A Pineywoods Home Health Care, Inc./ A Pineywoods Home Services Inc./A Pineywoods Home Medical Equipment, Inc. may use your health information, information that constitutes protected health information as defined in the Privacy Rule of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), for purposes of providing you treatment, obtaining payment for your care and conducting health care operations. We have established policies and procedures to guard against unnecessary disclosure of your protected health information.

USES OR DISCLOSURES WHICH DO NOT REQUIRE YOUR WRITTEN AUTHORIZATION

To Provide Treatment: We may use your health information to coordinate care within the Agency and with others involved in your care, such as your attending physician and other health care professionals who have agreed to assist us in coordinating your care. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications or care. We also may disclose your health care information to individuals outside of the Agency involved in your care including pharmacists, suppliers of medical equipment or other health care professionals.

To Obtain Payment: We may include your health information in invoices to collect payment from third parties for the care you receive from us. For example, we may be required by your health insurer to provide information regarding your health care status so that we can receive payment for services we provided to you. We also may need to obtain prior approval from your insurer and may need to explain to the insurer your need for home care and the services that will be provided to you. Your health information may also be provided to other providers or collection agencies in order to collect payment for care you receive.

To Conduct Health Care Operations: We may use and disclose health information for our own operations in order to facilitate the function of the Agency and as necessary to provide quality care to all of our patients. Health care operations includes such activities as:

• Quality assessment and improvement activities.
• Activities designed to improve health or reduce health care costs.
• Protocol development, case management and care coordination.
• Contacting health care providers and patients with information about treatment alternatives and other related functions that do not include treatment.
• Professional review and performance evaluation.
• Training programs including those in which students, trainees or practitioners in health care learn under supervision.
• Training of non-health care professionals.
• Accreditation, certification, licensing or credentialing activities.
• Accounting, reviews and auditing, including compliance reviews, medical reviews, legal services and compliance programs, by outside companies that assist in operating our health care services and other services provided by these “business associates”.
• Business planning and development including cost management and planning related analyses and formulary development.
• Business management and general administrative activities of the Agency.

For example we may use your health information to evaluate our staff performance, combine your health information with other Agency patients in evaluating how to more effectively serve all of our patients, and disclose your health information to our staff and contracted personnel for training purposes.

For Electronic Health Information Exchange: We may use and disclose your electronic health records directly to another health care professional through health information direct exchanges. Patient referrals, discharge summaries, and laboratory orders and results are examples of information exchanged which enables coordinated care.

For Appointment Reminders: We may use and disclose your health information to contact you as a reminder that you have an appointment for a home visit.

Any person or entity that performs functions regulated by HIPAA on behalf of A Pineywoods Home Health Care, Inc. which uses and/or disclosures individually identifiable health information is considered a Business Associate and signed agreements are entered into with these Business Associates, requiring the Business Associates to comply with HIPAA. Business Associates are now directly regulated by HIPAA and Privacy Rule Use/Disclosure provisions apply.

USES OR DISCLOSURES TO WHICH YOU MAY OBJECT

We may use or disclose your health information without your written authorization for the following purposes, unless you ask us not to.

To Family Members: We may use and disclose your health information to a family member, relative, or other involved in your health care or payment thereof, unless you object.

For Treatment Alternatives: We may use and disclose your health information to tell you about or recommend possible treatment options or alternatives and other health related benefits and services that may be of interest to you, unless you object.

For Assistance in Disaster Relief Efforts: We may use or disclose your health information to assist in disaster relief efforts, unless you object.

For Limited Marketing: We may use and disclose your health information to make a face-to-face communication to you to market a service or product and may provide a promotional gift of nominal value, unless you object.

If you wish to authorize use and disclosure of your protected health information in situations which require your authorization, you may contact the Privacy Official to obtain a Patient Authorization Form. All authorizations must be in writing.

If you authorize us to use or disclose your health information, you may revoke that authorization in writing at any time. You may contact the Privacy Official as detailed below in Your Rights With Respect to Your Protected Health Information – Right to revocation of authorization.

USES OR DISCLOSURES REQUIRED OR PERMITTED BY LAW

We may be required or permitted to use or disclose your health information in the following circumstances without your written authorization.

When Legally Required: We will disclose your health information when it is required or permitted by law to do so by any Federal, State or local law.

In Connection With Judicial And Administrative Proceedings: We may disclose your health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a subpoena, discovery request or other lawful process.

For Law Enforcement Purposes: As permitted or required by State law, we may disclose your health information to a law enforcement official for certain law enforcement purposes as follows:

• As required by law for reporting of certain types of wounds or other physical injuries pursuant to the court order, warrant, subpoena or summons or similar process.
• For the purpose of identifying or locating a suspect, fugitive, material witness or missing person.
• Under certain limited circumstances, when you are the victim of a crime.
• To a law enforcement official if we have a suspicion that your death was the result of criminal conduct including criminal conduct at the Agency.
• In an emergency or in order to report a crime.

To Conduct Health Oversight Activities: We may disclose your health information to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action.

When There Are Risks to Public Health: We may disclose your health information for public activities and purposes in order to:

• Prevent or control disease, injury or disability, report disease, injury, vital events such as birth or death and the conduct of public health surveillance, investigations and interventions.
• Report adverse events, product defects, to track products or enable product recalls, repairs and replacements and to conduct post-marketing surveillance and compliance with requirements of the Food and Drug Administration.
• Notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease.
• Notify an employer about an individual who is a member of the workforce as legally required.

In the Event of A Serious Threat To Health Or Safety: We may, consistent with applicable law and ethical standards of conduct, disclose your health information if we, in good faith, believe that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.

To Report Abuse, Neglect Or Domestic Violence: We are allowed to notify government authorities if we believe a patient is the victim of abuse, neglect or domestic violence.

To Coroners And Medical Examiners: We may disclose your health information to coroners and medical examiners for purposes of determining your cause of death or for other duties, as authorized by law.

To Funeral Directors: We may disclose your health information to funeral directors consistent with applicable law and if necessary, to carry out their duties with respect to your funeral arrangements.

For Organ, Eye Or Tissue Donation: We may use or disclose your health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs, eyes or tissue for the purpose of facilitating the donation and transplantation.

For Specified Government Functions: In certain circumstances, the Federal regulations authorize us to use or disclose your health information to facilitate specified government functions relating to military and veterans, national security and intelligence activities, protective services for the President and others, medical suitability determinations and inmates and law enforcement custody.

For Worker’s Compensation: We may release your health information for worker’s compensation or similar programs.

USES OF DISCLOSURES THAT REQUIRE YOUR WRITTEN AUTHORIZATION

All other uses and disclosures by us, other than those stated above, will require us to obtain from you a written authorization, in particular:

Marketing Goods and Services: If we market a third party’s goods or services to you and receive remuneration for that marketing, a written authorization from you is required.

Use of Third Party Psychotherapy Notes: If we use psychotherapy notes beyond treatment, payment, and health care operations, a written authorization from you is required.

If you or your representative authorizes us to use or disclose your health information, you may revoke that authorization in writing at any time. You may contact the Privacy Official as detailed below, in Your Rights With Respect to Your Protected Health Information – Right to revocation of authorization.

YOUR RIGHTS WITH RESPECT TO YOUR PROTECTED HEALTH INFORMATION

You have the following rights regarding the use and disclosure of your health information that we create or that we may maintain:

Right to request restrictions: You have the right to request restrictions on certain uses and disclosures of your health information. You have the right to request a limit on our disclosure of your health information to someone who is involved in your care or the payment of your care. We will consider your request but we are not legally required to grant your request, unless the restriction is to not tell your insurance company about a treatment and you or someone on your behalf has paid out of pocket for that treatment in full. If you wish to make a request for restrictions, please contact the Agency’s Privacy Official at (936) 634-1617 and obtain the Request For Restrictions on Use/Disclosure of Protected Health Information Form. Requests must be made in writing.

Right to receive confidential communications: You have the right to request that we communicate with you in a certain way. For example, you may ask that we only conduct communications pertaining to your health information with you privately with no other family members present, or by alternate means or location. If you wish to receive confidential communications, please contact the Agency’s Privacy Official at (936) 634-1617 and request the Request for Confidential Communications Form. Requests must be made in writing. We will not request that you provide any reasons for your request and will attempt to honor your reasonable requests for confidential communications.

Right to access: Inspect and copy your health information. You have the right to inspect and copy your health information, including billing records or ask for an electronic copy of health information kept electronically. If you wish to inspect and copy records containing your health information, please contact the Agency’s Privacy Official at (936) 634-1617 and request the Request for Access to Protected Health Information Form. Requests must be made in writing. If you request a copy of your health information, we may charge a reasonable fee for copying and assembling costs or creating an electronic copy associated with your request. We must provide you access or electronic copies of your electronically kept protected health information within 15 days of your written request.

Right to breach notification: You have the right to be notified in the event that we or one of our business associates discovers a breach of unsecured protected health information involving your medical information. If such a breach is discovered, you will be notified in writing and the notification will be delivered by first class mail.

Right to revocation of an authorization: You have the right to revoke an authorization you have previously provided. If you wish to revoke a previous authorization, please contact the Agency’s Privacy Official at (936) 634-1617 and request the Patient Revocation of Previous Authorization Form. Requests must be made in writing.

Right to amend health care information: You have the right to request that we amend your records, if you believe that your health information is incorrect or incomplete. That request may be made as long as the information is maintained by us. If you wish to request an amendment of your health records, please contact the Agency’s Privacy Official at (936) 634-1617 and request the Request for Amendment to Protected Health Information Form. Requests must be made in writing. We may deny the request if it is not in writing or does not include a reason for the amendment. The request also may be denied if your health information records were not created by us, if the records you are requesting are not part of our records, if the health information you wish to amend is not part of the health information you are permitted to inspect and copy, or if, in our opinion, the records containing your health information are accurate and complete.

Right to an accounting: Of with whom we’ve shared your information. You have the right to request a list (accounting) of the times we have shared your health information, who we shared it with and why. We will include all disclosures except those for treatment, payment, or health care operations, and certain other disclosures (such as any you have asked us to make). You may request an accounting of disclosures of your health information by us made for a period not to exceed six (6) years prior to the request date. We will provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee. If you wish to request an accounting of disclosures of your health information, please contact the Agency’s Privacy Official at (936) 634-1617 to request the Request for Accounting Disclosures of Protected Health Information Form. The request must be in writing.

Right to a paper copy of this notice. You have a right to a separate paper copy of this Notice at any time, even if you have received this Notice previously. To obtain a separate paper copy, please contact the Agency’s Privacy Official at (936) 634-1617. You may also obtain a copy of the current version of our Notice of Privacy Practices at our website, www.apwhhc.com.

Right to complain: You have the right to express complaints to us and to the Secretary of the U.S. Dept. of Health and Human Services (“DHHS”) if you believe that your privacy rights have been violated. Any complaints to us should be made in writing to the Agency’s Privacy Official whose contact information is listed below. The Agency encourages you to express any concerns you may have regarding the privacy of your information. Any complaints to DHHS may be made by sending a letter to 200 Independence Avenue, S.W. Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints. The law forbids us from taking retaliatory action against you for filing a complaint.

Right to choose someone to act for you: If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has the authority and can act for you before we take any action.

AGENCY’S DUTIES IN PROTECTING YOUR HEALTH INFORMATION

• We are required by State and Federal law to maintain the privacy and security of your protected health information.
• We are required to provide to you this Notice of our duties and privacy practices with respect to health information. This Notice discharges that duty.
• We must abide by the terms of the Notice currently in effect.
• We are required to promptly notify you if a breach occurs that may have compromised the privacy or security of your protected health information.

CHANGES TO THE TERMS OF THIS NOTICE
We reserve the right to change the terms of its Notice and to make the new Notice provisions effective for all health information that we maintain. If we make changes to this Notice, the new Notice will be available upon request, in our office, and on our web site.

CONTACT PERSON
We have designated the Agency’s Privacy Official as its contact person for all issues regarding patient privacy, this Notice, and your rights under the State and Federal privacy standards. You may contact this person by either writing or calling:

Privacy Official
P.O. Box 1743
Lufkin, TX 75902
(936) 634-1617
(888) 729-1831

EFFECTIVE DATE
This revised Notice is effective September 23, 2013.

The Agency has named a Compliance Officer that has made himself available to receive complaints/concerns of inaccurate care delivery or billing practices. The Compliance Officer has sole access to a designated e-mail account in which he will review weekly. Individuals have the ability to report concerns via [email protected] email account.