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NOTICE OF PRIVACY PRACTICES

Effective: October 1, 2014

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.

This notice will tell you how we may use and disclose protected health information about you. Protected health information means any health information about you that identifies you or for which there is a reasonable basis to believe the information can be used to identify you. In this notice, we call that protected health information “medical information.”

This notice will also tell you about your rights and our duties regarding medical information about you. It will also tell you how to complain to us if you believe we have violated your privacy rights.

How We May Use & Disclose Medical Information About You

We use and disclose medical information about you for several different purposes. Each of those purposes is described below.

For Treatment

We may use medical information about you to coordinate or manage your healthcare and related services by both other healthcare providers and us. We may disclose medical information about you to doctors, nurses, hospitals, and other facilities that become involved in your care. We may consult with other healthcare providers concerning you as part of the consultation share your medical information with them.

Similarly, we may refer you to another healthcare provider. As part of the referral, we may share medical information about you with that provider. For example, we may conclude you need to receive services from a physician with a particular specialty. When we refer you to that physician, we will also contact that physician’s office to provide medical information about you to them. Hence, they have the information they need to offer services to you.

For Payment

We may use and disclose medical information about you to be paid for the services we provide to you. This can include billing a third-party payer, state agency, or your insurance company. For example, we may need to give the state Medicaid program information about services we provide to you so we are reimbursed for those services. We also may need to provide the state Medicaid program information to ensure you are eligible for the medical assistance program.

For Healthcare Operations

We may use and disclose medical information about you for our own healthcare operations. These are necessary for us to operate OHI and maintain quality for the individuals we provide support and services to. For example, we may use medical information about you to review the services we offer and employees’ performance supporting you.

We may disclose medical information about you to train our staff and volunteers. We may also use the information to study ways to manage our organization, accreditation, licensing activities, or our compliance program more efficiently.

How We Will Contact You

Unless you tell us otherwise in writing, we may contact you by either telephone or by mail at your home or workplace. At either location, we may leave messages for you on the answering machine or voicemail. If you want to request that we communicate to you in a certain way or at a particular location, see “Right to Receive Confidential Communications” on page 9 of this Notice.

OHI Directory

We may include your name, location within OHI, your condition described in general terms, and your religious affiliation in our directory while you receive services. This information, except for your religious affiliation, may be released to people who ask for you by name. Your religious affiliation may be given to clergy members, such as a minister, priest, or rabbi.

Suppose you do not want to be included in our facility directory, or you wish to restrict the information we have in the directory. In that case, you must notify Margaret Longsworth, Director of Mental Health and Clinical Services, of your objection. She can be reached at (207) 605-1209.

Individuals Involved in Your Care

We may disclose to a family member, another relative, a close friend, or any other person identified by you medical information about you directly relevant to that person’s involvement with the services and support you receive or payment for those services. We also may use or disclose medical information about you to notify or assist in notifying those persons of your location, general condition, or death.

In the event of your death, we may disclose to any of those involved in your care for healthcare payment before your death and medical information about you relevant to that person’s involvement. Unless doing so is inconsistent with any prior expressed preference of yours known to us.

If there is a family member, another relative, or close friend you do not want us to disclose medical information about you to, please notify Margaret Longsworth at (207) 605-1209 or tell the staff member who is providing care to you.

Disaster Relief

We may use or disclose medical information about you to a public or private entity authorized by law or by its charter to assist in disaster relief efforts. This will be done to coordinate with those entities in notifying a family member, another relative, close friend, or other person identified by you of your location, general condition, or death.

Required by Law

We may use or disclose medical information about you when we are required to do so by law.

Public Health Activities

We may use or disclose medical information about you for public health activities and purposes. This includes reporting medical information to a public health authority authorized by law to collect or receive the information for purposes of preventing or controlling disease. Or one that is authorized to receive reports of child abuse and neglect. It also includes reporting for activities related to the quality, safety, or effectiveness of a United States Food and Drug administration regulated product or activity.

Health Information Exchange

We participate in HealthInfoNet, the statewide health information exchange (HIE) designated by Maine. The HIE is a secure computer system for healthcare providers to share important health information to support treatment and continuity of care. For example, suppose you are admitted to a healthcare facility not affiliated with OHI. In that case, healthcare providers will see important health information held in our electronic medical record systems.

Your record in the HIE includes prescriptions, lab test results, imaging reports, conditions, diagnoses, or health problems. To ensure your health information is entered into the correct record, also included are your full name and date of birth. All HIE information is kept private and used following applicable state and federal laws and regulations.

The information is accessible to participating providers to support treatment and healthcare operations. You do not have to participate in the HIE to receive care. For more information about HealthInfoNet and your choices regarding participation, visit www.hinfonet.org or call toll-free at 1-866-592-4352.

To an Employer

We may use or disclose medical information to your employer if:

  • We provide healthcare to you at your employer’s request to conduct an evaluation relating to medical surveillance of the workplace or evaluate if you have a work-related illness or injury.
  • The information disclosed will consist of findings concerning a work-related illness or injury or workplace-related medical surveillance.
  • The employer needs the findings to comply with its legal obligations to record the illness or injury or carry out its responsibilities for workplace medical surveillance.

We will provide written notice to you that the information is being disclosed to your employer. The written notice may be given when healthcare is provided or, if healthcare is provided at your employer’s worksite, by posting the notice at the location where the healthcare is delivered.

Proof of Immunization

We may use or disclose immunization information to a school about you:

  • If you are a student or prospective student of the school
  • The information is limited to proof of immunization.
  • The school is required by the State or other law to have proof of immunization before admitting you.
  • We obtain and document the agreement to the disclosure from either:
    • Your parent, guardian, or other person standing in loco parentis of you if you are an unemancipated minor
    • From you, if you are an adult or an emancipated minor
Victims of Abuse, Neglect, or Domestic Violence

We may disclose medical information about you to a government authority authorized by law to receive reports of abuse, neglect, or domestic violence if we believe you are a victim of abuse, neglect, or domestic violence. This will occur to the extent the disclosure is:

  • Required by law
  • Agreed to by you
  • Authorized by law
  • We believe the disclosure is necessary to prevent serious harm to you or other potential victims.

If you are incapacitated, and certain other conditions are met, a law enforcement or other public official represents that immediate enforcement activity, depending on the disclosure.

Health Oversight Activities

We may disclose medical information about you to a health oversight agency for activities authorized by law, including audits, investigations, inspections, licensure, or disciplinary actions. These and similar activities are necessary for appropriate oversight of the healthcare system, government benefit programs, and entities subject to various government regulations.

Judicial & Administrative Proceedings

We may disclose medical information about you in the course of any judicial or administrative proceeding in response to an order of the court or administrative tribunal. We also may disclose medical information about you in response to a subpoena, discovery request, or another legal process only if efforts have been made to tell you about the request or obtain an order to protect the information to be disclosed.

Disclosures for Law Enforcement Purposes

We may disclose medical information about you to a law enforcement official for law enforcement purposes:

  1. As required by law.
  2. In response to a court, grand jury, or administrative order, warrant, or subpoena.
  3. To identify or locate a suspect, fugitive, material witness, or missing person.
  4. About an actual or suspected victim of a crime, and that person agrees to the disclosure. If we cannot obtain that person’s agreement, in limited circumstances, the information may still be disclosed.
  5. To alert law enforcement officials to a death if we suspect the death may have resulted from criminal conduct.
  6. About crimes that occur at OHI.
  7. To report a crime in emergency circumstances.
Coroners & Medical Examiners

We may disclose medical information about you to a coroner or medical examiner for purposes like identifying a deceased person and determining the cause of death.

Funeral Directors

We may disclose medical information about you to funeral directors as necessary for them to carry out their duties.

Organ, Eye, or Tissue Donation

To facilitate organ, eye, or tissue donation and transplantation, we may disclose medical information about you to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs, eyes, or tissue.

Research

Under certain circumstances, we may use or disclose medical information about you for research. Before we disclose medical information for research, the study will have been approved through an approval process that evaluates the research project’s needs with your needs for privacy of your medical information. However, we may disclose medical information about you to a person who is preparing to research to permit them to prepare for the project. Still, no medical information will leave OHI during that person’s review of the information.

To Avert Serious Threats to Health or Safety

We may use or disclose protected health information about you if we believe the use or disclosure is necessary to prevent or lessen a serious or imminent threat to a person or the public’s health or safety. We also may release information about you if we believe the disclosure is necessary for law enforcement authorities to identify or apprehend an individual who admitted participation in a violent crime or is an escapee from a correctional institution or lawful custody.

Military

Suppose you are a member of the Armed Forces. In that case, we may use and disclose medical information about you for activities deemed necessary by the appropriate military command authorities to ensure the military mission’s proper execution. We may also release information about foreign military personnel to the relevant foreign military authority for the same purposes.

National Security & Intelligence

We may disclose medical information about you to authorized federal officials to conduct intelligence, counter-intelligence, and other national security activities authorized by law.

Protective Services for the President

We may disclose medical information about you to authorized federal officials so they can provide protection to the President of the United States, certain other federal officials, or foreign heads of state, or to conduct investigations authorized by specific federal laws.

Security Clearances

We may use medical information about you to make medical suitability determinations. We may disclose the results to officials in the United States Department of State for purposes of a required security clearance or service abroad.

Inmates & Persons in Custody

We may disclose medical information about an inmate or other individual to a correctional institution or law enforcement official having custody of the inmate or other individual. The disclosure will be made if the disclosure is necessary:

  • To provide healthcare to such individuals.
  • For the health and safety of such individual or other inmates
  • The health and safety of the officers or employees of or others at the correctional institution
  • The health and safety of such individuals and officers or other persons responsible for the transporting of inmates or their transfer from one institution, facility, or setting to another
  • Law enforcement on the premises of the correctional institution
  • The administration and maintenance of the safety, security, and good order of the correctional institution
Worker’s Compensation

We may disclose medical information about you to the extent necessary to comply with worker’s compensation and similar laws that provide benefits for work-related injuries or illness without regard to fault.

Fundraising

We may use and disclose medical information about you to contact you to raise funds for OHI. We may disclose medical information to a business associate of OHI or a foundation related to OHI, so the business associate or foundation may contact you to raise money for the benefit of OHI. We will only release:

  • Demographic information relating to you, including your name, address, other contact information, age, gender, and date of birth
  • Dates of healthcare provided to you
  • Department of service information
  • Treating physician
  • Outcome information
  • Health insurance status

You have the right to opt-out of receiving fundraising communications. If you do not want OHI or its foundation to contact you for fundraising, you must notify Margaret Longsworth at (207) 605-1209. You may also send her a letter at 203 Maine Avenue, Bangor ME, 04401.

Specific Uses & Disclosures Requiring Written Authorization

Psychotherapy Notes

Your authorization is required before we may use or disclose psychotherapy notes unless the use or disclosure is:

  • By the originator of the psychotherapy notes for treatment
  • For our training programs for students, trainees, or practitioners in mental health
  • To defend ourselves in a legal action or other proceeding brought by you.
  • When required by law
  • Permitted by law for oversight of the originator of the psychotherapy notes
Marketing

We may use and disclose medical information about you to communicate with you about a product or service to encourage you to purchase the product or service. Generally, this may occur without your authorization. However, your approval is required if:

  • Communication is to provide refill reminders or otherwise communicate about a drug or biologic that is, at the time, being prescribed for you.
  • We receive any financial remuneration in exchange for making the communication, which is not reasonably related to our cost in making the communication.

Except, as stated, we use or disclose your medical information for marketing purposes, and we receive direct or indirect financial remuneration from a third party for doing so. When an authorization is required to communicate with you about a product or service to encourage you to purchase the product or service, the authorization will state that financial remuneration to OHI is involved.

Sale of Information

Your authorization is required for any disclosure of your medical information when the disclosure is in exchange for direct or indirect remuneration from or on behalf of the medical information recipient. However, your authorization may not be required under certain conditions if the disclosure is for:

  • Public health purposes
  • Research
  • Treatment and payment
  • If we are being sold, transferred, merged, or consolidated.
  • A business associate of ours for activities undertaken on our behalf
  • You, when requested by you.
  • Required by law
  • When permitted by applicable law, the only remuneration received by us is a fee permitted by law.
Other Uses & Disclosures

Other uses and disclosures will be made only with your written authorization. You may revoke such an authorization at any time by notifying Margaret Longsworth, OHI, 203 Maine Avenue, Bangor ME, 04401 in writing of your desire to repeal it. However, if you revoke such an authorization, it will not affect actions taken by us in reliance on it.

Your Rights Concerning Medical Information About You.

You have the following rights concerning the medical information we maintain about you.

Right to Request Restrictions

You have the right to request that we restrict the uses or disclosures of medical information about you to carry out treatment, payment, or health care operations. You also have the right to request we restrict the use or disclosures we make to:

  • A family member, another relative, a close personal friend, or any other person you identified. For example, you could ask that we not disclose medical information about you to your sibling.
  • Public or private entities for disaster relief efforts.

To request a restriction, you may do so at any time. If you request a restriction, you should do so to Margaret Longsworth, OHI, 203 Maine Avenue, Bangor ME, 04401 and tell us:

  • What information you want to limit.
  • Whether you want to limit use or disclosure or both.
  • Whom you want the limits to apply. For example, disclosures to your spouse.

With one exception, we are not required to agree to any requested restriction. The exception is that we will always agree to a request to restrict disclosures to a health plan if:

  • The disclosure is to carry out payment or healthcare operations.
  • It is not otherwise required by law.
  • The information relates solely to a healthcare item or service for which you, or someone on your behalf, has paid us in full other than the health plan.

If we agree to a restriction, we will follow that restriction unless the information is needed to provide emergency treatment. Even if we agree to a restriction, either you or we can later terminate the restriction. However, we will not terminate a restriction that falls into the exception stated in the previous paragraph.

Right to Receive Confidential Communications

You have the right to request that we communicate medical information about you to you in a certain way or at a certain location. For example, you can ask that we only contact you by mail or at work. We will not require you to tell us why you are asking for confidential communication.

If you want to request confidential communication, you must write to Margaret Longsworth, OHI, 203 Maine Avenue, Bangor ME, and 04401. Your request must state how or where you can be contacted. We will accommodate your request.

However, we may, when appropriate, require information from you concerning how payment will be handled. We also may need an alternate address or another method to contact you.

Right to Inspect & Copy

With a few minimal exceptions, such as psychotherapy notes, you have the right to inspect and obtain a copy of medical information about you. To inspect or copy medical information about you, you must submit your request in writing to Margaret Longsworth, OHI, 203 Maine Avenue, Bangor ME, 04401. Your request should state specifically what medical information you want to inspect or copy.

Your request should state the form of access and copy you desire, such as in paper or electronic media. If you request a copy of the information, we may charge a fee for the costs of copying. If you ask that it be mailed, you may be charged for the cost of mailing.

We usually will act on your request within 30 calendar days after we receive your request. If we grant your request, in whole or in part, we will inform you of our acceptance of your request and provide access and copies. We may deny your request to inspect and copy medical information if the medical information involved is:

  1. Psychotherapy notes
  2. Information compiled in anticipation of, or use in, a civil, criminal, or administrative action or proceeding

If we deny your request, we will inform you of the basis for the denial, how you may have our denial reviewed, and how you may complain. If you request a review of our denial, it will be conducted by a licensed healthcare professional designated by us who was not directly involved in the denial. We will comply with the outcome of that review.

Right to Amend

You have the right to ask us to amend medical information about you. You have this right for so long as we maintain the medical information. To request an amendment, you must submit your request in writing to Margaret Longsworth, OHI, 203 Maine Avenue, Bangor, ME, 04401.

Your request must state the amendment desired and provide a reason in support of that amendment. We will act on your request within 60 calendar days after we receive your request. If we grant your request, in whole or in part, we will inform you of our acceptance of your request and provide access and copying.

If we grant the request, we will seek your identification of and agreement to share the amendment with relevant other persons in whole or in part. We will also make the appropriate amendment to the medical information by appending or otherwise providing a link to the amendment.

We may deny your request to amend medical information about you. We may deny your request if it is not in writing and does not provide a reason in support of the amendment. Also, we may deny your request to amend medical information if we determine the information:

  1. We did not create it unless the person or entity that created the information is no longer available to act on the requested amendment.
  2. It is not part of the medical information maintained by us.
  3. Would not be available for you to inspect or copy
  4. It is accurate and complete.

If we deny your request, we will inform you of the basis for the denial. You will have the right to submit a statement of disagreeing with our denial. We may prepare a rebuttal to that statement.

Your request for amendment, our denial of the request, your statement of disagreement, and our rebuttal, if any, will then be appended to the medical information involved or otherwise linked to it. All of that will then be included with any subsequent disclosure of the information. At our election, we may include a summary of any of that information.

If you do not submit a statement of disagreement, you may ask that we include your request for amendment and our denial of the information’s future disclosures. We will include your request for amendment and our denial, or a summary of that information, with any subsequent disclosure of the medical information involved. You also will have the right to complain about our denial of your request.

Right to an Accounting of Disclosures

You have the right to receive an accounting of disclosures of medical information about you. The accounting may be for up to six years before the date you request the accounting but not before April 14, 2003. Certain types of disclosures are not included in such an accounting:

  1. Disclosures to carry out treatment, payment, and healthcare operations
  2. Disclosures of your medical information made to you
  3. Disclosures that are incident to another use or disclosure
  4. Disclosures that you have authorized
  5. Disclosures for our facility directory or to persons involved in your care
  6. Disclosures for disaster relief purposes
  7. Disclosures for national security or intelligence purposes
  8. Disclosures to correctional institutions or law enforcement officials having custody of you
  9. Disclosures that are part of a limited data set for research, public health, or health care operations. A limited data set is where things that would directly identify you have been removed.
  10. Disclosures made before April 14, 2003.

Under certain circumstances, your right to an accounting of disclosures to a law enforcement official or a health oversight agency may be suspended. Should you request an accounting during the time your right is suspended, the accounting would not include the disclosure or disclosures to a law enforcement official to a health oversight agency.

To request an accounting of disclosures, you must submit your request in writing to Margaret Longsworth, OHI, 203 Maine Avenue, Bangor ME, 04401. Your request must state a time period for the disclosures. It may not be longer than six years from the date we receive your request and may not include dates before April 14, 2003.

Usually, we will act on your request within 60 calendar days after we receive your request. Within that time, we will either provide the accounting of disclosures to you or give you a written statement of when we will provide the accounting and why the delay is necessary.

There is no charge for the first accounting we provide to you in any 12 month period. For additional accountings, we may charge you for the cost of providing the list. If there will be a charge, we will notify you of the cost involved and allow you to withdraw or modify your request to avoid or reduce the fee.

Right to Copy of this Notice

You have the right to obtain a paper copy of our Notice of Privacy Practices. You may obtain a paper copy even though you agreed to receive the notice electronically. You may request a copy of our Notice of Privacy Practices at any time.

You may obtain a copy of our Notice of Privacy Practices over the Internet at our website at www.ohimaine.orgTo get a paper copy of this notice, contact Margaret Longsworth at OHI, 203 Maine Avenue, Bangor ME, 04401 or (207) 605-1209.

Our Duties

Generally

We are required by law to maintain the privacy of medical information about you, provide individuals with notice of our legal duties, and privacy practices with respect to medical information. We notify affected individuals following a breach of unsecured protected health information. We are required to abide by the terms of our Notice of Privacy Practices in effect at the time.

Our Right to Change Notice of Privacy Practices

We reserve the right to change this Notice of Privacy Practices. We reserve the right to make the new notice’s provisions effective for all medical information that we maintain, including those created or received before the new notice’s effective date.

Availability of Notice of Privacy Practices

A copy of our current Notice of Privacy Practices will be posted in the business office of OHI. A copy of the current notice also will be posted on our website at www.ohimaine.org. At any time, you may obtain a copy of the current Notice of Privacy Practices by contacting Margaret Longsworth at OHI, 203 Maine Avenue, Bangor ME, 04401 or (207) 605-1209.

Effective Date of Notice

The effective date of the notice is stated on the first page of this notice.

Complaints

You may complain to us and the United States Secretary of Health and Human Services if you believe we have violated your privacy rights. To file a complaint with us, contact Melinda Ward, Privacy Officer at OHI, 203 Maine Avenue, Bangor ME, 04401 or (207) 605-1256. All complaints should be submitted in writing.

To file a complaint with the United States Secretary of Health and Human Services, send your complaint to them in the care of the Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue SW, Washington, D.C. 20201. Complaints also may be filed online at http://www.hhs.gov/ocr. You will not be retaliated against for filing a complaint.

Questions & Information

If you have any questions or want more information concerning this Notice of Privacy Practices, please contact Margaret Longsworth at OHI, 203 Maine Avenue, Bangor ME, 04401, or by telephone (207) 605-1209.

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