PLACES FOR PEOPLE, INC. NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED OR DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE OR IF YOU REQUIRE MORE INFORMATION, PLEASE CONTACT OUR PRIVACY OFFICER AT THE CONTACT GIVEN AT THE END OF THIS NOTICE.
At PfP, we understand that your medical information about you and your health is personal. Our agency is committed to protecting your medical information. We are required by federal and state laws to maintain the privacy of your protected health information (PHI) and to give you this notice explaining our privacy practices with regard to that information. This notice explains your rights and our legal obligations regarding the privacy of your PHI.
Protected health information is information that individually identifies you. It may be used and disclosed by your physicians, our staff, another health care provider, Medicaid or health plan, your employer, or a healthcare clearing house that relates to your past, present, or future medical conditions, the provision of care to you for those conditions, or the past, present, or future payment for your health care.
HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION:
For your treatment—Your PHI may be provided to a physician, pharmacist, or other healthcare provider (specialist or laboratory) to whom you have been referred, to ensure they have the necessary information to diagnose, treat, or provide you a service.
For payment—Your PHI may be used and disclosed to enable us to bill and collect payment from Medicaid, Medicare, a private health plan, or you or a third party.
For health care operations—We may use and disclose your PHI in order to support the business activities of PfP or the independent providers who serve you. These activities include, but are not limited to, the evaluation of our team members in caring for you, quality assessment, and the disclosure of information to providers, medical students, and other authorized personnel for educational and learning purposes. Should the programs in which you are enrolled be authorized or paid for by the Missouri Department of Mental Health, Medicaid, the St Louis City Housing Authority, or other state and grant authorities, we may also need to release your PHI to determine your eligibility, as well as for quality evaluation, auditing, and licensure purposes.
As required by law—We will disclose your PHI when required to do so by federal, state or local law.
Appointment reminders, treatment alternatives, health related services, and client directory—We may use and disclose your PHI to contact you to remind you have a scheduled appointment, or to advise you of treatment options or alternatives which may be of interest to you. You may provide us with alternative instructions for our use of PHI for these purposes.
Other uses and disclosures—may include research when the protocols have been approved by a review board to ensure the privacy of your health information; correctional agencies if you are incarcerated or subject to conditions for probation or parole; communication with family or other individuals you identify, if you have not prohibited such information exchange and in the professional opinion of qualified staff the information is relevant to that person’s involvement in your care or payment related to your care.
Any other uses or disclosures require your written authorization. You may revoke the authorization at any time by submitting a request in writing and we will no longer disclose your PHI except to the extent that we have taken an action in reliance on the prior written authorization. By policy, PfP does not use protected health information for marketing or fundraising purposes without your consent. By law, PfP cannot release psychotherapy notes or substance abuse treatment notes without your consent.
PLACES FOR PEOPLE MUST NOTIFY AFFECTED INDIVIDUALS IF THERE IS A BREACH OF THEIR UNSECURED PHI.
A breach might include lost or stolen paper records, misdirected records sent to a third party, a hacked database including PHI, or unencrypted information sent electronically or stored on an unauthorized, unencrypted device, for example, an unencrypted texted message on a mobile phone.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION:
The right to inspect and copy—Under federal law you have the right to inspect and copy the PHI created by PfP, upon written request. We have up to 30 days to make your PHI available to you; fees may apply). You have a right to a summary of your PHI instead of the entire record, or an explanation of the PHI which has been provided.
The right to an electronic copy of electronic medical records—You have the right to request to be given to you or another individual or entity, an electronic copy of your medical records, if they are maintained in an electronic format, in the format you request. If the material is not readily producible by us we will provide it in either our standard electronic format or in hard copy form. Fees may apply.
The right to request restrictions—You may request a restriction or limitation of PHI we use or disclose for treatment, payment, or health care operations. You may request a restriction of disclosures to your health plan, if you have paid yourself “out-of-pocket” in full for the services that would be disclosed. You may also request a limit on the PHI we disclose about you to someone involved in your care or payment of your care. Your request must be made in writing to our Privacy Officer with specific instructions. If we agree to the restriction, we may override it only when legally compelled, or for emergency treatment purposes. By law, you may not request that we restrict the disclosure of your PHI for treatment purposes.
The right to request amendments—If you feel that the PHI we have is incorrect or incomplete, you may ask us to amend the information. A request and the reason for the requested amendment must be made in writing to our Privacy Officer. In certain cases we may deny your request. If we deny your request you ave the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy.
The right to an accounting of disclosures—You have the right to receive an accounting of disclosures except for those used for purposes of treatment, payment, or healthcare operations, disclosures for which you have given authorization, disclosures required by law, or those that occurred six years prior to the date of request. Your request must be made in writing and you must indicate in what form you want the list, for example on paper or by email. The first accounting of disclosures in any 12 month period will be free. Any additional requests within the same time period may incur a fee.
The right to request confidential communication—You may request that we communicate with you only in certain ways to preserve your privacy. For example, you may request that we contact you by mail at a specific address or call you at a specific telephone number. Your request must be made in writing with specific instructions on how and where we contact you. We will accommodate all reasonable requests and will not ask the reason for your request.
If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the United States Department of Health and Human Services. To file a complaint with us you must make it in writing to the Places for People Privacy Officer, 4130 Lindell, St Louis, MO 63108, or by email to email@example.com. Complaints must be submitted within 180 days of when you knew of or suspected the violation. There will be no retaliation against you for filing a complaint.
To file a complaint with the Secretary, mail it to: Secretary of the U.S. Department of Health and Human Services, 200 Independence Avenue S.W., Washington, DC 20201. For more information, call 877-696-6775 or go the website of the Office for Civil Rights, www.hhs.gov/ocr/hipaa/. There will be no retaliation against you for filing a complaint.
If you have any questions in reference to this form, please talk to a PfP staff member, supervisor, or the PfP Privacy Officer. The Privacy Officer’s phone number is 314-615-2121, or email firstname.lastname@example.org. You have the right to request a paper copy of this notice at any time. A copy of this notice may also be found on the Places for People website, www.placesforpeople.org.
Places for People is concerned about the privacy of our donors and guards your data closely. We value our relationship with you and recognize the importance of protecting the privacy of your personal information. The information we have about you is protected and secure, and we work diligently to ensure that your personal preferences regarding the use of your information are honored. The information you share with the Places for People is for organizational use only and is never shared, sold, or bartered with any other entity. The types of information collected may include your name, address, postal code, phone number and/or email address. This information is used solely for solicitation purposes that aid in the administration of our programs.
If you have any questions regarding this policy, use of your personal information or opting out of mailings we can be contacted via mail, email, or phone at the following:
Mrs. Ellen Kratz
Places for People
4130 Lindell Blvd
St. Louis, MO 63108