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 is effective as of November 1, 2003
USES AND DISCLOSURE OF HEALTH INFORMATION
TREATMENT, PAYMENT AND HEALTH CARE
OPERATIONS
Seniors Inc. uses and discloses your protected health information
for treatment, payment and health care operations. Some examples of
when our office may use or disclose your health care information
for these purposes include:
-
Providing your diagnosis or other information about your health to
your insurance provider or our billing service to obtain payment
for the health care services we provide;
-
Reviewing information as part of our quality improvement
program.
OTHER USES AND DISCLOSURES
Seniors Inc. may also use or disclose your protected health
information, in compliance with guidelines outlined by law, for the
following purposes:
-
Providing you with information related to your health;
-
Contacting you regarding appointments, information about treatment
alternatives, or other health related services;
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Incidental uses or disclosures (e.g., listing your name on a
sign-in sheet, etc.);
-
Compliance with all laws (including reports of suspected abuse,
neglect or violence);
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Providing certain specified information to law enforcement or
correctional institutions;
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Providing information to a coroner, medical examiner, funeral
director, or organ procurement organization;
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Public health activities when requested by a public health
authority or the FDA.
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Responding to health oversight agencies;
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Responding to court or administrative tribunal orders, subpoenas,
discovery requests or other lawful process;
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Research activities;
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When necessary to avert a serious threat to health or safety;
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Military affairs, veterans affairs, national security,
intelligence, Department of State, or presidential protective
service activities;
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Providing information regarding your location, general condition or
death to public or private disaster relief agencies; or
-
Informing a family member, other relative, or close personal friend
when:
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Information is relevant to the individual's involvement with your
care;
-
Notification of your location, general condition or death;
-
To assist in your heath care (e.g., pick-up prescriptions or other
documents, note follow-up care instructions, etc.).
AUTHORIZATION FOR OTHER USES
Seniors Inc. will make other uses and disclosure of your protected
health information only after obtaining your written authorization.
If you authorize a use not contained in this notice, you may revoke
your authorization at any time by notifying us in writing that you
wish to revoke your authorization.
YOUR RIGHTS REGARDING THE PRIVACY OF YOUR HEALTH
INFORMATION
Subject to limitations outlined by law, you have certain rights
related to use and disclosure of your protected health information,
including the right to:
-
Request restrictions on certain uses and disclosures. However,
Seniors Inc. is not obligated to agree to requested
restrictions.
-
Receive confidential communications of protected health
information.
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Inspect and copy your protected health information with some
limited exceptions;
-
Amend your health information;
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Receive an accounting of disclosures of your health
information;
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Obtain a copy of this notice.
SENIORS INC. DUTIES
REGARDING THE PRIVACY OF
YOUR HEALTH INFORMATION
Subject to limitations outlined by law, Seniors Inc. has certain
duties related to your protected health information, including:
-
Seniors Inc. is required by law to maintain the privacy of
protected health information and to provide individuals with notice
of our legal duties and privacy practices with respect to protected
health information.
-
Seniors Inc. is required to abide by the terms of the privacy
notice that is currently in effect.
-
Seniors Inc. reserves the right to change a privacy practice
described in this notice and to make such change effective for all
protected health information. Revised notice will be posted in our
office and available upon request.
CONCERNS
If you believe your privacy rights have been violated, you may make
a complaint by contacting the Seniors Inc. Human Resources
Coordinator, 5840 E. Evans Ave, Denver, CO, 80222, 303-300-6906 or
the Secretary for the Department of Health and Human Services. No
individual will be retaliated against for filing a complaint.