NOTICE OF PRIVACY PRACTICES FOR
PROTECTED HEALTH INFORMATION
Effective April 14, 2003; revised December 6, 2012
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 of Privacy Practices is provided to you as a requirement of the Privacy Rule of the Health Insurance Portability and Accountability Act (HIPAA).
During the course of providing services and care to you, Satellite Healthcare (hereinafter “Satellite”) gathers, creates, and retains certain personal information about you that identifies who you are and relates to your past, present, or future physical or mental condition, the provision of healthcare to you, and payment for your healthcare services. This personal information is characterized as your “protected health information.”
Satellite understands that the protected health information about you and your health is personal. We are committed to protecting this information about you. At the same time, we need to use your medical and personal information to provide you with quality care and to comply with certain legal requirements.
This Notice of Privacy Practices describes how Satellite maintains the confidentiality of your protected health information, and informs you about the possible uses and disclosures of such information. It also informs you about your rights with respect to your protected health information.
RESPONSIBILITIES OF SATELLITE HEALTHCARE
Satellite is required by federal and state law to maintain the privacy of your protected health information, and is also required by law to provide you with this Notice of Privacy Practices that describes its legal duties and privacy practices with respect to your protected health information. Satellite will abide by the terms of this Notice of Privacy Practices and reserves the right to change this or any future Notice and to make the new Notice provisions effective for all protected health information that it maintains, including protected health information already in its possession. Satellite will personally deliver or mail a revised Notice of Privacy Practices to you at your current address if it changes its Notice.
USE AND DISCLOSURE WITH YOUR AUTHORIZATION
Satellite will require a written authorization from you before it uses or discloses your protected health information, unless a particular use or disclosure is expressly permitted or required by law without your authorization. Satellite has prepared an authorization form for you to use that authorizes it to use or disclose your protected health information for the purposes set forth on the form. You are not required to sign such a form as a condition to obtaining treatment or having your care paid for. If you sign an authorization, you may revoke it at any time by written notice. Satellite then will not use or disclose your protected health information, except where it has already relied on your authorization.
HOW SATELLITE HEALTHCARE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION WITHOUT YOUR AUTHORIZATION
- Permissive Disclosures
In accordance with federal and state laws, Satellite may, in its discretion, use or disclose your protected health without your written authorization in the following circumstances. These examples are not exhaustive.
- Your Care and Treatment
Satellite may use or disclose your protected health information to provide you with or assist in your treatment, care and services. For example, it may disclose your health information to healthcare providers who are involved in your care to assist them in your diagnosis and treatment, as necessary. Satellite may also disclose your protected health information to individuals who will be involved in your care if you leave Satellite.
- Billing and Payment
- Medicare, Medicaid and Other Public or private health insurers
Satellite Healthcare may use or disclose your protected health information to public or private health insurers (including medical insurance carriers, HMOs, Social Security, Medicare, and Medicaid) in order to bill and receive payment for your treatment and services that you receive at Satellite. The information on or accompanying a bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.
- Health Care Providers
Satellite may also disclose your protected health information to healthcare providers in order to allow them to determine if they are owed any reimbursement for care that they have furnished to you and, if so, how much is owed.
- Medicare, Medicaid and Other Public or private health insurers
- Health Care Operations
Satellite may use your protected health information for its healthcare operations. These uses and disclosures are necessary to manage and to monitor our quality of services and care. For example, we may use your protected health information to review our services and to evaluate the performance of our staff in caring for you.
- Licensing, Accreditation and Funding
Satellite may disclose your protected health information to any government or private agency such as the Department of Public Health; the Department of Social Services; Dialysis Councils, ESRD Network or the Center for Medicare and Medicaid Services (CMS) responsible for licensing, accrediting, statistical and/or funding purposes. These oversight and funding activities include audits, surveys and statistics gathering; civil, administrative, or criminal investigations; inspections; licensure or disciplinary actions; civil, administrative, or criminal proceedings or actions; or other activities necessary for appropriate oversight and funding.
- Individuals Involved in Your Care or Payment for Your Care
Unless you specifically object, Satellite may disclose to a family member, other relative, a close personal friend, or to any other person identified by you, all protected health information directly relevant to such person’s involvement with your care or directly relevant to payment related to your care. Satellite may also disclose your protected health information to these same individuals to assist in notifying them of your location, general condition, or death.
- Provision of Basic Information about Patients
Unless you notify Satellite that you object, it will disclose your name, your facility or location in it, and your general condition, to anyone who asks for you by name. Similarly, Satellite may disclose your name, your facility or location in it, your general condition, and your religious affiliation to members of the clergy.
- Disaster Relief
Unless you specifically object, Satellite may disclose your protected health information to a public or private entity authorized to assist in disaster relief efforts as it relates to notifying a family member, personal representative or another person responsible for your care.
- Disclosures of Certain General Patient Information Within Dialysis Facility.
Unless you specifically object, Satellite may disclose certain general information about you (e.g., past activities, present interests, birthday, and location if hospitalized) to other patients and members of its staff, by means such as a newsletter or bulletin board. Satellite’s use and disclosure of this information is helpful in its pursuit of its general administrative and management objective of fostering a sense of community and nurturing care environment.
- Business Associates
Satellite may contract with certain individuals or entities to provide services on its behalf; examples include data processing, quality assurance, legal, or accounting services. Satellite may disclose your protected health information to a business associate, as necessary, to allow the business associate to perform its functions on Satellite's behalf. Satellite will require every business associate to sign a contract that obligates it to maintain the confidentiality of your protected health information.
Satellite may disclose your protected health information for research purposes pursuant to a written authorization provided by you unless a waiver of authorization is granted by an institutional review board or privacy board or upon receipt of certain assurances by researchers for access to your PHI as set forth in federal regulations.
- Peer Review
Satellite may disclose your protected health information to hospital or medical staffs to aid in the credentialing of applicants and in the peer review of medical staff members.
- Organ Procurement
If you are an organ donor, Satellite may disclose your protected health information following your death to an organ procurement agency or tissue bank in order to aid in using your organs or tissues in transplantation.
- Appointment Reminders
Satellite may use or disclose your protected health information to remind you about appointments.
- Treatment Alternatives or Health-related Benefits and Services
Satellite may use or disclose your protected health information to inform you about treatment alternatives or health-related benefits and services that may be of interest to you.
It is Satellite’s policy to allow its workforce members to share patients’ protected health information with one another to the extent necessary to permit them to perform their legitimate functions on Satellite’s behalf. The term “workforce” includes all employees, volunteers, trainees, and board and committee members. It does not include independent contractors such as consultants or vendors. At the same time, Satellite will work with and train its workforce to ensure there are no unnecessary or extraneous communications violating the rights of its patients to maintain the confidentiality of their protected health information.
Satellite may use and disclose to components of the Department of Veterans Affairs medical information about you to determine your eligibility for certain benefits.
- o. Public Health Activities
Satellite may disclose health information to a public health authority for public health activities or to a pharmaceutical or medical device company for the purpose of activities related to the quality, safety or effectiveness of an FDA-regulated product or activity. The disclosure may be necessary to do the following::
- Prevent or control disease, injury, or disability;
- Report births or deaths;
- Report reactions to medications or problems with products;
- As permitted by law, notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease;
- Notify appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic abuse.
- Workers' Compensation
Satellite may use or disclose your protected health information to comply with laws relating to workers’ compensation or similar programs.
If you are an inmate of a correctional institution or under the custody of a law enforcement official, Satellite may release medical information about you to that institution or official. This release would be necessary:
- For the institutions to provide you with health care;
- To protect your health and safety or the health and safety of others; or
- For the safety and security of the correctional institution.
- Your Care and Treatment
- Mandatory Disclosures
Satellite will disclose protected health information to outside persons or entities without your written authorization as required by law in the following circumstances:
- Court Order; Order of Administrative Tribunal
Satellite will disclose protected health information in accordance with an order of a court or of an administrative tribunal of a government agency.
Satellite will disclose protected health information in accordance with a valid subpoena issued by a party to adjudication before a court, an administrative tribunal, or a private arbitrator. Reasonable efforts will be made to notify you of the subpoena, or of efforts to obtain an order or agreement protecting your protected health information.
- Law Enforcement Agencies
Satellite will disclose protected health information to law enforcement agencies in accordance with a search warrant, a court order or court-ordered subpoena, or an investigative subpoena or summons.
Satellite will disclose protected health information to a coroner when he/she requests the information to identify a decedent; to notify next of kin; or to investigate deaths that may involve public health concerns, suspicious circumstances, elder abuse, or organ or tissue donation.
- National Security and Intelligence Activities, Protected Services for the Patient and Others
Satellite will disclose protected health information about a patient to authorized federal officials conducting national security and intelligence activities or as needed to provide protection to citizens of the United States, certain other persons or foreign heads of states, or to conduct certain special investigations.
- Other Disclosures Required by Law
Satellite will disclose protected health information about a patient when otherwise required by law.
- Court Order; Order of Administrative Tribunal
YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION
1. You have the following rights with respect to your protected health information. To exercise these rights, contact your Satellite facility Administrative Coordinator or Medical Assistant.
- Right to Request Access
You have the right to submit a written request to amend your protected health information maintained by Satellite. If your request for an amendment is denied, you will receive a written denial, including the reasons for such denial, and an opportunity to submit a written statement disagreeing with the denial.
This right of access does not apply to the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal or administrative proceeding; and other health information that is subject to law prohibiting access to protected health information.
- Right to Request Amendment
You have the right to submit a written request to amend your protected health information maintained by Satellite. If your request for an amendment is denied, you will receive a written denial, including the reasons for such denial, and an opportunity to submit a written statement disagreeing with the denial. To request an amendment, contact the administrative supervisor or medical assistant of your facility for an appropriate form.
- Denial of Request
Satellite may deny your request for an amendment if it does not include a reason to support the request. In addition, we may deny your request if you ask to amend information that:
- Was not created by Satellite, unless the person or entity that created the information is no longer available to make the amendment;
- Is not a part of the medical information kept by Satellite;
- Is not a part of the information which you would be permitted to inspect or copy;
- Is accurate and complete.
- Right to Request Restriction
You have the right to request restrictions on the use and disclosure of your protected health information for 1) treatment, payment or healthcare operations, or 2) providing information regarding your identity and status to persons inquiring about you or who are involved in your care. Satellite is not required to grant your request, but if it does, it will comply with your request, except in an emergency situation or until the restriction is terminated by you or Satellite.
- Right to Request Confidential Communications
You have the right to request that Satellite communicate protected health information to the recipient by alternative means or at alternative locations. Satellite will not ask you the reason for your request, and will accommodate reasonable requests when possible.
- Right to an Accounting
You have the right to receive an accounting of disclosures made of your health information, except for disclosures made for the purpose of treatment, payment, health care operations if such disclosures were made through a paper record or other health record that is not electronic, and for certain other purposes as set forth in federal regulations. If you request an accounting of disclosures of your PHI, the accounting will, to the extent required by federal law and regulations, include disclosures made for the purpose of treatment, payment and health care operations if such disclosures are made through an electronic health record.
- Right to Receive a Copy of the Notice of Privacy Practices
You have the right to request and receive a copy of Satellite's Notice of Privacy Practices for Protected Health Information in written or electronic form.
If you believe your privacy rights have been violated, you may file a complaint with your dialysis facility, Attention: Contact Person, Patient Privacy. You may also contact the Satellite Healthcare Corporate Office, 300 Santana Row Suite 300, San Jose, CA 95128, Attention: Privacy Officer. You also have the right to submit a complaint to the Office for Civil Rights (OCR), U.S. Department of Health and Human Services, 200 Independence Avenue SW, Room 509F HHH Building, Washington, DC 20201, Attention: Director. (Note: this is the OCR headquarters. For a list of regional offices, visit www.hhs.gov/ocr/office/about/rgn-hqaddresses.html). Satellite will not retaliate against you if you file a complaint.
You may obtain a copy of this Notice from the Administrative Coordinator or Medical Assistant at your Satellite facility, or view it electronically at the Satellite website at http://www.Satellitehealth.com. Look for “Patient Privacy Notice”. If you have questions about this Notice or would like further information about privacy rights, contact your Satellite facility Administrative Coordinator or Medical Assistant. You may also contact the Privacy Officer at 1 (800) 367-4033