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Living Independently for Elders (LIFE)
Notice of 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.
We understand that information about you and your health is very personal.
We are committed to protecting this medical information as required by law. In
choosing LIFE, your medical information may be used to provide the highest
quality of care, to educate healthcare professionals, and for health related
research.
We are required by law to protect the privacy of our Member’s protected health
information and to notify our Members of our legal duties and privacy practices
with respect to your protected health information. This Notice applies to our
use and disclosure of your health information for purpose of enrollment,
eligibility, and payment under the LIE programs as well as our use and
disclosure of your health information for purposes of providing you with
treatment under the LIFE program. The terms of this Notice of Privacy Practices
also apply to all of LIFE’s Network Providers.
We reserve the right to change this notice as necessary. You may receive a copy
of the most current notice at:
LIFE
Living Independently For Elders
4101 Woodland Avenue
Philadelphia, PA 19104-4510
USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION
Your Authorization is required for any disclosure of Protected Health
information, except for purposes related to Treatment, Payment and Operations of
LIFE and as otherwise described here:
Uses and Disclosures for Treatment. We will make uses and disclosures of your
protected health information as necessary for your care: for instance, to
doctors, nurses and others involved in assessing and implementing your care
plan.
Uses and Disclosures for Payment. We may use and disclose your health
information for billing and payment purposes. We may disclose your health
information to your personal representative or to an insurance or managed care
company, Medicare, Medicaid or the Pennsylvania Department of Public Welfare, or
the local Area Agency on Aging. As a condition of eligibility for enrollment,
LIFE will require you to sign a release permitting LIFE to disclose personal
information to Medicare, Medicaid, and the Pennsylvania Department of Public
Welfare, and the local Agency on Aging as a condition of your enrollment
agreement.
Uses and Disclosures for Health Care Operations. We will use and disclose
your protected health information as necessary, and as permitted by law, for
management of our health care operations. For example, we may use it in order to
conduct an evaluation of the services we provide; and for education and training
purposes.
Research. We may use or disclose some of your health information for
research purposes if the privacy aspects of the research project have been
reviewed and approved by LIFE’s Education and Research Committee. The research
may even occur after your death. You may be asked to authorize LIFE to use your
protected health information for such research; and so you may agree to do that
or not, based on your own choice.
Individuals Involved in Your Care or Payment for Your Care. Unless you
object, we may disclose health information about you to a family member, close
personal friend or other person you identify, including clergy, who is involved
in your care.
Emergencies. We may use or disclose your health information as necessary
in emergency treatment situations.
Other Uses and Disclosures. We are permitted or required by law to make certain
other uses and disclosures of your protected health information without your
consent or authorization, such as:
• We may release your personal health information for any purpose required by
law;
• We may release your personal health information for public health activities,
such as required reporting of disease, injury, and birth and death, and for
required public health investigations;
• We may release your personal health information to certain governmental
agencies if we suspect child abuse or neglect; we may also release your personal
health information to certain governmental agencies if we believe you to be a
victim of abuse, neglect, or domestic violence;
• We may release your personal health information to entities regulated by the
Food and Drug Administration if necessary to report adverse events, product
defects, or to participate in product recalls;
• We may release your personal health information if required by law to a
government oversight agency conducting audits, investigations, inspections and
related oversight functions;
• We may use or disclose your personal health information in emergency
circumstances, such as to prevent a serious and imminent threat to a person or
the public;
• We may release your personal health information if required to do so by a
court or administrative order, subpoena or discovery request; in most cases you
will have notice of such release;
• We may release your personal health information to law enforcement officials
to identify or locate suspects, fugitives or witnesses, or victims of crime, or
for other allowable law enforcement purposes;
• We may release your personal health information to coroners, medical
examiners, and/or funeral directors;
• We may release your personal health information if necessary to arrange an
organ or tissue donation from you or a transplant for you.
Business Associates and Network Providers. Certain components of our
services are performed through contracts with outside persons or organizations,
such as auditing, accreditation, legal services, transportation services,
medical equipment suppliers, etc. At times it may be necessary for us to provide
some of your protected health information to one or more of these outside
persons or organizations who assist us with our health care operations. In all
cases, we require these Business Associates and Network Providers to
appropriately safeguard the privacy of your information as required by law and
as practiced by LIFE.
RIGHTS THAT YOU HAVE
Listed below are your rights regarding your health information. Each of
these rights is subject to certain requirements, limitations and exceptions.
Exercise of these rights may require submitting a written request to LIFE. At
your request, LIFE will supply you with the appropriate form to complete to make
your request.
You have the right to:
Access Your Protected Health Information. Generally, you have the right
to access, inspect, and/or copy of your clinical or billing records or other
information that has been used to make a decision about your care. Requests for
access must be made in writing on a LIFE access request form. We may chose to
charge you a small processing fee to cover administrative and copying costs.
Request Amendments to Your Protected Health Information You have the
right to request amendment of your health information maintained by LIFE for as
long as the information is kept by or for LIFE. Your request must be made in
writing and must state the reason for the requested change.
We may deny your request for the amendment if the information: (a) was not
created by LIFE; (b) was written by some one who is no longer available to act
on your request; (c) is not part of the health information maintained by or for
LIFE; (d) is not part of the information to which you have a right of access; or
(e) is already accurate and complete, as determined by LIFE.
If we deny your request for amendment, we will give you a written denial
including the reasons for the denial and a statement of your right to submit a
written statement disagreeing with the denial. You may obtain an amendment
request form from LIFE’s Executive Director/Privacy Officer.
Accounting for Disclosures of Your Protected Health Information. You have
the right to receive an accounting of certain disclosures made by us of your
protected health information after April 14, 2003. Requests must be made in
writing and signed by you or your legally responsible representative. Accounting
request forms are available from LIFE’s Executive Director/Privacy Officer. The
first accounting in any 12-month period is free; you will be charged a nominal
fee for each subsequent accounting you request within the same 12-month period.
Restrictions on Use and Disclosure of Your Protected Health Information.
You have the right to request restrictions on our use or disclosure of your
health information. This includes the right to limit the degree of information
disclosed and to limit the persons to whom information is given.
We are not required to agree to your restriction request, but we will attempt to
accommodate reasonable requests when appropriate. We retain the right to
terminate an agreed-to restriction if we believe such termination is
appropriate. In the event of a termination by us, we will notify you.
You also have the right to terminate the restriction, in writing or orally,
by communicating such termination notice to LIFE’s Executive Director.
Confidential Communications. You have the right to request that we
communicate with you concerning your health matters in ways that most respect
your privacy. We will accommodate reasonable requests.
Paper Copy of Notice. As a Member you have the right to obtain a paper
copy of this Notice of Privacy Practices, even if you already have
requested such copy by e-mail or other electronic means.
ADDITIONAL INFORMATION
Complaints. If you believe your privacy rights have been violated, you
can file a complaint with LIFE’s Executive Director/Privacy Officer. You may
also file a complaint with the Secretary of the U.S. Department of Health and
Human Services in Washington D.C.
The U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
(202) 619-0257
Toll Free: 1-877-696-6775
There will be no retaliation for filing a complaint.
Acknowledging Receipt of this Notice. You will be asked to sign an
acknowledgment form that states you have received this Notice of Practice
Practices.
For further information. If you have questions or need further assistance
regarding this Notice, you may contact LIFE’s Executive Director/Privacy
Officer.
Effective Date. This Notice of Privacy Practices is effective April 14,
2003.
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