Easter Seals Disability Services

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU (AS A CLIENT OF EASTER SEALS) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION. 

PLEASE REVIEW THIS NOTICE CAREFULLY

A.  OUR COMMITMENT TO YOUR PRIVACY

Easter Seals is dedicated to maintaining the privacy of your individually identifiable health information (IIHI).  In conducting our business, we will create records regarding you and the treatment and services we provide to you.  We are required by law to maintain the confidentiality of health information that identifies you.  We also are required by law to provide you with this notice of our legal duties and the privacy practices that we maintain concerning your individually identifiable health information.  By federal and state law, we must follow the terms of the notice of privacy practices that we have in effect at the time.  

We realize that these laws are complicated, but we must provide you with the following important information:

·          How we may use and disclose your individually identifiable health information

·          Your privacy rights in your individually identifiable health information

·          Our obligations concerning the use and disclosure of your individually identifiable health information

The terms of this notice apply to all records containing your individually identifiable health information that are created or retained by Easter Seals.  We reserve the right to revise or amend this Notice of Privacy Practices.  Any revision or amendment to this notice will be effective for all of your records that Easter Seals has created or maintained in the past, and for any of your records that we may create or maintain in the future.  Easter Seals will post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time.

B.  IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:

Privacy Officer

1219 Dunn Avenue

Daytona Beach, FL 32120

386-255-4568

C.   WE MAY USE AND DISCLOSE YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION (IIHI) IN THE FOLLOWING WAYS

The following categories describe the different ways in which we may use and disclose your individually identifiable health information.

1.  Treatment.  Easter Seals including, but not limited to, our therapists, audiologists and teachers may use or disclose your individually identifiable health information in order to treat you or to assist others in your treatment.  We might use your individually identifiable health information in order to write a prescription for you.  Additionally, we may disclose your individually identifiable health information to others who may assist in your care, such as your spouse, children or parents. Finally, we may also disclose your individually identifiable health information to other health care providers for purposes related to your treatment.

2.  Payment.  Easter Seals may use and disclose your individually identifiable health information in order to bill and collect payment for the services and items you may receive from us.  For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment.  We also may use and disclose your individually identifiable health information to: obtain payment from third parties that may be responsible for such costs, such as family members; bill you directly for services and items; other health care providers and entities to assist in their billing and collection efforts.

3.  Health Care Operations.  Easter Seals may use and disclose your individually identifiable health information to operate our business.  Examples are to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities.  We may disclose your individually identifiable health information to other health care providers and entities to assist in their health care operations.

4.  Appointment Reminders.  Easter Seals may use and disclose your individually identifiable health information I to contact you and remind you of an appointment.

5.  Treatment Options.  Easter Seals may use and disclose your individually identifiable health information to inform you of potential treatment options or alternatives. 

6.  Health-Related Benefits and Services.  Easter Seals may use and disclose your individually identifiable health information to inform you of health-related benefits or services that may be of interest to you.

7.  Release of Information to Family/Friends.  Easter Seals may release your individually identifiable health information to a friend or family member that is involved in your care, or who assists in taking care of you.  For example, a parent or guardian may ask that a babysitter take their child to the pediatrician's office for treatment of a cold.  In this example, the babysitter may have access to this child's medical information.

8.  Marketing: Easter Seals will use your individually identifiable health information to inform you about new programs, services and/or products that might be beneficial to you.  We also reserve the right to contact you about Easter Seal promotional events and fundraisers.

9.  Disclosures Required By Law.  Easter Seals will use and disclose your individually identifiable health information when we are required to do so by federal, state or local law.

D.  USE AND DISCLOSURE OF YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION IN CERTAIN SPECIAL CIRCUMSTANCES

The following categories describe unique scenarios in which we may use or disclose your identifiable health information:

1.  Public Health Risks.  Easter Seals may disclose your individually identifiable health information to public health authorities that are authorized by law to collect information for the purpose of:

·          maintaining vital records, such as births and deaths

·          reporting child abuse or neglect

·          preventing or controlling disease, injury or disability

·          notifying a person regarding potential exposure to a communicable disease

·          notifying a person regarding a potential risk for spreading or contracting a disease or condition

·          reporting reactions to drugs or problems with products or devices

·          notifying individuals if a product or device they may be using has been recalled

·          notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information

·          notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.

2.  Health Oversight Activities.  Easter Seals may disclose your individually identifiable health information to a health oversight agency for activities authorized by law.  Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.

3.  Lawsuits and Similar Proceedings.  Easter Seals may use and disclose your individually identifiable health information in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding.  We also may disclose your individually identifiable health information in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested. 

4.  Law Enforcement.  We may release individually identifiable health information if asked to do so by a law enforcement official:

·          Regarding a crime victim in certain situations, if we are unable to obtain the person's agreement

·          Concerning a death we believe has resulted from criminal conduct

·          Regarding criminal conduct at our offices

·          In response to a warrant, summons, court order, subpoena or similar legal process

·          To identify/locate a suspect, material witness, fugitive or missing person

·          In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator)

7.  Research.  Easter Seals may use and disclose your individually identifiable health information for research purposes in certain limited circumstances.  We will obtain your written authorization to use your individually identifiable health information for research purposes except when an Institutional Review Board or Privacy Board has determined that the waiver of your authorization satisfies the following:  (i) the use or disclosure involves no more than a minimal risk to your privacy based on the following:  (A) an adequate plan to protect the identifiers from improper use and disclosure; (B) an adequate plan to destroy the identifiers at the earliest opportunity consistent with the research (unless there is a health or research justification for retaining the identifiers or such retention is otherwise required by law); and (C) adequate written assurances that the protected health information will not be re-used or disclosed to any other person or entity (except as required by law) for authorized oversight of the research study, or for other research for which the use or disclosure would otherwise be permitted; (ii) the research could not practicably be conducted without the waiver; and (iii) the research could not practicably be conducted without access to and use of the protected health information.

8.  Serious Threats to Health or Safety.  Easter Seals may use and disclose your individually identifiable health information when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public.  Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat. 

9.       Military.  Easter Seals may disclose your individually identifiable health information if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate authorities.

10.  National Security.  Easter Seals may disclose your individually identifiable health information to federal officials for intelligence and national security activities authorized by law.  We also may disclose your individually identifiable health information to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations. 

11.  Inmates.  Easter Seals may disclose your individually identifiable health information to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official.  Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.    

12.  Workers' Compensation.  Easter Seals may release your individually identifiable health information for workers' compensation and similar programs.

E.  YOUR RIGHTS REGARDING YOUR INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION

You have the following rights regarding the individually identifiable health information that we maintain about you:

1.  Confidential Communications. You have the right to request that Easter Seals communicate with you about your health and related issues in a particular manner or at a certain location.  For instance, you may ask that we contact you at home, rather than work.  In order to request a type of confidential communication, you must make a written request to Easter Seals' Privacy Officer at 386-255-4568 specifying the requested method of contact, or the location where you wish to be contacted.  Easter Seals will accommodate reasonable requests.  You do not need to give a reason for your request.

2.  Requesting Restrictions.  You have the right to request a restriction in our use or disclosure of your individually identifiable health information for treatment, payment or health care operations.  Additionally, you have the right to request that we restrict our disclosure of your individually identifiable health information to only certain individuals involved in your care or the payment for your care, such as family members and friends.  We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you.  In order to request a restriction in our use or disclosure of your individually identifiable health information, you must make your request in writing to Easter Seals' Privacy Officer at 386-255-4568.  Your request must describe in a clear and concise fashion:

(a)     the information you wish restricted;

(b)     whether you are requesting to limit our organization's use, disclosure or both; and

(c)     to whom you want the limits to apply.

3.  Inspection and Copies.  You have the right to inspect and obtain a copy of the individually identifiable health information that may be used to make decisions about you, including client medical records and billing records, but not including psychotherapy notes.  You must submit your request in writing to Easter Seals' Privacy Officer at

386-255-4568 in order to inspect and/or obtain a copy of your individually identifiable health information.  Easter Seals may charge a fee for the costs of copying, mailing, labor and supplies associated with your request.  Easter Seals may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Another licensed health care professional chosen by us will conduct reviews.

4.  Amendment.  You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for Easter Seals.  To request an amendment, your request must be made in writing and submitted to Easter Seals' Privacy Officer at 386-255-4568.  You must provide us with a reason that supports your request for amendment.  Easter Seals will deny your request if you fail to submit your request (and the reason supporting your request) in writing.  Also, we may deny your request if you ask us to amend information that is in our opinion: (a) accurate and complete; (b) not part of the individually identifiable health information kept by or for the practice; (c) not part of the individually identifiable health information which you would be permitted to inspect and copy; or (d) not created by Easter Seals, unless the individual or entity that created the information is not available to amend the information.

5.  Accounting of Disclosures.  All of our clients have the right to request an "accounting of disclosures."  An "accounting of disclosures" is a list of certain non-routine disclosures our organization has made of your individually identifiable health information for non-treatment, non-payment or non-operations purposes.  Use of your individually identifiable health information as part of the routine patient care in Easter Seals is not required to be documented.  For example, the doctor sharing information with the nurse; or the billing department using your information to file your insurance claim.  In order to obtain an accounting of disclosures, you must submit your request in writing to Easter Seals' Privacy Officer at 386-255-4568. All requests for an "accounting of disclosures" must state a time period, which may not be longer than six (6) years from the date of disclosure and may not include dates before April 14, 2003.  The first list you request within a 12-month period is free of charge, but Easter Seals may charge you for additional lists within the same 12-month period.  Easter Seals will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any costs. 

6.  Right to a Paper Copy of This Notice.  You are entitled to receive a paper copy of our notice of privacy practices.  You may ask us to give you a copy of this notice at any time.  To obtain a paper copy of this notice, contact Easter Seals' Privacy Officer at 386-255-4568. 

7.  Right to File a Complaint.  If you believe your privacy rights have been violated, you may file a complaint with Easter Seals or with the Secretary of the Department of Health and Human Services.  To file a complaint with Easter Seals, contact Easter Seals' Privacy Officer at 386-255-4568. All complaints must be submitted in writing.  You will not be penalized for filing a complaint.

8.  Right to Provide an Authorization for Other Uses and Disclosures.  Easter Seals will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law.  Any authorization you provide to us regarding the use and disclosure of your individually identifiable health information may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your individually identifiable health information for the reasons described in the authorization.  Please note, we are required to retain records of your care.

Again, if you have any questions regarding this notice or our health information privacy policies, please contact Easter Seals' Privacy Officer at 386-255-4568.

Date: 4/14/03

Revised: