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
Protection of Your Personally Identifiable Health Care Information Kahak Health Care (the “Company”) is providing this Notice of Privacy Practices (“Notice”) because the privacy of your Protected Health Information (“PHI”) is very important to you and to us, and in compliance with Federal and State regulations.
By “your PHI”S we mean the information that we maintain that specifically identifies you and your health status or services.
This Notice describes how we use your PHI within the Company and disclose it outside the Company, and why. This Notice covers:
I. Uses Or Disclosures Which Do Not Require Your Written Authorization:
A) Treatment, Payment, and Healthcare Operations:
To carry out your treatment, to obtain payment and to conduct health care operations. For example:
1. For treatment, we use your PHI to plan, coordinate, and provide your care. We disclose your PHI for treatment purposes to physicians and other health care professionals outside our agency who are involved in your continued care.
2. For payment, we use your PHI to prepare documentation required by your third-party payer (your insurance company).
3. For healthcare operations, we use or disclose your PHI, for example, to improve the quality of you our services, to plan better ways of treating patients, to evaluate staff performance and oversee the Company’s operation by an accredited agency.
B) Uses or Disclosures of Your PHI to Which You May Object:
We may use or disclose your PHI for the following purposes, unless you ask us not to:
1. Disclosure of your PHI to family, friends, or others identified by you who are involved in your care.
2. Assistance in disaster relief efforts.
3. Confirming our visits to your home or other appointments.
4. Informing you about treatment alternatives or other health-related benefits and services that may be of interest to you.
If you object to our use or disclosure of your PHI for any of these purposes please do so in writing.
C) Uses or Disclosures Required or Permitted :
Where we are required or permitted to do so, we may use or disclose your PHI in the following circumstances without your written authorization.
1. Federal, State or Local Law requirements.
2. Federal government investigation when required by the Commission d’accès à l’information of Québec to investigate or determine our compliance with Federal and State regulation.
3. Public health activities, for example, to report communicable diseases or death; or for matters involving the Food and Drug Administration.
4. Reporting of abuse, neglect or domestic violence.
5. Health oversight activities by a health oversight agency. (A health oversight agency is an organization authorized by the government to oversee eligibility and compliance and to enforce civil rights law.)
6. Judicial or administrative proceedings, for example responding to a court order or subpoena.
7. Law enforcement purposes, for example, to report certain types of wounds or other physical injuries or to identify or locate a suspect, fugitive, material witness, or missing person.
8. Use by coroners, medical examiners, or funeral directors.
9. Facilitating organ or tissue donation.
10. Research, provided that very strict controls are enforced.
11. Averting a serious threat to your health or safety or that of the public.
12. Workers’ Compensation.
II. Uses or Disclosures Which Require Your Written Authorization:
Your written authorization, which you may revoke (in writing), is required if we use or disclose your health information for Non-Treatment, Payment, or Healthcare Operations.
A) Our use of psychotherapy notes beyond treatment, payment, and healthcare operations.
B) Marketing of goods or services to you.
C) To other parties and/or organizations beyond treatment, payment, and healthcare operations.
III. Your Rights As A Patient To Privacy of Your PHI:
You have the right to request restrictions(s) on our uses and disclosures of your PHI; we may however refuse to accept the restrictions(s), if the restrictions(s) are deemed unreasonable.
B) You have the right to request that we communicate PHI with you confidentially or with an individual you identify. For example, to speak with you or an individual you identify only in private, to send mail to an address you designate or to telephone you at a number you designate.
C) You have the right to request access to your PHI in order to inspect or copy it.
D) You have the right to request in writing an amendment of your PHI providing a justifiable reason for the amendment. If we deny your request, you may submit a statement of disagreement.
E) You have the right to request an accounting of our disclosures of your PHI for purposes other than treatment, payment, and healthcare operations. We are not required to provide an accounting for disclosures before April 14, 2003 or for more than six years prior to the date of your request.
F) If you have received this Notice electronically, you then have the right to receive a paper copy.
G) Your request for any of the above must be in writing. We may deny your request and, if so, you may request a review of the denial. We will however make every attempt to honor your request. A nominal fee for copying, and/or supplies would be applied if there were more than one request per year.
IV. Our Duties In Protecting Your PHI:
A) We are required by law to maintain the privacy of your PHI.
B) We must inform patients or their legal representatives of our legal duties and privacy practices with respect to PHI. This Notice discharges that duty.
C) We must abide by the terms of the Notice currently in effect.
D) We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all PHI that we maintain. You may obtain a copy of the current Notice form at any time.
V. Complaints, Contact Person, Effective Date, and Acknowledgment:
A) You may complain to us and to the Commission d’accès à l’information of Québec if you believe your privacy rights have been violated.
B) You will not be retaliated against for filing a complaint.
C) You may file your request or complaint with our Company by writing to us at: