PRIVACY PRACTICES NOTICE
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO YOUR IDENTIFIABLE HEALTH INFORMATION.
A. Our Commitment to Your Privacy
Infinity Care Management, or "ICM", is dedicated to maintaining the privacy of your identifiable health information. In conducting our business, ICM will create records regarding you and the treatment and services ICM provide to you. ICM is required by law to maintain the confidentiality of health information that identifies you. ICM also is required by law to provide you with this notice of its legal duties ad privacy practices concerning your identifiable health information. By law, ICM must follow the terms of the notice of privacy practices that ICM have in effect at the time.
To summarize, this notice provides you with the following important information:
Ø How ICM may use and disclose your identifiable health information
Ø Your privacy rights in your identifiable health information
Ø ICM’s obligations concerning the use and disclosure of your identifiable health information.
The terms of this notice apply to all records containing your identifiable health information that are created or retained by our business. ICM reserves the right to revise or mend our notice of privacy practices. Any revision or amendment of this notice will be effective for all of your records our business has created or maintained in the past, and for any of your records ICM may create or maintain in the future. ICM will post a copy of our current notice in our offices in a prominent location, and you may request a copy of our most current notice at any time.
B. If You Have Questions About This Notice, Please Contact:
ICM’s designated “Privacy Officer” at (855) 488-8111 . You may also request a larger print notice for sight-impaired readers.
C. ICM May Use and Disclose Your Health Information in the Following Ways:
The following categories describe the different ways in which ICM may use and disclose your identifiable health information.
1. Treatment – ICM may use your identifiable health information to treat you. You may have undergone laboratory tests and ICM may use these results to determine your plan of care. Many of the people who work for ICM ay use or disclose your identifiable health information in order to treat you or to assist others in your treatment. Additionally, ICM may disclose your identifiable health information to others who may assist in your care, such as your doctor, therapists, spouse, children, or parents.
2. Payment – ICM may use and disclose your identifiable health information in order to bill and collect payment for the services ad items you may receive from us. For example, ICM may contact your long term care insurance provider to certify that you are eligible for benefits (and for what range of benefits), and ICM may provide your insurer with details regarding your treatment/services to determine if your insurer will cover, or pay for your treatment/services. ICM also may use and disclose your identifiable health information to obtain payment from third parties that may be responsible for such costs, such as family members. Also, ICM may use your identifiable health information to bill you directly for services and items.
3. Health Care Operations – ICM may use and disclose your identifiable health information to operate our business. As examples of the ways in which ICM may use and disclose your information for our operations, ICM may use your health information to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our business.
4. Appointment Reminders (Optional) – ICM may sue and disclose your identifiable health information to contact you and remind you of visits/deliveries, etc.
5. Health-Related Benefits and Services (Optional)- ICM may use and disclose your identifiable health information to inform you of health-related benefits or services that may be of interest to you.
6. Release of Information to Family/Friends (Optional)- ICM may release your identifiable health information to a friend or family member that is helping you pay for your health care, or who assists in taking care of you.
7. Disclosures Required By Law – ICM will use and disclose your identifiable health information when ICM is required to do so by federal, state or local law.
D. Use and Disclosure of Your Identifiable Health Information in Certain Special Circumstances:
The following categories describe unique scenarios in which ICM may use or disclose your identifiable health information.
1. Public Health Risks – ICM may disclose your identifiable health information to public health authorities that are authorized by law to collect information for the purpose of:
a. Maintaining vital records, such as birth and deaths
b. Reporting child abuse or neglect
c. Preventing or controlling disease, injury or disability
d. Notifying a person regarding potential exposure to a communicable disease
e. Notifying a person regarding a potential risk for spreading or contracting a disease or condition
f. Reporting reactions to drugs or problems with products or devices
g. Notifying individuals if a product/device they may be using has been recalled
h. Notifying appropriate gov’t agencies & authorities regarding potential abuse or neglect of an adult client including domestic violence; however ICM will only disclose this data if ICM is required or authorized by law to do so
i. Notifying your employer under limited circumstances related to workplace injury, illness, or medical surveillance.
2. Health Oversight Activities – ICM may disclose your identifiable health information to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, and business licensure; civil, administrative and criminal procedures or actions; compliance with civil rights laws and the health care system in general.
3. Lawsuits and Similar Proceedings – ICM may use and disclose your identifiable health information in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. ICM also may disclose your identifiable health information in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if ICM 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 – ICM may release identifiable health information if asked to do so by a law enforcement official:
a. Regarding a crime victim in certain situations, if ICM is unable to obtain the person’s agreement
b. Concerning a death ICM believes might have resulted from criminal conduct
c. Regarding criminal conduct at our office or around our vehicles
d. In response to a warrant, summons, court order, subpoena or similar legal process
e. To identify/locate a suspect, material witness, fugitive or missing person
f. 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)
5. Serious threats to health or Safety – ICM may use and disclose your identifiable heath information when necessary to reduce or prevent a serious threat to your health or the health or safety of another individual or the public. Under these circumstances, ICM will only make disclosures to a person or organization able to help prevent the threat.
6. Military – ICM may disclose your identifiable health information if you are a member of US or foreign military forces (including veterans) and if required by the appropriate military command authorities.
7. National Security – ICM may disclose your identifiable health information to federal official for intelligence and national security activities authorized by law. ICM also may disclose your identifiable health information to federal official in order to protect the President, other officials, foreign heads of state, or to conduct investigations.
8. Workers’ Compensation – ICM may release your identifiable health information for workers’ compensation and similar programs.
E. Your rights Regarding Your identifiable Health Information:
You have the following rights regarding the identifiable health information that ICM maintains about you:
1. Confidential Communications – You have the right to request that ICM communicate with you about your health and related issues in a particular manner or at a certain location. For instance, you may ask that ICM contact you at work rather than home. In order to request a type of confidential communication, you must make a written request to ICM’s Privacy Officer at 21430 Timberlake Road #325, Lynchburg, Virginia 24502, specifying the request method or contact, or the location where you wish to be contacted. ICM 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 ICM’s use or disclosure of your identifiable health information for treatment, payment or health care operations. Additionally, you have the right to request that ICM limit our disclosure of your identifiable health information to individuals involved in your care or the payment of your care, such as family members and friends. ICM is not required to agree to your request; however if ICM does agree, ICM is 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 identifiable health information, you must make your request in writing to ICM’s Privacy Officer at 21430 Timberlake Road #325, Lynchburg, Virginia 24502. Your request must describe in a clear and concise fashion; (a) the information you wish restricted; (b) whether you are requesting to limit ICM’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 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 ICM’s Privacy Officer at 21430 Timberlake Road #325, Lynchburg, Virginia 24502, in order to inspect and/or obtain a copy of your identifiable health information. ICM will charge a fee for the cost of copying, mailing, labor and supplies associated with your request. ICM may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. A review will be conducted by another licensed health care professional chosen by us.
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 ICM. To request an amendment, your request must be made in writing and submitted to ICM’s Privacy Officer at 21430 Timberlake Road #325, Lynchburg, Virginia 24502. You must provide us with a reason that supports your request for amendment. ICM will deny your request if you fail to submit your request (and the reason supporting your request) in writing. Also, ICM may deny your request if you ask us to amend information that is: (a) accurate and complete; (b) not part of the identifiable health information kept by or for ICM (c) not part of the identifiable health information which you would be permitted to inspect and copy; or (d) not created by ICM, 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 “account of disclosures” is a list of certain disclosures ICM has made of your identifiable health information. In order to obtain an accounting of disclosures, you must submit your request in writing to ICM’s Privacy Officer at 21430 Timberlake Road #325, Lynchburg, Virginia 24502. All requests for an “Account of Disclosures” must state a time period which may not be longer than six (6) years and may not include dates before April 14, 2003. The first list you request within a 12 month period is free of charge, but ICM will charge you for additional lists within the same 12 month period. ICM will notify you of the cost involved with the 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 ICM’s Privacy Practices Notice. You may ask ICM to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact ICM’s Privacy Officer at (855) 488-8111.
7. Right to File a Complaint – if you believe your privacy rights have been violated, you may file a complaint with ICM or with the Secretary of the Dept of Health & Human Services. To file a complaint with ICM, contact ICM’s Privacy Officer at 21430 Timberlake Road #325, Lynchburg, Virginia 24502. 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 – ICM 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 ICM regarding the use and disclosure of your identifiable health information may be revoked at any time in writing. After you revoke your authorization, ICM will no longer use or disclose your identifiable health information for the reasons described in the authorization. Please note ICM is required to retain records of your care.