Medical Privacy Policy

Clients - Joint Notice of Privacy Practices:
Effective Date: 7/01/17
THIS JOINT 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 are required by law to maintain the privacy of your health information and to give you notices
of our legal duties and privacy practices with respect to your protected health information. This Joint Notice
summarizes our duties and your rights concerning your protected health information. We are required to abide
by the terms of our Joint Notice that is currently in effect.
Uses and Disclosures of Information That We May Make Without Written Authorization. We may use or
disclose protected health information for the following purposes without your written authorization. These
examples are not meant to be exhaustive.
1. Treatment: We may use or disclose protected health information to provide treatment to you. For
example; doctors or agency staff may use information in your medical records to diagnose or treat
your condition. Also, we may disclose your information to health care providers outside the agency
so that they may help treat you.
2. Payment: For billing and collections purposes for services rendered, we may use or disclose
protected health information. For example; insurance companies may use information in your
medical file such as progress notes, care plans and/or doctor’s orders to process and issue
payment for services.
3. Health Care Operations: We may use or disclose protected health information for certain health
care operations that are necessary to ensure that our patients receive quality care. For example; we
may use information from your medical records to review the performance or qualifications of
physicians and staff; train staff; or make business decisions affecting the agency and its services.
4. Required by law: We may use or disclose protected health information to the extent that such use
or disclosure is required by law.
5. Threat to Health or Safety: We may use or disclose protected health information to avert a serious
threat to your health and safety or the health and safety of others.
6. Abuse or Neglect: We must disclose protected health information to the appropriate government
agency if we believe it is related to child abuse or neglect, or if we believe that you have been a
victim of abuse, neglect or domestic violence.
7. Communicable Diseases: We are required to disclose protected health information concerning
certain communicable diseases to the appropriate government agency. To the extent authorized by
law, we may also disclose protected information to a person who may have been exposed to a
communicable disease or may otherwise be at risk of contracting or spreading the disease or
condition.
8. Public Health Activities: We may use or disclose protected health information for certain public
health activities, such as reporting information necessary to prevent or control disease, injury or
disability; reporting births and deaths; or reporting limited information for FDA activities.
9. Health Oversight Activities: We may disclose protected health information to governmental health
oversight agencies to help them perform certain activities authorized by law, such as audits,
investigations, and inspections.
10. Judicial and Administrative Proceedings: We may disclose protected health information in response
to an order of a court or administrative tribunal. We may also disclose protected information in
response to a subpoena, discovery request or other lawful process if we receive satisfactory

R07-2024

assurances from the person requesting the information that they have made efforts to inform you of
the request or to obtain a protective order.
11. Law Enforcement: We may disclose protected health information, subject to specific limitations, for
certain law enforcement purposes, including to identify, locate, or catch a suspect, fugitive, material
witness or missing person; to provide information about the victim of a crime; to alert law
enforcement that a person may have died as a result of a crime; or to report a crime.
12. National Security: We may disclose protected health information to authorized federal officials for
national security activities.
13. Coroners and Funeral Directors: We may disclose protected health information to a coroner or
medical examiner to identify a deceased person, determine cause of death, or permit the coroner or
medical examiner to fulfill their legal duties. We may also disclose information to a funeral director
to allow them to carry out their duties.
14. Organ Donation: We may use or disclose protected health information to organ procurement
organizations or other entities engaged in the procurement, banking, or transplantation of cadaveric
organs or tissue.
15. Research: We may use or disclose protected health information for research if approved by an
institutional review board or privacy board and appropriate steps have been taken to protect the
information.
16. Workers' Compensation: We may disclose protected health information as authorized by workers'
compensation laws and other similar legally-established programs.
17. Appointments and Services: We may use or disclose protected health information to contact you to
provide appointment reminders, or to provide information about treatment alternatives or other
health-related benefits and services that may be of interest to you.
18. Marketing: We may use or disclose protected health information for limited marketing activities,
including face-to-face communications with you about our services.
19. Business Associates: We may disclose protected health information to our third party business
associates who perform activities involving protected health information for us, i.e., billing services.
Our contracts with the business associates require them to protect your health information.
20. Military: If you are in the military, we may disclose protected health information as required by
military command authorities.
21. Inmates or Persons in Police Custody: If you are an inmate or in the custody of law enforcement,
we may disclose protected health information if necessary for your health care; for the health and
safety of others; or for the safety or security of the correctional institution.

Uses and Disclosures of Information That We May Make Unless You Object. We may use and disclose
protected health information in the following instances without your written authorization unless you object. If
you object, please notify the Privacy Contact identified below.
1. Persons Involved in Your Health Care: Unless you object, we may disclose protected health information
to a member of your family, relative, close friend, or other person identified by you who is involved in
your health care or the payment for your health care. We will limit the disclosure to the protected health
information relevant to that person’s involvement in your health care or payment.
2. Notification: Unless you object, we may use or disclose protected health information to notify a family
member or other person responsible for your care of your location and condition. Among other things,
we may disclose protected health information to a disaster relief agency to help notify family members.
Uses and Disclosures of Information That We May Make With Your Written Authorization. We will obtain a
written authorization from you before using or disclosing your protected health information for purposes other
than those summarized above. You may revoke your authorization by submitting a written notice to the Privacy
Contact identified below.
Your Rights Concerning Your Protected Health Information. You have the following rights concerning your
protected health information. To exercise any of these rights, you must submit a written request to the Privacy
Contact identified below.

R07-2024
1. Right to Request Additional Restrictions. You may request additional restrictions on the use or
disclosure of your protected health information for treatment, payment or health care operations. We
are not required to agree to a requested restriction. If we agree to a restriction, we will comply with the
restriction unless an emergency or the law prevents us from complying with the restriction, or until the
restriction is terminated.
2. Right to Receive Communications by Alternative Means. We normally contact you by telephone, text
messaging or mail at your home address. You may request that we contact you by some other method
or at some other location. We will not ask you to explain the reason for your request. We will
accommodate reasonable requests. We may require that you explain how payment will be handled if an
alternative means of communication is used.
3. Right to Inspect and Copy Records. You may inspect and obtain a copy of protected health information
that is used to make decisions about your care or payment for your care. We may charge you a
reasonable cost-based fee for providing the records. We may deny your request under limited
circumstances, e.g., if you seek psychotherapy notes; information prepared for legal proceedings; or if
disclosure may result in substantial harm to you or others.
4. Right to Request Amendment to Record. You may request that your protected health information be
amended. You must explain the reason for your request in writing. We may deny your request if we did
not create the record unless the originator is no longer available; if you do not have a right to access
the record; or if we determine that the record is accurate and complete. If we deny your request, you
have the right to submit a statement disagreeing with our decision and to have the statement attached
to the record.
5. Right to an Accounting of Certain Disclosures. You may receive an accounting of certain disclosures
we have made of your protected health information within six years prior to the date of your request.
We are not required to account for disclosures for treatment, payment, or health care operations; to
family members or others involved in your health care or payment; for notification purposes; or pursuant
to our facility directory or your written authorization. We may charge a reasonable cost-based fee for all
subsequent requests during that 12-month period.
Right to a Copy of This Joint Notice. You have the right to obtain a paper copy of this Joint Notice upon
request. You have this right even if you have agreed to receive the Joint Notice electronically.
Changes to This Joint Notice. We reserve the right to change the terms of our Joint Notice of Privacy Practices
at any time, and to make the new Notice provisions effective for all protected health information that we
maintain. If we materially change our privacy practices, we will prepare a new Joint Notice of Privacy Practices,
which shall be effective for all protected health information that we maintain. We will post a copy of the current
Joint Notice in the agency and on our website. You may obtain a copy of the current Joint Notice by contacting
the Privacy Contact identified below.
Complaints. You may complain to us or to the Secretary of Health and Human Services if you believe your
privacy rights have been violated. You may file a complaint with us by notifying our Privacy Contact identified
below. All complaints must be in writing. We will not retaliate against you for filing a complaint.
Entities Covered By This Joint Notice. This Joint Notice of Privacy Practices applies to the Devoted to Home
agency; their affiliates and units wherever located; their employees, staff and volunteers whom we allow to
help you while you are recovering or disabled. This Joint Notice of Privacy Practices also applies members of
the Staff of Devoted to Home, who have agreed to abide by its terms concerning the services they perform in
your home. Members of your Medical Staff, including your personal physician, may have different privacy
policies or practices relating to their use or disclosure of protected health information created or maintained in

R07-2024