Notice of Privacy Practice

This notice describes how information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Understanding Your Health Record/Information:

Your health or medical record contains protected health information; such as notes about your symptoms, examination and test results, diagnoses, treatments, and plan for future care or treatment. Federal and State law recognize the importance of the privacy of your records.
This Notice describes the privacy practices of any individual authorized to enter information into your MedSource Health Care System medical record, including the practices of all of MedSource Health Care System employees, health care professionals, and other staff or personnel, as well as all offices and branches of MedSource Health Care System

OUR PLEDGE REGARDING YOUR MEDICAL INFORMATl0N:

MedSource Health Care System uses the medical record that we create in the course of providing quality home health care and services to you so that we may comply with certain legal requirements. MedSource Health Care System understands that medical information about you and your health is personal. We are committed to protecting your medical information.

This Notice applies to all records of your care generated by MedSource Health Care System, whether made by MedSource Health Care System personnel or by your personal doctor. Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your medical information which was or is created in the doctor’s office or clinic.

MedSource Health Care System is required by law to:

Make sure that medical information that identifies you is kept private;
Give you this Notice of our legal duties and privacy practices with respect to your medical information;
Follow the terms of the current Notice.

HOW WE MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION:

The following categories describe different ways that MedSource Health Care System uses and discloses medical information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

For Treatment. We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, or other home health agency personnel who are involved in taking care of you in the home. For example, a doctor referring you for home care for a non-healing wound would need to communicate to your nurse if you have diabetes because diabetes may slow the healing process. In addition, the nurse may need to tell the dietitian or home health aide if you have diabetes so that we can arrange for appropriate meals.
For Payment: We may use and disclose medical information about you so that the treatment and services you receive from the home health agency may be billed and payment may be collected from you, an insurance company or a third party. Fat example, we may need to give your health-plan information about care you received in the home so that your health plan will pay us or reimburse you for the care. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment
For Health Care Operations: We may use and disclose medical information, about you for health care operations. These uses and disclosures are necessary to run the home health agency and make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you.
We may also share information with doctors, nurses, and other home heath agency personnel for utilization review and earning purposes.
We may also compare medical information we have with medical information from other home health agencies as part of MedSource Home Care System’s ongoing quality improvement efforts.
Treatment Alternatives. We may use and disclose medical information to tell you about or recommend, possible treatment options or alternatives that may be of interest to you.
Health-Related Benefits and Services. We may use and disclose medical information to tell you about health related benefits or services that may be of interest to you.
Individuals Involved in Your Care or Payment for Your Care. We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care.
We may also tell your family or friends your condition and that you are receiving home health care.
In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location, if moved.
As Required By Law. We will disclose medical information about you when we are required to do so by federal, state or local law.
To Avert a Serious threat to Health or Safety. We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.

SPECIAL SITUATIONS

Organ and Tissue Donation: If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Workers Compensation: We may release medical information about you for workers compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Public Health Risks: We may disclose medical information about you for public health activities. These activities generally include the following:
- to prevent or control disease injury or disability;
- to report births and deaths;
- to report child abuse or neglect;
- to report reactions to medications or problems with products;
- to notify people of recalls of products they may be using;
- to notify a person who may have been exposed to a disease or may be, at risk for contracting or spreading a disease or condition;
- to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence.
Health Oversight Activities: We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system government programs, and compliance with civil rights laws.
Lawsuits and Disputes: State laws vary as to what is required before we may release your medical information when you are involved in a lawsuit or a dispute. In many states, we may disclose medical information about you in response to a court or administrative order.We may also disclose medical information about you in response to a lawful subpoena, discovery request or other lawful process by someone else involved in the dispute, but only if adequate notice has been provided to you about the request for release or disclosure of your records.
1. Law Enforcement. We may release medical information if asked to do so by a law enforcement official;
2. In response to a court order, warrant, summons or similar process;
3. To identify or locate a suspect, fugitive material witness, or missing person;
4. About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
5. About a death we believe may be the result of criminal conduct: and in emergency circumstances to report a crime; the location of the crime or victims; or the identity description or location of the person who committed the crime.
6. Coroners, Medical Examiners and Funeral Directors. We may release medical information to a coroner or medical examiner.

You have the following Rights regarding Your Medical Information:

Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care. Often this includes medical and billing records, but usually does not include psychotherapy notes. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to MedSource Health Care System. If you request a copy of the information, we may charge a fee for the costs of copying mailing, etc. associated with your request. We may deny your request to inspect and copy in certain very limited circumstances.
Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask MedSource Health Care System to amend the information. You have the right to request an amendment for as long as the information is kept by MedSource Health Care System. To request an amendment, your request must be made in writing and submitted to MedSource Health Care System. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason: to support the request. In addition, we may deny your request if you ask us to amend information that:
- Was not created by us, unless the person or entity that created the information is no longer available
  to make the amendment;
- Is not part of the medical information kept by MedSource Health Care System;
- Is not part of the information which you would be permitted to inspect and copy; or
- Is accurate and complete.
You may also request that the denial be reviewed. Another licensed health care professional chosen by MedSource Health Care System will review your request and the denial. The person conducting the review will not be the person who denied your request. MedSource Health Care System will comply with the outcome of the review.
Right to an Accounting of Disclosures. You have the right to request an accounting of disclosures by MedSource Health Care System. This is a list of the disclosures of your medical information by MedSource Health Care System. To request this list or accounting of disclosures, you must submit your request in writing to MedSource Health Care System. Your request must state a time period which may not be longer than six years. Your request should indicate in what format you want the list. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list.
Right to Request Restrictions. You have the right to request a limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in treatment or payment for your care. To request restrictions, you must make your request in writing to MedSource Health Care System, and you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply (for example disclosures to your spouse).

We are not required to agree to your request. If we agree, we will comply with your request unless the information is needed to provide you emergency treatment
Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. To request confidential communications, you must make your request in writing to MedSource Health Care System and must specify how or where you wish to be contacted. We will not ask you the reason for your request. We will accommodate all reasonable requests.

CHANGES TO THIS NOTICE

We reserve the right to change this Notice. We reserve the right to make the revised Notice effective for medical information we already have about you; as well as any information we receive in the future. We will post a copy of the current Notice in the MedSource Health Care System agency branches. The Notice will contain the effective date on the top of the first page.

COMPLAINTS

If you believe our privacy rights have been violated, you may file a complaint with the home health agency or with the Secretary of the Department of Health and Human Services. To file a complaint with MedSource Health Care System, you may call 1-800-458-9858 for information about the handling of complaints. The same persons are listed on the first page as contacts for more information about this Notice.

All complaints must be submitted in writing. You will not be penalized for filing a complaint.

Written complaints may be faxed to : 972-572-9782 or mailed to:
MedSource Health Care System

8100 Liberty Grove Rd., Suite 100 Rowlett, Texas 7508

ATTN: HIPAA COMPLAINTS