Blue Valley Lutheran Homes Society, Inc. 

                                        P.O. Box 166 ∙ Hebron, NE  68370-0166 

 

      NOTICE OF PRIVACY INFORMATION PRACTICE 

  

THIS NOTICE DESCRIBES HOW PHI (PROTECTED HEALTH INFORMATION) ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY. 

  

This notice takes effect on April 14, 2003 and remains in effect until we replace it.  

  

OUR PLEDGE REGARDING MEDICAL INFORMATION: 

The privacy of you PHI (Protected Health Information) is important to Blue Valley Lutheran Homes Society, Inc.  We understand that your PHI (Protected Health Information) is personal and we are committed to protecting it.  We create a record of the care and services you receive at our facilities.  We need your record of PHI (Protected Health Information) to provide you with quality care and to comply with certain legal requirements.  This notice will tell you about the ways we may use and share PHI (Protected Health Information) about you.  We also describe your rights and certain duties we have regarding the use and disclosure of PHI (Protected Health Information).  

OUR LEGAL DUTY: 

            Law Requires Us to:  

1.      Keep your PHI (Protected Health Information) private. 

2.      Give you this notice describing our legal duties, privacy practices and your rights regarding your PHI (Protected Health Information). 

3.      Follow the terms of the notice that is now in effect. 

We Have the Right to: 

1.      Change our privacy practices and the terms of this notice at any time, provided that law permits the changes. 

2.      Make changes in our privacy practices and the new terms of our notice effective for all PHI (Protected Health Information) that we keep including information previously created or received before the changes. 

Notice of Change to Privacy Practices: 

1.      Before we make an important change in our privacy practices we will change this notice and make the new notice available upon request. 

WHO WILL FOLLOW THIS NOTICE? 

1.      Any healthcare professional authorized to enter information into your chart. 

2.      All Departments and units of Blue Valley Lutheran Homes Society, Inc. 

3.      Any member of a volunteer group we allow to help you while you are in Blue Valley Lutheran Homes Society, Inc. 

4.      All employees, staff and other Blue Valley Lutheran Homes Society, Inc. personnel. 

  

All these entities, sites and locations follow the terms of this notice.  In Addition, these entities, sites and locations may share medical information with each other for the treatment, payment and homes operations described in this Notice. 

Each time you receive care at Blue Valley Lutheran Homes Society, Inc. a record is made of your visit.  Your medical record may include your symptoms, what was found during your physicals, test results, diagnoses, treatment given and a plan for the future care of treatment.  Your financial record may include facts about your bill and insurance.  Together this is called your PHI (Protected Health Information).  

USE AND DISCLOSURE OF YOUR MEDICAL INFORMATION: 

The following section describes different ways that we use and disclose PHI (Protected Health Information).  Not every use or disclosure will be listed.  However, we have listed all of the different ways we are permitted to use and disclose PHI (Protected Health Information).  We will not use or disclose your PHI (Protected Health Information) for any purpose not listed below without your specific written authorization.  Any specific written authorization you provide may be revoked at any time by writing to us. 

A.     For Treatment:  We may use PHI (Protected Health Information) about you to provide you with medical treatment or services.  We may disclose PHI (Protected Health Information) about you to doctors, physician's assistant, nurse practitioner, nurses, technicians or other people who are taking care of you.  We may also share PHI (Protected Health Information) about you to your other health care providers to assist them in treating you. 

B.     For Payment:  We may use and disclose your PHI (Protected Health Information) for payment purposes. 

C.     For Health Care Operations:  We may use and disclose your PHI (Protected Health Information) for our health care operations.  This might include measuring and improving quality, evaluating the performances of employees, conducting training programs and getting the accreditation certificates, license and credentials we need to serve you.  

  

ACCESS TO ACCESS AND COPY PHI (Protected Health Information):  

You have the right to access your PHI (Protected Health Information) within 24 hrs upon an oral or written request and after receipt of your PHI for inspection.  If the patient/guardian requests a copy of the PHI or agrees to a summary or explanation of such information, Blue Valley Lutheran Homes Society, Inc. may charge a reasonable, cost-based fee supplies and labor for copying and postage.  Blue Valley Lutheran Homes Society, Inc. may also charge a fee for preparing an explanation or summary of the PHI (if agreed to by the patient in advance). 

  

Blue Valley Lutheran Homes Society, Inc. denies access, in whole or in part, to PHI, Blue Valley Lutheran Homes Society, Inc. must, to the extent possible, give the patient/guardian access to any other PHI requested, after excluding the PHI as to which Blue Valley Lutheran Homes Society, Inc. has a ground to deny access.  Blue Valley Lutheran Homes Society, Inc. must provide a timely, written denial to the patient/guardian.  The denial must be in plain language and contain: 

1.      The basis for the denial. 

2.      A statement of the patient's review rights, including a description of how the patient may exercise such review rights; and 

3.      A description of how the patient may complain to Blue Valley Lutheran Homes Society, Inc. (see Complaint policy) or to the Secretary of Health and Human pursuant to the procedures in §160.306.  The description must include the name, or title, and telephone number of the contact person or office designated for complaints (see Complaint policy). 

4.      Guardian of Patient denies request for access. 

  

            If Blue Valley Lutheran Homes Society, Inc. does not maintain the PHI that is the subject of the patient's request for access, and Blue Valley Lutheran Homes Society, Inc. knows where the requested PHI is maintained (i.e. business associate), Blue Valley Lutheran Homes Society, Inc. must inform the patient where to direct the request for access. 

  

All requests for access must be submitted to PRIVACY OFFICER, or his or her designee, for the purpose of accepting or denying the requests.  PRIVACY OFFICER shall develop and maintain a Patient Information Request Form to document request for access to PHI. 

  

            If Blue Valley Lutheran Homes Society, Inc. grants a request for access, Blue Valley Lutheran Homes Society, Inc. must provide the access requested by the patient, including inspection or obtaining a copy, or both, of the PHI about them in the designated record sets.  If the patient requests a copy of the PHI or agrees to a summary or explanation of such information, Blue Valley Lutheran Homes Society, Inc. may charge a reasonable, cost-based fee supplies and labor for copying and postage.  Blue Valley Lutheran Homes Society, Inc. may also charge a fee for preparing an explanation or summary of the PHI (if agreed to by the patient in advance). 

  

YOUR PROTECTED HEALTH INFORMATION SERVES AS A: 

1.      Basis for planning your care and treatment. 

2.      Means of communication among many health professionals who have a role in your care. 

3.      Legal document describing the care you received. 

4.      Record by which you or your insurance company can check that services billed were provided. 

5.      Source of information to: 

                                                             a.      Educate health professionals. 

                                                             b.      Provide data for medical research. 

                                                             c.      Improve public health. 

                                                             d.      Plan and market Blue Valley Lutheran Homes Society, Inc. 

                                                             e.      Improve the care we give. 

  

UNDERSTANDING HOW YOUR PROTECTED HEALTH INFORMATION IS USED HELPS YOU TO: 

1.      Ensure accuracy. 

2.      Follow the agreed-upon treatment plan. 

3.      Know who, what, when, where and why others may use all or part of your protected health information. 

4.      Make a more informed decision when giving permission to share information with appropriate companies, agencies and healthcare workers. 

YOUR PROTECTED HEALTH INFORMATION RIGHTS: 

Although your medical records and financial records are the property of Blue Valley Lutheran Homes Society, Inc. (BVLH'S), the information belongs to you.  BVLH'S complies with all federal and state laws and regulations that apply to this topic.  We have policies that give you the right to request in writing your desire to: 

1.      Restrict with whom we may share your protected health information. 

2.      Look at and get all or part of your protected health information. 

3.      Obtain an accounting of disclosures of your protected health information. 

4.      Request to amend your protected health information. 

5.      Have us communicate with you in a certain way or at a certain location. 

6.      Change your mind about sharing your protected health information except for what has already been shared. 

OUR RESPONSIBILITIES: 

Blue Valley Lutheran Homes Society, Inc. is required to: 

1.      Protect the privacy of your protected health information. 

2.      Provide you with a current copy of the Notice of Privacy Rights and Practices. 

3.      Do what we say we'll do in this notice. 

4.      Notify you if we are unable to agree to your written request, Blue Valley Lutheran Homes Society, Inc. will honor resident requests whenever possible. 

We will use and share your protected health information only with your permission, except as described in the Notice or as required by state or federal regulations.  We have the right to change this Notice and apply it to the protected health information we already have about you and any we receive in the future. 

  

EXAMPLES OF SHARING INFORMATION FOR TREATMENT, PAYMENT AND THE OPERATION OF BLUE VALLEY LUTHERAN HOMES SOCIETY, INC.: 

1.      We will use your protected health information for Treatment. 

For example: 

a.       Information obtained by a nurse, doctor or other member of your healthcare team will be written in your medical record and used to determine the treatment that should work best for you.  Members of your healthcare team will document their actions, your progress and response to treatment. 

b.       We will provide any facility or provider involved in your care with information that may assist in your treatment. 

c.       When you are no longer receiving care at BLVH, we will provide information to any healthcare provider that cares for you.  These copies of your medical record help them continue your plan of care after dismissal. 

2.      We will use your protected health information for Payment.  

For example: 

a.       We will send a bill to you and/or your insurance company.  The information may include your name, diagnosis, procedures and supplies used. 

b.       We will provide needed information to other healthcare providers for their billing purposes.  For example, if you are brought in by ambulance, the information collected will be given to the ambulance provider for their billing purposes. 

3.      We will use your protected health information for the Operation of BVLH'S. 

                   For example: 

a.       BVLH'S staff members may use information in your medical record to assess the results of your care.  This information is used to improve the services we provide. 

b.       BVLH may share your protected health information with other healthcare providers for their operations if they have or had a relationship with you. 

4.      We will allow our business associates to use your protected health information if needed.  

For example: 

a.       People or companies, known as business associates, who are not employed by us, provide some services. 

b.       BVLH requires business associates to protect patient's health information. 

5.      We may provide information about you in the facilities directories. 

                    For example: 

a.       Unless you tell us not to, we may use your name, location, general condition and religious affiliations for directory purposes in terms that do not communicate specific medical information about you.  The directory information may also be released to people who contact Blue Valley Lutheran Homes Society, Inc. and ask for you by name.  This is so your family, friends and the clergy may visit you in Blue Valley Lutheran Homes Society, Inc.  We may also use your name on a nameplate next to or on your door to identify your room, unless you notify us that you object. 

6.      We may give your protected health information to individuals involved in your care or payment for your care. 

For example: 

a. Health professionals, using their best judgment, may release protected health information about you to a family member, close personal friend or any other person identified by you as being involved in your medical care or who is involved in the payment of your care.    

7.      We may use your protected health information for fundraising activities.  

For example: 

                                                             a.      We may use medical information about you to contact you in an effort to raise money for Blue Valley Lutheran Homes Society, Inc. and its operations. 

                                                             b.      If you don't want to be contacted for fundraising efforts you must contact Blue Valley Lutheran Homes Society, Inc. in writing. 

8.   We will provide your protected health information to coroners, medical examiners and funeral directors. 

                    For example:       

                                                             a.      Identify a deceased person. 

                                                             b.      Allow funeral directors to carry out their duties. 

9.      We will share your protected health information with organ transplant organizations. 

For example: 

a. Following state law, we will share protected health information with organizations or groups that manage, bank or transplant organ and tissue donations. 

10.   We will share protected health information about you to assist public health activities or as required by law. 

For example: 

        a. Prevent or control disease, injury or disability. 

        b. Report births, deaths and child abuse and neglect. 

        c.             Report reactions to medications or problems with faulty products. 

        d. Notify a person who may have been exposed to a disease or may be at risk for getting or spreading a disease or condition. 

        e. Notify an appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. 

11.   We will give your protected health information to law enforcement. 

For example: 

a.   In response to a court order, subpoena, warrant, summons or similar 

      process. 

                                    b.   If we suspect you are a victim of an accident or crime. 

                                    c.   If death occurs, which we believe may be the result of a crime. 

                          d.   In an emergency to report a crime committed on the premises; the  

                                location of the crime or victims; or identity; description or location of                      

                              the person who committed the crime. 

  

ORGANIZED HEALTH CARE ARRANGEMENT  

Blue Valley Lutheran Homes Society, Inc. staff and independent providers who belong to the Medical Staff must be able to share protected health information freely for treatment, payment and health care operations.  Therefore, each eligible provider on Blue Valley Lutheran Homes Society, Inc. medical staff has entered into an "Organized Health Care Arrangement" or OHCA.  Under the OHCA, each provider will: 

·         Use a joint notice of privacy practices (this Notice) for all inpatient and outpatient visits. 

·         Obtain a single signed acknowledgement of receipt. 

·         Share protected health information from inpatient and outpatient hospital visits with eligible providers so that they can help the hospital with its health care operations. 

·         Follow the privacy and information practices described in the Notice.  Each OHCA participant is individually responsible to follow the practices in this Notice. 

  

Complaints or questions about your privacy rights must be made in writing to the Privacy Officer at Blue Valley Lutheran Homes Society, Inc., P.O. Box 166, Hebron, NE. 68370.  If you have questions with regard to the contents of this Notice, please call 402-768-6045. 

  

If you believe your privacy rights have been violated, you have the right to file a complaint in writing with the Secretary of Health and Human Services.  Nothing will be held against you for filing a complaint. 

  

  

Reference: Code of Federal Register 164.520/1-23-03 

4-13-03/Version 1