The Gift of Life Foundation
1348
Carmichael Way
Montgomery, Alabama 36106
Phone: (334) 272-1820
NOTICE OF PRIVACY PRACTICES
Effective April 14, 2003
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.
Under
the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) we
are required to maintain the privacy of your protected health information and
provide you with notice of our legal duties and privacy practices with respect
to such protected health information.
We
will take reasonable measures to abide by the terms of this Notice of Privacy
Practices. We may change the terms
of our notice at any time. The new
notice will be effective for all protected health information that we maintain
at that time. You may ask questions
or obtain a copy of the notice by contacting our Privacy Officer at (334)
272-1820.
Permitted
Uses and Disclosures of Your Health Information
1.
General Uses and Disclosure. Under the Privacy Rules, we are permitted to use and disclose
your Health Information for the following purposes and in support of the
following, without obtaining your permission, unless more stringent state or
federal laws apply:
·
Treatment: We are permitted to use
and disclose your Health Information in the provision and coordination of your
health care. For example, we may
disclose your Health Information to your physician, hospital and to other health
care providers who have a need for such information for your care and treatment.
·
Payment:
We are permitted to use and disclose your Health Information for the
purposes of determining coverage, billing, and reimbursement.
For example, your provider may submit a claim to us for payment.
The claim form will include information that identifies you, your
diagnosis, and treatment or supplies used in the course of treatment.
·
Health Care Operations: We are
permitted to use and disclose your Health Information for our health care
operations. Health care operations
include, but may not be limited to, quality assessment and improvement
activities, management and general administrative activities.
For example, we may call your name in the waiting room when a GOL
representative is ready to see you; you may be asked to use a sign-in sheet at a
registration desk; or a letter, phone, or home visit may be used to remind you
or your appointment or provide a required visit.
·
Business Associates: We are permitted to use
and disclose your Health Information with a third party “Business Associate”
that performs various activities (e.g., billing, quality assurance, peer
review). Whenever an arrangement
between our office and a business associate involves the use or disclosure or
your protected health information we will have a written contract that contains
terms that will protect the privacy of your protected health information.
·
Required by Law: We are permitted to
disclose your Health Information when required to do so by federal, state or
local law (e.g., in response to a subpoena, discovery request, or other lawful
order from a court.)
·
Public Health: We are permitted to
disclose your Health Information to public health or legal authorities charged
with preventing or controlling disease, injury or disability.
·
Communicable Disease: We are permitted to
disclose your Health Information, if authorized or required by law, to a person
who may have been exposed to a communicable disease or are at risk of
contracting or spreading the disease or condition.
·
Health Oversight Activities: We may
disclose protected health information to a health oversight agency for
activities authorized by law, such as audits, investigations, licensure and
inspections. Oversight activities
seeking this information include government agencies such as Medicaid that
oversee the health care system; government benefits program, other government
regulatory programs and civil rights laws.
·
Food and Drug Administration (FDA): We
are permitted to disclose to the FDA your Health Information relative to adverse
events with respect to food, supplements, product defects or problems, or post
marketing surveillance information to enable product recalls, repairs, or
replacement.
·
Abuse or Neglect: We are permitted to
disclose your Health Information to a local, state, or federal government
authority if we have reasonable belief that abuse, neglect or domestic violence
as occurred.
·
Law Enforcement: We may disclose your
Health Information when requested by a law enforcement official as part of law
enforcement activities; investigations of criminal conduct; in response to court
orders; in emergency circumstances; or when required to do so by law.
·
Coroners, Funeral Directors, and Organ Donation: We may disclose your Health Information to a coroner, medical
examiner, or funeral director consistent with applicable law to carry our their
duties; or to an organ procurement organization for procurement, banking, or
transplantation or cadaver organs, eyes, or tissue for the purpose of
facilitating donation and transplantation.
·
Research: We may disclose your
Health Information to researchers when their research has been approved by an
institutional review board that has reviewed the research proposal and
established protocols to ensure the privacy of your protected health
information.
·
Criminal Activity: Consistent with
applicable federal and state laws, we may use and disclose health information
when necessary to prevent a serious threat to your health and safety or the
health and safety or the public or another person.
·
Military, Veterans, and National Security: When appropriate conditions apply, we may use or disclose
Health Information of individuals who are Armed Forces personnel (1) for
activities deemed necessary by appropriate military command authorities; (2) for
eligibility determination of VA benefits, or (3) to foreign military authority
if you are a member of that foreign military services.
We may also disclose your Health Information to authorized federal
officials for conducting national security and intelligence activities,
including for the provision of protective services to the President or others
legally authorized.
·
Workers’ Compensation: We may
disclose your Health Information to the extent authorized to comply with
workers’ compensation laws and other similar legally established programs.
·
Inmates:
If you are an inmate of a correctional institution or under the custody
of a law enforcement official, we may release your Health Information to the
institution or official, where such information is necessary.
2. Uses and Disclosures Which Require an Opportunity to
Verbally Agree or Object. Except
in emergency situations, you will be notified in advance and have opportunity to
verbally agree or object to the following use and disclosure of your Health
Information.
·
Communication with Family or Friends: Our
service professionals, using their best judgment, may disclose to a family
member, other relative, close personal friend, or any other person you identify,
health information relevant to that person’s involvement in your care or
payment related to your care.
·
Marketing: We may use or disclose
your Health Information, as necessary, to provide you with information about
health care and health-related benefits and services that may be of interest to
you.
3. Uses and Disclosures Which Require Your Written
Authorization. As required
by the Privacy Rules, all other uses and disclosures of your Health Information
(not described above) will be made only with your written permission, which is
called an Authorization. You
may revoke this authorization, at any time, in writing, except to the extent
that action has been taken in reliance on the use or disclosure indicated in the
authorization.
Your
Rights
The
following describes your rights regarding the Health Information we maintain
about you. To exercise your rights,
you must submit your request in writing to our Privacy Officer at 1348
Carmichael Way, Montgomery, Alabama 36106.
Right
to Request Restrictions. You have the right to
request that we restrict uses or
disclosures of your health information to carry out treatment, payment, health
care operations, or communications with family or friends. We are not required to agree to a restriction.
Right
to Receive Confidential Communications. You
have the right to request that we send communications that contain your health
information by alternative means or to alternative locations.
We must accommodate your request if it is reasonable and you clearly
state that the disclosure of all or part of that information could endanger you.
Right
to Inspect and Copy. You have the right to
inspect and copy heath information that we maintain about you in a designated
record set. A “designated record
set” is a group of records that we maintain such as enrollment, payment, and
claims adjudication record systems. If
copies are requested or you agree to a summary or explanation of such
information, we may charge a reasonable, cost-based fee for the costs of
copying, including labor and supply cost of copying; postage; and preparation
cost of an explanation or summary, if such is requested.
We may deny your request to inspect and copy in certain circumstances as
defined by law. If you are denied
access to your health information, you may request that the denial be reviewed.
Right
to Amend.
You have the right to have us amend your health information for as long
as we maintain such information. Your
written request must include the reason or reasons that support your request.
We may deny your request for an amendment if we determine that the record
that is the subject of the request was not created by us, is not available for
inspection as specified by law, or is accurate and complete.
Right
to Receive an Accounting of Disclosures. You
have the right to receive an accounting of disclosures of your health
information made by us in the six years prior to the date the accounting is
requested (or shorter period as requested).
This does not include disclosures made to carry out treatment, payment
and health care operations; disclosures made to you; communications with family
and friends; for national security or intelligence purposes; to correctional
institutions or law enforcement officials; or disclosures made prior to HIPAA
compliance date of April 14, 2003. Your
first request for accounting in any 12-month period shall be provided without
charge. A reasonable, cost-based
fee shall be imposed for each subsequent request for accounting within the same
12-month period.
Right
to Obtain a Paper Copy. You have the right to
obtain a paper copy of this Notice of Privacy Practices at any time.
Complaints
You
may contact us or the Secretary of Health and Human Services if you believe your
privacy rights have been violated by us. You
may file a grievance with us or get further information about the complaint
process by notifying our Privacy Officer at The Gift of Life Foundation, 1348
Carmichael Way, Montgomery, Alabama 36106.
We will not retaliate against you for filing a complaint.
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