INFO LINE’S TELEPHONE REASSURANCE SERVICE
NOTICE OF PRIVACY PRACTICES
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.
If you have any questions about this notice please contact:
Mary Lynne Zahler, Manager - Lifeline, I&R, and 211, at 330-762-0609.
Info Line’s Telephone Reassurance Service is required by law to take reasonable steps to ensure the privacy of your personally identifiable health information. This notice describes how we protect the personal health information that we have about you which relates to your Telephone Reassurance service and how we may use and disclose this information. This notice also describes your rights with respect to your personal health information and how you can exercise those rights. More specifically, this notice is intended to inform you about:
Info Line’s uses and disclosures of Protected Health Information (PHI);
Your privacy rights with respect to your PHI;
Info Line’s duties with respect to your PHI;
Your right to file a complaint with Info Line and to the Secretary of the U.S. Department of Health and Human Services; and
The person or office to contact for further information about Info Line’s privacy practices.
Please read this notice carefully.
I. Uses and Disclosures of PHI.
We understand that the health information that we have about you is personal. Therefore, we protect this information from inappropriate use or disclosure. Our employees are required to keep your information confidential and to only disclose this information when necessary for treatment, our own operations or for payment, when applicable.
Treatment. We may use and disclose health information about you to provide you with the proper assistance. We may disclose this information about you to others if necessary after telephoning you.
Our Operations. We may use or disclose health information about you for our own decisions and operations. These purposes include evaluating proper procedures, quality assurance measures and monitoring, internal audits, and responding to funding requests and requirements.
Payment. We may use and disclose health information to seek payment from third party payors for those clients whose service is paid for by someone else. We may need to give your diagnoses or health condition in order to receive payment for our service.
Treatment Alternatives. We may use and disclose health information to tell you about health-related benefits or services that may be of interest to you.
Individuals Involved in Your Care or Payment of Your Care. We may release health information about you to a family member or friend who is involved with your care.
Notification by Message. There may be times in which we attempt to reach you by telephone to discuss your personal health information or to remind you to take medications or check on you. If we do not reach you by telephone, we may leave messages regarding your personal health information on your answering machine or voice mail.
Other Uses. We may disclose your personal health information in the following circumstances if required to do so:
When required by law;
When required or permitted for public health activities
When authorized or required by law to report information about abuse, neglect or domestic violence
For health oversight activities authorized by law, such as audits, investigations, licensure or disciplinary actions and other necessary activities for oversight (for example to investigate complaints about us or to investigate Medicare or Medicaid fraud).
For lawsuits or disputes, in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested
For law enforcement purposes
To a coroner or medical examiner if necessary to identify a deceased person or determine the cause or time of death
Except as otherwise stated in this notice, uses and disclosures will be made only with your written authorization subject to your right to revoke such authorization.
II. YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU:
You have the following rights regarding the personal health information that we maintain about you.
Right to Inspect and Copy. You have the right to inspect and copy any personal health information that is contained in your file in our office.
You will be required to submit your request to inspect and copy your records in writing to: Manager, Access Services, Info Line, Inc., 474 Grant St., Akron, OH 44311. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
In very limited circumstances we may deny your request to inspect and obtain a copy of your personal health information. If we do, you may request that the denial be reviewed. The review will be conducted by an individual chosen by us who was not involved in the original decision to deny your request. We will comply with the outcome of that review.
Right to Amend. You have the right to ask us to amend the personal health information that we have about you if you feel that it is incorrect or incomplete. We will periodically ask you to update your health information but we will not change our previous records without a formal request to amend.
To request an amendment to your previous records, your request must be made in writing to: Manager, Access Services, Info Line, Inc., 474 Grant St., Akron, OH 44311.
We may deny your request if it does not include a reason to support the request or if:
It is accurate and complete;
It was not created by us, unless the person or entity that created the health information is no longer available to make the amendment;
It is not part of the personal health information kept by or for us; or
It is not part of the personal health information which you would be permitted to inspect and copy.
Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures”. This is a list of disclosures we made of medical information about you. However, such accounting will not include disclosures of your heath information made: (1) for treatment, payment or health care operations; (2) to you or your representatives about your own protected health information; (3) for disclosures which you authorized; (4) to law enforcement officers, correctional institutions or for purposes of national security and (5) prior to April 14, 2003.
To request an accounting, you must submit your request in writing to Manager, Access Services, Info Line, Inc., 474 Grant St., Akron, OH 44311. Your request must state a time period and your request should state in what form you want the list (i.e. on paper, electronically, etc). The first list that you request within a 12-month time period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions. You have a right to request a restriction or limitation on the personal health information that we use or disclose about you for treatment, payment or health care operations, or that we disclose to someone who may be involved in your care or payment for your care like a family member or friend. For example, you could ask that we not disclose that you were a particular medication.
We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
To request a restriction, you must make your request in writing to Manager, Access Services, Info Line, Inc., 474 Grant St., Akron, OH 44311. In your request, you must tell us (1) what information you want to limit, (2) whether you want to limit our use, disclosure or both, (3) to whom you want the limits to apply (for example, disclosures to your son or daughter).
Right to Request Confidential Communications. You have the right to request that we communicate with you about your health information in a certain way or at a certain location if you tell us that communication in another manner may endanger you. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing to Manager, Access Services, Info Line, Inc., 474 Grant St., Akron, OH 44311. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to File a Complaint. If you believe that your privacy rights have been violated, you may file a complaint with Info Line or with the Secretary of the Department of Health and Human Services. To file a complaint with Secretary of Health and Human Services please contact Secretary of the U.S. Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Avenue, S.W., Washington, D.C. 20201. To file a complaint with us, please contact: Mary A. Raitano, Manager, Access Services, Info Line, Inc., 474 Grant St., Akron, OH 44311. All complaints must be in writing. You will not be penalized for filing a complaint.
We reserve the right to change this notice at any time. We reserve the right to make the revised or changed notice effective for personal health information we already have about you as well as any personal health information that we may receive in the future. We will post a copy of the current notice in our lobby and on our website. The notice will contain the effective date on the first page, in the top, right corner.
You have a right to a paper copy of this notice. To obtain a copy of this notice contact Info Line, Inc. 474 Grant St., Akron, OH 44311 at 330-374-0333.
Other uses and disclosures of medical information not covered by this notice or other laws will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission in writing at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the service we have provided you.
Info Line, Inc. - Bringing people and services together since 1975
703 South Main Street # 211 • Akron OH 44311 • Administration: 330.762.5627 • FAX: 330.253.1137
© 2001 -2008 Info Line, Inc., Akron OH 44311. All rights reserved.
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