PRIVACY PRACTICES NOTICE
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.
Autumn Leaves® is providing this Notice of Privacy Practices because the privacy of your health information is very important to you and to us, and in compliance with federal regulations.
By “your health information” we mean the information that we maintain that specifically identifies you and your health status.
This Notice describes how we use your health information with Autumn Leaves and disclose it outside Autumn Leaves, and why. The Notice covers:
- Uses or disclosures, which do not require your written authorization.
- Treatment, payment, and health care operations.
- Uses or disclosures of your health information to which you may object.
- Uses or disclosure required or permitted.
- Uses or disclosures which require your written authorization.
- Your rights as a patient regarding privacy of your health information.
- Our duties in protecting your health information.
- Complaints, contact person, effective date, and acknowledgement.
Uses or disclosures which do not require your written authorization
Treatment, Payment, and Health Care Operations.
We use or disclose your health information to carry out your treatment; to obtain payment for your treatment; and to conduct health care operations. For example:
- For treatment, we use your health information to plan, coordinate, and provide your care. We disclose your health information for treatment purposes to physicians and other health care professionals outside our agency who are involved in your care.
Uses or Disclosures Required or Permitted.
When we are required or permitted to do so, we may use or disclose your health information in the following circumstances without your written authorization:
- Federal government investigation, when required by the Secretary of Health and Human Services to investigate or determine our compliance with federal regulation.
- Federal, state of local law requirements.
- Public health activities, for example to report communicable diseases or death; or for matters involving the Food and Drug Administration.
- Reporting of abuse, neglect or domestic violence.
- Health oversight activities by a health oversight agency. (A health oversight agency is an organization authorized by the government to oversee eligibility and compliance and to enforce civil rights laws.)
- Judicial or administrative proceedings, for example responding to a court order or subpoena.
- Law enforcement purposes, for example to report certain types of wounds or other physical injuries or to identify or locate a suspect, fugitive, material witness, or missing person.
- Use by coroners, medical examiners, or funeral directors.
- Facilitating organ, eye, or tissue donation.
- Averting a serious threat to your health or safety or that of the public.
- Specialized government functions such as military or veterans’ affairs; national security, and intelligence activities.
- Worker’s compensation.
Our Duties in Protecting Your Health Information:
- We are required by law to maintain the privacy of your health information.
- We must inform patients or their legal representatives of our legal duties and privacy practices with respect to health information. This Notice discharges that duty.
- We must abide by the terms of the Notice currently in effect.
- We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all health information that we maintain. At any time, you may obtain a copy of the current notice from the Privacy Officer.
Complaints, Contact Person, Effective Date, and Acknowledgement:
Secretary of Health and Human Services
- You may complain to us and to the Secretary of Health and Human Services if you believe your privacy rights have been violated.
- You will not be retaliated against for filing a complaint.
- You may file your complaint with our agency by writing to the Privacy Officer.
- You may file a complaint with the Secretary of Health and Human Services by writing to:
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, DC 20201
For further information, you may write or call:
Autumn Leaves Privacy Officer
c/o Constant Care Management Company
545 E. John Carpenter Frwy., Ste. 545
Irving, TX 75062
Telephone: (214) 239-8400
This notice is effective November 2013.