Kenosha Visiting Nurse Association, Inc.
NOTICE OF PRIVACY PRACTICES
Effective April 14, 2003

The following uses and disclosures do not require your consent, and include, but are not limited to a release of information contained in financial records and/or medical records, including information concerning communicable diseases such as Human Immune Deficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS), drug/alcohol abuse, and treatment records and/or laboratory test results, medical history, treatment progress and/or any other related information to your insurance company, self-funded or third party health plan, Medicare, Medicaid or any other person or entity that may be responsible for paying or processing for payment any portion of your bill for services. Any person or entity affiliated with or representing for purposes of administration, billing and quality and risk management. Any hospital, nursing home or other health care facility to which you may be admitted. Any assisted living or personal care facility of which you are a resident. Any physician providing you care. Licensing and accrediting bodies, including the information contained in the OASIS Data Set to the state agency acting as a representative of the Medicare/Medicaid program. Contact you to provide appointment reminders or information about other health activities we provide. Contact you to raise funds for KVNA and its affiliates. Other health care providers to initiate treatment.

“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.”

Visiting Nurse Community Care, Inc., Kenosha Visiting Nurse Assn., Inc., and Visiting Nurse Management Corp. (an affiliated covered entity known as VNMC & Affiliates) is required by law to maintain the privacy of your Protected PHI. (PHI). We are also required to give you this notice of your rights and our legal duties and privacy practices with respect to the uses and disclosures of your PHI. [45 CFR 165.520]. We will use or disclose your PHI in a manner that is consistent with this notice.
We maintain a record (paper/electronic) of the PHI we receive and collect about you and of the care we provide to you. The medical record is the physical property and responsibility of VNMC & Affiliates. We maintain policies and procedures about our work practices including how we provide your care and how we protect your PHI.

USES AND DISCLOSURES OF YOUR PHI: We may use and disclose your PHI without your consent for purposes of treatment, payment, and/or health care operations. Treatment includes but is not limited to providing, coordinating or managing health care and related services, consultation between health care providers relating to patient or referral of a patient for health care from one provider to another. For example, your doctor or a hospital discharge planner may disclose your PHI to our nurse so that we can provide home care services. Payment includes billing and collecting for the services we provide, determining plan eligibility and coverage, utilization review (UR), pre certification, medical necessity review. For example, a bill may be sent to you or a third-party payer such as Medicare or an insurance company. The bill may include information that identifies you, your diagnosis and the services, equipment or supplies we used to care for you. Sometimes we may disclose your PHI to an insurance company before the start of your care to determine if the insurance company will pay for the particular services, equipment or supplies. Health Care Operations includes but is not limited to general agency administrative and business functions like conducting training programs with students or new employees; licensing, survey certification, accreditation and credentialing activities; internal auditing and certain fundraising and marketing activities. For example, KVNA periodically holds clinical record review meetings where the consulting professional of our record review committee will audit clinical records.  The purpose is for meeting professional standards and utilization review.
The following uses and disclosures do not require your consent, and include, but are not limited to a release of information contained in financial records and/or medical records, including information concerning communicable diseases such as Human Immune Deficiency Virus (HIV) and Acquired Immune Deficiency Syndrome (AIDS), drug/alcohol abuse, and treatment records and/or laboratory test results, medical history, treatment progress and/or any other related information to your insurance company, self-funded or third party health plan, Medicare, Medicaid or any other person or entity that may be responsible for paying or processing for payment any portion of your bill for services. Any person or entity affiliated with or representing for purposes of administration, billing and quality and risk management. Any hospital, nursing home or other health care facility to which you may be admitted. Any assisted living or personal care facility of which you are a resident. Any physician providing you care. Licensing and accrediting bodies, including the information contained in the OASIS Data Set to the state agency acting as a representative of the Medicare/Medicaid program. Contact you to provide raise funds for KVNA and its affiliates. Other health care providers to initiate treatment.
We are also permitted to use or disclose information about you without consent or authorization in the following circumstances: To remind you about appointments, visits or equipment delivery. In emergency treatment situations, if we attempt to obtain consent as soon as practicable after treatment. Where substantial barriers to communicating with you exist and we determine that the consent is clearly inferred from the circumstances. Where we are required by law to provide treatment and we are unable to obtain consent. Where the use or disclosure of medical information about you is required by federal, state or local law. To provide information to state or federal public health authorities, as required by law to prevent or control disease, injury or disability; report births and death; report child abuse or neglect; report reactions to medications or problems with products; notify persons of recalls of products they may be using; notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence if you agree or when required or authorized by law. Health care oversight activities such as audits, investigations, inspections and licensure by a government health oversight agency as authorized by law to monitor the health care system, government programs and compliance with civil rights laws. Certain judicial administrative proceedings if you are involved in a lawsuit or a dispute. We may disclose medical information about you in response to a court or administrative order, 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. Certain law enforcement purposes such as helping to identify or locate a suspect, fugitive, material witness or missing person, or to comply with a court order or subpoena and other law enforcement purposes. To coroners, medical examiners and funeral directors, in certain circumstances, for example to identify a deceased person, determine the cause of death or to assist in carrying out their duties. For organ, eye or tissue donation purposes to communicate to organizations involved in procuring, banking or transplanting organs and tissues (if you are an organ donor). We may use your PHI for research. Before we disclose any of your PHI for such research purposes, the project will be subject to an extensive approval process and we will usually request your written authorization before granting access to your individually identifiable PHI. To avert a serious threat to the health and safety of a particular person or the general public, such as when a person admits to participation in a violent crime or serious harm to a victim or is an escaped convict. Any disclosure would only be to someone able to help prevent the threat. For specialized government functions, including military and veterans’ activities, national security and intelligence activities, protective services for the President and others, medical suitability determinations, correctional institutions and custodial situations. We may disclose your PHI without your consent for Workers’ Compensation purposes: If you are an inmate of a correctional institution we may use and disclose your PHI without your consent.
We may use or disclose your PHI without consent or authorization provided you are informed in advance and given the opportunity to agree, prohibit or restrict the disclosure in the following circumstances: Use of a directory of individuals served by our agency. To a family member or friend who is involved in your medical care or who helps pay for your care. To an entity assisting in a disaster relief effort (such as the Red Cross) so that your family can be notified about your condition, status, and location. Other uses and disclosures will be made only with our written authorization. That authorization may be revoked, in writing, at any time, except in limited situations.

PATIENT RIGHTS
You have the right, subject to certain conditions, to: Request restrictions on uses and disclosures of your protected PHI for treatment, payment or health care operations.  However, we are not required to agree to the request. Restrictions to which we agree will be documented. Agreements for further restrictions may, however, be terminated under applicable circumstances (e.g. emergency treatment). Confidential communication of PHI.  We will arrange for you to receive PHI by reasonable alternative means or at alternative locations. Your request must be in writing. We do not require an explanation for the request as a condition of providing communications on a confidential basis and will attempt to honor reasonable requests for confidential communications. Inspect and obtain copies of protected PHI which is maintained in a designated record set, except for psychotherapy notes, information compiled in reasonable anticipation of,  or for use in a civil, criminal or administrative action or proceeding, or protected PHI that is subject to the Clinical laboratory Improvements Amendments of 1988 [42 USC 263a and 45 CFR 493 (a)(2)]. If you request a copy of your PHI, we will charge a reasonable fee for copying of $.45 per page copied. Request to amend protected PHI for as long as the protected PHI is maintained in the designated record set. A request to amend your record must be in writing and must include a reason to support the requested amendment. We will act on your request within sixty (60) days of receipt of the request.  We may extend the time for such action by up to 30 days, if we provide you with a written explanation of the reasons for the delay and the date by which we will complete action on the request.  We may deny the request for amendment if the information contained in the record was not created by us, unless the originator of the information is no longer available to act on the requested amendment; is not part of the designated medical record set; would not be available for inspection under applicable laws and regulations; and the record is accurate and complete.  If we deny your request for amendment, you will receive a timely, written denial in plain language that explains the basis for the denial, your rights to submit a statement disagreeing with the denial and an explanation of how to submit that statement. Receive an accounting of disclosures of protected PHI made by our agency for up to six (6) years prior to the date on which the accounting is requested for any reason other than for treatment, payment or health operations and other applicable exceptions. The written accounting includes the date of each disclosure, the name/address (if known) of the entity or person who received the protected PHI, a brief description of the information disclosed and a brief statement of the purpose of the disclosure or a copy of your written authorization or a written request for disclosure. We will provide the accountings within 60 days of receipt of a written request. However, we may extend the time period for providing the accounting by 30 days if we provide you with a written statement of the reasons for the delay and the date by which you will receive the information. We will provide the first accounting you request during any 12-month period without charge.  Subsequent accounting requests may be subject to a reasonable cost-based fee. To obtain a paper copy of this notice, even if you had agreed to receive this notice electronically from us upon request.

COMPLAINTS
If you believe that your privacy rights have been violated, you may complain to KVNA or the Secretary of the U.S. Department of Health and Human Services. There will be no retaliation against you for filing a complaint. The complaint should be filed in writing and should state the specific incident(s) in terms of subject, date and other relevant matters.  A complaint to the Secretary must be filed in writing within 180 days of when the act or omission complained of occurred, and must describe the acts or omissions believed to be in violation of applicable requirements. [45 CFR 160.306] For further information regarding filing a complaint, contact: Chief Operating Officer/Privacy Official, Visiting Nurse Management Corp., 600 52nd Street, 300, Kenosha, WI 53140 or designee.

EFFECTIVE DATE
This notice is effective April 14, 2003. We are required to abide by the terms of the notice currently in effect, but we reserve the right to change these terms as necessary for all protected PHI that we maintain.  If we change the terms of this notice (while you are receiving service), we will promptly revise and distribute a revised notice to you as soon as practicable by mail, e-mail (if you have agreed to electronic notice) or hand delivery.

If you require further information about matters covered by this notice, please contact: Director of Human Resources/Privacy Official, Visiting Nurse Management Corp., 600 52nd Street, 300, Kenosha, WI 53140 or designee.