Page 23 - Home Health Marketing

 For specialized government functions, including military and veterans’ activities, national security and
intelligence activities, protective services for the President, foreign heads of state and others, medical
suitability determinations, correctional institution and custodial situations; and
 For Workers’ Compensation purposes: Workers’ compensation or similar programs provide benefits for work-
related injuries or illness.

We are permitted to use or disclose protected health information about you provided you are informed in
advance and given the opportunity to individually agree to, prohibit, opt out or restrict the disclosure in
the following circumstances.
 Use of a directory (includes name, location, condition described in general terms) of individuals served by our Agency;
 Share information to a public or private entity authorized by law or by its charter to assist in disaster relief efforts for
purposes of notifying your family, personal representatives or certain others of your location or general condition;
 Provide proof of immunization to a school that is required by state or other law to have such proof with
agreement to disclosure by parent, guardian or other person acting in loco parentis if record is of an
unemancipated minor; and
 Provide a family member, relative, friend or other identified person, prior to, or after your death, the information
relevant to such person’s involvement in your care or payment for care; to notify a family member, relative,
friend or other identified person of your location, general condition or death.

Other uses and disclosures not covered in this notice will be made only with your authorization. Authorization
may be revoked, in writing, at any time, except in limited situations for the following disclosures:
 Marketing of products or services or treatment alternatives that may be of benefit to you when we receive
direct payment from a third party for making such communications;
 Psychotherapy notes under most circumstances, if applicable; and
 Any sale of protected health information resulting in financial gain by the agency unless an exception is met.
YOUR RIGHTS – You have the right, subject to certain conditions, to:
 Request restrictions on uses and disclosures of your protected health information for treatment,
payment or health care operations. However, we are not required to agree to any requested restriction.
Restrictions to which we agree will be documented. Agreements for further restrictions may, however be
terminated under applicable circumstances (e.g., emergency treatment).
We must agree to your request to restrict disclosure of protected health information about you to a health
plan if: 1) the disclosure is for the purpose of carrying out payment or health care operations and is not
otherwise required by law; and 2) the protected health information pertains solely to a health care item or
service for which you or someone on your behalf paid the covered entity in full.
 Confidential communication of protected health information. We will arrange for you to receive protected
health information 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.
If you request your protected health information to be transmitted directly to another person designated by
you, your written request must be signed and clearly identify the designated person and where the copy of
protected health information is to be sent.
 Inspect and obtain copies of protected health information that 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 health information that may not be disclosed
under the Clinical Laboratory Improvements Amendments of 1988.

If the requested protected health information is maintained electronically and you request an electronic copy,
we will provide access in an electronic format you request, if readily producible, or if not, in a readable
electronic form and format mutually agreed upon.

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