Notice of Our Privacy Practice and Notice to the Public
HIPAA Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY
This Notice applies to the Northern Lights Services, Inc. (“Facility”) located at 706 Bratley Drive, Washburn, Wisconsin 54891
Our Legal Duty
Facility is required by law to maintain the privacy of your protected health information (“PHI”) and to provide you with a notice of its legal duties and privacy practices. State and federal laws require the Facility to: maintain the privacy of your health information; provide you with this Notice of Privacy Practices (“Notice”) about its legal duties and privacy practices and your legal rights pertaining to health information it collects and maintains about you; notify you following a breach of unsecured protected health information; follow the privacy practices described in this Notice while it is in effect; notify you if it is unable to agree to a requested restriction pertaining to your health information; and accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.
Facility reserves the right to change its information practices and to make the changes effective for all protected health information it maintains. Should its information practices change, it will change its Notice and make the new Notice available to you.
How We Will Use or Disclose Your Health Information
We use and disclose health information about you for treatment, to obtain payment for healthcare operations and for other purposes. For example:
- Treatment. We may disclose health information about you to physicians, hospitals, medical technicians or other healthcare providers who are or who may be providing you treatment.
- Payment. We may use and disclose your health information to obtain payment for services we provide to you.
- Healthcare operations. We may use and disclose your health information in connection with our healthcare operations including quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, investigating claims, conducting training programs, accreditation, certification, licensing or credentialing activities.
- Business associates. We may disclose your health information to our business associates so that they can perform services for us. To protect your health information, we require our business associates to keep your information confidential.
- Directory, Newsletters, and Webpage. Unless you notify us that you object, we may use your name, location in the facility, and general condition for directory purposes. This information may be provided to people who ask for you by name. We may also use your name on a facility directory, and/or name plate next to or on your door in order to identify your room, unless you notify us that you object. Furthermore, unless you notify us that you object, we may use your name, likeness and information for publication in our newsletters or on our webpage at http://northernlightsservices.org/php/index.php. The newsletters or webpage may include birthdays, pictures of you, background information about you, dates of discharge or transfer, and other newsworthy information about your stay at our home. We believe our newsletters and webpage are a necessary part of our healthcare operations, fostering a collegial, family-type atmosphere for the benefit and welfare of our residents and the individuals we serve.
- Notification of Persons Involved in Care. We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, of your location and general condition. If we are unable to reach your family member or personal representative, then we may leave a message for them at the phone number that they have provided us or on an answering machine.
- Communication with family. We may disclose to a family member, relative, 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.
- Research. We may disclose 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 health information.
- Funeral directors. We may disclose health information to funeral directors and coroners to carry out their duties.
- Organ procurement organizations. Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
- Marketing. We may use your health information to inform you about treatment alternatives or other health related benefits and services that may be of interest to you. We will not disclose your health information to others for the purpose of marketing.
- Food and Drug Administration (“FDA”). We may disclose to the FDA health information relative to adverse events with respect to food, supplements, products and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.
- Workers compensation. We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
- Public health. As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
- Law enforcement. We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.
- Reports. Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more residents, workers or the public.
- Required by Law. We may use or disclose your health information as may be required by law.
- National Security. We may disclose your health information to federal and State officials as may be required for national security activities.
- Breaches of Unsecured PHI. We may contact you to provide you with any notice of any breach of your unsecured PHI.
Uses and disclosures of an individual’s health information for purposes other than those listed will be made only with the resident’s written authorization, which later may be revoked. For example, a specific authorization will be required for use or disclosure of your PHI 1) if it involves certain psychotherapy notes; 2) for marketing (except if the communication is face-to-face, or is for a promotional gift of nominal value) or for any marketing that involves financial remuneration; or 3) for any sale of your PHI. In these situations, you may withdraw your authorization at any time and must do so in writing to Facility. Your withdrawal may not be effective in certain situations where we have already taken action in reliance on your authorization.
Your Health Information Rights
Although your health record is the property of the Facility, you have the following rights:
- Inspection and Copying. You may look at and obtain copies of health information about you (with limited exceptions). Requests to view or to obtain copies of your health information must be in writing, and signed by you or your authorized representative. If you request copies, we will charge you a reasonable copying and administrative fee according to law.
- Restriction. You may request additional restrictions on the use and disclosure of health information about you. Although we will consider and attempt to accommodate all reasonable requests, we are under no obligation to accept or abide by such requests. The request must be in writing and sent to the Facility (to the Privacy Officer, contact information provided at the end of this Notice). If you request, we must agree to restrict disclosures to health plans if you pay out of pocket in full for any service we provide.
- Amendments. You may request that we amend or make additions to your health information. Such requests must be made in writing, and must explain the reason for requesting the amendment or addition. We may deny your request under certain circumstances.
- Disclosure Accounting. You may request that we provide you with a written statement of all disclosures of your health information made by us during a time period not exceeding six (6) years immediately prior to the date of your request. Such an accounting does not apply to disclosures made for reasons of treatment, payment or health care operations; disclosures made to you or your legal representative, or any other individual involved with your care; disclosures to correctional institutions or law enforcement officials; and disclosures for national security purposes. You may obtain this accounting at no charge once in a twelve (12) month period but you will be charged a reasonable fee for our efforts to comply with additional requests by you in any twelve (12) month period.
- Copy of Notice of Privacy Practices. This Notice is posted at the Facility and is on our website: http://northernlightsservices.org/php/index.php , and you have the right to obtain a paper copy of our Notice.
- Revocation of Authorization. You may revoke an authorization to use or disclose health information, except to the extent that action has already been taken in reliance on your authorization. Such a revocation must be in writing signed by you or your authorized representative.
For More Information or to Report a Problem
If have questions and would like additional information, you may contact the Facility’s Privacy and Compliance Officer, Chris Smith, at 13185 West Green Mountain Drive, Lakewood, Colorado 80228, 303-980-0611.
If you believe that your privacy rights have been violated, you may file a complaint with us. A complaint must be filed in writing and sent to the Privacy Officer at the above address. You may also file a complaint with the Secretary of the United States Department of Health and Human Services. There will be no retaliation for filing a complaint.
Title VI Notice to the Public
Notifying the Public of Rights Under Title VI
Northern Lights Services, Inc
- Northern Lights Services, Inc operates its programs and services without regard to race, color, and national origin in accordance with Title VI of the Civil Rights Act. Any person who belives she or he has been aggrieved by any unlawful discriminatory practice under Title VI may file a complaint with Northern Lights Services, Inc.
- For more informaiton on Northern Lights Services, Inc civil rights program and the procedures to file a complaint contact Jennifer Augustine, NHA; email at firstname.lastname@example.org or visit our administrative office at 706 Bratley Drive, Washburn, WI 54891.
- A complainant may file a complaint directly with the Federal Transit Adminsitration by filing a complaint with the Office of Civil Rights, Attention: Title VI Program Coordinator, East Building, 5th Florr-TCR, 1200 New Jersey Ave., SE Washington, DC, 20590.
- If information is needed in a different language, contact 715-373-5621.