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.

PLEASE REVIEW IT CAREFULLY.

What Is a Notice of Privacy Practices?

HNA understands that your health information is personal. We create and maintain a record with information about the care and services you receive at HNA. We need this information to provide you with quality care and to comply with the law. This Notice of Privacy Practices (Notice) applies to all information about your care that HNA, and all of the people and places that make up HNA, may create, maintain, or receive. This includes information that HNA receives from other doctors and medical facilities that are not part of HNA, but that HNA keeps to help give you better care. The Notice tells you about the ways we may use and share your health information, as well as the legal duties we have about your health information. The Notice also tells you about your rights under federal (United States) and state (Pennsylvania or Ohio, as applicable) laws. In this Notice, the words “we,” “us,” and “our” mean HNA and all the people and places that make up HNA, which are described below.

Who Follows HNA’s Notice of Privacy Practices?

All of the people and places that make up HNA follow this Notice. HNA includes hospice services, doctors, rehabilitation services, skilled nursing services, home health services, behavioral health services, and other related health care providers. HNA also includes departments, units, and staff within our health care facilities, health care professionals permitted by us to provide services to you, and students, residents, trainees, volunteers, and others involved in providing your care. HNA may share and use your health information for purposes of treating you, obtaining payment for services provided to you, and/or health care operations as described in this Notice. You can learn more about HNA at www.homenursingagency.com.

Our Duty to Protect Your Health Information

We are required by law to:

• Make sure that information that identifies you is kept private.
• Make available to you this Notice that describes the ways we use and share your health information as well as your rights under the law about your health information.
• Follow the Notice that is currently in effect.

How We May Use and Share Your Health Information with Others

The law permits us to use and share your health information in certain ways. When we share this information with others outside of HNA, we will share what is reasonably necessary. When we act in response to your written permission, share information to help treat you, or are directed by the law, we will share all information that you, your health care provider, or the law permits or requires. The list below tells you about different ways that we may use your health information and share it with others. We have also provided you with examples of what we mean. Every possible example of how we may use or share information is not listed below. However, all of the ways we are permitted to use and share information fall into one of the groups below. When possible, we will use health information that does not identify you.

• If we believe that you have been a victim of abuse, neglect (except child abuse or neglect), or domestic violence, we may share your health information with an authorized government agency. We will do so either if you agree to our sharing this information or if the law allows us to do so and we believe that we need to share the information in order to protect you or someone else. If we decide to share your health information for this purpose, we will tell you unless we believe that telling you would put you at risk of harm, or you are a personal representative of the victim and may be involved in the abuse, neglect, or injury.
   
• We may share your health information in response to an administrative or court order, a subpoena, a discovery request, or other legal process if we are advised that you have been made aware of the request or we receive notice either that you agree or, if you disagree with the request, that you are taking action to prevent the disclosure.
   
• We may share your health information with a law enforcement official or authorized individuals 1) to comply with laws, including laws that require the reporting of injury or death suspected to have been caused by criminal means; 2) in response to a court order, warrant, subpoena, or summons; 3) or in emergency situations.
   
• If asked to do so by a law enforcement official, we may share your health information if you are an adult victim of a crime and, in certain limited cases, we are unable to obtain your permission and the law enforcement official meets certain conditions described by law.

b. To Prevent a Serious Threat to Health or Safety. We may use and share your health information with persons who may be able to prevent or lessen the threat or help the potential victim of the threat when doing so is necessary to prevent a serious threat to the health and safety of you, the public, or another person. State law may require such disclosure when an individual or group has been specifically identified as the target or potential victim.

c. Organ and Tissue Donation. To assist in the process of eye, organ, or tissue transplants, in the event of your death, we may share your health information with organizations that obtain, store, or transplant eyes, organs, or tissue.

d. Special Government Purposes. We may use and share your health information with certain government agencies, such as:

• Military and Veterans. We may share your health information with military authorities as the law permits if you are a member of the armed forces (of either the United States or a foreign government).
   
• National Security and Intelligence. We may share your health information with authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law.
    
• Protective Services for the President and Others. We may share your health information with authorized federal officials to protect the President of the United States, other authorized persons, or foreign heads of state. We may also share your health information for purposes of conducting special investigations as authorized by law.

e. Workers’ Compensation. We may share your health information for workers’ compensation or similar programs that provide benefits for work-related injuries or illness.

f. Public Health. We may share your health information with public health authorities for public health purposes to prevent or control disease, injury, or disability. This includes, but is not limited to, reporting disease, injury, and important events such as birth or death, and conducting public health monitoring, investigations, or activities. For example, we may share your health information to 1) report child abuse or neglect; 2) collect and report on the quality, safety, and effectiveness of products and activities regulated by the Food and Drug Administration (FDA) (such as drugs and medical equipment, and could include product recalls, repairs, and monitoring); or 3) notify a person who may have been exposed to or is at risk of spreading a disease.

g. Health Oversight. We may share your health information with a health oversight agency for purposes of 1) monitoring the health care system; 2) determining benefit eligibility for Medicare, Medicaid, and other government benefit programs; and 3) monitoring compliance with government regulations and civil rights laws.

h. Coroners, Medical Examiners, and Funeral Directors. We may share your health information with a coroner or medical examiner in order to identify a deceased person, determine the cause of death, or for other reasons allowed by law. We also may share your health information with funeral directors, as necessary, so they can carry out their duties.

i. Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may share your health information with the correctional institution or law enforcement official. This would be necessary 1) for the institution to provide you with health care; 2) to protect your health and safety or the health and safety of others; or 3) for the safety and security of the correctional institution.

C. In All Other Ways, We Will Require Your Written Permission Before Your Health Information Is Used or Shared With Others

Except as stated in Sections A and B, your written permission is required before we can use or share your health information with anyone outside of HNA. This permission is provided through a form. If you give us permission to use or share health information about you, you may cancel that permission, in writing, at any time. If you cancel your permission, we will no longer use or share your health information for the reasons you have given us in your written permission. However, we are unable to take back any information that we have already shared with your permission.

Your Rights Concerning Your Health Information

The law gives you the following rights about your health information:

3. Right to Ask for an "Accounting of Disclosures."

a. Generally. You have the right to ask us for an “accounting of disclosures.” This is a list of those people and organizations who have received or have accessed your health information. This right does not include information made available for treatment, payment, or health care operations, or made available when you have provided us with permission to do so. You must put your request in writing and give it to HNA staff or the place where you received care. You can call the HNA office or the place where you received care to find out how to ask for the list. You must include in your written request how far back in time you want us to go, which may not be longer than six years.

b. Information That Is Maintained Electronically. Subject to a schedule established by federal law, if we maintain your health information electronically (in our computer), you have the right to ask for an accounting of disclosures of where HNA disclosed your health information. In accord with federal law, you may request an accounting for a period of three years prior to the date the accounting is requested. You also have the right to ask HNA for an accounting of the disclosures of our business associates. We will post a list of all of our business associates and how to contact them on our website.

b. Services Paid For by You. Where you have paid for your services out of pocket in full, at your request, we will not share information about those services with a health plan for purposes of payment or health care operations. “Health plan” means an organization that pays for your medical care.

Violation of Privacy Rights

In the event that a breach of your protected health information occurs by HNA or one of its business associates, you will be provided with written notification as required by law.

If you believe your privacy has been violated by us, you may file a confidential complaint directly with us. You can do this by contacting the HNA Privacy Officer at the facility where you received care or by calling 814.946.5411 or 1.800.992.2554 during HNA’s regular business hours of 8:00 am to 4:00 pm.

You also may file a complaint with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with the Secretary of Health and Human Services, you must 1) name the HNA place or person that you believe violated your privacy rights and describe how that place or person violated your privacy rights; and 2) file the complaint within 180 days of when you knew or should have known that the violation occurred. All complaints to the Secretary of the U.S. Department of Health and Human Services must be in writing and addressed to:

U.S. Department of Health and Human Services
200 Independence Ave. S.W.
Washington, DC 20201

You will not be penalized for filing a complaint.

Changes to This Notice

We reserve (have) the right to change this Notice. We reserve (have) the right to make the revised or changed Notice effective for health information we already have about you and for any future health information. We will post a copy of the revised Notice in the places where we provide services. The Notice will contain the effective date on the first page, in the top left-hand corner. We will provide to you, if you ask us, a copy of the Notice that is currently in effect each time you register at HNA for treatment or health care services.

If You Have Questions About This Notice

If you have any questions about this Notice, please contact the HNA Privacy Officer at 814.946.5411 or 1.800.992.2554.

Form# 983 Revised 9/23/2013

Please contact HNA's Privacy Officer at 1.800.992.2554 for a complete listing of our Business Associates and their contact information.