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.

OUR PLEDGE TO PROTECT YOUR PRIVACY

Kindred Care Health and Wellness (referred to as “KCHW” in this Notice) is committed to protecting the privacy of your health information. Health information that identifies you (“protected health information,” or “health information”) includes your medical record and any information related to your care or the payment for your care.

We are required by law to:

• Ensure your health information is kept private (with certain exceptions),
• Provide you with this Notice of our legal duties and privacy practices with respect to health information about you; and
• Abide by the terms of the Notice currently in effect.

WHO WILL FOLLOW THIS NOTICE

The following parties share the commitment to protect your privacy and will comply with this Notice:

• Any healthcare professional authorized to create or update your medical information at KCHW.
• All employees, volunteers, trainees, students, contractors, and medical staff members at KCHW.
• All departments and locations operated by Kindred Care Health and Wellness.

HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

The following sections describe different ways in which we may use and share your health information:

For Treatment

To provide you with medical care, we may share information among doctors, nurses, technicians, medical assistants, and other healthcare professionals involved in your care. For example, different department at KCHW may share your health information to coordinate services you need such as pharmacy, lab work, x-rays, etc. We may also share your information with outside providers in order to provide you with care not available at our facility. For example, we may disclose your health information to your Cardiologist for care coordination purposes.

Electronic exchange of health information helps ensure better care and coordination of care. KCHW participates in health information exchange(s) that allow outside providers who need information to treat you to access your health information through a secure health information exchange.

For Payment

We may use and disclose information to bill and collect payment for healthcare services that we or others provide to you. This includes uses and disclosures to submit health information and collect payment from you, your health insurance company, HMO/PPO, or a third party. We may disclose your health information to verify that your payor will pay for your health care such as when you are going to receive a treatment to determine whether your payor will cover the treatment. For certain services, if your permissions needed to release health information to obtain payment, you will be asked for permission.

For Health Care Operations

We may use and disclose your health information for healthcare operations like quality improvement, staff training, scheduling, or evaluating services.

Business Associates

KCHW contracts with outside entities that perform business services, such as billing, management consultants, quality assurance reviewers, accountants, or attorneys. Each contractor is contractually required to safeguard your information.

Appointment Reminders and Health Information

We may use and disclose health information to contact you about appointments reminders or provide information about treatment alternatives or other health-related benefits. We will use the information you provide to us (such as mobile phone, home phone, email address, and/or mail service) to communicate with you.

Individuals Involved in Your Care

We may release health information about you to a family member or friend who is involved in your medical care. We may also give information to someone who helps pay for your care. Unless there is a specific written request made to and agreed to by the clinic privacy office from you, we may also notify a family member, personal representative or another person responsible for for your care about your location and general condition. This does not apply to patients receiving treatment for certain conditions, such as substance/alcohol abuse. In addition, we may disclose health information about you to an organization assisting in a disaster relief effort (such as the Red Cross) so that your family can be notified about your condition, status and location.

To Avert a Serious Threat

We may use and disclose certain information about you when necessary to prevent a serious threat to your health and safety or the health and safety of others. However, any such disclosure will only be to someone able to prevent or respond to the threat, such as law enforcement  when a patient reveals participation in a violent crime.

SPECIAL SITUATIONS

We may also use or disclose your health information in the following situations:

Workers’ Compensation

We may release health information about you for workers compensation or similar programs. These programs provide benefits for work-related injuries or illness.

Public Health Reporting

We may disclose health information about you for public health activities. These activities include, but are not limited to the following:

• To prevent or control disease, injury or disability;
• To report births and deaths;
• To report the abuse or neglect of children, elders and dependent adults;
• To report reactions to medications or problems with products;
• To notify you of the recall of products you may be using;
• To notify a person who may be have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
• To notify the appropriate government authority if we believe you have been the victim of abuse, neglect, or domestic violence; we will only make this disclosure when required or authorized by law.

Health Oversight Activities

We may disclose health information to a health oversight agency, such as the California Department of Public Health or the Center for Medicare and Medicaid Services, for activities authorized by law. These oversight activities include audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Legal and Administrative Proceedings

If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to to a court or administrative order. We may also disclose health information about you in response to a subpoena, legally enforceable discovery request, or other lawful process by someone else involved in the dispute.

Law Enforcement

We may release health information at the request of law enforcement officials in limited circumstances, for example:

• In response to a court order, subpoena, warrant, summons, or similar process;
• To identify or locate a suspect, fugitive, material witness, or missing person;
• About the victim of a crime if, under certain limited circumstances, the victim is unable to consent;
• About a death we believe may be the result of criminal conduct;
• About criminal conduct at the clinic; and
• In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.

Medical Examiners, Coroners, and Funeral Directors

We may release health information to a corner or medical examiner. This may be necessary to identify a deceased person to determine the cause of death. We may also release health information about patients of the clinic to funeral directors as necessary to carry out their duties with respect to the deceased.

Organ and Tissue Donation

We may release health information to organizations that handle organ, eye, or tissue procurement or transplantation, as necessary to facilitate organ or tissue donation. The procurement or transplantation organization needs your authorization for any actual donations.

Military, National Security, and Intelligence

If you are a member of the armed forces, we may release health information about you as required by military command authorities. We may also release health information about foreign military personnel to the appropriate foreign military authority. Upon receipt of a request, we may release health information to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law. We will only provide this information after the Privacy Officer has validated the request and reviewed and approved our response.

Other Uses or Disclosures Required By Law

We may also use or disclose health information about you when required to do so by federal, state, or local laws not specifically mentioned in this Notice. For example, we may disclose health information as part of a lawful request in a government investigation.

USES AND DISCLOSURES THAT REQUIRE YOUR WRITTEN AUTHORIZATION

Your written authorization is required for:

• Most uses and disclosures of psychotherapy notes,
• Uses and disclosures for marketing purposes,
• Disclosures that constitute a sale of health information,
• Any other uses not covered by this Notice.
• You may revoke your authorization at any time in writing.

YOUR RIGHTS

You have the following rights regarding health information we maintain about you:

Inspect and Copy your health records

You have the right to inspect and obtain a paper or electronic copy of health information that may be used to make decisions about your care. Usually, this includes medical and billing records, but may not include some mental health information. We reserve the right to charge a fee to cover the cost of providing your health information records to you.

Request an Amendment if you believe information is incorrect

If you believe that the health information we have on file for you is incorrect or incomplete, you may ask us to amend the health information. To request an amendment, you must file an appropriate written request. In addition, you must provide a reason that supports your request. KCHW can only amend information that we created or that was created on our behalf. If your health information is accurate and complete, or if the information was not created by KCHW, we may deny your request to amend. If we deny your request, we will reply to you in writing with our reasons for doing so.

Even if we deny your request to amend, you have the right to submit a written addendum. Addendums may not exceed 250 words for each item or statement in your record you believe is incomplete or incorrect.

Receive an Accounting of Disclosures made outside of treatment, payment, or operations

You have the right to request an “accounting of disclosures” which is a list describing how we have shared your health information with outside parties. This accounting is a list of the disclosures we made of your health information for purposes other than treatment, payment, health care operations, and certain other purposes consistent with law You may request an accounting of disclosures for up to six years before the date of your request. If you request an accounting more than once during a twelve month period, we will charge you a reasonable fee.

Request Restrictions on certain disclosures

You have the right to request restrictions on certain uses or disclosures of your health information. Requests for restrictions must be in writing. In most cases, we are not required to agree to your requested restriction. However, if we do agree, we will comply with your request unless the information is needed to provide you emergency treatment or comply with the law. If we do not agree to your request, we will reply to you in writing with the reason. We are legally required to accept certain requests not to disclose health information to your health plan for payment or health care operations purposes as long as you have paid out- of-pocket and in full in advance of the particular service included in your request. If the service or item is part of a set of related services, and you wish to restrict disclosures for the set of services, then you must pay in full for the related services. It is important to make the request and pay before receiving the care so that we can work to fully accommodate your request. We will comply with your request unless otherwise required by law.

Request Confidential Communications at a specific location or method

You have the right to request that we communicate with you about your health information or medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work, rather than at your home. We will not ask you the reason for your request. We will work to accommodate all reasonable requests. Your request must be in writing and specify how and where you wish to be contacted.

Receive Notification of a Breach of your health information

KCHW is committed to safeguarding your health information and proactively works to prevent health information breaches from occurring. If a breach of unsecured health information occurs, we will notify you in accordance with applicable state and federal laws.

Obtain a Paper Copy of this Notice at any time.

You have the right to a copy of this Notice. It is available at the front desk and by visiting our website at www.kindredcarehw.com/privacy.

To obtain more information about how to request a copy of your health information, receive an accounting of disclosures, amend or add an addendum to your health information, please contact:

Kindred Care Health and Wellness

In Person Location and Mailing Address:

1157 W. Lacey Blvd.

Hanford, Ca. 93230

Phone: 559-583-4024 Fax: 888-355-9551

CHANGES TO THIS NOTICE

We reserve the right to change our privacy practices and update this Notice accordingly. We reserve the right to make the revised or changed Notice effective for health information we already have about you as well as any information we receive in the future. We post copies of the current Notice in the clinic and on our Internet site and copies are available at registration areas. If the Notice is significantly changed, we will post the new Notice in our registration areas and provide it to you upon request. The Notice contains the effective date on the first page, in the top left-hand corner.

QUESTIONS OR COMPLAINTS

KCHW values the privacy of your health information as an important part of the care we provide to you. If you have questions about this Notice or the clinic’s privacy practices, please contact us by telephone at 559-583-4024, by email at kindredcarehw@gmail.com, or by mail at Kindred Care Health and Wellness, 1157 W. Lacey Blvd., Hanford, Ca. 93230.

You have the right to file a complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, without retaliation.