For The Use And Disclosure Of Protected Health Information (PHI)

Effective 04/14/03

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!

This Notice has been prepared by Transitional Living, Inc.  It tells you how Protected Health Information about you can be created, shared, protected and maintained.  For purposes of this Notice, the pronouns “we”, “us”, and “our” refer to Transitional Living and include any person who assists in providing care to you through any department or service of Transitional Living, Inc. at any Transitional Living, Inc. location or any business associate of Transitional Living who performs a service on behalf of Transitional Living, Inc. utilizing your health information.

What is Protected Health Information?

§          Protected Health Information (PHI) is the information we create and obtain in the course of providing our services to you; 

§          PHI is any information that we have about you from the past, present, or future about your mental or physical health condition; 

§          PHI is spoken, written, or electronically recorded information and is;

§          Created by or given to anyone providing care to you; a health plan; a public health authority; your employer; your insurance company; your school or university; or anyone who processes health information about you.

Uses of Your Protected Health Information With Your Consent

§          With your consent, we can share information about your health with other specialists so that you can receive the most appropriate treatment.  For example, your counselor could share with your treating physician that you are depressed.  The doctor could then prescribe medication to help you feel better.

§          With your consent, we can share information about when and for what purpose you were seen, so that we can be paid for treating you.  For example, we could send a form to your insurance company stating when or for what condition you were at our facility.  They can then send us money to help cover your costs of being seen.

§          With your consent, we can share information with other healthcare entities to ensure that you obtain the correct diagnosis.  For example, if you were complaining about being tired all the time, we could obtain a sample of your blood and send it to a blood laboratory.  The blood laboratory could send us back information that your blood sample contained high sugar levels.  This could help us determine whether you have diabetes.

§          With your consent, we may use information about your friends and/or relatives such as their  name and address in order to make contact in the future to raise money for our organization.  No information about your health or healthcare will be used or disclosed for fundraising purposes.   

Your Health Information Rights

The health record we maintain and billing records are the physical property of Transitional Living, Inc.  The information contained in the health record, however, belongs to you. 

You have a right to:

§          Request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations.  We are not required to agree to your request.  To request restrictions, you must make your request in writing to the Privacy Officer.  In your request, you must tell us 1) what information you want to limit; 2) whether you want to limit our use, disclosure or both; and 3) to whom you want the limits to apply, for example, disclosures to your spouse.

§          Obtain a paper copy of the Notice of Privacy Practices for Protected Health Information by making a request to our Privacy Officer.  We may change the terms of this Notice of Privacy Practices from time to time.  You can always get a copy of the current Notice of Privacy Practices by requesting it from the Privacy Officer.

§          Inspect and obtain a copy of your designated record set. This “designated record set” is the psychiatric, medical or other treatment records and billing records maintained by or for Transitional Living, Inc. that are used to make decisions about you.  You have the right to inspect and copy these records unless your right to access particular identified information is specifically restricted in your treatment plan because a licensed health care professional has determined that providing you with the information is likely to endanger the life or physical safety of you or others.  Any such restrictions will be explained to you and such restrictions must be renewed annually to retain their validity.  If you request copies, we will charge a fee for the cost of copying, mailing or other related supplies.  We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

§          Request that we amend your Protected Health Information if you feel the information is incomplete or incorrect. Your request must be made in writing and submitted to the Privacy Officer.  In addition, you must provide a reason that supports your request.  We may deny your request if you ask us to amend information that 1) was not created by us, unless the person or entity that created the information is no longer available to make the amendment; 2) is not part of the medical information kept by or for the agency; 3) is not part of the information which you would be permitted to inspect and copy or; 4) is accurate and complete.    You may file a written statement of disagreement if your amendment request is denied.

§          Request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.  To request confidential communications, you must make your request in writing to the Privacy Officer.  We will not ask you the reason for your request.  We will accommodate all reasonable requests.  Your request must specify how or where you wish to be contacted. 

§          Request an accounting of disclosures we made of medical information about you.  To request this accounting of disclosures, you must submit your request in writing to the Privacy Officer.  Your request must state a time period that may not be longer than six years and may not include dates before February 26, 2003.  Your request should indicate in what form you want the list, for example, on paper or electronically.  We will charge you for the cost of providing the list.  We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

§          Revoke, in writing to the Privacy Officer, authorizations that you made previously except to the extent information or action has already been taken. Understand that we are unable to take back any disclosures we have already made with your permission and that we are required to retain our records of the care that we provided to you. If you revoke your consent, we reserve the right to refuse to provide further treatment to you, on the basis of your refusal to allow us to share your information for purposes of treatment, payment, and healthcare operations.

Our Responsibilities

§          We will maintain the privacy of your Protected Health Information as required by law.  At your request, we will provide you with a Notice of Privacy Practices containing our legal responsibilities and privacy practices regarding Protected Health Information.

§          We will follow the terms of the Notice of Privacy Practices currently in effect.

§          We reserve the right to change the terms contained in this Notice of Privacy Practices.  If we do this, it will affect all Protected Health Information maintained by us.  We will notify you that we have changed the Notice of Privacy Practices by posting it at our offices, and by mailing it to you at the address you provide.

§          We will notify you if we cannot accommodate a requested restriction.

§          We reserve the right to amend, change, or eliminate provisions in our privacy practices and to enact new provisions regarding the Protected Health Information we maintain.

Disclosures and Uses Without Your Consent

For Healthcare Operations:  We may use and disclose medical information about you for agency operations.  These uses and disclosures are necessary to run the agency and make sure that all of our clients receive quality care.  For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you.  We may also combine medical information about many agency clients to decide what additional services the agency should offer, what services are not needed, and whether certain new treatments are effective.

Appointment Reminders:  We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or services at the agency.

Treatment Alternatives:  We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

Health Related Benefits and Services:  We may use and disclose medical information to tell you about health related benefits or services that may be of interest to you.

Your Protected Health Information can be shared without your prior consent or authorization in an emergency so long as consent is obtained as soon as possible; and when required by law:

§          For health oversight activities.  These include audits, investigations, inspections, and licensure as authorized by law and are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

§          For the following public health risks: to prevent or control disease, injury or disability; to report births and deaths; to report child abuse or neglect; to report reactions to medications or problems with products; to notify people of recalls of products they may be using; to notify a person who may 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 a client has been the victim of abuse, neglect or domestic violence as required/authorized by law.

§          For judicial and administrative proceedings in response to a court or administrative order, a subpoena, discovery requests 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.

§          For law enforcement purposes: 1) in response to a court order, subpoena, warrant, summons or similar process; 2) to identify or locate a suspect, fugitive, material witness, or missing person; 3) to provide information about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement; 4) to provide information about a death we believe may be the result of criminal conduct; 5) to provide information about criminal conduct at the agency; and 6) 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.

§          To a coroner/medical examiner to identify a deceased person or determine the cause of death.

§          To a funeral director to provide information about a client as necessary to carry out duties.

§          For organ/eye/tissue donation if you are an organ donor and if permitted by applicable law, we may disclose PHI to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.  In making such a disclosure, we will not identify you as a recipient of mental health services.

§          For research purposes when the research has been approved by an institutional review board (IRB) that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.

§          To avert serious threats to health or safety made toward you or another person.  Any disclosure, however, would only be to someone able to help prevent the threat.

§          To facilitate specialized government functions: 1) for specified military and veteran activities.  For example, we may disclose PHI without your authorization to military authorities who are able to demonstrate that they have the authority to receive such information; 2) for national security and intelligence activities.  For example, we may disclose PHI to those federal authorities authorized to conduct national security activities pursuant to the National Security Act; 3) to help provide protective services for the president and others specified by federal law; 4) to promote the health and safety of a particular inmate or any other person at a correctional institution or who is involved with an inmate in a custodial situation.

§          To facilitate eligibility determinations or enrollment into public benefit programs according to specific

        requirements

§          For Workers Compensation, which is a program that provides benefits for work-related injuries or illness.

Your Protected Health Information can be shared without your prior consent or authorization when there are substantial communication barriers and it is reasonable to believe that you are giving your consent or authorization.

We have Business Associates with whom we may share your Protected Health Information.  For example, we may need to communicate certain medical information such as any allergies you may have to a pharmacy in order to have a prescription filled for you. 

All other uses and disclosures not described in this notice require your signed authorization.  You may revoke your authorization of uses and disclosures not described in this notice at any time with a written statement addressed to our Privacy Officer.

Questions Or Complaints

If you have questions about our Notice or our privacy practices or require further information, pleas contact our Privacy Officer at the address noted below.

You have the right to file a written complaint with our Privacy Officer at: Transitional Living, Inc., 2052 Princeton Road, Hamilton, OH 45011, Telephone Number:  (513) 863-6383, if you believe your privacy rights have been violated. 

You may also file a written complaint with the Secretary of the United States Department of Health and Human Services at the following address:  HIPAA Complaint, 7500 Security Blvd., C5-24-04, Baltimore, MD  21244.

We will not retaliate or take action against you for filing a complaint.

Effective Date Of This Notice:  April 14, 2003.