NOTICE OF PRIVACY PRACTICES - PLEASE READ CAREFULLY

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

This Notice of Privacy Practices is provided to you as required by Section 164.520 of the Health Insurance Portability and Accountability Act (HIPAA). It describes how we may use or disclose your protected health information, with whom that information may be shared, and the safeguards we have in place to protect it. This notice also describes your rights.

ACKNOWLEDGEMENT OF RECEIPT

You will be asked to sign an acknowledgment of receipt of this notice. The delivery of your services will in no way depend upon your signed acknowledgment. We will also use and disclose your protected health information for provision, payment, and reporting of services, when necessary. We reserve the right to change this notice. Should the Notice of Privacy Practices change, the revised notice will be posted in our office and available on our website at www.agingresources.org. Upon request, a copy of the revised notice will be provided to you. The effective date of this notice is March 1, 2005.

HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION

The following are examples of permitted uses and disclosures of your protected health information. These examples are not exhaustive.

Required Uses and Disclosures

By law, we must disclose your protected health information to you unless it has been determined by a competent medical authority that it would be harmful to you. We must also disclose health information to the Secretary of the Department of Health and Human Services (DHHS) for investigations or determinations of our compliance with laws on the protection of your health information.

Other Disclosures
We may use and disclose information under other circumstances without an authorization. These include:

• When the use/disclosure in required by federal, state, or local law or other judicial/administrative proceeding.

• When the use/disclosure is necessary for public health activities to prevent or control disease, injury, or disability.

• When the disclosure relates to victims of abuse, neglect, or domestic violence.

• When the use/disclosure is related to health oversight activities related to the monitoring, investigating, inspecting, or disciplining those who work here.

• When the disclosure relates to death including information provided to coroners, and funeral directors for identification, determination of the cause of death, or for funeral preparations.

• When the use/disclosure relates to medical research and only after a special approval process.

• When the use/disclosure is to avert a serious threat to health or safety to you or the public.

• When the use/disclosure relates to military, national security, and other government functions.

• When the use/disclosure relates to compliance with worker's compensation programs.

• When the use/disclosure relates to correctional institutions and other law enforcement custodial situations.

• When a person identified by you needs information related to care, payment or notification of your condition.

• When information is shared for disaster relief services such as to the Red Cross.

• When information is used to provide you with treatments, services, products or providers in order to manage or coordinate your healthcare.

TREATMENT
We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to subcontractor, such as a home health agency, who provides care to you. This would also apply to other Elder Options personnel who are involved with providing your services.

PAYMENT
Your protected health information will be used, as needed, to obtain payment for your health care services. This may include certain activities Elder Options might undertake before it approves or pays for the health care services recommended for you such as determining eligibility or coverage for benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, your information may be shared with a business associate, such as a lead agency to arrange payment for respite services.

HEALTH CARE OPERATIONS
We will use or disclose, as needed, your protected health information to support the daily activities related to health care. These activities include, but are not limited to, quality assessment activities, monitoring exercises, investigations, oversight or staff performance reviews, communications about a service, conducting or arranging for other health care related activities, protocol development, case management and care coordination. For example, we may release your name and phone number to a subcontractor or other provider to arrange a health program or service that you have requested.

Disclosure to Family, Caregivers, and Close Friends
We may disclose to a family member, caregiver, a close personal friend, or any other person identified by you, health information about you that is directly relevant to that person’s involvement with the services and supports you receive or payment for those services and supports. If there is a family member, other relative, or close personal friend that you do not want us to disclose health information about you to, please notify Elder Options.

Required Authorization for Disclosure
Any other use or disclosure of personal health information about you requires your written authorization/informed consent as directed in state and federal statute. Under circumstances other than those stated above, we will ask for you to complete and sign a Consent/Authorization Form in order to use or disclose your information. If you sign this Authorization, you can later cancel this in writing and we will not disclose any further personal health information. If you wish to withdraw authorization, please contact us at (352) 378-6649.

COMPLAINTS
If you desire further information about your privacy rights, are concerned that we have violated your privacy rights, or disagree with a decision that we made about access to your Information, you may file a written complaint with the Elder Options Privacy Officer at, (352) 378-6649, or the Office of Civil Rights of the Unites States Department of Health and Human Services. There will be no retaliation against you for filing a complaint.