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OKLAHOMA DEPARTMENT OF VETERANS AFFAIRS
HIPAA NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW INDIVIDUALLY IDENTIFIABLE HEALTH
INFORMATION (IIHI) ABOUT YOU MAY BE USED AND DISCLOSED AND HOW
YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT
CAREFULLY.
If you have any questions about this notice, please contact the Health Information Manager of
the facility (or his/her designee).
WHO WILL FOLLOW THIS NOTICE.
This notice describes our agency’s practices and that of:
¾ Any health care professional authorized to enter information into your medical record or
review information in your medical record;
¾ All departments and units of the facility;
¾ Any member of a volunteer group we allow to help you while you are in the facility;
¾ All employees and or associates of ODVA;
¾ All volunteers or volunteer groups recognized by ODVA;
¾ Any individual participating in educational programs which may utilize ODVA facilities
for training purposes.
OUR PLEDGE REGARDING INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION
(IIHI):
We understand that medical/health information about you and your health is personal. We are
committed to protecting medical information about you. We create a record of the care and
services you receive at agency facilities. We need this record to provide you with quality care
and to comply with certain legal requirements. This notice applies to all of the records of your
care generated by the facility, whether made by facility personnel or contracted personnel.
Health care providers outside this facility may have different policies or notices regarding their
use and disclosure of your medical information created in their setting.
This notice will tell you about the ways in which we may use and disclose medical information
about you. We also describe your rights and certain obligations we have regarding the use and
disclosure of medical information.
Rev. May 2017
ODVA Form #1300
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We are required by law to:
¾ Make sure that medical information that identifies you is kept private;
¾ Give you this notice of our legal duties and privacy practices with respect to medical
information about you; and
¾ Follow the terms of the notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE MEDICAL/HEALTH INFORMATION ABOUT
YOU.
The following categories describe different ways that we use and disclose medical information.
For each category of uses or disclosures we will explain what we mean and try to give some
examples. Not every use or disclosure in a category will be listed. However, all of the ways we
are permitted to use and disclose information will fall within one of the categories.
¾ For Treatment: We may use medical information about you to provide you with
medical treatment or services. We may disclose medical information about you to
doctors, nurses, technicians, or other facility personnel who are involved in taking care of
you. For example, a doctor treating you for a broken leg may need to know if you have
diabetes because diabetes may slow the healing process. In addition, the doctor may need
to tell the dietitian if you have diabetes so that we can arrange for appropriate meals.
Different departments of the facility also may share medical information about you in
order to coordinate the different things you need, such as prescriptions, lab work and x-
rays. We also may disclose medical information about you to people outside the facility
who maybe involved in your medical care after you leave the facility, such as family
members, clergy or others we use to provide services that are part of your care.
¾ For Payment: We may use and disclose medical information about you so that the
treatment and services you receive at the facility may be billed and payment may be
collected from you.
¾ For Health Care Operations: We may use and disclose medical information about you
for health care operations. These uses and disclosures are necessary to run the facility
and make sure that all of our residents 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
residents to decide what additional services the facility should offer, what services are not
needed, and whether certain new treatments are effective. We may also disclose
information to doctors, nurses, technicians, and other facility personnel for review and
learning purposes. We may also combine the medical information we have with medical
information from other facilities to compare how we are doing and see where we can
make improvements in the care and services we offer. We may remove information that
identifies you from this set of medical information so others may use it to study health
care and health care delivery without learning who the specific residents are.
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¾ Room Identification: Your name and a photo of you may be posted outside your room
door for location and identification purposes.
¾ Recognition/Memorials:
Your name, photo, military affiliation, veteran organization
affiliation, or service dates may be used in newspapers, newsletters, press releases or
center displays for recognition purposes. This information may also be provided to
military organizations for monuments or memorials.
¾ Appointment Reminders: We may use and disclose medical information to contact you
as a reminder that you have an appointment for treatment or medical care at another
facility.
¾ 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.
¾ 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.
¾ Facility Directory: We may include certain limited information about you in the facility
directory while you are a resident. This information may include your name, location in
the facility, your general condition (e.g., fair, stable, etc.) and your religious affiliation.
The directory information, except for your religious affiliation, may also be released to
people who ask for you by name. Your religious affiliation may be given to a member of
the clergy, such as a priest or rabbi, even if they don’t ask for you by name. This is so
your family, friends and clergy can visit you in the facility and generally know how you
are doing.
¾ Individuals Involved in Your Care or Payment for Your Care: We may release
medical information about you to a friend or family member who is involved in your
medical care. We may also give information to someone who helps pay for your care.
We may also tell your family or friends your condition and that you are in the facility. In
addition, we may disclose medical information about you to an entity assisting in a
disaster relief effort so that your family can be notified about your condition, status and
location.
¾ Research: Under certain circumstances, we may use and disclose medical information
about you for research purposes. For example, a research project may involve comparing
the health and recovery of all patients who received one medication to those who
received another, for the same condition. All research projects, however, are subject to a
special approval process. This process evaluates a proposed research project and its use
of medical information, trying to balance the research needs with patient’s need for
privacy of their medical information. Before we use or disclose medical information for
research, the project will have been approved through this research approval process, but
we may, however, disclose medical information about you to people preparing to conduct
a research project, for example, to help them look for patients with specific medical
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needs, so long as the medical information they review does not leave the facility. We
will almost always ask for your specific permission if the researcher will have access to
your name, address or other information that reveals who your are, or who will be
involved in your care at this facility.
¾ As Required By Law: We will disclose medical information about you when required
to do so by federal, state or local law.
¾ To Avert a Serious Threat To Health or Safety:
We may use and disclose medical
information about you when necessary to prevent a serious threat to your health and
safety or the health and safety of the public or another person. Any disclosure, however,
would only be to someone able to help prevent the threat.
¾ Volunteer Groups / Service Organizations: We may disclose certain limited
information such as birth date or home town/county to approved organizations for the
purposes of recognition.
SPECIAL SITUATIONS
¾ Organ and Tissue Donation: If you are an organ donor, we may release medical
information to organizations that handle organ procurement or organ, eye or tissue
transplantation or to an organ donation bank, as necessary to facilitate organ or tissue
donation and transplantation.
¾ Military and Veterans: We may disclose medical information about you to the U. S.
Department of Veterans Affairs. This disclosure is necessary for the Department of
Veterans Affairs to determine if you are eligible for certain benefits.
¾ Workers’ Compensation: We may release medical information about you for workers’
compensation or similar programs. These programs provide benefits for work-related
injuries or illnesses.
¾ Federal Agencies:
We may disclose medical information about you to other federal
agencies such as the Social Security Administration for the purpose of determining
eligibility for benefits.
¾ Public Health Risks:
We may disclose medical information about you for public health
activities. These activities generally include the following:
o To prevent or control disease, injury or disability;
o To report births and deaths;
o To report child abuse or neglect
o To report elder abuse or neglect
o To report reactions to medications or problems with products;
o To notify people of recalls of products they may be using;
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o To notify a person who may have been exposed to a disease or may be at risk of
contracting or spreading a disease or condition;
o To notify the appropriate government authority if we believe a resident has been
the victim of abuse, neglect or domestic violence. We will only make this
disclosure if you agree or when required or authorized by law.
¾ Health Oversight Activities: We may disclose medical information to a health
oversight agency for activities authorized by law. These oversight activities include, for
example, audits, investigations, inspections, and licensure. The activities are necessary
for the government to monitor the health care system, government programs, and
compliance with civil rights laws.
¾ Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose
medical information about you in response to a court or administrative order. We may
also disclose medical information about you in response to a subpoena, discovery request,
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.
¾ Law Enforcement: We may release medical information if asked to do so by a law
enforcement official:
o In response to a court ordered subpoena, warrant, summons or similar process;
o To identify or locate a suspect, fugitive, material witness, or missing person;
o About the victim of a crime if, under certain limited circumstances, we are unable
to obtain the person’s agreement;
o About a death we believe may be the result of criminal conduct;
o About criminal conduct at the facility; and
o 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.
¾ Coroners, Medical Examiners and Funeral Directors:
We may release medical
information to a coroner or medical examiner. This may be necessary, for example, to
identify a deceased person or determine the cause of death. We may also release medical
information about residents to funeral directors as necessary to carry out their duties.
¾ Residents Under Court Order:
If you are a resident of the facility under court order or
under the custody of a law enforcement official, we may release medical information
about you to the court or law enforcement official. This release would be necessary (1)
for the facility to provide you with appropriate health care; (2) to protect your health and
safety or the health and safety of others; or (3) for the safety and security of other
residents and personnel.
¾ Allied Health Care Personnel:
We may release information about you to emergency
personnel, such as ambulance attendants, EMTs, etc., who may be involved in your
transportation and/or treatment during a medical emergency.
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YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU.
You have the following rights regarding medical information we maintain about you:
¾ Right to Inspect and Copy:
You have the right to inspect and copy medical information
that may be used to make decisions about your care. Usually, this includes medical and
billing records, but does not include psychotherapy notes.
To inspect and copy medical information that may be used to make decisions about you,
you must submit your request in writing to the Health Information Manager or his/her
designee. If you request a copy of the information, we may charge a fee for the costs of
copying, mailing or other supplies associated with your request.
We may deny your request to inspect and copy in certain very limited circumstances. If
you are denied access to medical information, you may request that the denial be
reviewed. Another licensed health care professional chosen by the facility will review
your request and the denial. The person conducting the review will not be the person
who denied your request. We will comply with the outcome of the review.
¾ Right to Amend:
If you feel that medical information we have about you is incorrect or
incomplete, you may ask us to amend the information. You have the right to request an
amendment for as long as the information is kept by or for the facility.
To request an amendment, your request must be made in writing and submitted to the
Health Information Manager of this facility (or their designee). In addition, you must
provide a reason that supports your request if you ask us to amend information that:
o Was not created by us, unless the person or entity that created the information was
no longer available to make the amendment;
o Is not part of the medical information kept by or for the facility;
o Is not part of the information which you would be permitted to inspect and copy;
or
o Is accurate and complete.
¾ Right to an Accounting of Disclosures:
You have the right to request an “accounting of
disclosures.” This is a list of the disclosures we made of medical information about you.
To request this list or accounting of disclosures, you must submit your request in writing
to the Health Information Manager or his/her designee. Your request must state a time
period which may not be longer than six years and may not include dates before April 14,
2003. Your request should indicate in what form you want the list (for example, on
paper, electronically, etc.) We may charge a fee for this list. We will notify you of any
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cost involved and you may choose to withdraw or modify your request at that time before
any costs are incurred.
¾ Right to Request Restrictions:
You have the right to request a restriction or limitation
on the medical information we use or disclose about you for treatment, payment or health
care operations. You also have the right to request a limit on the medical information we
disclose about you to someone who is involved in your care or the payment for your care,
like a family member or friend. For example, you could ask that we not use or disclose
information about a surgery you had.
We are not required to agree to your request. If we do agree, we will comply with your
request unless the information is needed to provide you emergency treatment.
To request restrictions, you must make your request in writing to the Health Information
Manager or his/her designee. 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.
¾ Right to Request Confidential Communications
: You have the right to 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
Health Information Manager or his/her designee. 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.
¾ Right to a Paper Copy of This Notice: You have the right to a paper copy of this
notice. You may ask us to give you a copy of this notice at any time. Even if you have
agreed to receive this notice electronically, you are still entitled to a paper copy of this
notice. You will be offered a paper copy of this notice upon admission to the facility.
CHANGES TO THIS NOTICE
¾ We reserve the right to change this notice. We reserve the right to make the revised or
changed notice effective for medical information we already have about you as well as
any information we receive in the future. We will post a copy of the current notice in the
facility. The notice will contain on the first page, in the top right-hand corner, the
effective date.
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COMPLAINTS
¾ If you believe your privacy rights have been violated, you may file a complaint with the
facility or with the Secretary of the Department of Health and Human Services. To file a
complaint with the facility, contact the Health Information Manager or his/her designee.
All complaints must be submitted in writing.
You will not be penalized for filing a complaint.
OTHER USES OF MEDICAL INFORMATION.
¾ Other uses and disclosures of medical information not covered by this notice or the laws
that apply to us will be made only with your written permission. If you provide us
permission to use or disclose medical information about, you may revoke that permission,
in writing, at any time. If you revoke your permission, we will no longer use or disclose
medical information about you for the reasons covered by your written authorization.
You 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.
