Tammy and Ronald Eschete, Owners
Privacy Notice
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.
TERREBONNE HOMECARE, INC. is providing this
Notice of Privacy Practices because the privacy
of your health information is very important to
you and to us, and in compliance with federal
regulations.
By “your health information” we mean the
information that we maintain that specifically
identifies you and your health status.
Summary
This Notice describes how we use your health
information within TERREBONNE HOMECARE, INC. and
disclose it outside TERREBONNE HOMECARE, INC.,
and why.
The Notice covers:
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Uses or disclosures which do not require
your written authorization.
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Treatment, payment, and health care operations.
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Uses or disclosures of your health
information to which you may object.
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Uses or disclosures
required or permitted.
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Uses or disclosures which
require your written authorization.
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Your rights as a patient
regarding privacy of your health
information.
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Our duties in protecting
your health information.
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Complaints, contact person, effective date,
and acknowledgment.
Uses or
Disclosures Which Do Not Require Your
Written Authorization
Treatment, Payment, and Health Care
Operations
We use or disclose your health information to
carry out your treatment; to obtain payment for
your treatment; and to conduct health care
operations. For example:
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For treatment,
we use your health information to plan,
coordinate, and provide your care. We
disclose your health information for
treatment purposes to physicians and other
health care professionals outside our agency
who are involved in your care.
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For payment,
we use your health information to prepare
documentation required by your insurance
company or HMO or by Medicare or Medicaid.
We disclose that part of your health
information that these organizations require
to pay us.
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For health care operations,
we use or disclose your health information,
for example, to improve the quality of our
services, to plan better ways of treating
patients, and to evaluate staff performance.
Uses or Disclosures of Your Health Information
to Which You May Object
We may use or disclose your health information
for the following purposes, unless you ask us
not to.
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Informing family and friends.
We may disclose your health information to family,
friends, or others identified by you who are
involved in your care.
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Assistance in disaster
relief efforts<.
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Confirming our visits to your home or other appointments.
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Informing you about
treatment alternatives
or other health-related benefits and services that
may be of interest to you.
If you object to our use of your health
information for any of these purposes please
contact our PRIVACY OFFICIAL.
Uses or Disclosures Required or Permitted
Where we are required or permitted to do so, we
may use or disclose your health information in
the following circumstances without your written
authorization.
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Federal government
investigation, when required by the
Secretary of Health and Human Services to
investigate or determine our compliance with
federal regulation.
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Federal, state or local
law requirements.
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Public health activities,
for example to report communicable diseases
or death; or for matters involving the Food
and Drug Administration.
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Reporting of abuse,
neglect or domestic violence.
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Health oversight
activities by a health oversight agency.
(A health oversight agency is an
organization authorized by the government to
oversee eligibility and compliance and to
enforce civil rights laws.)
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Judicial or administrative
proceedings, for example responding to a
court order or subpoena.
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Law enforcement purposes,
for example to report certain types of
wounds or other physical injuries or to
identify or locate a suspect, fugitive,
material witness, or missing person.
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Use by coroners, medical
examiners, or funeral directors.
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Facilitating organ, eye,
or tissue donation.
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Research, provided that
very strict controls are enforced.
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Averting a serious threat
to your health or safety or that of the
public.
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Specialized government
functions such as military or veterans’
affairs; national security, and intelligence
activities.
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Workers' compensation.
Uses or Disclosures Which Require Your Written
Authorization
Your written authorization, which you may revoke
(in writing), is required if we use or disclose
your health information for any purpose other
than those stated above. In particular
your authorization is required if:
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We use or disclose your
psychotherapy notes other than for treatment
or health care operations as specified in
federal regulations.
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We use or disclose your health information
for marketing of goods or services.
Your Rights As A
Patient to Privacy Of Your Health Information
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Right to Request
Restrictions
You have
the right to request restrictions on our uses
and disclosures of your health information. Your
request must be in writing. We will make every
attempt to honor your request; however, we may
refuse to accept the restriction.
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Right to Request
Confidential Communications
You have the
right to request that we communicate with
you confidentially, for example to speak
with you only in private; to send mail to an
address you designate; or to telephone you
at a number you designate. Your request must
be in writing. We will make every attempt to
honor your request.
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Right to Request
Access to Your Health Information
You have the
right to request access to your health
information in order to inspect or copy it.
Your request must be in writing. We
may deny your request and, if so, you may
request a review of the denial.
However, we will make every attempt to honor
your request.
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Right to Request an
Amendment of Your Health Information
You have the
right to request an amendment to your health
information. Your request must be in writing and
must provide a reason for the amendment. We may
deny your request and, if so, you may submit a
statement of disagreement. However, we will make
every attempt to honor your request.
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Right to Request an
Accounting of Disclosures of Your Health
Information
You have the
right to request an accounting of our
disclosures of your health information for
purposes other than treatment, payment, and
health care operations. Your request
must be in writing. We will make every
attempt to honor your request. We are
not required to provide an accounting for
disclosures before April 14, 2003 or for
more than 6 years prior to the date of your
request.
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Right to Obtain a
Paper Copy of this Notice
If you
received this Notice electronically, you
have the right to receive a paper copy.
To exercise any of these rights please write or
telephone our PRIVACY OFFICIAL.
Our Duties in
Protecting Your Health Information
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We are required by law to
maintain the privacy of your health
information.
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We must inform patients or
their legal representatives of our legal
duties and privacy practices with respect to
health information. This Notice
discharges that duty.
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We must abide by the terms
of the Notice currently in effect.
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We reserve the right to change the terms of
this Notice and to make the new Notice
provisions effective for all health
information that we maintain. At any
time, you may obtain a copy of the current
notice from our PRIVACY OFFICIAL.
Complaints, Contact Person, and Effective Date
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You may
complain to us and to the Secretary of
Health and Human Services if you believe
your privacy rights have been violated.
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You will
not be retaliated against for filing a
complaint.
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You may file your complaint with our agency
PRIVACY OFFICIAL by writing to:
PRIVACY
OFFICIAL
Terrebonne Homecare, Inc.
P.O. Box 3063
Houma, LA 70361
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You may file a complaint with the Office for Civil Rights by writing or calling:
Office for Civil Rights
U.S. Department of Health and Human Services
1301 Young Street, Suite 1169
Dallas, TX 75202
Voice Phone (214) 767-4056
FAX (214) 767-0432
TDD (214) 767-8940
For further information you may write or call
our PRIVACY OFFICIAL at (985) 873-7000.
This notice is effective August 3, 2009.