NOTICE OF PRIVACY PRACTICES
This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review this notice carefully.
In the course of rendering health care services, Martha Lloyd Community Services creates, obtains, and/or maintains health information. Every time you receive a health-related service from Martha Lloyd Community Services, a record of your visit is created. Typically, this record contains information about your general condition, symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a basis for planning your care and treatment. This information is communicated among our staff who contributes to your care. This information is also used by Martha Lloyd Community Services to obtain payment for services, for educating our staff, as a source of data for research, as a source of information for public health officials charged with the responsibility for monitoring our organization and the services it provides, for organization-wide strategic planning, and to apply for and maintain accreditation.
Understanding what is in your medical record and how your health information is used helps you to ensure its accuracy, better understand who, what, when, where and why others may access your health information, and to make more informed decisions when you are requested to authorize disclosure of healthcare information to others.
YOUR HEALTH INFORMATION RIGHTS
Although your health record remains the physical property of Martha Lloyd Community Services, you have access to the information contained in our records. Access is defined as the physical review and/or obtaining a physical copy of health care records. You have numerous rights when it comes to your health information. You have the right to request a restriction on certain uses and disclosures of your information. You also have the right to inspect and/or obtain a copy of your healthcare record, but before requesting a copy of your healthcare record, please inquire whether any fee will be charged for the reproduction of the information requested. You have the right to receive an accounting of certain disclosures of your health information, and you have the right to receive communications of your health information by alternative means or to alternative locations. You have the right to revoke your authorization to use or disclose health information except to the extent that use or disclosure has already been taken. You also have the right to obtain a paper copy of this Notice
A special relationship normally exists between parents and their minor child affording parental rights to control and protect health information of their child. Martha Lloyd Community Services offers parents access to their minor child’s health records unless: 1) an applicable law prohibits such disclosure; 2) an order from a court of competent jurisdiction appoints a personal representative for the minor other than the parents; or, 3) a written agreement between parents and their minor, furnished to Martha Lloyd Community Services in advance of any disclosure, limits access of a parent to a minor’s health information.
PROVIDER Responsibilities
We will not disclose your health information without your consent or authorization, except as described in this Notice. Martha Lloyd Community Services is required by law to maintain the privacy of your health information and to provide you with a notice as to our legal duties and privacy practices with respect to the information we collect and maintain about you. Martha Lloyd Community Services is required to abide by the terms of this notice, to notify you in writing if we are unable to agree to a requested restriction on the use of your health information, and to accommodate reasonable requests made by you to communicate health information by alternative means or to alternative locations. We reserve the right to change our privacy and disclosure practices at any time and to make the new provisions effective for all protected health information we maintain. Should our practices change, we will notify you in writing.
TO REQUEST ASSISTANCE OR TO REPORT A COMPLAINT OR PROBLEM
If you have questions, would like additional information, or experience a problem, you may contact the Privacy Officer at 570-297-2185. If you believe your privacy rights have been violated, you can file a complaint with the Martha Lloyd Community Services Privacy Officer or with the United States Secretary of Health and Human Services, U.S. Department of Health and Human Service, 200 Independence Avenue S. W., Washington, D.C. 20201. Telephone: (202) 619-0257 or toll free 1-877-696-6775. You may also contact the United States Office of Civil Rights at 1- 866-627-7748. There will never be any type of retaliation for making an inquiry or for filing a complaint, and you will never be asked to waive your right to make a complaint or report a problem as a condition of receiving services from Martha Lloyd Community Services.
EXAMPLES of Disclosures for Treatment Payment and Healthcare Operations Where Disclosure or Use May occur Without Consent or Authorization:
The following list of examples is not exhaustive and may not apply to your situation. If you have a question or concern, please consult with the Martha Lloyd Community Services Director of Compliance at 570-297-2185.
Treatment: This means that information obtained by a nurse, physician or other member of the Martha Lloyd Community Services staff will be recorded in your health record and used to determine the course of treatment that should work best for you. Physician orders and notes from the staff who comply with these orders will be recorded along with any observations. This practice helps the healthcare team know how you are responding to the services outlined in your service plan.
Payment: We will use your healthcare information to prepare, submit and/or process bills to you or a third-party payer, including Medicare, Medicaid, and other federal, state or locally- administered program payers. The information on the bill may include information that identifies you, as well as your diagnosis, procedures performed and/or supplies and equipment furnished to you.
Maintenance of Healthcare Operations: Members of our healthcare staff, the risk or quality improvement manager, and members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and services provided by Martha Lloyd Community Services.
Appointment Reminders: We may contact you to remind you of a scheduled appointment.
Business Associates: In some instances, we may utilize external vendors – referred to as “business associates” – to provide services in support of Martha Lloyd Community Services operations. When contracting with a business associate, we may disclose your health information so the business associate can perform the tasks that we have asked them to do. We require our business associates to appropriately safeguard your healthcare information from further disclosure without your written consent or authorization.
Directory of Individuals Served: Unless you notify Martha Lloyd Community Services in writing of your objection, we will maintain your name and primary service location in one of our facilities or enrollment in a non-residential program for directory purposes. The directory is used for operational purposes.
Notification in Case of Emergency: Unless you notify Martha Lloyd Community Services in writing of your objection Martha Lloyd Community Services staff, using its best judgment, may use or disclose health information about your general condition and location to notify or assist in notifying a family member, personal representative, or another person responsible for your care and welfare.
Research: We may disclose your demographic and health information to researchers when an institutional review board has reviewed and approved the research proposal, and established protocols to ensure the privacy of your health information.
Funeral directors: We may disclose health information that is consistent with applicable law to funeral directors so that they may carry out their duties.
Organ Procurement Organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
Marketing: We may contact you to provide information about health-related benefits and services that may be of interest to you.
Fundraising: Fundraising activities are an important operational component helping Martha Lloyd Community Services to maintain its successful programs and operations. Martha Lloyd Community Services, or one of its affiliated business partners, may solicit you as part of our fundraising activities. You have the right to have your name removed from the Martha Lloyd Community Services solicitation list. You are not obligated to participate or support any fundraising activity and our services or your employment status will not be affected in any manner by any decision to support or receive information regarding and fundraising activity. If you wish to remove your name from our solicitation list, please ask a Martha Lloyd Community Services staff member for assistance.
Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.
Public Health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability. Included, as public health disclosures are any disclosures of your health information as requirement statutes regarding reportable instances or suspected Adult or Child abuse or neglect.
Court Orders and Subpoenas: We may disclose your health information pursuant to any court order or subpoena pertaining to any purpose defined by statute and as ordered by a court of competent jurisdiction.
Licensing and Accreditation Organizations: We may disclose your health information pursuant to licensing and accreditation activities to maintain the health, safety and welfare of the people we serve and/or to promote quality outcomes.
Correctional Institution: Should you become an inmate of a correctional institution or be placed under supervision of the juvenile or adult criminal court, we may disclose to the institution or agents thereof, probation or parole officer or their designees, health information necessary to preserve or maintain your health and the health and safety of other individuals.
Law Enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena. Federal law also makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes, in good faith, that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more individuals served, employees or the public.
Martha Lloyd Community Services
Attn: Admissions
66 Lloyd Lane
Troy, PA 16947