BERING OMEGA COMMUNITY SERVICES
Notice of Privacy Practices
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.
Bering Omega Community Services is committed to providing services designated to meet your needs. We are equally committed to respecting your privacy and protecting the information about you that we may receive. We have prepared this Notice to advise you of what information we collect and how we protect it. Bering Omega Community Services (referred to herein as Bering Omega) and its professional staff, employees, and volunteers follows the privacy practices described in this Notice. We are required by law to maintain the privacy of your health information, whether in paper or electronic records, and to protect the integrity, confidentiality, and availability of your electronic health information when it is collected, maintained, used or transmitted by Bering Omega. However, we must use and disclose your medical information to the extent necessary to provide you with quality health care. To do this, Bering Omega must share your medical information as necessary for treatment, payment and health care operations.
What Information We Collect:
As an essential part of our business, we obtain certain personal information about you in order to provide a service to you. Some of the information comes directly from you, on applications or other forms, and may include information you provide during visits to our agency or while speaking with our staff. We may also receive information from physicians and other health providers or agencies. The types of information we receive may include addresses, a social security number, family information, current and past clinical history, and financial information.
What are Treatment, Payment, and Health Care Operations?
Treatment includes sharing information among health care providers involved in your care. For example, your nurse may disclose information about your condition with a pharmacist or an outside physician to discuss appropriate medications. Bering Omega may also disclose your medical information as required by Medicaid or another entity, such as a health plan, for that entity’s determinations concerning, for example, medical necessity or the entity’s payment responsibility. We may also use and disclose your medical information to improve the quality of care at Bering Omega, for example, for review and training purposes.
How Will Bering Omega Use My Medical Information?
Your medical information may be used or disclosed, unless you ask for restrictions on a specific use or disclosure, for the following purposes:
- Family members or close friends who may consent to your treatment consistent with state and federal law.
- As required by law.
- Public health activities, including disease prevention, injury or disability; reporting births and deaths; reporting child abuse or neglect; reporting reactions to medications or product problems; notification of recalls; infectious disease control; notifying government authorities of suspected abuse, neglect or domestic violence (if you agree or as required or authorized by law).
- Health oversight activities, e.g., audits, inspections, investigations, and licensure.
- Lawsuits and disputes. (We will attempt to provide you advance notice of a subpoena before disclosing the information.)
- Law enforcement (e.g., in response to a court order or subpoena).
- To coroners and medical examiners.
- Certain research projects approved by an Institutional Review Board.
- To prevent a serious threat to health or safety.
- To military command authorities if you are a member of the armed forces.
- National security and intelligence activities.
- Protection of the President or other authorized persons for foreign heads of state, or to conduct special investigations.
- Workers’ Compensation. (Your medical information regarding benefits for work-related illnesses may be released as appropriate.)
- To carry out treatment, payment, and health care operations functions through business associates, e.g., to install a new computer system.
Certain types of information may be subject to additional restrictions on disclosure, such as AIDS or HIV test results, status or other related information and psychotherapy notes.
Other Ways Bering Omega May Use My Medical Information:
In addition, Bering Omega may contact you to provide appointment reminders and to inform you of treatment alternatives or benefits or services related to your health that may be of interest to you. (You will have the opportunity to refuse to receive this information.)
Your authorization is Required for Other Disclosures:
Except as described above, we will not use or disclose your medical information unless you authorize Bering Omega in writing to disclose your information. You may revoke your permission, which will be effective only after the date of your written revocation.
You have Rights Regarding Your Medical Information:
You have the following rights regarding your medical information, provided that you make a written request to invoke the right on the form provided by Bering Omega:
- Right to request restriction. You may request limitations on your medical information we use or disclose for health treatment, payment or operations, but we are not required to agree to your request. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment.
- Right to confidential communications. You may request communications in a certain way or at a certain location, but you must specify how or where you wish to be contacted.
- Right to inspect and copy. You have the right to inspect and copy your medical information regarding decisions about your care. We may charge a fee for copying, mailing and supplies. Under limited circumstances, your request may be denied; in some cases you may request review of the denial by another licensed health care professional chosen by Bering Omega. Bering Omega will comply with the outcome of the review.
- Right to request amendment. If you believe that the medical information we have about you is incorrect or incomplete, you may request an amendment on the form provided by Bering Omega, which requires certain specific information. Bering Omega is not required to accept the amendment.
- Right to accounting of disclosures. You may request a list of the disclosures of your medical information that have been made to persons or entities in the past six years, but not prior to April 14, 2003 (such list will not include disclosures made pursuant to an authorization or for treatment, payment, and health care operations). After the first request, there may be a charge.
- Right to a copy of this Notice. You may request a paper copy of this Notice at any time, even if you have been provided with an electronic copy. You may obtain an electronic copy of this Notice at our web site, www.beringomega.org.
Requirements Regarding This Notice:
Bering Omega is required by law to provide you with this Notice. We will be governed by this Notice for as long as it is in effect. Bering Omega may change this Notice, and these changes will be effective for medical information we have about you as well as any information we receive in the future. Each time you visit Bering Omega for health care services, you may receive a copy of the Notice in effect at the time.
If you believe your privacy rights have been violated, you may file a complaint with Bering Omega or with the Secretary of the United States Department of Health and Human Services. You will not be penalized or retaliated against in any way for making a complaint to Bering Omega or the Department of Health and Human Services.
Contact: Call Ann Reed, Vice President of Operations at 713-341-3777 if:
- you have a complaint;
- you have any questions about this Notice;
- you wish to request restrictions on uses and disclosures for health care treatment, payment, or operations; or
- you wish to obtain a form to exercise your individual rights described in paragraph 6.
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