COMPLETE HOME CARE INC. 

THIS NOTICE DESCRIBES HOW HEALTH

INFORMATION ABOUT YOU MAY BE USED AND

DISCLOSED AND HOW YOU CAN GET ACCESS TO

YOUR IDENTIFIABLE HEALTH INFORMATION.

PLEASE REVIEW THIS NOTICE CAREFULLY

OUR COMMITMENT TO YOUR PRIVACY

To summarize, this notice provides you with the following important information:

• How we may use and disclose your identifiable health information
• Your privacy rights in your identifiable health information
• Our obligations concerning the use and disclosure of your identifiable health information.

The terms of this notice apply to all records containing your identifiable health information that are created or retained by our office. We reserve the right to revise or amend our notice of privacy practices. Any revision or amendment to this notice will be effective for all of our records we have created or maintained in the past, and for any of your records we may create or maintain in the future. Our company will post a copy of our current notice in our office in a prominent location, and you may request a copy of our most current notice during any office visit.

IF YOU HAVE QUESTIONS ABOUT THIS NOTICE, PLEASE CONTACT:

Larry Quinn

Phone 662-862-7828 Day

Phone 662-862-2928 Nights

WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION IN THE FOLLOWING WAYS:

The following categories describe the different ways in which we may use and disclose your identifiable heath information:

Treatment. Complete Home Care Inc. may use your identifiable health information to treat you. For example we may disclose your identifiable health information to others who may assist in your care, such as your physician, therapists, spouse, children, or parents.

Payment. Complete Home Care Inc. may use and disclose your identifiable health information in order to bill and collect payment for services and items you may receive from us. Foe example, we may contact your health insurer to certify that you are eligible for benefits and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your identifiable health information to obtain payment from third parties who may be responsible for such costs, Such as family members. Also, we may use your identifiable health information to bill you directly for services and items.

Deliveries. Complete Home Care Inc. may use and disclose your identifiable health information to contact you for deliveries.

Release of Information to Family/Friends. Complete Home Care Inc. may release your identifiable health information to a friend or family member who is helping you pay for your health care or who assists in taking care of you.

Disclosures Required By Law. Complete Home Care Inc. will use and disclose your identifiable health information when we are required to do so by federal, state, or local law.

USE AND DISCLOSURE OF YOUR IDENTIFIABLE HEALTH INFORMATION IN CERTAIN SPECIAL CIRCUMSTANCES

Public Health Risks. Complete Home Care may disclose your identifiable health information to public health authorities that are authorized by law to collect information for the purpose of:

·        Maintaining vital records, such as births and deaths

·        Reporting child abuse or neglect

·        Preventing or controlling disease, injury, or disability

·        Notifying a person regarding potential exposure to a communicable disease

·        Notifying a person regarding a potential risk for spreading or contracting a disease or condition

·        Reporting reactions to drugs or problems with products or devices

·        Notifying individuals if a product or device they may be using has been recalled

·        Notifying appropriate government agency (ies) and authority (ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information

·        Notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.

Health Oversight Activities. Complete Home Care Inc. may disclose your identifiable health information to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure, and disciplinary actions: civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws, and the health care system in general.

Lawsuits and Similar Proceedings. Complete Home Care Inc. may use and disclose your identifiable health information in response to a court or administrative order if you are involved in a lawsuit or similar proceeding, We also may disclose your identifiable health information in response to a discovery request, subpoena, or other lawful process by another party involved in the dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested

Law Enforcement. Complete Home Care Inc. may release identifiable health information if asked to do so by a law enforcement official:

·        Regarding a crime victim in certain situations, if we are unable to obtain the person’s agreement

·        Concerning a death we believe might have resulted from criminal conduct

·        Regarding criminal conduct at our offices

·        In response to a warrant, summons, court order, subpoena, or similar legal process

·        To identify/locate a suspect, material witness, fugitive, or missing person

·        In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator

Serious threats to Health or Safety. Complete Home Care Inc. may use and disclose your identifiable health information when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.

Military. Complete Home Care Inc. may disclose your identifiable health information if you are a member of U. S. or foreign military forces (including veterans) and if required by the appropriate military command authorities.

National Security. Complete Home Care Inc. may disclose your identifiable health information to federal officials for intelligence and national security activities authorized by law. We also may disclose your identifiable health information to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.

Inmates. Complete Home Care Inc. may disclose your identifiable health information to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you; (b) for the safety and security of the institution; and/or (c) to protect your health and safety or the health and safety of other individuals.

Workers’ Compensation. Complete Home Care Inc. may release your identifiable health information for workers’ compensation and similar programs.

YOUR RIGHTS REGARDING YOUR IDENTIFIABLE HEALTH INFORMATION

You have the following rights regarding the identifiable health information that we maintain about you:

Confidential Communications. You have the right to request that Complete Home Care Inc. communicate with you about your health and related issues in a particular manner or at a certain location. In order to request a type of confidential communication, you must make a written request to Complete Home Care Inc. marked to the attention of Larry Quinn located at 709 S Adams St. Fulton, MS 38843 or call 662-862-7828 for further information. In this request you must the method of contact and the location where you wish to be contacted. We will accommodate all reasonable requests.

Requesting Restrictions. You have the right to request a restriction in our use or disclosure of your identifiable health information for treatment, payment, or health care operations. Additionally, you have the right to request that we limit our disclosure of your identifiable health information to individuals involved in your care or the payment for your care, such as family members and friends. We are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction in our use or disclosure of your identifiable health information, you must make your request in writing to Larry Quinn 709 S Adams St. Fulton, MS 38843 or call 662-962-7828 for further information. Your request must describe in a clear and concise fashion: (a) the information you wish restricted; (b) whether you are requesting to limit our office use, disclosure, or both; and (c) to whom you want the limits to apply.

Inspection and Copies. You have the right to inspect and obtain a copy of the identifiable health information that may be used to make decisions about you, including patient medical records and billing records. You must submit your request in writing to Larry Quinn 709 S Adams St. Fulton, MS 38843 in order to inspect and/or obtain a copy of your identifiable health information. Complete Home Care may charge a fee for the cost of copying, mailing, labor, and supplies associated with your request. We may deny you’re your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial. Another licensed health care professional chosen by us will conduct reviews.

Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for Complete Home Care Inc. To request an amendment, your request must be made in writing and submitted to Larry Quinn 709 S Adams St. Fulton, MS 38843 or call 662-862-7828 for more information. You must provide us with a reason that supports your request for amendment. Complete Home Care Inc. will deny your request if you fail to submit your request (and the reason supporting) your request) in writing. Also, we may deny your request if you ask us to amend information that is: (a) accurate and complete; (b) not part of the identifiable health information kept by or for the organization; (c) not part of the identifiable health information which you would be permitted to inspect and copy; or (d) not created by our organization, unless the individual or entity that created the information is not available to amend the information.

Accounting of Disclosures. All of our patients have the right to request an “accounting of disclosures.” An “accounting of disclosures” is a list of certain disclosures Complete Home Care Inc. has made of your identifiable health information. In order to obtain an accounting of disclosures, you must submit your request in writing to Larry Quinn 709 S Adams St. Fulton, MS 38843 or call 662-862-7828 for more information. All requests for an “accounting of disclosures” must state a time period, which may not be longer than six years and may not include dates before April 14^th 2003. The first list you request within a 12-month period is free of charge, but we may charge you for additional lists within the same 12-month period. Complete Home Care Inc. will notify you of the costs involved with additional request, and you may withdraw your request before you incur any cost.

Right to a Paper Copy of this Notice. You are entitled to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact Larry Quinn 709 S Adams St. Fulton, MS 38843 or call 662-862-7828 and one will be mailed to you.

Right to File a Compliant. If you believe your privacy rights have been violated, you may file a complaint with Complete Home Care Inc. or with the Secretary of the Department of Health and Human Services. To file a complaint with Complete Home Care Inc. contact Larry Quinn 709 S Adams St, Fulton, MS 38843 Phone 662-862-7828. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

Right to Provide an Authorization for Other Uses and Disclosures. Complete Home Care Inc. will obtain your written authorization for uses and disclosures that are not identified by this notice or permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your identifiable health information may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your identifiable health information for the reason described in the authorization. Please note, we are required to retain records of your care.