Privacy

Notice of Privacy Practices (Effective 4/14/04)

THIS NOTICE APPLIES TO RESPONSEWORKS CLIENTS AND DESCRIBES HOW YOUR PROTECTED HEALTH INFORMATION MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.

Your personal health and medical information is defined as Protected Health Information (PHI) by The Health Insurance Portability and Accountability Act, also known as HIPAA. PHI is information about you that includes demographic information that may identify you and information that relates to your past, present, or future health (physical or behavioral) or medical condition and any related healthcare services.

This Notice explains how, when and why we may use or share your PHI. This Notice also describes your rights as our client to access and control your health information.

ResponseWorks is required to follow the terms of this Notice, but we may change our privacy practices and this Notice at any time. If we make changes, we will update this Notice on the website accordingly. You may also request a revised Notice by calling our Privacy Officer.

Uses and Disclosure of Your Protected Health Information

ResponseWorks uses PHI and shares it with others for a variety of reasons. Sometimes we are allowed by law to use or share your PHI without your written agreement. Other circumstances require us to obtain your written agreement to share PHI.

For Treatment: We may disclose your PHI to caregivers who are involved in providing your health care or Employee Assistance Program (EAP) services. For example, your PHI may be shared with the health professional that is treating you.

For Payment: We may use and disclose your PHI for our payment-related activities and those of health care providers and other health plans, including for example:

• Paying claims from the health professionals who have provided services to you.
• Coordinating benefits with other insurance you may have
• Obtaining payment for our services

Healthcare Operations: We may use or disclose your PHI to support necessary business activities. For example, we may use your PHI to determine your eligibility for certain services. We may also use your PHI to evaluate our performance in caring for you. Unless you provide us with different instructions, we may send information to your home, such as this Notice, client satisfaction surveys or other health-related benefits and services information.

To Others Involved in Your Care: We may, under certain circumstances disclose to a member of your family, a close friend or any other person you identify, the PHI directly relevant to that person’s involvement in your health care or payment for your health care.

When Required by Law: We will share your PHI when required by federal, state or local law. We may share your PHI when a law requires us to report information about suspected abuse, neglect or domestic violence, or related to suspected criminal activity. We must also share your PHI with authorities that monitor our compliance with privacy requirements.

For Public Health Activities: We may share your PHI when we are required to collect information about a disease, injury or disability, or to report information to a public health authority.

For Health Oversight Activities: We may share your PHI with an agency responsible for monitoring the health care system for activities authorized by law, such as those related to investigations and inspections.

Relating to decedents: We may share PHI related to an individual’s death with coroners, medical examiners or funeral directors.

For Research: We may use your PHI to perform select research activities, provided that criteria established measures to protect your privacy are in place.

Threats to Health and Safety We may share your PHI with law enforcement or other persons who might prevent or reduce the risk of harm in order to avoid a serious threat to health or safety.

To Our Business Associates: We will share your PHI with certain contractors, defined under HIPAA as Business Associates, to perform activities necessary to treatment, payment and/or healthcare operations. We will maintain a written agreement with such Business Associates to protect your PHI from unlawful uses or disclosures.

Lawsuits and Disputes We may disclose your PHI in the course of a judicial or administrative proceedings, in response to an order of a court or tribunal (to the extent expressly authorized), and in certain conditions in response to subpoena, discovery request, or other lawful processes.

Law Enforcement: We may release your PHI to a law enforcement official in response to a court order, subpoena, warrant, summons or similar process. We may also release your PHI to identify or locate a suspect, fugitive, material witness or missing person, or about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement. We may release your PHI in relation to a death believed to be the result of criminal conduct, about criminal conduct at a hospital, and in emergency situations to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.

Your Rights Regarding Your Protected Health Information

Restriction Requests: You have the right to request that we place restrictions on the ways we use or disclose your PHI for treatment, payment or health care operations. We are not required to agree to these additional restrictions; but if we do, we will abide by them (except as needed for emergency treatment or as required by law) unless we notify you that we are terminating our agreement.

Right to Choose How We Contact You: You have the right to ask that we contact 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 by mail. You must make your request in writing. We will agree to your request as long as it is reasonable for us to do so.

Right to Inspect and Copy Your PHI: With certain exceptions, you have the right to look at or receive a copy of your PHI contained in the group of records that are used by or for us to make decisions about you, including our enrollment, payment, claims adjudication and case or medical management notes. We will not provide access to psychotherapy notes, information we collect for legal actions or any lab test information protected by law and you cannot appeal those decisions. We reserve the right to charge a reasonable cost-based fee for copying and postage. If you request an alternative format, such as a summary, we may charge a cost-based fee for preparing the summary. If we deny your request for access, we will tell you the basis for our decision and whether you have a right to further review.

Right to Request Changes or Corrections of Your PHI: If you believe that there is a mistake or missing information in your PHI, you may request that we correct this. You must submit your request in writing, along with the reasons that support your request. We will respond within the time required by law. We may deny the request if we determine that the PHI: (1) is correct and complete; (2) was not created by us and is not part of our records, or (3) is a type of information that we cannot disclose. If we deny your request for changes, we will tell you in writing the reasons for the denial and explain your rights to have your request of our denial, together with any statement of disagreement made part of your PHI. If we approve the request for changes, we’ll change the PHI, and tell you and others that need to know, about the change.

Right to Disclosure Accounting You have the right to an accounting of certain disclosures of your PHI, such as disclosures required by law. This accounting requirement applies to disclosures we make beginning on and after April 14, 2004. If you request this accounting more than once in a 12 month period, we may charge you a fee covering the cost of responding to these additional requests. You can request a list of disclosures going back up to six years but no earlier than April 14, 2004.

Questions and Complaints

If you want more information about our privacy practices, or a written copy of this notice please call us at (800) 301-2265. If you are concerned that we may have violated your privacy rights you have a right to file a complaint with ResponseWorks, Inc. or the U.S. Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized or retaliated against in any way for filing a complaint. If you have any questions on filing a complaint please contact our Privacy Officer at (800) 301-2265.

You will be requested to acknowledge your receipt of this Notice of Privacy Practices by signature on a form designed for that purpose. ResponseWorks, Inc. will retain that form, once signed by you, within the medical record established for you by ResponseWorks, Inc. If you refuse or are unable to sign the acknowledgment form that we provided you with this Notice, we will document your records accordingly as part of our good faith effort to promote your review and understanding of this Notice of Privacy Practices.

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