INDEPENDENT NURSING CARE, LLC

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.

If you have any questions about this notice, please contact the Independent Nursing Care, LLC Privacy Officer at 716-655-8776.

This Notice of Privacy Practices describes the legal obligations of Independent Nursing Care, LLC and your legal rights regarding your protected health and personal information  held by Independent Nursing Care, LLC under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). Among other things, this Notice describes how your Protected Health Information or private information (collectively referred to as “Protected Health Information”) may be used or disclosed to carry out treatment, payment, or health care operations, or for any other purposes that are permitted by law. This notice applies to all information and records related to your care that our agency workforce members and Business Associates (described below) have received or created.

 OUR RESPONSIBILITIES: We are required by law to:

– Maintain the privacy of your Protected Health Information;

– Provide you with certain rights with respect to your Protected Health Information;

– Provide you with a copy of this Notice of our legal duties and privacy practices regarding health

information about you;

– Follow the terms of our Notice that is currently in effect.

 HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION: The following describes the ways we may use and disclose your Protected Health Information. Except for the purposes described below, we will use and disclose this information only with your written permission. You may revoke such permission at any time by writing to our Privacy Officer. Independent Nursing Care, LLC limits information to the minimum necessary to accomplish the intended purpose of its use, disclosure or request. Here are examples of how we may use and disclose your health information:

For Treatment. We may use and disclose Protected Health Information for your treatment/care and to provide you with health/home care services. For example, we may disclose Protected Health Information to doctors, nurses or other personnel, including people outside of our agency, who are involved in your medical care and need the information to provide you with medical care.

Private Information refers to unencrypted personal information in combination with any one or more of the following elements: 1) social security number, 2) driver’s license or non-driver identification card number, or 3) account number, credit or debit card number, in combination with any required security or access code which would permit access to an individual’s financial account.

For Payment. We may use and disclose Protected Health Information so that we may bill and receive payment for your health care services. For example, we may use your Protected Health Information on a claim to your insurance company, Medicare or Medicaid in order to receive payment for services provided to you. We may also disclose your Protected Health Information to receive authorization from your insurance company for the services you need.

For Health Care Operations. We may use and disclose your Protected Health Information for health care operations purposes. These uses and disclosures are necessary to make sure all of our patients receive quality care and to operate and manage our office. For example, we may use Protected Health Information to evaluate Agency services, including the performance of our staff and to educate our staff.

WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION FOR OTHER SPECIFIC PURPOSES:

 As Required by Law. We will disclose your Protected Health Information when required to do so by international, federal, state or local law.

 Business Associates. We may share your Protected Health Information with our vendors and agents who help us with obtaining payment or carrying out our business functions. These are called our “Business Associates.” For example, we may give your Protected Health Information to a billing company to assist us with our billing for services, or to a law firm or an accounting firm that assists us in complying with the law or improving our services. To protect and safeguard your Protected Health Information, we require our Business Associates to appropriately safeguard your information.

Public Health Activities I Risks. We may disclose your Protected Health Information for public health activities including the reporting of disease, injury, vital events, reporting reactions to medications or problems with products, and the conduct of public health surveillance, investigation and/or intervention. We may also disclose your information to notify a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition if a law permits us to do so.

 Health Oversight Activities. We may disclose your Protected Health Information to health oversight agencies authorized by law to conduct audits, investigations, inspections and licensure actions or other legal proceedings. These agencies provide oversight for the Medicare and Medicaid programs, among others.

 Appointment Reminders, Treatment Alternatives and Health Related Benefits and Services. We may use and disclose Protected Health Information to contact you to remind you of a service time or appointment with us. We also may use and disclose Protected Health Information to tell you about treatment alternatives or health-related benefits and services that may be of interest to you.

 Judicial and Administrative Proceedings. We may disclose your Protected Health Information in the course of certain judicial or administrative proceedings.

Reporting Victims of Abuse, Neglect or Domestic Violence. If we have reason to believe that you have been a victim of abuse, neglect or domestic violence, we may use and disclose your Protected Health Information to notify a government authority if required or authorized by law, or if you agree to the report.

 Law Enforcement. We may use and disclose your Protected Health Information if asked by a law enforcement official if the information is

• in response to a court order, subpoena, warrant, summons or similar process;
• limited information to identify or locate a suspect, fugitive, material witness or missing person;
• about the victim of a crime even if, under certain very limited circumstances, we are unable to obtain the person’s agreement;
• about a death that we believe may be the result of criminal conduct; and
• about criminal conduct.

 Data Breach Notification Purposes. We may use or disclose your Protected Health Information to provide legally required notices of unauthorized access to or disclosure of your health information as soon as possible but no later than 60 days following the discovery of the breach. A “breach” means the unauthorized access, acquisition, use or disclosure of Protected Health Information which compromises the security or privacy of Protected Health Information, except where an unauthorized person to who such information is disclosed would not have reasonably been able to retain such information.

 Research. In general, we will request that you sign a written authorization before using your Protected Health Information or disclosing it to others for research purposes. However, we may use or disclose your Protected Health Information without your written authorization for research purposes provided that the research has been reviewed and approved by a special Privacy Board or Institutional Review Board.

 Coroners, Medical Examiners, Funeral Directors, Organ Procurement Organizations. We may release your Protected Health Information to a coroner or medical examiner as necessary for reasons such as the identification of a deceased person or determination of a cause of death. We also may release to a funeral director as necessary for their duties. If you are an organ donor, we may use Protected Health Information to organizations that handle organ procurement.

 To Avert a Serious Threat to Health or Safety. We may use and disclose your Protected Health Information when necessary to prevent a serious threat to your health or safety or the health or safety of the public or another person. However, any disclosure would be made only to someone able to help prevent the threat.

 Workers’ Compensation. We may use or disclose your Protected Health Information to comply with laws relating to workers’ compensation or similar programs.

 Military and Veterans. If you are a member of the armed forces, we may use and disclose your Protected Health Information as required by military command authorities. We may also use and disclose Protected Health Information about foreign military personnel as required by the appropriate foreign military authorities.

National Security and intelligence Activities, Protective Services. We may disclose Protected Health Information to authorized federal officials for intelligence, counter­intelligence, and other security activities authorized by law. Also as needed to provide protection to the President of the United States, foreign heads of state or to conduct special investigations.

 USES AND DISCLOSURES THAT REQUIRE US TO GIVE YOU AN OPPORTUNITY TO OBJECT AND OPT OUT:

 Individuals Involved in Your Care or Payment for Your Care. Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your Protected Health Information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment.

 Disaster Relief. We may disclose your Protected Health Information to disaster relief organizations that seek your Protected Health Information to coordinate your care, or notify family and friends of your location or condition in a disaster. We will provide you with an opportunity to agree or object to such a disclosure whenever we practically can do so.

 Fundraising. Independent Nursing Care, LLC does not participate in fundraising activities that would involve sending or making communications to our present or former patients for the purposes of raising money for ourselves or another entity. Independent Nursing Care, LLC does not share information regarding our clients to other entities for the purpose of fundraising. Individuals have the right to opt out of fundraising solicitation and their decision will have no impact on the treatment or payment for services received from Independent Nursing Care, LLC.

 YOUR WRITTEN AUTHORIZATION IS REQUIRED FOR OTHER USES AND DISCLOSURES:

The following uses and disclosures of your Protected Health Information will be made only with your written authorization:

1. Uses and disclosures of Protected Health Information for marketing purposes;
2. Disclosures that constitute a sale of your Protected Health Information.

Other uses and disclosures of Protected Health Information not covered by this Notice or the laws that apply to use will be made only with your written authorization. If you do give us an authorization, you may revoke it at any time by submitting a written revocation to our Privacy Officer and we will no longer disclose Protected Health Information under the authorization. But disclosures that we made in reliance on your authorization before you revoked it will not be affected by the revocation.

YOUR RIGHTS:

You have the following rights regarding the Protected Health Information we have about you:

Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can request that we speak to you only at a private location in your home. We will accommodate your reasonable requests. The Agency will use the phone number(s) provided by you as the contact number(s) for communication of schedules and/or staff members who will be providing care. Messages may be left on the voice mail/answering machine for the phone numbers provided unless a request to restrict this manner of communication is received from the individual.

 Right to Amend. If you feel the Protected Health Information we have is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for our office. To request an amendment, you must make your request, in writing to: Independent Nursing Care, LLC, Attn: HIPAA Privacy Officer, 1038 Davis Road, P O Box 489, West Falls, NY  14170.

Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures we made of Protected Health Information for purposes other than treatment, payment and health care operations or for which you provide written authorization. To request an accounting of disclosures, you must make your request, in writing, to Independent Nursing Care, LLC Attn: HIPAA Privacy Officer, 1038 Davis Road, P O Box 489, West Falls, NY  14170.

 Right to Request Restrictions. You have the right to request a restriction or limitation on the Protected Health Information we use or disclose for treatment, payment, or health care operations. You also have the right to request a limit on the Protected Health Information we disclose to someone involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not share information about a particular diagnosis or treatment with your spouse. To request a restriction, you must make your request, in writing to Independent Nursing Care, LLC, Attn: HIPAA Privacy Officer, 1038 Davis Road, P O Box 489, West Falls, NY  14170.

We are not required to agree to your requested restriction, and in some cases, the law may not permit us to accept your restriction. However, if we do agree to accept your restriction, we will comply with your restriction in most situations. We may not be permitted to honor your restriction(s) in the following situations: (1) if you are being transferred to another health care institution, (2) the release of records is required by law, (3) the release of information is needed to provide you emergency treatment, or (4) the release is required by a third party payor contract.

Out-of-Pocket Payments. If you paid out-of-pocket (or in other words, you have requested that we not bill your health plan) in full for a specific item or service, you have the right to ask that your Protected Health Information with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations and we will honor that request.

Right to Inspect and Copy. You have a right to inspect and copy Protected Health Information that may be used to make decisions about your care or payment for your care. This includes medical and billing records, other than psychotherapy notes. To inspect and copy this Protected Health Information, you must make your request in writing, Independent Nursing Care, LLC, Attn: HIPAA Privacy Officer, 1038 Davis Road, P O Box 489, West Falls, NY  14170.

We have up to 30 days to make your Protected Health Information available to you and we may charge a reasonable fee for the costs of copying, mailing or other supplies associated with your request. We do not charge a fee if you need the information for a claim for benefits under the Social Security Act or other state or federal needs-based benefit program. We may deny your request in certain limited circumstances. If we do deny your request, you have the right to have the denial reviewed by a licensed health care professional who was not directly involved in the denial of your request, and we will comply with the outcome of the review. To request a denial review, please submit a written request to Independent Nursing Care, LLC, Attn: HIPAA Privacy Officer, 1038 Davis Road, P O Box 489, West Falls, NY  14170.

 Right to an Electronic Copy of Electronic Medical Records.  If your Protected Health Information is maintained in an electronic format (known as an electronic medical record or an electronic health record), you have the right to request an electronic copy of your record. We will make every effort to provide access to your Protected Health Information in the form or format you request, if it is readily producible in such form or format. We may charge a reasonable, cost-based fee for labor associated with transmitting the electronic medical record.

 Right to Get Notice of a Breach. You have the right to be notified in the event that we (or a Business Associate) discover a breach of any of your unsecured Protected  Health Information.

 Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice. One is provided to you upon admission to services, however you may ask for additional copies. You may obtain a paper copy of this notice by calling our office at 716-655-8776 or submitting a request in writing to Independent Nursing Care, LLC, Attn: HIPAA Privacy Officer, 1038 Davis Road, P O Box 489, West Falls, NY 14170.

 COMPLAINTS:

If you believe that your privacy rights have been violated, you may file a complaint with our office or with the Office for Civil Rights of the United States Department of Health and Human Services. To file a complaint with the Office for Civil Rights of the United States Department of Health and Human Services, go to the website http://www.hhs.gov/hipaa/filing-a-complaint/complaint-process/index.html. The complaint form must be completed and submitted in writing to Centralized Case Management Operations, US Department of Health and Human Services, 200 Independence Avenue, SW, Room 509F HHH Building, Washington, DC 20201. You will not be penalized, or in any other way retaliated against, for filing a complaint with the Office for Civil Rights or with us.

 CHANGES TO THIS NOTICE:

We will promptly revise and distribute this Notice whenever there is a material change to the uses or disclosures of your individual rights, our legal duties, or other privacy practices stated in this Notice. We reserve the right to change this Notice and to make the revised or new Notice provisions effective for all Protected Health Information already received and maintained by the Agency as well as for all Protected Health Information we receive in the future. We will post a copy of the current Notice at the Agency. Additionally, we will provide a copy of the revised Notice to all patients active at time of effectiveness by mailing or hand-delivering a paper copy to them or their personal representative.

March 11, 2016