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.
As an essential part of our commitment to you, the Aculert Safety Network maintains the privacy of certain confidential health care information about you, known as Protected Health Information or PHI . We are required by law to protect your health care information and to provide you with the attached Notice of Privacy Practices.
The Notice outlines our legal duties and privacy practices with respect
to your PHI. It not only describes our privacy practices and your legal
rights, but lets you know, among other things, how we are permitted to
use and disclose PHI about you, how you can access and copy that information,
how you may request amendment of that information, and how you may request
restrictions on our use and disclosure of your PHI.
We are also required to abide by the terms of the version of this Notice
currently in effect. In most situations we may use this information as
described in this Notice without your permission, but there are some situations
where we may use it only after we obtain your written authorization, if
we are required by law to do so.
We respect your privacy, and treat all health care information
about our patients with care under strict policies of confidentiality
that all of our staff are committed to following at all times.
PLEASE READ THE FOLLOWING
DETAILED NOTICE. IF YOU HAVE ANY QUESTIONS ABOUT IT, PLEASE CONTACT
OUR PRIVACY OFFICER, AT 562-432-9833.
PRIVACY PRACTICES OF ACULERT
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.
health information is personal, and we are committed to protecting
it. Your health information is also very important to our ability to provide
you with quality care, and to comply with certain laws. This Notice
applies to all records about your care that our personnel create. (Your
physician may have different policies and a different Notice regarding
your health information that is created in the physician’s
office.) In addition, the hospital at which you receive care
may also have different policies and a different Notice regarding your
We Are Legally Required to Safeguard Your Protected Health Information
We are required by law to:
- maintain the privacy of your health information,
also known as “protected
health information” or “ PHI”
- provide you with this Notice
- comply with this Notice
FUTURE CHANGES TO OUR
PRACTICES AND THIS NOTICE
We reserve the right to change our privacy practices and to make any such change applicable to the PHI we obtained about you before the change, as well as to information we receive in the future. If a change in our practices is material, we will revise this Notice to reflect the change. You may obtain a copy of any revised Notice by contacting Customer Service at 1-562-432-9833. We will also make any revised Notice available in our Administrative Offices.
How We May Use and Disclose
Your Protected Health Information
The law requires us to obtain your prior authorization for
some uses and disclosures. In other circumstances, the law allows us
to use or disclose your PHI without your authorization. The following
gives examples of each of these circumstances.
USES AND DISCLOSURES THAT DO NOT REQUIRE YOUR AUTHORIZATION
USES AND DISCLOSURES THAT REQUIRE US TO GIVE YOU THE OPPORTUNITY
- We may use or disclose your PHI toprovide
treatment to you or in order for others to provide
treatment to you. For example, we may disclose your PHI to
physicians, nurses, and other health care personnel who are involved
in your care.
- We may also use or disclose your PHI to your insurance
order to get paid for treatment provided to you. For
example, we may use your PHI to create the bills that we submit
to the insurance company, or we may disclose certain portions
of your PHI to our business associates who perform billing and claims
processing or other services for us. We may also disclose your PHI to
another health care provider or insurance company for their
such as to get paid for treatment provided to you or to process
claims under your health insurance plan.
- We may also use or disclose your PHI for our operations related
to health care. For example, we may use your PHI to evaluate
the quality of care you received from us, or to evaluate
the performance of those involved with your care. We may also provide
your PHI to our attorneys, accountants and other consultants to make
sure we are complying with the laws that affect us. In addition, we
may also disclose your PHI to another health care provider, health
insurance plan or health care clearinghouse for purposes of their operations related to health care.
However, we will only do so if they have or have had a
relationship with you and if the PHI they request pertains to that
relationship. In addition, we will disclose your PHI to these third
parties for limited purposes only, such as for them to conduct quality
improvement activities, or to review the performance of a health care
provider, or for training purposes.
- There are stricter requirements for use and disclosure for
some types of PHI , for example, drug and alcohol abuse patient
information and HIV tests. However, there are still
limited circumstances in which these types of information may be used
or disclosed without your authorization.
CERTAIN USES AND DISCLOSURES DO NOT REQUIRE YOUR AUTHORIZATION
- If you do not object, we may provide relevant portions of your PHI to
a family member, friend or other person you indicate is involved
in your health care or in helping you get insurance coverage or otherwise
provide for payment for your health care. We may use or disclose your PHI
to notify your family or personal representative of your location or condition.
In an emergency or when you are not capable of agreeing or objecting to
these disclosures, we will disclose your PHI as we determine is in your
best interest, but will give you the opportunity to object to future disclosures
to family and friends if possible. Unless you object, we may also disclose
your PHI to persons performing disaster relief activities.
The law allows us to disclose your PHI without your authorization in
the following circumstances:
- When Required by Law. We disclose PHI when we are required to do
so by federal, state or local law.
- For Public Health Activities. For example, we disclose PHI when
we report adverse reactions to a drug or medical device,
or to notify a person who may have been exposed to a disease
in compliance with applicable law. We may also report your PHI to the
local emergency medical services agency in connection with its oversight
role over ambulance services. We may also use and disclose your PHI as
necessary to comply with federal and state laws that govern workplace
- For Reports About Victims of Abuse, Neglect or Domestic
Violence. We will disclose your PHI in these reports only
if we are required or authorized by law to do so, or if you otherwise
- To Health Oversight Agencies. We will provide your PHI as requested
to government agencies who have authority to audit or investigate
- For Lawsuits and Disputes. If you are involved in a lawsuit or dispute,
we may disclose your PHI in response to a court order or administrative
order. We may also disclose your PHI in response to a subpoena
or other lawful process by someone else involved in the dispute, but only
if efforts have been made to tell you about the request (which may include
written Notice to you) or to obtain a court order that will protect the
- To Law Enforcement. We may release your PHI as permitted by law if
asked to do so by a law enforcement official, in the following
circumstances: (a) in response to a court order issued by a court in the
county where the records are located, grand-jury subpoena, court-ordered
warrant, administrative request or similar process; (b) to identify or
locate a suspect, fugitive, material witness or missing person; (c) about
the victim of a crime if, under certain limited circumstances, we are
unable to obtain the person’s
agreement; (d) about a death we believe may be due to criminal
conduct; (e) about criminal conduct at our agency; and (f) in emergency
circumstances, to report a crime, its location or victims, or the identity,
description or location of the person who committed the crime.
- To Coroners, Medical Examiners and Funeral Directors. We may disclose
your PHI to facilitate the duties of these individuals.
- To Organ Procurement Organizations. We may disclose your PHI to facilitate
organ donation and transplantation.
- To Avert a Serious Threat to Health or Safety. We may disclose your
PHI to someone who can help prevent a serious threat to your health
and safety or the health and safety of another person or the public.
- For Specialized Government Functions. For example, we may disclose
your PHI to authorized federal officials for intelligence and national
security activities that are authorized by law, or so that they
may provide protective services to the President or foreign heads of state
or to conduct special investigations authorized by law.
- To Workers’ Compensation or Similar Programs. We may provide
your PHI to these programs in order for you to obtain benefits
for work-related injuries or illness.
- If you are an inmate of a correctional institution or under the custody
of a law enforcement official, we may release your PHI to the correctional
institution or law enforcement official as necessary for the institution
to provide you with health care, to protect your health or safety
or that of others or for the safety and security of the correctional institution.
Other Uses and Disclosures of Your Protected Health Information
Other uses and disclosures of your PHI that are not covered by this Notice
or the laws that apply to us will be made only with your written authorization.
If you give us written authorization for a use or disclosure of your PHI
, you may revoke that authorization, in writing, at any time. If you revoke
your authorization we will no longer use or disclosure your PHI for the
purposes specified in the written authorization, except that we are unable
to take back any disclosures we have already made with your permission.
In addition, we can use or disclose your PHI after you have revoked your
authorization for actions we have already taken in reliance on your authorization.
We are also required to retain certain records of the uses and disclosures
made when the authorization was in effect.
Your Rights Related to Your Protected Health Information
You have the following rights:
The Right to Request Limits on Uses and Disclosures of Your
You have the right to ask us to limit how we use and disclose
your PHI , as long as you are not asking us to limit uses and disclosures
that we are required or authorized to make to the Secretary
of the Department of Health and Human Services, related to
patient directory, or the disclosures described in Section
III , above. Any such request must be submitted in writing
to our Privacy Officer. We are not required to agree to your request.
If we do agree, we will put it in writing and will abide by the
agreement except when you require emergency treatment.
The Right to Choose How We Communicate With You.
You have the right
to ask that we send information to you at a specific address (for
example, at work rather than at home) or in a specific manner (for
example, by e-mail rather than by regular mail, or never by telephone).
We must agree to your request as long as it would not be disruptive
to our operations to do so. You must make any such request in writing,
addressed to our Privacy Officer.
The Right to See and Copy Your PHI.
Except for limited circumstances,
you may look at and copy your PHI that may be used to make decisions
about your care if you ask in writing to do so. Any such request
must be addressed to our Customer Service Office. In certain situations
we may deny your request, but if we do, we will tell you in writing
of the reasons for the denial and explain your rights with regard
to having the denial reviewed. If you ask us to copy your PHI , we
will not charge you for the complete set of documents. Alternatively,
we may provide you with a summary or explanation of your PHI , as
long as you agree to that and in advance.
The Right to Correct or Update Your PHI.
If you believe
that the PHI we have about you is incomplete or incorrect, you may
ask us to amend it. Any such request must be made in writing and
you must tell us why you think the amendment is appropriate. In addition,
the following procedures apply:
- We will not process your request if it is not in writing or
does not tell us why you think the amendment is appropriate.
We will inform you in writing as to whether the amendment will be
made or denied. If we agree to make the amendment, we will ask you
who else you would like us to notify of the amendment. We may deny
your request if you ask us to amend information that:
- was not created by us, unless the person who created the
information is no longer available to make the amendment;
- is not part of the PHI we keep about you;
- is not part of the PHI that you would be allowed to see or
- is determined by us to be accurate and complete.
- If we deny the requested amendment, we will tell you in writing
how to submit a statement of disagreement or complaint,
or to request inclusion of your original amendment request in your
PHI . Any request must be made in writing and must be addressed
to our Fire Administration Office.
The Right to Get a List of the Disclosures We Have Made.
have the right to get a list of instances in which we have
disclosed your PHI. The list will not include certain disclosures,
such as disclosures we have made for treatment, payment
and health care operations purposes, those that are a byproduct
of another use or disclosure permitted under our privacy policies
or by law, those made under an authorization provided by you, those
made directly to you or your family or friends or through our facility
directory, or for disaster relief purposes. Neither will the list
include disclosures we have made for national security purposes
or to law enforcement personnel, or disclosures made before April
- Your request for a list of disclosures must be made in writing
and be addressed to our Customer Service Office. The list we provide
will include disclosures made within the last six years (except not
for those made prior to April 14, 2003 ) unless you specify a shorter
period. The first list you request within a 12-month period will
be free. You will be charged our costs for providing any additional
lists within the 12-month period.
You may contact our Privacy Officer if you have questions or comments
about our privacy practices.
If you believe your privacy rights have been violated, you may file a complaint
with us. To file a complaint with us, put your complaint in writing and
address it to our Privacy Officer at the Aculert Safety Network, PO Box 190114, Boise, ID 83719-0114. You can also file a complaint with
the Secretary of the Federal Department of Health and Human Services. We
will not retaliate against you for filing a complaint.
Effective Date: January 1, 2010.