THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Effective December 08, 2011
At the AIDS Resource Center of Wisconsin we are grateful for the trust you have placed in us to provide you with health and social services. That is why we are committed to keeping your personal health information confidential and private. We believe that protecting your privacy is one of our most important responsibilities. ARCW strongly adheres to state and federal medical records and HIV confidentiality laws that protect your privacy. Thank you for trusting us with your privacy, a trust that we will always honor.
Because you have entrusted ARCW to protect your privacy, we want to provide you with a complete explanation of how your personal health information may be used and to whom it may be disclosed. We will explain the use and disclosure of your health information when needed for your treatment, payment for health care or other health care operations, and when required by law. We will also explain your rights to access and control how your personal health information is used.
Personal health information is about you. It includes information that may identify who you are; where you live; your past, present or future physical or behavioral health conditions; and the health care services that you have received. It is important that you carefully review the information we are providing you. If you have any questions or if you prefer that we not use or disclose your personal health information in the manner that we described, please contact the ARCW Privacy Officer;
ARCW Privacy Officer
820 North Plankinton Avenue
Milwaukee, Wisconsin 53203
YOUR PERSONAL HEALTH INFORMATION
Each time you visit a hospital, physician, dentist, or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examinations and test results, diagnoses, treatment, and a place for future care or treatment. This information, often referred to as your healthcare or medical record, serves as a:
• Basis for planning your care and treatment
• Means of communication among the many health professionals who contribute to your care
• Legal document describing the care you received
• Means by which your third party payer can verify that services billed were actually provided
• Tool in educating health professionals
• Source of information for public health officials charged with improving the health of the nation
• Source of data for facility planning and marketing
• Tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.
Understanding what is in your record and how your health information is used helps you to:
• Ensure accuracy
• Better understand who, what and why others may access your health information
• Make more informed decisions when authorizing disclosure to others
HOW ARCW MAY USE AND DISCLOSE YOUR PERSONAL HEALTH INFORMATION
For Treatment. We may use medical and behavioral health information about you to provide, coordinate and manage your treatment or services. We may disclose healthcare information about you to other doctors, pharmacists, nurses, technicians, medical, dental, nursing and social services students, or other personnel who are involved in your care. For example, A laboratory or medical specialist may need to know information about you to run tests or to provide treatment.
We may also provide subsequent healthcare providers with copies of various reports that should assist him or her in treating you. For example, your healthcare information may be provided to a physician to whom you have been referred so that the physician has important information regarding your previous treatment and diagnosis. The amount of information shared will be the “minimum necessary” for a healthcare provider to make informed decisions about your care.
For payment. We may use and disclose healthcare information about your treatment and services to bill and collect payment from you, your insurance company, or a third party payer. For example, we may need to give your insurance company information before it approves or pays for the health care services we recommend for you. The insurance company may use that information to make a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for the hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.
For Health Care Operations. We may use or disclose, as needed, your health information in order to support our business activities. These activities may include, but are not limited to quality improvement, employee performance reviews, student training, agency licensing, marketing, legal advice, accounting support, healthcare records storage, transcription, complaint resolution, and other agency operations. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment by telephone.
Research. Under certain circumstances, we may use and disclose health information about you for research purposes. For example, a research project may involve comparing the health and recovery of all individuals who receive one medication to those who receive another. All research projects, however, are subject to a special approval process. This process includes evaluating a proposed research project and its use of health information, trying to balance the research needs with your need for privacy of your health information. Before we use or disclose health information for research, the project will have been approved through this research approval process. Additionally, when it is necessary for research purposes and so long as the health information does not leave ARCW, we may disclose your health information to researchers preparing to conduct a research project, for example, to help the researchers look for individuals with specific health needs. Lastly, if certain criteria are met, we may disclose your health information to researchers after your death when it is necessary for research purposes.
Those who receive this information are obligated to maintain its confidentiality under Wisconsin law.
ARCW USES AND DISCLOSURES MADE WITH YOUR CONSENT OR OPPORTUNITY TO OBJECT
Individuals Involved in Your Care or Payment for Your Care. Unless you request otherwise and in emergency situations, privacy law permit us to use professional judgment to disclose information to family members, relatives, close friends, or others who are helping care for you or helping you pay your medical bills.
Communications. We may communicate to you via newsletters, mailings or other means regarding treatment options: information on health-related benefits or services, disease-management programs, wellness programs; to assess your satisfaction with our services; to remind you that you have a healthcare appointment; as part of fund raising efforts; for population-based activities relating to training programs or reviewing competence of health care professionals; or other community based initiatives or activities in which we are participating. If you are not interested in receiving these materials, please contact the Privacy Officer.
ARCW USES AND DISCLOSURES MADE WITHOUT YOUR AUTHORIZATION OR OPPORTUNITY TO OBJECT
When required by federal, state or local law, ARCW is required to disclose health information without your authorization and without providing you with an opportunity to object. Disclosure may be made to the following entities, including but not limited to:
• Judicial/law enforcement court order
• Public health authorities
• Health care oversight agencies
• Coroners, medical examiners and funeral directors
• Workers compensation agents
• National security and public safety authorities
• Authorities on abuse and domestic violence
• Disaster relief efforts
WHEN ARCW MAY NOT USE OR DISCLOSE YOUR HEALTH INFORMATION
Except as provided in this Notice of Privacy Practices, ARCW will not use or disclose your health information without written authorization from you. If you do authorize ARCW to use or disclose your health information for another purpose, you may revoke your authorization in writing at any time. If you revoke your authorization, we will no longer be able to use or disclose health information about you for the reasons covered by your written authorization, though we will be unable to recover disclosures we have already made with your permission.
YOUR HEALTH INFORMATION RIGHTS
You Have the Right to Request Restrictions. You have the right to request a restriction or limitation on the healthcare information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the healthcare information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a procedure that you had. We ask that you submit these requests in writing to our Privacy Officer.
We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment.
You Have the Right to Request Confidential communication. You have the right to request that we communicate with you about healthcare matters in a certain way or at a certain location. We will agree to the request to the extent that it is reasonable for us to do so. For example, you can ask that we use an alternative address for billing purposes. We ask that you submit these requests in writing to our Privacy Officer.
You Have the Right to Inspect and Copy Your HealthCare Information. You have the right to inspect and receive a copy of your healthcare information that may be used to make decisions about your care. We ask that you submit these requests in writing. Usually, this includes medical and billing records, but does not include psychotherapy notes or information complied in reasonable anticipation of, or for use, a civil, criminal, or administrative action or proceeding. Requests for access to and copies of your medical information must be submitted to our Privacy Officer in writing. We may charge a reasonable fee to cover the costs of copying these records.
You have the Right to Request an Amendment to Your HealthCare Information.
If you feel that healthcare information we have about you is incorrect or incomplete, you may ask us to amend the information by submitting a request in writing to our Privacy Officer. You have the right to request an amendment for as long as we keep the information. We may deny your request for an amendment and if this occurs, you will be notified of the reason for the denial.
You Have the Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures that we have made of your health information. To request this list of disclosures, you must submit your request in writing to ARCW’s Privacy Officer at this facility. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a twelve-month period will be free. For additional lists during the same twelve-month period, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
You Have the Right to a Paper Copy of this Notice of Privacy Practices. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. To exercise any of your rights, please obtain the required forms from our Privacy Officer and submit your request in writing.
CHANGES TO THIS NOTICE
ARCW reserves the right to change this Notice. We reserve the right to make the revised Notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in a clear and prominent location to which you have access. The Notice is available to you upon request. The Notice will contain on the first page, the effective date. In addition, if we revise the Notice, we will offer you a copy of the current Notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with the ARCW Compliance Officer. All complaints must be submitted in writing. You will not be penalized for filing a complaint. You may also file a complaint with the Federal Department of Health and Human Services.
820 N. Plankinton Ave.
Milwaukee, WI 53203
U.S. Department of Health and Human Services
Office of Civil Rights, Region V
233 N. Michigan Ave, Suite 240
Chicago, IL 60601
AVAILABILITY OF THIS NOTICE
ARCW provides this Notice of Privacy Practices to all patients and clients. This Explanation is posted in all ARCW offices and on the ARCW website at www.arcw.org. All patients and clients will be notified of any changes to this Notice of Privacy Practices.