NOUIS HOME CARE, INC.
NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW PROTECTED MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Information we gather about you is classified in Minnesota as private data and will only be used by authorized individuals. The Minnesota Government Data Practices Act and the Federal Health Insurance Portability and Accountability Act (HIPPA) require that when we ask you to provide us with private or confidential information about yourself that you be told:

• the purpose for which the information will be used
• the legal requirements, if any, of supplying it
• the consequences to you of providing the information or refusing to supply it.

PURPOSE – The information we ask from you will be used for continuity of care; to support your treatment plan and goals; and to provide the services you request or require. The information will also be used to establish your ability to pay for our services or to collect reimbursement for services from a third party payer such as a social service agency.

LEGAL REQUIREMENTS AND CONSEQUENCES – You are not legally required to provide any of the information we request. In most cases it is to your benefit to provide the information since failure to provide the information means we will be unable to provide the services you request and/or require. In some situations, providing services will be hindered. If you are here because of a court order and you refuse to provide information, that refusal may be communicated to the court, your case manager(s), and/or the governing agency. If you do not provide financial/insurance information, you may be responsible for your cost(s) of care.

PRIVACY PRACTICES

1. Nouis Home Care is permitted to make uses and disclosures of protected health information for treatment, payment, and health care operations. Following are some examples:
a. For treatment-if you desire medication, then we will provide information to one of your prescribing doctors.
b. For payment-we will disclose certain information to those who are responsible for providing or facilitating payment (i.e. social service/public health county organization, insurance company, guardian/conservator, etc) for you room and board and other services.
c. For health care operations-Another provider reviews your chart to help ensure you are receiving appropriate care.
2. Nouis Home Care is permitted or required, under specific circumstances, to use or disclose protected health information without the individuals written authorization. Nouis Home Care will disclose protected health information as prescribed by law. This includes the following.
a. Pursuant to Court Order
b. Pursuant to a statute authorizing release including:
i. Reporting any suspected vulnerable adult or child abuse or neglect
ii. Reporting substance abuse by a pregnant woman
iii. Providing information to a Pre-Commitment Screening Team if a commitment is being considered.
c. Pursuant to a contract authorizing access including various accrediting firms or auditors
d. Per the request of the Commissioner of Human Services for:
i. A new use of data approved by the commissioner
ii. Fraud investigation
iii. Investigating a child mortality case by a Child Mortality Review Team
e. Per the request of the Food and Drug Administration (FDA) if the FDA needs access to the information to warn you about health hazards associated with a medication.
f. If you are deemed to be in imminent danger of causing injury to yourself or others, we will release information to appropriate others to prevent any harm.
g. If you are under probation or parole we may release information about you to the delegated authorities to provide health care, to protect your health and safety or the health and safety of others.
h. If you are a current or former member of the armed forces, we may release information about you as required by military authorities.
i. A medical emergency that leaves you incapacitated.
j. To obtain reimbursement for service fees through the county or veteran agencies, and the courts
k. Information compiled by Nouis Home Care to defend itself in any court case
l. To the county medical examiner to identify, or locate relatives or a deceased person.
m. To a mental health ombudsman or decedents.
3. Other uses and disclosures will be made only with your written authorization, and you may revoke such authorization at any time by providing written notice to Nouis Home Care. You cannot revoke an authorization or consent to the extent that Nouis Home Care has already taken action on the authorization or consent.
4. You have the following rights regarding your protected health information:
a. The right to request restrictions on certain uses and disclosures of protected health information. This request must be in writing. However, Nouis Home Care is not required to agree to a requested restriction.
b. The right to receive confidential communications or protected health information, as applicable.
c. The right to inspect and copy protected health information, as provided in the Privacy Regulation.
d. The right to amend protected health information, as provided in the Privacy Regulation.
e. The right to receive an accounting of disclosures of protected health information. This request must be in writing.
f. The right to obtain a paper copy of this Notice from Nouis Home Care. The right extends to an individual who has agreed to receive the notice electronically.
5. Nouis Home Care is required by law to maintain the privacy of protected health information and to provide individuals with notice of its legal duties and Privacy Practices with respect to protected health information.
6. Nouis Home Care is required to abide by the terms of the Notice of Privacy Practices currently in effect.
7. Nouis Home Care reserves the right to change the terms of this Notice. The new Notice provisions will be effective for all protected health information that it maintains.
8. Nouis Home Care will provide current residents with a revised Notice by posting in our offices and making the Notices available to all our residents.
9. Individuals may complain to Nouis Home Care and to the Secretary of the Department of Health and Human Services, without fear or retaliation by Nouis Home Care, if they believe their privacy rights have been violated. An individual may file a complaint with Nouis Home Care by completing a complaint form which can be provided to you by management.
10. This notice is in effect on January 1, 2016.

Rev. 4/16