MIRACLE HANDS PERSONAL HOME CARE, LLC
NOTICE OF PRIVACY PRACTICES (HIPAA)
Health Insurance Portability and Accountability Act, a 1996 Federal law that restricts access to individuals’ private medical information. This notice describes how Miracle Hands Personal Care Agency uses your medical information. Your information may be used and disclosed and how you can get access to this information.
Please read it carefully
Your health information is personal and private. The law says that we (how Miracle Hands Personal Care Agency) must protect this information. When you first asked for our services, you gave us information that helped us decide if you qualified. It became part of your file, which we keep in our office. Also, in your file, is information that is given to us by hospitals, doctors and other people who treat you. A federal law says that we must give you this notice to help you understand what our legal duties are and how we will protect your health information.
When is it okay for us to share your health information?
If you sign a special form that tells us it is ok to share your health information with someone, then we will share it. You can cancel this at any time by notifying us in writing except if we have already shared information. Your information can be shared without your okay when we need to approve or pay for services. We can share it when we review our programs and try to make them better. Under the law, these uses are called treatment, payment and health care operations. The law says that there are some other situations when we may need to share information without your okay. Here are some examples:
For the medical treatment and payment
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When you need emergency care
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To tell you about treatment choices
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To remind you about appointments
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To help our business partners do their job
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To help review program quality
For your personal reasons
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To tell your family and other who help with your care, things they need to know
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To be listed in a patient directory
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To tell a funeral director of your health
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If you have signed organ donation papers, to make sure your organs are donated according to your wishes.
For public health reasons
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To help researchers study health problems
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To help public health officials stop the spread of disease or prevent an injury
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To protect you or another person if we think that you are in danger
Other special uses
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To help the police, courts and other people who enforce the law
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To obey laws about reporting abuse and neglect
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To report information to the military
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To help government agencies review our work and investigate problems
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To obey court orders
What are your rights?
You can ask us not to share your information in some situations. However, the law says that we do not always have to agree with you. If you are reading this notice on the Internet or bulletin board, you can ask for a paper copy of your own. You can ask to look at your health information and get a copy of it. You may be charge a fee for the copies based on Division policy. However, you need to remember that we do not have a complete medical record of you. Our records mostly deal with payments to your doctors and other people who care for you. If you want a copy of your complete medical record, you should ask your doctor or provider of health care. If you think that something is missing from or wrong in your health record that we have, you can ask us to make changes. You can ask to have a copy of your health information provided in electronic format if it is available. You can ask us to give you a list of the times that we have shared your information for the purpose of treatment, payment or health care operations. You may ask to restrict the release of your health information to a health plan when you have paid out of pocket in full for items or services. You can ask us to mail health information to an address that is different from your usual address or to deliver the information to you in another way.
What if you have a complaint?
If you think that we have not kept out promise to protect your health information, you may complain to us or to the U.S. Department of Health and Human services. Nothing will happen to you if you complain.
What are our responsibilities?
Under the law, we must keep your health information private except in situations like the ones listed in this notice. We must give you this notice that explains out legal duties about privacy. We must follow what we have told you in this notice. We must agree when you make reasonable request to send your health information to a different address or to deliver it in a way other than regular mail. We must notify you if there is a breach of your unsecured health information. We will only use or share the minimum amount of your health information necessary to perform our duties. We must tell you if we cannot agree when you ask us to limit how your information is shared.
Contact Information
If you have any questions or complaints about our privacy rules, please contact us at:
Miracle Hands Personal Home Care
Department of Health and Human Services
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Office of Civil Rights
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90 7th street, suite 1-100
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San Francisco, CA 94103
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Phone: (415) 437-3810
I have been given this notice and understand its content. By signing this document I accept receipt of the Privacy Policy issued by Miracle Hands Personal Home Care.
Personal Care Services Recipient Request for Provider Transfer
Purpose: Use this form to verify a recipient’s request to transfer to another provider. All fields, signatures and initials must be completed and are required for processing of this transfer request. Provider is required to submit verification of release of information. Incomplete forms will not be acted upon.
RECIPIENT INFORMATION
The Recipient, Legally Responsible Individual (LRI) or Personal Care Representative (PCR) must complete Section I. Indicate the reason for the transfer, initial the items below to indicate an understanding of the changes that may occurdue to the transfer and sign the form.
Recipient/LRI/PCR must initial, complete the following and sign below:
