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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 of Privacy Practices, contact NIVC SERVICES, INC. Privacy Officer at (641) 423-3301.

This Notice of Privacy Practices describes how the NIVC SERVICES, INC. (NIVC) may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. Your “Protected Health Information” (PHI) is information about you, including demographic information, that may identify you and that relates to your past, present, or future physical or mental health condition and related health care services.

NIVC SERVICES, INC. is required to abide by the terms of this Notice of Privacy Practices. NIVC SERVICES, INC. may change the terms of this Notice, at any time. The new notice will be effective for all PHI that NIVC SERVICES, INC. maintains at that time. Upon request, NIVC SERVICES, INC. will provide you with any revised Notice of Privacy Practices. This policy will be reviewed with the client on an annual basis.

PERMITTED USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION

Your PHI may be used and disclosed by NIVC SERVICES, INC. for the purpose of providing or accessing health care services for you. Your PHI may also be used and disclosed to pay your health care bills and to support the business operations of NIVC SERVICES, INC.

The following categories describe ways that NIVC SERVICES, INC. is permitted to use and disclose health care information. Examples of types of uses and disclosures are listed in each category. Not every use or disclosure for each category is listed; however, all of the ways NIVC SERVICES, INC. is permitted to use and disclose information falls into one of these categories:

  1. Treatment
    NIVC SERVICES, INC. may use and disclose your PHI to provide, coordinate or manage your health care and any related services. This includes the coordination or management of your health care with a third party that has already obtained your permissions to have access to your PHI. For example, NIVC SERVICES, INC. would disclose your PHI, as necessary, to a home health agency that provides care to you. Another example is that PHI may be provided to a facility to which you have been referred to ensure that the facility has the necessary information to treat you.
  2. Payment
    NIVC SERVICES, INC. may use and disclose PHI about you so that the treatment and services you receive may be billed to and payment collected from you, an insurance company or a third party. NIVC SERVICES, INC. may also discuss your PHI about a service you are going to receive to determine whether you are eligible for the service, and for undertaking utilization review activities. For example, authorizing a service may require that your relevant PHI be discussed with a provider to determine your need and eligibility for the service.
  3. Healthcare Operations
    NIVC SERVICES, INC. may use or disclose, as needed, your PHI in order to support its business activities. These activities include, but are not limited to, quality assessment activities, employee review activities, licensing and conducting, or arranging for other business activities. For example, NIVC SERVICES, INC. may use or disclose your PHI, as necessary, to contact you to remind you of your appointment or to provide information about alternate services or other health-related benefits.

NIVC SERVICES, INC. may share your PHI with third party “business associates” that perform various activities (e.g. billing, transcription services) for NIVC SERVICES, INC. Whenever an arrangement between NIVC SERVICES, INC. and a business associate involves the use or disclosure of your PHI, NIVC SERVICES, INC. will have a written contract that contains terms that will protect the privacy of your PHI.

USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION REQUIRING YOUR WRITTEN AUTHORIZATION

Other uses and disclosures of your PHI will be made only with your written authorization, unless otherwise permitted or required by law as described below. Additional uses and disclosures that require individual authorization include an individual’s right to opt out of fundraising communications, an individual’s right to restrict certain disclosures of PHI to health plans when the individual pays, in full, for the service out of pocket, and an individual’s right to notice of a breach of unsecured PHI and specific rights of individuals with regard to genetic information. You may revoke this authorization, at any time, in writing, except to the extent that NIVC SERVICES, INC. has taken an action in reliance on the use or disclosure indicated in the authorization.

NIVC SERVICES, INC. may use and disclose your PHI in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your PHI. If you are not present or able to agree or object to the use or disclosure of the PHI, then NIVC SERVICES, INC. may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the PHI that is relevant to your health care will be discussed.

  1. Others Involved in Your Healthcare
    Unless you object, NIVC SERVICES, INC. may disclose to a member of your family, a relative, a close friend, or any other person you identify, your PHI that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, NIVC SERVICES, INC. may disclose such information as necessary if NIVC SERVICES, INC., based on its professional judgment, determines that it is in your best interest. NIVC SERVICES, INC. may use or disclose PHI to notify or assist in notifying a family member, personal representative, or any other person that is responsible for your care of your location, general condition, or death. Finally, NIVC SERVICES, INC. may use or disclose your PHI to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.
  2. Emergencies
    NIVC SERVICES, INC. may use or disclose your PHI in an emergency treatment situation. If this happens, NIVC SERVICES, INC. shall try to obtain your acknowledgement of receipt of the Notice of Privacy Practices as soon as reasonably practicable after the delivery of treatment.

OTHER PERMITTED AND REQUIRED USED AND DISCLOSURES THAT MAY BE MADE WITHOUT YOUR AUTHORIZATION OR OPPORTUNITY TO OBJECT

NIVC SERVICES, INC. may use or disclose your PHI in the following situations without your consent or authorization. These situations include:

  1. Required by Law
    NIVC SERVICES, INC. may use or disclose your PHI to the extent that the law requires the use or disclosure. You will be notified, as required by law, of any such used or disclosures.
  2. Public Health
    NIVC SERVICES, INC. may use or disclose your PHI for public health activities and purposes to a public health authority that is permitted by law to collect or receive information. The disclosure will be made for the purpose of controlling disease, injury, or disability. NIVC SERVICES, INC. may also disclose your PHI, if directed by the public health authority, to a forting government agency that is collaborating with the public health authority.
  3. Communicable Diseases
    NIVC SERVICES, INC. may disclose your PHI, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease.
  4. Health Oversight
    NIVC SERVICES, INC. may disclose your PHI to a health oversight agency for activities authorized by law, such as audits, investigations and inspections. Oversight agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights laws.
  5. Abuse or Neglect
    NIVC SERVICES, INC. may disclose your PHI to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, NIVC SERVICES, INC. may disclose your PHI if it believes that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.
  6. Food and Drug Administration
    NIVC SERVICES, INC. may disclose your PHI to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.
  7. Legal Proceedings
    NIVC SERVICES, INC. may disclose your PHI in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process.

    8. Law Enforcement
    NIVC SERVICES, INC. may also disclose your PHI, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime, (4) suspicion that death has occurred as a result of criminal conduct, (5) in the event that a crime occurs on NIVC SERVICES, INC. premises, and (6) medical emergency (not on NIVC SERVICES, INC.’s premises) and it is likely that a crime has occurred.

  8. Coroners, Funeral Directors, and Organ Donation
    NIVC SERVICES, INC. may disclose your PHI to a coroner or medical examiner to perform other duties authorized by law. We may also disclose your PHI to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. We may disclose such information in reasonable anticipation of death. PHI may be used and disclosed for cadaveric organ, eye, or tissue donation purposes.
  9. Research
    NIVC SERVICES, INC. may disclose your PHI to health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
  10. Criminal Activity
    Consistent with applicable federal and state laws, NIVC SERVICES, INC. may disclose your PHI, if it believes that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. NIVC SERVICES, INC. may also disclose your PHI if it is necessary for law enforcement authorities to identify or apprehend an individual.
  11. Military Activity and National Security
    When the appropriate conditions apply, NIVC SERVICES, INC. may use or disclose your PHI of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military service. NIVC SERVICES, INC. may also disclose your PHI to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.
  12. Workers’ Compensation
    Your PHI may be disclosed by NIVC SREVICES, INC. as authorized to comply with workers’ compensation laws and other similar legally established programs.
  13. Inmates
    NIVC SERVICES, INC. may use or disclose your PHI if you are an inmate of a correctional facility and NIVC SERVICES, INC. created or received your PHI in the course of providing care to you.
  14. Required Uses and Disclosures
    Under the law, NIVC SERVICES, INC. shall make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine NIVC SERVICES, INC.’s compliance with the requirements of 45 C.F.R. section 164.500 et. Seq.

YOUR RIGHTS

The following are a list of your rights with respect to your PHI and a brief description of how you may exercise these rights:

RIGHT TO INSPECT AND COPY YOUR PROTECTED HEALTH INFORMATION

This means you may inspect and obtain a copy of PHI about you that is contained in a designated record set for as long as NIVC SERVICES, INC. maintains the PHI. A “designated record set” contains medical and billing records and any other records that NIVC SERVICES, INC. uses in making decisions about you.

Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and PHI that is subject to law that prohibits access to PHI. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed. Please contact the NIVC SERVICES, INC. Privacy Officer if you have questions about access to your medical record.

RIGHT TO REQUEST A RESTRICTION OF YOUR PROTECTED HEALTH INFORMATION

This means you may ask NIVC SERVICES, INC. not to use or disclose any part of your PHI for the purposes of treatment, payment or healthcare operations. You may also request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.

NIVC SERVICES, INC. is not required to agree to a restriction that you may request. If NIVC SERVICES, INC. believes that it is in your best interest to permit use and disclosure of your PHI, your PHI will not be restricted. If NIVC SERVICES, INC. does agree to the requested restriction, it may not use or disclose your PHI in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with NIVC SERVICES, INC. You may request a restriction in writing to the NIVC SERVICES, INC. Privacy Officer.

RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS FROM NIVC SERVICES BY ALTERNATIVE MEANS OR AT AN ALTERNATIVE LOCATION

NIVC SERVICES, INC. will accommodate reasonable requests. NIVC SERVICES, INC. may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. NIVC SERVICES, INC. will not request an explanation from you as to the basis for the request. Please make this request in writing to the NIVC SERVICES, INC. Privacy Officer.

RIGHT TO REQUEST AN AMENDMENT TO YOUR PROTECTED HEALTH INFORMATION

This means you may request an amendment of PHI about you in a designated record set for as long as NIVC SERVICES, INC. maintains this information. In certain cases, NIVC SERVICES, INC. may deny your request for an amendment. If NIVC SERVICES, INC. denies your request for amendment, you have the right to file a statement of disagreement with NIVC SERVICES, INC. and NIVC SERVICES, INC. may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. All requests for amendments must be in writing.

RIGHT TO RECEIVE AN ACCOUNTING OF CERTAIN DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION

This right applies to disclosures for purposes other than treatment, payment, or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures NIVC SERVICES, INC. may have made to you, to family members, or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occur after April 14, 2003.

RIGHT TO OBTAIN A PAPER COPY OF THIS NOTICE
You have the right to obtain a paper copy of this notice, upon request, even if you have agreed to accept this notice electronically.

COMPLAINTS
You may file a complaint to NIVC SERVICES, INC. or the Secretary of Health and Human Services if you believe your privacy rights have been violated by NIVC SERVIES, INC. You may file a complaint against NIVC SERVICES, INC. by notifying the NIVC SERVICES, INC. Privacy Officer. NIVC SERVICES, INC. will not retaliate against you for filing a complaint.

You may contact NIVC SERVICES, INC. Privacy Officer, Mike Willms or your Employment Coordinator at 1225 South Harrison, Mason City, Iowa 50401, (641) 423-3301 for further information about the complaint process.

NIVC SERVICES, INC. reserves the right to change the terms of our Notice of Privacy Practices. We also reserve the right to make the revised or changes Notice of Privacy Practices effective for all health information we already have about you as well as any health information we receive in the future. We will post a copy of the current Notice of Privacy Practices at our main office at each site where we provide care. You may also obtain a copy of the current Notice of Privacy Practices by calling us at (641) 423-3301 and requesting that a copy be sent to you in the mail or by asking for one any time you are at our offices.

All NIVC services will follow the Notice of Privacy Practices.

This notice was published and becomes effective on April 14, 2003