As required by the privacy regulations created as a result of the HIPAA/Omnibus Act 2013.
This notice describes how health information about you (as a client of Home Sweet Home In-Home Care) may be used and disclosed and how you can get access to your individually identifiable health information. Please review this notice carefully. The privacy of your health information is important to us.
A. Our commitment to your privacy:
Our practice is dedicated to maintaining the privacy of your individually identifiable health information
(also called protected health information, or PHI). In conducting our business, we will create records
regarding you and the treatment and services we provide to you. We are required by law to maintain the
confidentiality of health information that identifies you. We also are required by law to provide you with
this notice of our legal duties and the privacy practices that we maintain in our company concerning your
PHI. By federal and state law, we must follow the terms of the Notice of Privacy Practices that we have
while it is in effect.
We realize that these laws are complicated, but we must provide you with the following important
- How we may use and disclose your PHI,
- Your privacy rights in your PHI,
- Our obligations concerning the use and disclosure of your PHI.
The terms of this notice apply to all records containing your PHI that are created or retained by our company. We reserve the right to revise or amend this Notice of Privacy Practices. Any revision or amendment to this notice will be effective for all of your records that our practice has created or maintained in the past, and for any of your records that we may create or maintain in the future. Our practice will post a copy of our current Notice in our offices in a visible location at all times, and you may request a copy of our most current Notice at any time.
B. If you have questions about this Notice, please contact:
William Najacht, Client Care Manager, 45045 W Red Arrow Hwy. Suite C. Paw Paw, MI 49079
C. We may use and disclose your PHI in the following ways:
The following categories describe the different ways in which we may use and disclose your PHI.
1. Treatment. We may use your PHI to treat you. For example, we may disclose your PHI to others who
may assist in your care, such as your spouse, children, parents. We may also need to disclose your PHI to
other health care providers for purposes related to your treatment.
2. Payment. We may use and disclose your PHI in order to bill and collect payment for the services and
items you may receive from us. We also may use and disclose your PHI to obtain payment from third
parties that may be responsible for such costs, such as family members, Medicaid, Medicare, LTC
insurance or other responsible third party payers. Also, we may use your PHI to bill you directly for
services and items. We may disclose your PHI to other health care providers and entities to assist in their
billing and collection efforts.
3. Health care operations. We may use and disclose your PHI to operate our business. Our practice may use your PHI to evaluate the quality of care you received from us, to conduct cost-management and
business planning activities, care improvement activities, reviewing competence and qualification of care
providers, evaluating provider performance & conducting training programs. We may disclose your PHI
to other health care providers and entities to assist in their health care operations.
4. Your Authorization: In addition to our use of your health information for treatment, payment or
healthcare operations, you may give us written authorization to use your health information or to disclose
it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time.
Your revocation will not affect any use of disclosure permitted by our authorization while it was in effect.
Unless you give us a written authorization, we cannot use or disclose your health information for any
reason except those described in this Notice.
5. Appointment reminders. We may use and disclose your PHI to contact you and remind you of an
appointment or scheduling change.
6. Health-related benefits and services. We may use and disclose your PHI to inform you of healthrelated benefits or services that may be beneficial or be of interest to you.
7. Release of information to family/friends. We may release your PHI to a friend or family member that is involved in your care, or who assists in taking care of you.
8. Persons Involved In Care: We may use or disclose health information, including identifying or
locating, to notify, or assist in the notification of a family member, your personal representative or another
person responsible for your care, of your location, your general condition, or death. If you are present,
then prior to use or disclosure of your health information, we will provide you with an opportunity to
object to such use or disclosures. In the event of your incapacity or emergency circumstances we will
disclose health information based on a determination using our professional and reasonable judgment and
only disclosing health information that is directly relevant to the person’s involvement in your healthcare.
We will also use or professional judgment and our experience with common practice to make reasonable
inferences of your best interest in allowing a person to pick up filled prescriptions, medical supplies and
other similar forms of health information.
9. Disclosures required by law. Our practice will use and disclose your PHI when we are required to do so by federal, state or local law.
D. Use and disclosure of your PHI in certain special circumstances:
The following categories describe unique scenarios in which we may use or disclose your identifiable
1. Public health risks. Our practice may disclose your PHI to public health authorities that are authorized
by law to collect information for the purpose of:
- Maintaining vital records, such as births and deaths,
- Preventing or controlling disease, injury or disability,
- Notifying a person regarding potential exposure to a communicable disease,
- Notifying a person regarding a potential risk for spreading or contracting a disease or condition,
- Reporting reactions to drugs or problems with products or devices,
- Notifying individuals if a product or device they may be using has been recalled,
- Notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or
neglect of an adult patient (including domestic violence); however, we will only disclose this
information if the patient agrees or we are required or authorized by law to disclose it,
- Notifying your employer under limited circumstances related primarily to workplace injury or
illness or medical surveillance.
2. Health oversight activities. We may disclose your PHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.
3. Lawsuits and similar proceedings. Our practice may use and disclose your PHI in response to a court or administrative order, discovery request, subpoena or other lawful process.
4. Law enforcement. We may release PHI if required to do so by a law enforcement official
5. Deceased patients. We may release PHI to a medical examiner or coroner to identify a deceased
individual or to identify the cause of death. If necessary, we also may release information in order for
funeral directors to perform their jobs.
6. Serious threats to health or safety. We may use and disclose your PHI when necessary to reduce or
prevent a serious threat to your health and safety or the health and safety of another individual or the
public. Under these circumstances, we will only make disclosures to a person or organization able to help
prevent the threat.
7. Military. We may disclose your PHI if you are a member of U.S. or foreign military forces (including
veterans) and if required by the appropriate authorities.
8. National security. We may disclose your PHI to federal officials for intelligence and national security
activities authorized by law. We also may disclose your PHI to federal and national security activities
authorized by law. We also may disclose your PHI to federal officials in order to protect the president,
other officials or foreign heads of state, or to conduct investigations.
9. Workers’ compensation. Our practice may release your PHI for workers’ compensation and similar
E. Your rights regarding your PHI:
You have the following rights regarding the PHI that we maintain about you:
1. Access: You have the right to look at or get copies of your health information, with limited exceptions.
You must make a request in writing to obtain access to your health information. You may request access
by sending us a letter, using the contact information listed at the end of this Notice. We will charge you a
reasonable cost-based fee for expenses such as copies and staff time.
2. Confidential communications. You have the right to request that our practice communicate with you
about your health and related issues in a particular manner or at a certain location. For instance, you may
ask that we contact you at home, rather than work. In order to request a type of confidential
communication, you must make a written request to William Najacht, Client Care Manager, 45045 W
Red Arrow Hwy. Suite C. Paw Paw, MI 49079 specifying the requested method of contact, or the location
where you wish to be contacted. We will accommodate reasonable requests. You do not need to give a
reason for your request.
3. Requesting restrictions. You have the right to request a restriction in our use or disclosure of your PHI for treatment, payment or health care operations. Additionally, you have the right to request that we
restrict our disclosure of your PHI to only certain individuals involved in your care or the payment for
your care. We are not required to agree to your request; however, if we do agree, we are bound by our
agreement except when otherwise required by law, in emergencies or when the information is necessary to
treat you. In order to request a restriction in our use or disclosure of your PHI, you must make your request
in writing to William Najacht, Client Care Manager, 45045 W Red Arrow Hwy. Suite C. Paw Paw, MI
49079. Your request must describe in a clear and concise fashion:
- The information you wish restricted and to whom,
- Whether you are requesting to limit our practice’s use, disclosure or both.
4. Amendment. You may ask us to amend your health information if you believe it is incorrect or
incomplete, and you may request an amendment for as long as the information is kept by us. To request an
amendment, your request must be made in writing and submitted to William Najacht, Client Care
Manager, 45045 W Red Arrow Hwy. Suite C. Paw Paw, MI 49079. You must provide us with a reason that
supports your request for amendment. We may deny your request under certain conditions.
5. Accounting of disclosures. All of our patients have the right to request an “accounting of disclosures.”
An “accounting of disclosures” is a list of certain non-routine disclosures our practice has made of your
PHI for purposes not related to treatment, payment or operations. In order to obtain an accounting of
disclosures, you must submit your request in writing to William Najacht, Client Care Manager, 45045
W Red Arrow Hwy. Suite C. Paw Paw, MI 49079.
6. Right to a paper copy of this notice. You are entitled to receive a paper copy of our notice of privacy
practices. You may ask us to give you a copy of this notice at any time.
7. Right to file a complaint. If you believe your privacy rights have been violated, you may file a
complaint with us or with the U.S. Department of Health and Human Services. To file a complaint with
us, contact William Najacht, Client Care Manager, 45045 W Red Arrow Hwy. Suite C. Paw Paw, MI
49079. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
QUESTIONS AND COMPLAINTS
If you want more information about our privacy practices or have question or concerns, please contact us.
If you are concerned that we may have violated your privacy rights, or you disagree with a decision we
made about access to your health information or in response to a request you made to amend or restrict the
use or disclosure of your health information, you may discuss it with us using the contact information
listed at the end of this Notice. You also may submit a written complaint to the U.S. Department of
Health and Human Services. We will provide you with the address to file your complaint upon your
We support your right to the privacy of your health information. We will not retaliate in any way if you
choose to file a complaint with us or with the U.S. Department of Health and Human Services.
Client Care Manager
45045 W Red Arrow Hwy.
Paw Paw, MI 49079