Our mission is to provide the best service and care for you to increase quality of life and patient independence through the principles of compassion, integrity, knowledge and uncompromising service.

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Privacy Policy

NOTICE OF PRIVACY PRACTICES FOR PROTECTED HEALTH INFORMATION

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.

This Notice describes the privacy practices of Envision Home Health LLC, dba Envision Home Health

and Hospice, dba Envision Hospice. We are committed to maintaining your confidentiality and

protecting your health information.

This Notice describes your rights and our duties regarding your Protected Health Information related to

the care and services we provide to you in our facilities, other health care and residential facilities and

your home. It also applies to our health care professionals including but not limited to physicians, nurses,

and aides that provide care to you. Each provider will follow the terms of this Notice and we will use and

share your Protected Health Information with each other, as necessary, for the purposes of treatment,

payment, and health care operations.

Our agency is required by law to maintain the privacy of protected health information, to provide you

adequate notice of your rights and our legal duties and privacy practices with respect to protected health

information and to notify affected individuals following a breach of unsecured protected health

information. [45 CFR §164.520] We will use or disclose protected health information in a manner that is

consistent with this notice.

The agency maintains a record (paper/electronic file) of the information we receive and collect about you

and of the care we provide to you. This record includes physicians’ orders, assessments, medication lists,

clinical progress notes and billing information.

As required by law, the agency maintains policies and procedures about our work practices, including

how we coordinate care and services provided to our patients. These policies and procedures include how

we create, receive, access, transmit, maintain and protect the confidentiality of all health information in

our workforce and with contracted business associates and/or subcontractors; security of the agency

building and electronic files; and how we educate staff on the privacy of patient information.

As our patient, information about you must be used and disclosed to other parties for purposes of

treatment, payment, and health care operations . Examples of information that must be disclosed:

● Treatment: Providing, coordinating or managing health care and related services, consultation

between health care providers relating to a patient or referral of a patient for health care from one

provider to another. For example, we meet on a regular basis to discuss how to coordinate care

for patients and to schedule visits.

● Payment: Billing and collecting for services provided, determining plan eligibility and coverage,

utilization review (UR), precertification, medical necessity review. For example, occasionally the

insurance company requests a copy of the medical record be sent to them for a coverage review

prior to paying the bill.

● Health Care Operations: General agency administrative and business functions, quality

assurance/improvement activities; medical review; auditing functions; developing clinical

guidelines; determining the competence or qualifications of health care professional; evaluating

agency performance; conducting training programs with students or new employees; licensing,

survey, certification, accreditation and credentialing activities; internal audit; and certain

fundraising activities and with your authorization, marketing activities. For example, our agency

periodically holds clinical record review meetings where the consulting professional of our record

review committee will audit clinical records for meeting professional standards and utilization

review.

The following uses and disclosures do not require your consent , and include, but are not limited to, a

release of information contained in financial records and/or medical records, including information

concerning communicable diseases such as Human Immunodeficiency Virus (HIV) and Acquired

Immunodeficiency Syndrome (AIDS), drug/alcohol abuse, psychiatric diagnosis and treatment records

and/or laboratory test results, medical history, treatment progress and/or any other related information as

permitted by state law to:

1. Your insurance company, self-funded or third-party health plan, Medicare, Medicaid or any other

person or entity that may be responsible for paying or processing for payment any portion of your

bill for services;

2. Any person or entity affiliated with or representing us for purposes of administration, billing and

quality and risk management;

3. Any hospital, nursing home or other health care facility to which you may be admitted;

4. Any assisted living or personal care facility of which you are a resident;

5. Any physician provide you care;

6. Licensing and accrediting bodies, including the information contained in the OASIS Data Set to

the state agency acting as a representative of the Medicare/Medicaid program;

7. Contact you to raise funds for the Agency; you will be given the right to opt out of receiving such

communications;

8. Any business associate or institutionally related foundation for the purpose of raising funds for

the agency (information may include; demographics – name, address, contact information, age

gender, date of birth; dates of health care provided; department of services; treating physician;

outcome information; and health insurance status). You will be given the right to opt out;

9. Refill reminders for drug, biological and /or drug deliver systems that have already been

prescribed to you;

10. Marketing communications promoting health products, services and information if the

communication is made face to face with you or the only financial gain consists of a promotional

gift of nominal value provided by the agency; and

11. Other health care providers to initiate treatment.

We are permitted to use or disclose information about you without consent or authorization in the

following circumstances:

1. In emergency treatment situations , if we attempt to obtain consent as soon as practicable after

treatment;

2. Where substantial barriers to communicating with you exist and we determine that the consent

is clearly inferred from the circumstances;

3. Where we are required by law to provide treatment and we are unable to obtain consent;

4. Where the use or disclosure of medical information about you is required by federal, state or

local law ;

5. To provide information to state or federal public health authorities , as required by law to :

prevent or control disease, injury or disability; report births and deaths; report child abuse or

neglect; report reactions to medications or problems with products; notify persons of recalls of

products they may be using; notify a person who may have been exposed to a disease or may be

at risk for contracting or spreading a disease or condition; and notify the appropriate government

authority if we believe a patient has been the victim of abuse, neglect or domestic violence (if you

agree or when required or authorized by law);

6. Health care oversight activities such as audits, investigations, inspections and licensure by a

government health oversight agency as authorized by law to monitor the health care system,

government programs and compliance with civil rights laws;

7. To business associates regulated under HIPAA that work on our behalf under a contract that

requires appropriate safeguards of protected health information;

8. Certain judicial administrative proceedings in response to a court or administrative order, a

subpoena, discovery request or other lawful process by someone else involved in the dispute, but

only if efforts have been made to tell you about the request or to obtain an order from the Court

protecting the information requested;

9. Certain law enforcement purposes such as helping to determine whether a crime has occurred,

to alert law enforcement to a crime on our premises or of your death if we suspect it resulted from

criminal conduct, identify or locate a suspect, fugitive, material witness or missing person, or to

comply with a court order or subpoena and other law enforcement purposes.

10. To coroners, medical examiners and funeral directors, in certain circumstances, for example

to identify a deceased person, determine the cause of death or to assist in carrying out their duties;

11. For cadaveric organ, eye or tissue donation purposes to communicate to organizations

involved in procuring, banking or transplanting organs and tissues (e.g., if you are an organ

donor);

12. For certain research purposes under very select circumstances. We may use your health

information for research. Before we disclose any of your health information for such research

purposed, the project will subject to an extensive approval process. We will usually request your

written authorization before granting access to your individually identifiable health information;

13. To avert a serious threat to health and safety: To prevent or lessen a serious and imminent

threat to the health or safety of a particular person or the general public, such as when a person

admits to participation in a violent crime or serious harm to a victim or is an escaped convict.

Any disclosure, however, would only be to someone able to help prevent the threat;

14. For specialized government functions , including military and veterans’ activities, national

security and intelligence activities, protective services for the President, foreign heads of state and

others, medical suitability determination, correctional institution and custodial situations; and

15. For Workers’ Compensation purposes : Workers’ compensation or similar programs provide

benefits for work-related injuries or illness.

We are permitted to use or disclose information about you provided you are informed in advance

and given the opportunity to individually agree to, prohibit, opt out or restrict the disclosure in the

following circumstances:

1. Use of a directory (includes name, location, condition described in general terms) of individuals

served by our Agency;

2. Provide proof of immunization to a school that is required by state or other law to have such

proof with agreement to disclosure by parent, guardian or other person acting in loco parentis if

record is of an unemancipated minor; and

3. Provide a family member, relative, friend or other identified person, prior to, or after your death,

the information relevant to such person’s involvement in your care or payment for care; to notify a

family member, relative, friend or other identified person of your location, general condition or

death.

Other uses and disclosures not covered in this notice will be made only with your authorization.

Authorization may be revoked, in writing, at any time, except in limited situations for the following

disclosures:

1. Marketing of products or services or treatment alternatives that may be of benefit to you when we

receive direct payment from the third party for making such communications;

2. Psychotherapy notes under most circumstance, if applicable; and

3. Any sale of protected health information resulting in financial gain by the agency unless an

exception is met.

YOUR RIGHTS – You have the right, subject to certain conditions, to:

● Request restrictions on uses and disclosures of your protected health information for

treatment, payment or health care operations; however, we are not required to agree to any

requested restriction. Restrictions to which we agree will be documented. Agreements for further

restrictions may, however be terminated under applicable circumstances (e.g. emergency

treatment).

We must agree to your request to restrict disclosure of protected health information about you to a health

plan if: 1) the disclosure is for the purpose of carrying out payment or health care operations and is not

otherwise required by law; and 2) the protected health information pertains solely to a health care item or

service for which you or someone on your behalf paid the covered entity in full. (164.522 Rights to

request privacy protection for protected health information).

● Confidential communication of protected health information. We will arrange for you to

receive protected health information by reasonable alternative means or at alternative locations.

Your request must be in writing. We do not require an explanation for the request as a condition

of providing communications on a confidential basis and will attempt to honor reasonable

requests for confidential communication.

If you request your protected health information to be transmitted directly to another person designated by

you, your written request must be signed and clearly identify the designated person and where the copy of

protected health information is to be sent.

● Inspect and obtain copies of protected health information that is maintained in a designated

record set, except for psychotherapy notes, information compiled in reasonable anticipation of, or

for use in, a civil, criminal or administrative action or proceeding, or protected health information

that may not be disclosed under the Clinical Laboratory Improvements Amendments of 1988 [42

USC §263a and 45 CFR § 493 (a)(2)]. If you request a copy of your health information, we will

charge a reasonable, cost-based fee that includes only the cost of labor for copying, supplies and

postage, if applicable, in accordance with applicable state and federal regulations.

If the request protected health information is maintained electronically and you request an electronic

copy, we will provide access in an electronic format you request, if readily producible, or if not, in a

readable electronic form and format mutually agreed upon.

If we deny access to protected health information, you will receive a timely, written denial in plain

language that explains the basis for the denial, your review rights and an explanation of how to exercise

those rights. If we do not maintain the medical record, we will tell you where to request the protected

health information.

● Request to amend protected health information for as long as the protected health information

is maintained in a designated record set. A request to amend your record must be in writing and

must include a reason to support the requested amendment. We will act on your request within

sixty (60) days of receipt of the request. We may extend the time for such action by up to 30

days, if we provide you with a written explanation of the reasons for the delay and the date by

which we will complete action on the request.

We may deny the request for amendment if the information contained in the record was not created by us,

unless you provide a reasonable basis for believing the originator of the information is no longer available

to act on the requested amendment; is not part of the designated medical record set; would not be

available for inspection under applicable laws and regulation; or the record is accurate and complete. If

we deny your request for amendment, you will receive a timely, written denial in plain language that

explains the basis for the denial, your rights to submit a statement disagreeing with the denial and

explanation of how to submit that statement.

● Receive an accounting of disclosures of protected health information made by our Agency for

up to six (6) years prior to the date on which the accounting is requested for any reason other than

for treatment, payment or health operations and other applicable exceptions. The written

accounting includes the date of each disclosure, the name/address (if known) of the entity or

person who received the protected health information, a brief description of the information

disclosed and a brief statement of the purpose of the disclosure or a copy of the written request

for disclosure. We will provide the accountings within 60 days of receipt of a written request;

however, we may extend the time period for providing the accounting by 30 days if we provide

you with a written statement of the reasons for the delay and the date by which you will receive

the information. We will provide the first accounting you request during any 12-month period

without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee.

● Receive notification of any breach in the acquisition, access, use or disclosure of unsecured

protected health information by the agency, its business associates, and/or subcontractors.

● Obtain a paper copy of this notice , even if you had agreed to receive this notice electronically,

from us upon request.

COMPLAINTS – If you believe that your privacy rights have been violated, you may complain to the

Agency or to the Secretary of U.S. Department of Health and Human Services. There will be no

retaliation against you for filing a complaint. The complaint should be filed in writing, and should state

the specific incident(s) in terms of subject, date, and other relevant matters. A complaint to the Secretary

must be filed in writing within 180 days of when the act or omission complained of occurred, and must

describe the acts or omissions believed to be in violation of applicable requirement. [45 CFR § 160.306]

For further information regarding filing a complaint, contact: Sherie Stewart, Envision Home Health

and Hospice, 1345 W 1600 N #202, Orem, UT 84057; Phone: (801) 225-7971 .

EFFECTIVE DATE – This notice is effective February 23, 2014. We are required to abide by the terms

of the notice currently in effect, but we reserve the right to change these terms as necessary for all

protected health information that we maintain. If we change the terms of this notice (while you are

receiving service), we will promptly revise and distribute a revised notice to you as soon as practicable by

mail, email (if you have agreed to electronic notice, hand delivery or by posting on our website.

If you have any questions about this Notice or would like further information concerning your

privacy rights, contact our Privacy Officer at:

Sherie Stewart, COO

Privacy Officer,

Envision Home Health LLC

1345 W 1600 N #202

Orem, UT 84057

Phone: (801) 225-7971

Toll-free: (866) 471-5733

Effective Date of this Notice: September 16, 2013

Revised Date: February 23, 2014