DIVINE CONNECTIONS HOME CARE

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, please contact the Compliance Officer, Divine Connections Home Care, 4101 Marlton Pike, Merchantville, NJ 08109.

WHO WILL FOLLOW THIS NOTICE:

This notice describes our agency's practices and that of:

• Any health care professional authorized to enter information into your client record

• All employees, staff, volunteers and other agency personnel

• All departments, sites and locations of the agency follow the terms of this notice. In addition, these entities may share medical information with each other for treatment, payment or agency operation purposes described in this notice

OUR PLEDGE REGARDING MEDICAL INFORMATION:

We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive with the agency. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by the agency, whether made by agency personnel, referring agency or personal doctor.

This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.

We are required by law to:

• make sure that medical information that identifies you is kept private

• give you this notice of our legal duties and privacy practices with respect to medical information about you

• follow the terms of the notice that is currently in effect

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU.

The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all the ways we are permitted to use and disclose information will fall within one of the categories.

Treatment/Services: We may use medical information about you to provide you with medical or social services. We may disclose medical information about you to doctors, nurses, social workers or other agency personnel who are involved in your care. We also may disclose medical information about you to people outside the agency who may be involved in your medical care after you leave the agency's services, such as family members, clergy or others we use to provide services that are part of your care.

Payment: We may use and disclose medical information about you so that the treatment and services you receive by the agency may be billed to and payment may be collected from you, an insurance company, or a third party. We may also tell your health plan or third-party payer about any services you are going to receive to obtain prior approval or to determine whether your plan/funding source will cover the service.

Health Care Operations: We may use and disclose medical information about you for agency operations. These uses and disclosures are necessary to run the agency and make sure that all of our clients receive quality care. We may also combine medical information about many agency clients to decide what additional services the agency should offer, what services are not needed, and whether certain new services are effective. We may also disclose information to doctors, nurses, social workers and other agency personnel for review and learning purposes. We may also combine the medical information we have with medical information from other agencies to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of medical information, so others may use it to study health care and health care delivery without learning who the specific clients are.

Appointment Reminders: We may use and disclose medical information to contact you, a family member or the responsible party as a reminder of an appointment with agency personnel regarding your services.

Health Related Benefits and Marketing: We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you. If you do not want the agency to contact you for health-related benefits or services, you must notify our Compliance Officer in writing.

Individuals Involved in Your Care of Payment: We may release medical information about you to a friend, family member or responsible person who is involved in your medical care. We may also tell your family or friends your condition and that you are cared for by the agency. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.

As Required by Law: We will disclose medical information about you when required to do so by federal, state or local law. If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to 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 protecting the information requested.

Law Enforcement: We may release medical information if asked to do so by a law enforcement official:

· In response to a court order, subpoena, warrant, summons or similar process

· To identify or locate a suspect, fugitive, material witness, or missing person

· About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement

· About a death we believe may be the result of criminal conduct

· In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime

Health and Safety: We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat. We also may disclose information about you for public health activities. These activities generally are to help prevent or control disease, injury or disability; to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; to notify the appropriate government authority if we believe a client has been the victim of abuse, neglect or domestic violence.

Health Oversight Activities: We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Special Permission Situations: If you are a current member or retired from the armed forces, we may release medical information about you as required by military command authorities, or to assist the veterans' administration with your care. We may also release information to individuals such as a medical examiner or funeral director, so they may carry out their lawful duties.

Workers' Compensation and Disability: We may release medical information about you for workers' compensation or similar programs. These programs provide benefits for work or other related illnesses.

National Security: We may release medical information about you to authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law.

YOUR RIGHTS REGARDING MEDICAL INFORMATION

You have the following rights regarding medical information we maintain about you:

Right to Inspect and Copy: You have the right to inspect and copy medical information that may be used to make decisions about your care. This includes medical and billing records but does not include psychotherapy notes. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to our Compliance Officer. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by the agency will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.

Right of Amend: If you feel that the medical information we have about you is incorrect or incomplete; you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the agency. To request an amendment, your request must be made in writing and submitted to our Compliance Officer. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

· Was not created by us, unless the person or entity that created the information is no longer available to make the amendment

· Is not part of the medical information kept by or for the agency

· Is not part of the information which you would be permitted to inspect and copy or is accurate and complete

Right to an Accounting of Disclosures: You have the right to request an "accounting of disclosures". This is a list of the disclosures we made of medical information about you. To request this accounting of disclosures, you must submit your request in writing to our Compliance Officer. Your request must state a time period, which may not be longer than six years and may not include dates before January 1, 2025, Your request should indicate in what form you want the list (paper or electronically). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

Right to Request Restrictions: You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operation. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. We are not required to agree to your request If we do agree, we will comply with your request within a reasonable amount of time, unless the information is needed to provide you emergency treatment or services. To request restrictions, you must make your request in writing to our Compliance Officer. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply.

Right to Request Confidential Communications: You have the right to request that we communicate with you in a certain way or at a certain location. To request confidential communications, you must make your request in writing to our Compliance Officer. We will not ask you the reason for your request. We will accommodate all reasonable requests, with the exception of communications during an emergency situation. Your request must specify how or where you wish to be contacted.

Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. To receive a paper copy of this notice, please send a request to our Compliance Officer Divine Connections Home Care, 4101 Marlton Pike, Merchantville, NJ 08109, (856) 209-5231

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with the agency or with the Secretary of the Department of Health and Human Services. To file a complaint with the agency, contact the agency's Compliance Officer at (856) 209-5231.

All complaints must be submitted in writing.

You will not be penalized for filing a complaint.

OTHER USES OF MEDICAL INFORMATION

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

CHANGES TO THIS NOTICE

We reserve the right to change this notice. We reserve the right to make the revised or change notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the agency. The notice will contain on the first page, in the top right-hand corner the effective date. In addition, each time you are enrolled in, or are admitted to, Divine Connections Home Care, for services, we would offer you a copy of the current notice in effect.

Date Implemented: 09/30/2024

Date Revised: ____/____/______