HOUSECALLS BY SIVNA 
 
NOTICE OF PRIVACY PRACTICES
 

HouseCalls by SIVNA is required by law to maintain the privacy of your protected health information. We are required to provide you with this Notice of our legal duties and privacy practices with respect to your health information that the Department collects and maintains. We are required to follow the terms of this Notice. We are committed to protecting your privacy and the confidentiality of your health information.

How we use and disclose your information

Your health information may be used and released without your permission for the following purposes:
 

• Treatment: For treatment, we use your health information to plan, coordinate, and provide your care. We disclose your health information for treatment purposes to physicians and other health care professionals outside our agency who are involved in your care.
   
• Payment: We use your health information to prepare documentation required by your insurance company or HMO or by Medicare or Medicaid. We disclose that part of your health information that these organizations require to pay us.
   
• Operations: We use or disclose your health information, for example, to improve the quality of our services, to plan better ways of treating patients, and to evaluate staff performance.

Below are additional circumstances in which we may use or disclose your health information without your authorization. They include, but are not limited to:
 

• A request from a personal representative directed to you in obtaining care;
  
• Public health purposes to control disease;
   
• Reporting of abuse, neglect, or domestic violence;
   
• Federal, state, or local law requirements;
   
• Assisting the government in overseeing health care programs;
   
• Law enforcement purposes;
   
• Certain requests for information from coroners, medical examiners and funeral directors;
   
• Organ donations;
   
• Military and Veteran’s purposes;
   
• Research, provided very strict controls are enforced;
   
• To avert a serious threat to health or safety;
   
• National security purposes;
   
• Worker’s compensation;
   
• Disaster relief efforts.
   

Uses or Disclosures of Your Health Information to Which You May Object

• Informing family and friends. We may disclose your health information to family, friends, or others identified by you who are involved in your care.
   

• Assistance in disaster relief efforts.
   

• Confirming our visits to your home or other appointments.
   

• Informing you about treatment alternatives or other health-related benefits and services that may be of interest to you.

If you object to our use of your health information for any of these purposes please contact:
 

Privacy Official
Southwestern Illinois Visiting Nurse Association
(618) 236-5800.
 

Your Rights 

• Right to Request Restrictions: You have the right to request restrictions on our uses and disclosures of your health information, however we may refuse to accept the restriction.
   

• Right to Request Confidential Communications: You have the right to request that we communicate with you confidentially, for example to speak with you only in private; to send mail to an address you designate; or to telephone you at a number you designate. Your request must be made in writing. We will make every attempt to honor your request.
   

• Right to Inspect and Copy: You have the right to request access to your health information in order to inspect or copy it. Your request must be made in writing. We may deny your request, and if so, you may request a review of the denial. However, we will make every attempt to honor your request. We may charge a fee for any costs associated with the copying and mailing of your request.
   

• Right to Request an Amendment: You have the right to request an amendment to your protected health information, if you determine that it is inaccurate or incomplete. Your request must be made in writing. We may deny your request, and if so, you may submit a statement of disagreement. However, we will make every attempt to honor your request.
   

• Right to an Accounting of Disclosures: Effective April 14, 2003, you have the right to request a list of disclosures that have been made for purposes other than treatment, payment, and health care operations. We will make every attempt to honor your request. We are not required to provide an accounting for disclosures before April 14, 2003 or for more than 6 years prior to the date of your request.
   

• Right to a Paper Copy of this Notice: You have the right to request a paper copy of this notice from HouseCalls of SIVNA at any time..
   

All requests for making restrictions, inspecting, copying, amending, or obtaining an accounting of your protected health information must be made in writing to:
 
Privacy Officer of
Housecalls of SIVNA
7 Executive Woods Court, Suite D
Swansea, Illinois 62226
(618) 236-5820
 

Complaints
 

If you believe your privacy rights have been violated, you may file a complaint in writing with either or both of the following:

 
Privacy Officer of
Housecalls of SIVNA
7 Executive Woods Court, Suite D
Swansea, Illinois 62226

  
Secretary Office for Civil Rights
U.S. Dept. of Health and Human Services
233 N. Michigan Ave., Suite 240
Chicago, IL 60601

  

You will not be penalized or retaliated against for filing a complaint

Changes to this notice:
 
We reserve the right to change this notice at any time.  We may make the revised notice effective for all protected health information we currently maintain about you, as well as any information received in the future.  At any time, you may obtain a copy of the current notice by calling to request it at 618-236-5820

Patient Rights
 

As a patient of HouseCalls of SIVNA, you have certain rights as explained below.
 

• Dignity and Respect. You have the right to have relationships with health care providers that are based on honesty and ethical standards of conduct. You have the right to be informed of the procedure to lodge complaints regarding the care that is, or fails to be, furnished and about a lack of respect for property. (To lodge complaints with us call 1-800-466-3227 from 8 a.m. to 4 p.m. Monday through Friday.) You also have the right to know about the disposition of such complaints and to voice your grievance without fear of discrimination or reprisal for having done so.
   

• Decision Making. You have the right to be notified in advance about the care that is to be furnished. You have the right to be informed in writing of your rights under state law to make decisions concerning medical care, including the right to accept or refuse treatment, and the right to formulate advance directives. You have the right to be informed in writing of policies and procedures for implementing advance directives, including any limitations if the provider cannot implement an advance directive on the basis of conscience. You have the right to have health care providers comply with advance directives in accordance with state law requirements. You have the right to refuse services without fear of reprisal or discrimination.
   

• Privacy. You have the right to confidentiality of your medical record as well as information about your health, social and financial circumstances and about what takes place in the home. You have the right to expect the health care provider to release information only as required by law or authorized by the client and to be informed of procedures for disclosure.
   

• Financial Information. You have the right to be informed of the extent to which payment may be expected from Medicare, Medicaid, or any other payor known to your health care provider. You have the right to be informed of any charges that will not be covered by Medicare and to be informed of any charges for which you may be liable. You have the right to receive this information, orally and in writing, before care is initiated and within 30 calendar days of the date we become aware of any changes. You have the right to have access, upon request, to all bills for your health care service regardless of whether your bill is paid out-of-pocket or by another party.
   

• Quality of Care. You have the right to receive care of the highest quality. You have the right to be told what to do in case of an emergency. 
   

Patient Responsibilities
 

As a patient of Housecalls of SIVNA, you have certain responsibilities as explained below:
 

• Notify us of any changes in your condition (e.g., hospitalization, symptoms to be reported, etc.);
   

• Notify us if your scheduled visit needs to be changed;
   

• Inform us of the existence of any changes made to advance directives;
   

• Advise us of any problems or dissatisfaction with the provision of our health care services;
   

• Provide a safe environment for your services to be provided in;
   

• Carry out mutually agreed responsibilities.
   

This notice is effective April 14, 2003.