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1-800-781-0070.
Dial Extension 400 for Jean.

Assistance Plus
1604 Benton Ave.
Benton, Maine 04901
(207) 453-4708 or 1-800-781-0070

HIPAA 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.

Our Commitment to Your Privacy

We strongly believe in protecting the privacy and security of “protected health information” (“PHI”) about you.  PHI is information that we create or receive that identifies you and concerns your past, present, or future physical or mental health or condition.

We are required by the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”) and the regulations thereunder, the Health Information Technology for Economic and Clinical Health Act, Public Law 111-005 (the “HITECH Act”) and the regulations thereunder, and applicable Maine state law to maintain the privacy of your PHI and provide you with this Notice of Privacy Practices (“Notice”).  This Notice describes how we may use and disclose your PHI to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by state and federal law. This Notice also explains your rights to access and control your PHI.

This Notice relates to PHI created or received by Assistance Plus in connection with medical treatment provided by Assistance Plus.  Assistance Plus is a “covered entity” within the meaning of HIPAA.  To help you understand your rights, and explain our legal obligations regarding your PHI, we are pleased to provide you with the following important information:

• How we may use and disclose your PHI
• Your privacy rights with respect to 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 received by Assistance Plus. We are required by law to abide by the terms of the Notice currently in effect. We reserve the right to revise or amend this Notice. Any revision or amendment to this Notice will be effective for all of your records that Assistance Plus has created or received in the past, and for any of your records that we may create or receive in the future. Assistance Plus will post a copy of our current Notice in our office in a visible location at all times, and you may request a copy of our most current Notice at any time.

YOUR PRIVACY RIGHTS ARE IMPORTANT TO US. IF YOU HAVE QUESTIONS REGARDING THIS NOTICE OF PRIVACY PRACTICES OR OUR HEALTH INFORMATION PRIVACY POLICIES, PLEASE CONTACT THE PRIVACY CONTACT PERSON, CLAIRE WILSON, AT Assistance Plus at (207) 453-4708 or 1-800-781-0070; E-mail cwilson@assistanceplus.com

• Understanding Your Health Record Information

When you become a client, we obtain medical information, brief medical history, diagnosis, physical assessment, and a plan for your care and treatment. After each visit by your caregiver, Assistance Plus staff (“Staff”) documents a record of that visit. This information, which we refer to as your health or medical record, is an essential part of the health care and services we provide for you. It serves as a:

• Basis for planning your care and treatment.
• Means of communication among health professional who contribute to your care.
• Legal document describing the care you received.
• Means by which you and your pay source can verify that services billed were actually provided.

WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION IN THE FOLLOWING WAYS

The following categories describe the different ways in which we may use and disclose your PHI:

Treatment.  We disclose medical information about you to your direct care staff assigned to you so they can best meet your specific needs. After each visit, a record of that visit becomes part of your record providing us with information to help determine the course of treatment that works best for you.

Payment.  Your Schedulers/Administrative Staff have access to information about you since they coordinate all the different services you need including staffing.  For example: we may use and disclose health information that identifies you, as well as your diagnosis, to your pay source so that we can be reimbursed for the services the agency is providing you.

Health Operations.  Assistance Plus may use and disclose your PHI to assist in the operation of the business.  For example: the Staff and Quality Improvement may use this information in your health record to assess the care. This information will be used in an effort to continually improve the quality and effectiveness of the healthcare and services we provide.

Business Associates.  Business associates are independent professionals that use client health information provided by us in order to perform services for the agency. Examples of business associates are our software consultant who provides us with the latest current technical support for our software system, our answering service and our information disposal service who professionally shreds our data.

Appointment Reminders.  We may use and disclose your PHI to contact you to remind you about an appointment.  You may request that we provide such reminders only in a certain way or only at a certain place. We will try to accommodate reasonable requests.

Release of Information to Family/Friends.  Assistance Plus may disclose your health information to a family member, close friend or other person you identify, to the extent the information is relevant to that person’s involvement in your care or payment related to your care.  We will provide you with an opportunity to object to such a disclosure whenever it is reasonably practicable for us to do so. We may disclose the health information of minor children to their parents or guardians unless such disclosure is otherwise prohibited by law.

Disclosure Required by Law.  Assistance Plus may disclose your health information as required by federal, state, or local law.

Health Related Benefits and Services.  Assistance Plus may use and disclose PHI to tell you about health-related benefits or services that may be of interest to you. In face-to-face communications, such as appointments with your physician, we may tell you about other products or services that may be of interest to you.

Marketing.  In most circumstances, we are required by law to receive your written authorization before we use or disclose your health information for marketing purposes. However, we may provide you with promotional gifts of nominal value. We do not sell or license your PHI.

USE AND DISCLOSURE OF YOUR PHI IN CERTAIN SPECIAL CIRCUMSTANCES

The following categories describe special circumstances in which we may use or disclose your PHI:

Public Health Risks.  Assistance Plus may disclose your PHI to public health authorities that are authorized by law to collect information for the purposes of:

• Maintaining vital records, such as births and deaths
• Reporting child abuse or neglect
• 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 agencies and authorities regarding the potential abuse or neglect of an adult (including domestic violence); however, we will only disclose this information if the client agrees or we are required or authorized by law to disclose this information

HIV Infection Status.  State law protects the confidentiality of HIV infection status. We may not disclose any information regarding HIV infection status without your written consent except as required by law.

Lawsuits and Similar Proceedings.  We may use and disclose your PHI in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding.

Law Enforcement.  We may release PHI if asked to do so by a law enforcement official under the following circumstances:

• Regarding a crime victim when authorized by law
• Concerning a death we believe has resulted from criminal conduct when authorized or required by law
• Regarding criminal conduct at our offices
• In response to a warrant, summons, court order, or similar legal process

Organ and Tissue Donation.  If you are an organ donor, we may release your PHI to organizations that handle organ, eye, or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation.

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.

Military.  Assistance Plus may disclose your PHI if you are a member of US or foreign military forces (including veterans) and if required by the appropriate authorities.

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 officials in order to protect the President, other officials, or foreign heads of state, or to conduct investigations.

Inmates. Assistance Plus may disclose your PHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary:

• For the institution to provide health care services to you
• For the safety and security of the institution, and/or
• To protect your health and safety or the health and safety of other individuals

• YOUR RIGHTS REGARDING YOUR PHI

You have the following rights regarding the PHI that we maintain about you:

Confidential Communications. You have the right to request that Assistance Plus communicate with you about your health and related issues in a particular manner or at a certain location.  The request must be made in writing to the Privacy Contact Person, Claire Wilson, specifying the requested method of contact, or the location where you wish to be contacted. Call (207) 453-4708 or 1-800-781-0070 for more information. Assistance Plus will accommodate all reasonable requests.  You do not need to give a reason for your request.

Requesting Restrictions.  You have the right to request a restriction on our use or disclosure of your PHI for treatment, payment, or health care operations. If you paid out-of-pocket in full for a health care service or item provided by Assistance Plus, you have the right to restrict disclosure of your PHI to your health plan for purposes of payment or health care operations, and we are required to honor this request. 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, such as family members and friends. Except as noted above, 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. 

• The information you wish to restrict;
• Whether you are requesting to limit Assistance Plus’s use, disclosure, or both; and
• To whom you want the limits to apply.

Inspection and Copies. You have the right to inspect and obtain a copy of your PHI that may be used to make decisions about you, including your medical records and billing records, but not including psychotherapy notes.  You must submit a request in writing to the Privacy Contact Person, Claire Wilson, in order to inspect and/or obtain a copy of your PHI.  Call (207) 453-4708 or 1-800-781-0070 for more information. If your medical information is maintained in an electronic health record, you also have the right to request that an electronic copy of your record be sent to you or to another individual or entity.  Assistance Plus may charge a fee for the costs of copying, mailing, labor, and supplies associated with the request. Assistance Plus may deny the request under certain limited circumstances; however, you may request a review of the denial.  Another licensed health care professional chosen by Assistance Plus will conduct such reviews.

Amendment. You may ask us to amend your health information if you believe it is incorrect or incomplete, and may request an amendment for as long as the information is kept by or for Assistance Plus. To request an amendment, you must submit your request in writing to the Privacy Contact Person, Claire Wilson.  Call (207) 453-4708 or 1-800-781-0070 for more information. You must provide us with a reason that supports your request for amendment.  Assistance Plus will deny your request if you fail to submit your request (and the reason supporting your request) in writing.  Also, we may deny your request if, in our opinion:

• The PHI is accurate and complete
• The information is not part of the PHI kept by or for Assistance Plus
• The amendment is not part of the PHI which you would be permitted to inspect and copy, or
• The PHI in question was not created by Assistance Plus, unless the individual or entity that created the information is not available to amend the information

Accounting of Disclosures. You have the right to request an “accounting of disclosures.”  An accounting of disclosures is a list of certain disclosures Assistance Plus has made of your PHI.  In your accounting, we are not required to list certain disclosures, including:

• Disclosures made for treatment, payment and health care operations purposes or disclosures made incident to treatment, payment and health care operations, unless the disclosures were made through an electronic health record.  If the disclosures were made through an electronic health record, you have the right to request an accounting of disclosures for treatment, payment and health care operations;
• Disclosures made pursuant to your authorization;
• Disclosures made to create a limited data set;
• Disclosures made directly to you.  To request an accounting of disclosures, you must submit your request in writing to the Privacy Contact Person, Claire Wilson.  Call (207) 453-4708 or 1-800-781-0070 for more information. All requests for accounting and disclosure must state a time period, which may not be longer than six (6) years from the date of disclosure for all disclosures that were not through an electronic health record and may not be longer than three (3) years from the date of disclosure for disclosures through an electronic health record for treatment, payment or health care operations. The first accounting requested in a twelve (12) month period is free of charge, but Assistance Plus may charge for additional accountings within the same twelve (12) month period.  Assistance Plus will notify you of the costs involved with additional requests, and you may withdraw your request before you incur any cost.

Right to Provide an Authorization for Other Uses and Disclosures.  Assistance Plus will obtain your written authorization for uses and disclosures that are not identified by this Notice or permitted by applicable law.  Any authorization you provide us regarding the use and disclosure of your PHI may be revoked at any time in writing.  Once an authorization is revoked, we will no longer use or disclose your PHI for the reasons described in the authorization. Please note: we are required to retain records of your care.

Right to Receive Notice of a Breach.  Assistance Plus is required to notify you by first class mail or by e-mail (if you have indicated a preference to receive information by e-mail), of any breaches of Unsecured Protected Health Information as soon as possible, but in any event, not later than sixty (60) days following the discovery of the breach.  “Unsecured Protected Health Information” is information that is not secured through the use of a technology or methodology identified by the Secretary of the Department of Health and Human Services to render the PHI unusable, unreadable, and indecipherable to unauthorized users.  The notice is required to include the following information:

• A brief description of the breach, including the date of the breach and the date of its discovery, if known;
• A description of the type of Unsecured Protected Health Information involved in the breach;
• Steps you should take to protect yourself from potential harm resulting from the breach;
• A brief description of actions we are taking to investigate the breach, mitigate losses, and protect against further breaches;
• Contact information, including a toll-free telephone number, e-mail address, Web site or postal address to permit you to ask questions or obtain additional information.

Complaints.  If you believe your privacy rights have been violated, you may file a complaint with us or with the Secretary of the Department of Health and Human Services, 200 Independence Ave., S.W., Washington, D.C. 20201. To file a complaint with us, contact the Privacy Contact Person, Claire Wilson, at the address above. All complaints must be submitted in writing and should be submitted within one hundred eighty (180) days of when you knew or should have known that the alleged violation occurred. See the Office of Civil Rights website, www.hhs.gov/ocr/hipaa for more information. You will not be penalized for filing a complaint. 

• EFFECTIVE DATE OF NOTICE

This notice was published and originally became effective on April 14, 2003. This Notice was last updated on April 1, 2010. Please note that changes in law affecting your privacy rights may take effect at different times.  Please speak with the Privacy Contact Person, Claire Wilson, if you have any questions.

If you have questions you may contact the Privacy Contact Person, Claire Wilson, at Assistance Plus at (207) 453-4708 or 1-800-781-0070.

If you believe your privacy rights have been violated, you can file a complaint with the above Privacy Contact Person or with the Secretary of Health and Human Services, Washington, D.C. There will be no retaliation for filing a complaint.

Assistance Plus

1604 Benton Ave.

Benton, Maine 04901

(207) 453-4708 or 1-800-781-0070

Acknowledgment of Receipt of

HIPAA Notice of Privacy Practices

I have been provided with a copy of Assistance Plus’s HIPAA Notice of Privacy Practices that provides a complete description of “protected health information” uses and disclosure. I have had an opportunity to ask questions about anything I do not understand. I understand that I have the right to review the notice prior to signing the Acknowledgment. I understand that Assistance Plus reserves the right to change its notice and practices. If it does so, it will be posted and available to be by contacting the Privacy Contact Person, Claire Wilson, at Assistance Plus at (207) 453-4708 or 1-800-781-0070.

I understand that I have the right to object to informing family and friends about my health care condition. I understand that I have the right to request restrictions as to how my health information may be used or disclosed and that the organization is not required to agree to the restrictions requested. However, if Assistance Plus agrees, it is bound by this agreement.

__________________________________ Effective Date:   

Signature of Client or Legal Representative

__________________________________ Client’s Date of Birth:   

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