Our Privacy Policy
You may read our policy on this page or to download a PDF copy CLICK HERE.
ASHE SERVICES FOR AGING, INC. NOTICE OF PRIVACY PRACTICES-
Effective: April 14, 2003
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATIONABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This notice will tell you how we may use and disclose protected health information about
you. Protected health information means any health information about you that identifies
you or for which there is a reasonable basis to believe the information can be used to
identify you. In this notice, we call all of that protected health information, “medical
information.”
This notice also will tell you about your rights and our duties with respect to medical information about you. In addition, it will tell you how to complain to us if you believe
we have violated your privacy rights.
How We May Use and Disclose Medical Information About You.
We use and disclose medical information about you for a number of different purposes.
Each of those purposes is described below.
For Treatment.
We may use medical information about you to provide, coordinate or manage your health
care and related services by both us and other health care providers. We may disclose
medical information about you to doctors, nurses, hospitals and other health facilities
who become involved in your care. We may consult with other health care providers
concerning you and as part of the consultation share your medical information with them.
Similarly, we may refer you to another health care provider and as part of the referral
share medical information about you with that provider. For example, your physician
may order equipment for you to use in the home, and we will need to contact the provider
of your choice, and give them the information needed so that the proper equipment can be
ordered and delivered to your home.
For Payment.
We may use and disclose medical information about you so we can be paid for the
services we provide to you. This can include billing you, your insurance company, or a
third party payor. For example, we may need to give your insurance company or
Medicaid information about the health care services we provide to you so that Medicaid
will pay us for those services. We also may need to provide your insurance company or
Medicaid, with information about your medical condition and the health care you need to
receive to determine if you are covered by that insurance or program.
For Health Care Operations.
We may use and disclose medical information about you for our own health care
operations. These are necessary for us to operate Ashe Services for Aging and to
maintain quality health care for our patients. For example, we may use medical
information about you to review the services we provide and the performance of our
employees in caring for you. We may disclose medical information about you to train
our staff, volunteers and students working in Ashe Services for Aging. We also may use
the information to study ways to more efficiently manage our organization.
How We Will Contact You.
Unless you tell us otherwise in writing, we may contact you by either telephone or by
mail at either your home or your workplace. At either location, we may leave messages
for you on the answering machine or voice mail. If you want to request that we
communicate to you in a certain way or at a certain location, see “Right to Receive
Confidential Communications” on page 7 of this Notice.
Appointment Reminders.
We may use and disclose medical information about you to contact you to remind you of
an appointment you have with us.
Treatment Alternatives.
We may use and disclose medical information about you to contact you about treatment
alternatives that may be of interest to you.
Health Related Benefits and Services.
We may use and disclose medical information about you to contact you about healthrelated
benefits and services that may be of interest to you.
Marketing Communications.
We may use and disclose medical information about you to communicate with you about
a product or service to encourage you to purchase the product or service. This may be:
To describe a health-related product or service that is provided by us;
For your treatment;
For case management or care coordination for you;
To direct or recommend alternative treatments, therapies, health care providers, or
settings of care.
We may communicate to you about products and services in a face-to-face
communication by us to you. We also may communicate about products or services in the
form of a promotional gift of nominal value.
All other use and disclosure of medical information about you by us to make a
communication about a product or service to encourage the purchase or use of a product
or service will be done only with your written authorization.
Individuals Involved in Your Care.
We may disclose to a family member, other relative, a close personal friend, or any other
person identified by you, medical information about you that is directly relevant to that
person’s involvement with your care or payment related to your care. We also may use
or disclose medical information about you to notify, or assist in notifying, those persons
of your location, general condition, or death. If there is a family member, other relative,
or close personal friend that you do not want us to disclose medical information about
you to, please notify your Case Manager or Nurse.
Disaster Relief.
We may use or disclose medical information about you to a public or private entity
authorized by law or by its charter to assist in disaster relief efforts. This will be done to
coordinate with those entities in notifying a family member, other relative, close personal
friend, or other person identified by you of your location, general condition or death.
Required by Law.
We may use or disclose medical information about you when we are required to do so by
law.
Public Health Activities.
We may disclose medical information about you for public health activities and purposes.
This includes reporting medical information to a public health authority that is authorized
by law to collect or receive the information for purposes of preventing or controlling
disease, or one that is authorized to receive reports of abuse and neglect. It also includes
reporting for purposes of activities related to the quality, safety or effectiveness of a
United States Food and Drug Administration regulated product or activity.
Victims of Abuse, Neglect or Domestic Violence.
We may disclose medical information about you to a government authority authorized by
law to receive reports of abuse, neglect, or domestic violence, if we believe you are a
victim of abuse, neglect, or domestic violence. This will occur to the extent the
disclosure is: (a) required by law; (b) agreed to by you; or, (c) authorized by law and we
believe the disclosure is necessary to prevent serious harm to you or to other potential
victims, or, if you are incapacitated and certain other conditions are met, a law
enforcement or other public official represents that immediate enforcement activity
depends on the disclosure.
Health Oversight Activities.
We may disclose medical information about you to a health oversight agency for
activities authorized by law, including audits, investigations, inspections, licensure or
disciplinary actions. These and similar types of activities are necessary for appropriate
oversight of the health care system, government benefit programs, and entities subject to
various government regulations. However, disclosure of medical information about you
to the North Carolina Department of Health and Human Services, as part of an inspection
to determine if we comply with licensure requirements, will not occur if you object to
that disclosure of your medical information
Judicial and Administrative Proceedings.
We may disclose medical information about you in the course of any judicial or
administrative proceeding in response to an order of the court or administrative tribunal.
We also may disclose medical information about you in response to a subpoena,
discovery request, or other legal process but only if efforts have been made to tell you
about the request or to obtain an order protecting the information to be disclosed.
Disclosures for Law Enforcement Purposes.
We may disclose medical information about you to a law enforcement official for law
enforcement purposes:
a. As required by law.
b. In response to a court, grand jury or administrative order, warrant or subpoena.
c. To identify or locate a suspect, fugitive, material witness or missing person.
d. About an actual or suspected victim of a crime and that person agrees to the
disclosure. If we are unable to obtain that person’s agreement, in limited
circumstances, the information may still be disclosed.
e. To alert law enforcement officials to a death if we suspect the death may have
resulted from criminal conduct.
f. About crimes that occur at our facility.
g. To report a crime in emergency circumstances.
Coroners and Medical Examiners.
We may disclose medical information about you to a coroner or medical examiner for
purposes such as identifying a deceased person and determining cause of death.
Funeral Directors.
We may disclose medical information about you to funeral directors as necessary for
them to carry out their duties.
Organ, Eye or Tissue Donation.
To facilitate organ, eye or tissue donation and transplantation, we may disclose medical
information about you to organ procurement organizations or other entities engaged in
the procurement, banking or transplantation of organs, eyes or tissue.
Research.
Under certain circumstances, we may use or disclose medical information about you for
research. Before we disclose medical information for research, the research will have
been approved through an approval process that evaluates the needs of the research
project with your needs for privacy of your medical information. We may, however,
disclose medical information about you to a person who is preparing to conduct research
to permit them to prepare for the project, but no medical information will leave Ashe
Services for Aging during that person’s review of the information.
To Avert Serious Threat to Health or Safety.
We may use or disclose protected health information about you if we believe the use or
disclosure is necessary to prevent or lessen a serious or imminent threat to the health or
safety of a person or the public. We also may release information about you if we believe
the disclosure is necessary for law enforcement authorities to identify or apprehend an
individual who admitted participation in a violent crime or who is an escapee from a correctional institution or from lawful custody.
Military.
If you are a member of the Armed Forces, we may use and disclose medical information
about you for activities deemed necessary by the appropriate military command
authorities to assure the proper execution of the military mission. We may also release
information about foreign military personnel to the appropriate foreign military authority
for the same purposes. We may use and disclose medical information about you to
components of the Department of Veterans Affairs that determine eligibility or
entitlement to benefits or that provide benefits.
National Security and Intelligence.
We may disclose medical information about you to authorized federal officials for the
conduct of intelligence, counter-intelligence, and other national security activities
authorized by law.
Protective Services for the President.
We may disclose medical information about you to authorized federal officials so they
can provide protection to the President of the United States, certain other federal officials,
or foreign heads of state.
Inmates; Persons in Custody.
We may disclose medical information about you to a correctional institution or law
enforcement official having custody of you. The disclosure will be made if the disclosure
is necessary: (a) to provide health care to you; (b) for the health and safety of others; or,
(c) the safety, security and good order of the correctional institution.
Workers Compensation.
We may disclose medical information about you to the extent necessary to comply with
workers’ compensation and similar laws that provide benefits for work-related injuries or
illness without regard to fault.
Other Uses and Disclosures.
Other uses and disclosures will be made only with your written authorization. You may
revoke such an authorization at any time by notifying Wanda Roten, Privacy Officer,
Ashe Services for Aging 180 Chatty Rob Lane, West Jefferson, NC 28694 in writing of
your desire to revoke it. However, if you revoke such an authorization, it will not have
any affect on actions taken by us in reliance on it.
Your Rights With Respect to Medical Information About You.
You have the following rights with respect to medical information that we maintain about
you.
Right to Request Restrictions.
You have the right to request that we restrict the uses or disclosures of medical
information about you to carry out treatment, payment, or health care operations. You
also have the right to request that we restrict the uses or disclosures we make to: (a) a
family member, other relative, a close personal friend or any other person identified by
you; or, (b) to public or private entities for disaster relief efforts. For example, you could
ask that we not disclose medical information about you to your brother or sister.
To request a restriction, you may do so at any time. If you request a restriction, you
should do so to your Case Manager or Nurse, Ashe Services for Aging, 180 ChattyRob
Lane, West Jefferson, NC 28694 and tell us: (a) what information you want to limit; (b)
whether you want to limit use or disclosure or both; and, (c) to whom you want the limits
to apply (for example, disclosures to your spouse). This is not required to be in writing,
but would assist us with your request, if you would do so.
We are not required to agree to any requested restriction. However, if we do agree, we
will follow that restriction unless the information is needed to provide emergency
treatment. Even if we agree to a restriction, either you or we can later terminate the
restriction.
Right to Receive Confidential Communications.
You have the right to request that we communicate medical information about you to you
in a certain way or at a certain location. For example, you can ask that we only contact
you by mail or at work. We will not require you to tell us why you are asking for the
confidential communication.
If you want to request confidential communication, you must do so in writing to Wanda
Roten, Privacy Officer, Ashe Services for Aging, 180 ChattyRob Lane, West Jefferson,
NC 28694. Your request must state how or where you can be contacted.
We will accommodate your request. However, we may, when appropriate, require
information from you concerning how payment will be handled. We also may require an
alternate address or other method to contact you.
Right to Inspect and Copy.
With a few very limited exceptions, such as psychotherapy notes, you have the right to
inspect and obtain a copy of medical information about you.
To inspect or copy medical information about you, you must submit your request in
writing to Wanda Roten, Privacy Officer, Ashe Services for Aging, 180 ChattyRob Lane, West Jefferson, NC 28694. Your request should state specifically what medical
information you want to inspect or copy. If you request a copy of the information, we
may charge a fee for the costs of copying and, if you ask that it be mailed to you, the cost
of mailing.
We will act on your request within thirty (30) calendar days after we receive your
request. If we grant your request, in whole or in part, we will inform you of our
acceptance of your request and provide access and copies.
We may deny your request to inspect and copy medical information if the medical
information involved is:
a. Psychotherapy notes;
b. Information compiled in anticipation of, or use in, a civil, criminal or
administrative action or proceeding;
If we deny your request, we will inform you of the basis for the denial, how you may
have our denial reviewed, and how you may complain. If you request a review of our
denial, it will conducted by a licensed health care professional designated by us who was
not directly involved in the denial. We will comply with the outcome of that review.
Right to Amend.
You have the right to ask us to amend medical information about you. You have this
right for so long as the medical information is maintained by us.
To request an amendment, you must submit your request in writing to Wanda Roten,
Privacy Officer, Ashe Services for Aging, 180 ChattyRob Lane, West Jefferson, NC
28694. Your request must state the amendment desired and provide a reason in support of
that amendment.
We will act on your request within sixty (60) calendar days after we receive your request.
If we grant your request, in whole or in part, we will inform you of our acceptance of
your request and provide access and copying.
If we grant the request, in whole or in part, we will seek your identification of and
agreement to share the amendment with relevant other persons. We also will make the
appropriate amendment to the medical information by appending or otherwise providing
a link to the amendment.
We may deny your request to amend medical information about you. We may deny your
request if it is not in writing and does not provide a reason in support of the amendment.
In addition, we may deny your request to amend medical information if we determine
that the information:
a. Was not created by us, unless the person or entity that created the information is
no longer available to act on the requested amendment;
b. Is not part of the medical information maintained by us;
c. Would not be available for you to inspect or copy; or,
d. Is accurate and complete.
If we deny your request, we will inform you of the basis for the denial. You will have the
right to submit a statement of disagreeing with our denial. Your statement may not
exceed 2 pages. We may prepare a rebuttal to that statement. Your request for
amendment, our denial of the request, your statement of disagreement, if any, and our
rebuttal, if any, will then be appended to the medical information involved or otherwise
linked to it. All of that will then be included with any subsequent disclosure of the
information, or, at our election, we may include a summary of any of that information.
If you do not submit a statement of disagreement, you may ask that we include your
request for amendment and our denial with any future disclosures of the information. We
will include your request for amendment and our denial (or a summary of that
information) with any subsequent disclosure of the medical information involved.
You also will have the right to complain about our denial of your request.
Right to an Accounting of Disclosures.
You have the right to receive an accounting of disclosures of medical information about
you. The accounting may be for up to six (6) years prior to the date on which you request
the accounting but not before April 14, 2003.
Certain types of disclosures are not included in such an accounting:
a. Disclosures to carry out treatment, payment and health care operations;
b. Disclosures of your medical information made to you;
c. Disclosures that are incident to another use or disclosure;
d. Disclosures that you have authorized;
e. Disclosures for disaster relief purposes;
f. Disclosures for national security or intelligence purposes;
g. Disclosures to correctional institutions or law enforcement officials having
custody of you;
h. Disclosures that are part of a limited data set for purposes of research, public
health, or health care operations (a limited data set is where things that would
directly identify you have been removed).
i. Disclosures made prior to April 14, 2003.
Under certain circumstances your right to an accounting of disclosures to a law
enforcement official or a health oversight agency may be suspended. Should you request
an accounting during the period of time your right is suspended, the accounting would
not include the disclosure or disclosures to a law enforcement official or to a health
oversight agency.
To request an accounting of disclosures, you must submit your request in writing to
Wanda Roten, Privacy Officer, Ashe Services for Aging, 180 ChattyRob Lane, West
Jefferson, NC 28694. Your request must state a time period for the disclosures. It may
not be longer than six (6) years from the date we receive your request and may not
include dates before April 14, 2003.
Usually, we will act on your request within sixty (60) calendar days after we receive your
request. Within that time, we will either provide the accounting of disclosures to you or
give you a written statement of when we will provide the accounting and why the delay is
necessary.
There is no charge for the first accounting we provide to you in any twelve (12) month
period. For additional accountings, we may charge you for the cost of providing the list.
If there will be a charge, we will notify you of the cost involved and give you an
opportunity to withdraw or modify your request to avoid or reduce the fee.
Right to Copy of this Notice.
You have the right to obtain a paper copy of our Notice of Privacy Practices. You may
obtain a paper copy even though you agreed to receive the notice electronically. You
may request a copy of our Notice of Privacy Practices at any time.
You may obtain a copy of our Notice of Privacy Practices over the Internet at our web
site, www.asheaging.org .
To obtain a paper copy of this notice, contact Wanda Roten, Privacy Officer, Ashe
Services for Aging, 180 ChattyRob Lane, West Jefferson, NC 28694 (336) 246-2461.
Our Duties Generally.
We are required by law to maintain the privacy of medical information about you and to
provide individuals with notice of our legal duties and privacy practices with respect to
medical information.
We are required to abide by the terms of our Notice of Privacy Practices in effect at the
time.
Our Right to Change Notice of Privacy Practices.
We reserve the right to change this Notice of Privacy Practices. We reserve the right to
make the new notice’s provisions effective for all medical information that we maintain,
including that created or received by us prior to the effective date of the new notice.
Availability of Notice of Privacy Practices.
A copy of our current Notice of Privacy Practices will be posted on the Senior Center
Bulletin Board (1st floor of Ashe Services for Aging). A copy of the current notice also
will be posted on our web site, www.asheaging.org .
At any time, you may obtain a copy of the current Notice of Privacy Practices by
contacting Wanda Roten, Privacy Officer, Ashe Services for Aging, 180 ChattyRob
Lane, West Jefferson, NC 28694 (336) 246-2461.
Effective Date of Notice.
The effective date of the notice will be stated on the first page of the notice.
Complaints.
You may complain to us and to the United States Secretary of Health and Human
Services if you believe your privacy rights have been violated by us.
To file a complaint with us, contact Wanda Roten, Privacy Officer, Ashe Services for
Aging, 180 ChattyRob Lane, West Jefferson, NC 28694 (336) 246-2461. All complaints
should be submitted in writing.
To file a complaint with the United States Secretary of Health and Human Services, send
your complaint to him or her in care of: Office for Civil Rights, U.S. Department of
Health and Human Services, 200 Independence Avenue SW, Washington, D.C. 20201.
You will not be retaliated against for filing a complaint.
Questions and Information.
If you have any questions or want more information concerning this Notice of Privacy
Practices, please contact Wanda Roten, Privacy Officer, Ashe Services for Aging, 180
ChattyRob Lane, West Jefferson, NC 28694 (336) 246-2461.
For any of the above concerns, if Wanda Roten is not available, you may ask for or write to Lisa Osborne, RN, Assistant Privacy Officer, Ashe Services for Aging, 180 ChattyRob Lane, West Jefferson, NC 28694.