Notice of Privacy Practices
If you have any questions about this notice, please call 701-258-7838 and ask for the Privacy Officer.
At the admissions meeting for services at Pride, Inc. a master file is developed. Typically, this master file contains information on health, test results, diagnoses, treatment, a plan for the future, including treatment goals, objectives, and supports, and a second file with billing related information. This notice applies to all the records of your care generated by Pride, Inc.
We are required by law to maintain the privacy of your Protected Health Information (PHI) and provide you a description of our privacy practices. We will abide by the terms of this notice and will notify you if we cannot agree to a requested restriction. We will accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.
The following categories describe examples of the way we use and disclose information:
For treatment: We may use medical, social, and psychological information about you to provide you treatment or services. We may disclose this information about you to program coordinators, nurses, behavior analysts, direct support professionals and other team members who are involved in taking care of you and supporting you at Pride, Inc. For example: The vocational staff may have to coordinate with the residential staff to make changes in the transit schedule to pick up at a different time, due to a change in the work schedule. Different departments of Pride, Inc. also may share information about you in order to coordinate the different things you may need assistance with, such as prescriptions, behavior plans, or plans for the future.
We work with other covered entities involved in your treatment, such as pharmacies, clinics, hospitals, providers of therapies, and other providers of developmental disability services and may provide information to them as a part of providing quality treatment to you.
For Payment: We may use and disclose information about your treatment and services to bill and collect payment from you, your insurance company, the Department of Human Services or other third party payers. For example, we may need to give the Department of Human Services the dates of services provided to you in ISLA, Group Homes, Day Supports, Extended Services, or other programs provided by Pride, Inc. We may also tell your insurance plan about treatment you are going to receive to determine whether your plan will cover services through Pride, Inc.
We may also use and disclose information:
To business associates we have contracted with to perform the agreed upon service and billing for it;
To assess your satisfaction with our services;
To tell you about possible treatment alternatives;
To tell you about new benefits or services;
To contact you as part of fund raising efforts;
For population based activities relating to improving or reducing care costs;
For conducting training programs and reviewing competence of health care professionals.
Business Associates: There are some services provided in our organization through contracts with business associates. Examples may include a computer business who works with our billing software and auditors who complete our necessary audit procedures. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve asked them to do and bill your third party for services rendered. To protect your treatment information, we require the business associate to appropriately safeguard your information.
Individuals Involved in Your Care or Payment for Your Care: In emergency situations, we may release information about you to a friend or family member who is involved in your treatment team or who helps pay for your care. In addition, we may disclose information about you to an entity assisting in a disaster relief effort so that you can be notified about your condition, status, and location.
Research: We may disclose information to researchers when an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI information has approved their research.
Future Communications: We may communicate to you via newsletters, mailings, or other means regarding treatment options, program related information, or other community based initiatives or activities our organization is participating in. Information may be sent to you or your guardian regarding financial support for programs at Pride, Inc. Should you not wish to receive this information, or want to be taken off (opt out of) the mailing list, you may send your written request to the Privacy Officer.
Pride, Inc. Business Practices: Pride, Inc. may page individuals in services to alert them Transit has arrived, to let them know they have a phone call, or to let them know someone has arrived to see them. An examples of this is when Transit arrives to take someone to an appointment. In the group home setting, roommates may call out the name of the person who is being called, when the phone rings. Pride, Inc. also faxes work schedules to Transit with the person’s name, to allow for better coordination of rides. If you wish to opt out of any of these practices, please inform the Privacy Officer, in writing at the address at the end of this statement.
Pride, Inc. typically uses a fax machine to transmit doctors orders to the living setting to assure changes in medications are implemented quickly and with a three-way check. Fax machines are used by the nurses to transmit information to the personal physicians of individuals we support.
If you wish to opt out of this practice, please inform the Privacy Officer, in writing at the address at the end of this statement.
As Required by Law:
Funeral Directors: We may disclose health information to funeral directors consistent with applicable law to carry out their duties.
Organ Procurement Organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects or post marketing surveillance information to enable product recalls, repairs or replacement.
Workers Compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
Public Health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.
Correctional Institution: Should you be an inmate of a correctional institution, we may disclose to the institution or their agents, health information necessary for your health, and the health and safety of other individuals.
Law Enforcement: We may disclose health information for law enforcement purposes as required by law, or in response to a valid subpoena.
Federal Law makes provision for your information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a workforce member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers, or the public.
Your Health Information Rights
Although your master file record is the physical property of Pride, Inc., you have the right to:
Inspect and Copy: You have the right to inspect and copy information that may be used to make decisions about your care. Usually, this includes habilitation and billing records, but does not include psychotherapy notes. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to information, you may request that the denial be reviewed. Another professional chosen by Pride, Inc. 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.
Amend: If you feel that 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 Pride, Inc. We may deny your request for an amendment and if this occurs, you will be notified of the reason for the denial.
An Accounting of Disclosures: You have the right to request an accounting of disclosures. This is a list of the disclosures we make of information about you.
Request Restrictions: You have the right to request a restriction or limitation on the information we use or disclose about you for treatment, payment, or health care operations. 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 payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about an incident that occurred. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
Request Confidential Communications: You have the right to request that we communicate about treatment matters in a certain way or at a certain location. We will agree to the request to the extent that it is reasonable for us to do so. For example, you can ask that we use an alternative address for billing purposes.
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. If you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
To exercise any of your rights, please obtain the required forms from the Privacy Officer and submit your request in writing.
CHANGES TO THIS NOTICE
We reserve the right to change this notice and the revised or changed notice will be effective for information we already have about you as well as any information we receive in the future. The current notice will be posted at Pride, Inc. and include the effective date. In addition, if you leave services at Pride, Inc. and later return for treatment, we will offer you a copy of the current notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with the Pride, Inc. by contacting the main number and asking for the Privacy Officer, or with the Secretary of the Department of Health and Human Services. To file a complaint with Pride, Inc. contact the Privacy Officer. All complaints must be submitted in writing.
You will not be penalized for filing a complaint.
OTHER USES OF INFORMATION
Other uses and disclosures of 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 information about you for the reasons covered by your written authorization. Please 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 you.
P.O. Box 4086
Bismarck, ND 58502-4086