Medical Information Policy
Privacy Notice Regarding Use and Disclosure of Medical Records
THIS PRIVACY NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS MEDICAL INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY BEORE SIGNING ANY DOCUMENTS.
PURPOSE OF THIS NOTICE:
In general, any information that concerns your health, treatment, or payment for treatment, is considered confidential and is protected as confidential by WEL. This Privacy Notice describes WEL’s Privacy Practices, specifically – the uses and disclosures WEL may make of your medical information and what rights you have with respect to your medical information. Medical information includes, but is not limited to, your name; address; other personal identifying data; health status; and record of treatment that has been, are being, and will be provided to you in the future. WEL requires that all programs, employees, staff, and any party in a working or business relationship with WEL comply with WEL Privacy Practices.
USE AND DISCLOSURE OF MEDICAL INFORMATION FOR TREATMENT, PAYMENT, AND HEALTH CARE OPERATIONS:
Federal Law permits WEL to use and disclose your personal medical information for the purpose of treatment, payment, and health care operations without further authorization from you:
Treatment means the provision, coordination, or management of health care related and therapeutic services provided completely or in part by WEL. WEL can share your medical information and records with another provider involved in your health care for the benefit of your coordinated care. Also, WEL may contact you by phone or other means to remind you about an appointment or address a specific aspect of your care.
Please note that relevant laws prohibit certain medical information, such as psychotherapy notes, from being shared without your knowledge. WEL must obtain a written Authorization from you before all or part of that medical information can be used or released. At the time the medical information is being requested, you will be provided with a written Authorization explaining the specific medical information requested and the purpose of the request for the specific medical information. Your signature on the Authorization will provide the consent necessary for the use or release of this information.
Payment refers to reimbursement to WEL by your healthcare insurer for services that have been provided to you. In order to process payment, your healthcare insurer may require that WEL provide medical information to confirm your eligibility for services provided, to coordinate benefits with other payers who may be responsible for reimbursement for the services, and as part of the payers claims management procedures which covers billings, collections, appeals, medical necessity review activities, utilization review activities, or for disclosure to consumer reporting agencies. For instance, WEL can disclose the information required by your insurer’s plan to determine whether the services provided to you by WEL were medically necessary.
Health Care Operations cover a range of internal operations performed by WEL or its Business Associates to manage information, data, and services on behalf of WEL and the individuals we serve. These operations include, but are not limited to, quality assessment and improvement activities including research; peer review; credentialing and licensing; training programs; legal and financial services; business planning and development; implementing and monitoring WEL compliance and privacy practices; customer services; internal grievances; creating de-identified or re-identified information for data aggregation and other purposes including research, fundraising, marketing and due diligence activities. Examples of such operations are evaluation of the performance of therapists to ensure that they meet WEL quality standards and engaging legal counsel or accountants to represent WEL interests when required.
THE USE AND DISCLOSURE OF MEDICAL INFORMATION WHEN YOUR CONSENT OR AUTHORIZATION IS NOT REQUIRED:
Under the following additional circumstances, WEL is permitted by law to use or disclose your medical information without further authorization from you:
Facility Directory: Unless you object, WEL may include certain limited information about you in the WEL directory while you are a patient at WEL. This information may include your name, location where you are receiving care, condition (in general terms) and your religious affiliation. This directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy even if they don’t ask for you by name.
Individuals Involved in Your Care or Payment for Your Care: Unless you object, WEL may release related medical information about you to a friend or family member involved in your medical care or any other person you identify. WEL may also give information to someone who helps pay for your care. WEL may also tell your family or friends your condition and that you are in the facility. In addition, WEL 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.
Research: Under certain circumstances, WEL may use and disclose medical information about you for research purposes. All research projects are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with patients’ need for privacy of their medical information. Before WEL uses or discloses medical information for research, the project will have been approved through this research approval process by an institutional review board.
As Required By Law: WEL will disclose medical information about you when required to do so by federal, state or local law.
To Avert a Serious Threat to Health or Safety: WEL may use or disclose medical information about you when necessary to prevent a serious threat to the health and safety of yourself, another person or the public. Any disclosure, however, would only be to someone able to help prevent the threat.
Military and Veterans: If you are a member of the armed forces, WEL may release medical information about you as required by military command authorities.
Workers’ Compensation: WEL may release medical information about you for workers’ compensation or similar programs that provide benefits for work-related injuries or illness.
Public Health Risks: WEL may disclose medical information about you for public health activities. These activities generally include the following: to prevent or control disease, injury or disability;
- to report births and deaths;
- to report child abuse or neglect;
- to report reaction to medications or other problems with products related to healthcare;
- to provide notifications that products have been recalled;
- to notify a person who may be at risk of contracting or spreading a disease or condition;
- to notify the appropriate government authority if WEL believes a patient has been the victim of abuse, neglect or domestic violence where required by law.
Health Oversight Activities: WEL may disclose medical information to health oversight agencies for activities authorized by law such as audits, investigations and inspections. These agencies monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes: WEL may disclose medical information about you in response to a court or administrative order or other process under certain circumstances.
Law Enforcement: WEL may release medical information if asked to do so by a law enforcement official:
- in response to a court order, warrant, summons or similar legal process;
- to locate or identify a suspect, fugitive, material witness, or missing person;
- about the victim of a crime under certain limited circumstances;
- about a death believed to be the result of criminal conduct;
- about criminal conduct on the premises of WEL; and
- in emergency circumstances to report a crime.
Coroners, Medical Examiners, Funeral Directors, and Organ/Tissue Donation: WEL may release medical information to a coroner or medical examiner, for example, to identify a deceased person or determine the cause of death. WEL may also release medical information about patients of WEL to funeral directors, as authorized by law, where necessary to carry out their duties. If you are an organ donor, WEL may release medical information to entities that handle organ or tissue procurement or transplantation.
National Security and Intelligence Activities: WEL may also disclose your medical information to authorized federal officials conducting national security, intelligence and counterintelligence activities. WEL may disclose medical information about you to authorized federal officials so they may provide protection to the President or other authorized persons or conduct special investigations.
Inmates: If you are an inmate of a correctional institution or under the custody of law enforcement, WEL may release medical information about you to the correctional institution or law enforcement official.
Fundraising: WEL may use your name and address, or the name of your representative or next of kin, in order to make contact as part of a WEL fundraising effort. We may also share with information with the WEL Foundation that will contact you for fundraising efforts. If you do not wish to be contacted for these fundraising campaigns you may opt-out; please write to: DeWayne McMullin, Chief Financial Officer, Wesley Enhanced Living, 101 E. County Line Road; Suite 200; Hatboro, PA 19040
AUTHORIZATION FOR OTHER USES AND DISCLOSURES OF MEDICAL INFORMATION:
WEL is prohibited, by law, from using or disclosing your medical information without written Authorization for any purpose other than those purposes listed above. This prohibition includes most uses and disclosures of psychotherapy notes, uses and disclosure for marketing purposes; uses and disclosures that constitute the sale of protected health information; other uses and notices not specifically described herein.
An Authorization serves as a written permission that specifically identifies the information being sought for use or disclosure and clearly states the purpose for which the use or disclosure is being requested. Further, you may revoke your Authorization at any time except: (1) to the extent that the medical information has been used or disclosed in reliance on your Authorization or (2) your Authorization was obtained as a condition of obtaining insurance coverage.
Please note that WEL cannot guarantee that once your medical information has been released to the third party named in an Authorization that the third party will abide by the rules stated in WEL Privacy Notice.
INDIVIDUAL RIGHTS WITH RESPECT TO MEDICAL INFORMATION:
An individual of appropriate age and legal capacity, who understands the nature of the medical information and the purpose for which medical information may be used or disclosed, shall control access to his or her personal medical information.
Access: Refers to physical examination of medical information, but does not include physical possession of the information. You do have the right to request a copy of the relevant information; this includes the right to request an electronic copy of the electronic protected health information. The medical information to which you may have access usually includes medical and billing records, but not psychotherapy notes if, upon documentation by the medical team leader, it is determined that granting such access will constitute a substantial detriment to the medical process. Access may be denied in certain circumstances, such as for the protection of another individual’s confidentiality, to safeguard information under the Privacy Act, or in other circumstances set forth by the Privacy Rule. Any review of the denial of access would be performed by a licensed health care professional designated by WEL who did not participate in the denial of your request.
Breach: You have the right to be notified in that event that WEL, or a Business Associate, discover a breach of unsecured protected health information.
Restrictions: You may request restrictions on the use and disclosure of your medical information for treatment, payment and operational purposes. You have the right to restrict disclosures of protected health information to health plans when you or another third party other than the health plan has paid for services out of pocket, in full; you have the right to restrict disclosure to a health plan of protected health information for payment or health care operations purposes; if the request is not otherwise required by law. WEL shall be bound by all reasonable and appropriate requests for such restriction to which it agrees in writing, except in emergency circumstances or if you are being transferred to another health care institution. WEL reserves the right to request the withdrawal of certain restrictions at any time during treatment. However, WEL is not bound to accept your requested restrictions if it does not believe that it reasonably can or should comply with the requested restrictions. WEL reserves the right to exercise such discretion and give a written refusal in response to your request for restrictions.
Please address any written requests for restrictions to: Suzanne H. Lachman, Corporate Compliance Officer, Wesley Enhanced Living, 101 E. County Line Road; Suite 200; Hatboro, PA 19040
Confidential Communications: You may request that WEL communicate with you about medical matters in a certain way or at a certain location. For example, you may request that all communication be directed to your home and not to you at work. Also, as a part of WEL’S quality improvement practices, WEL may call to remind you about an appointment or follow up by phone after services have been provided to confirm the service and the quality of the service provided. On such phone calls, WEL may appear on your “Caller ID” service. You may request that WEL call you on a phone which will not identify WEL on your “Caller ID.”
Such request for confidential communication must be made in writing. WEL will attempt to accommodate such requests. Please address any requests for confidential communications to: Suzanne H. Lachman, Corporate Compliance Officer, Wesley Enhanced Living, 101 E. County Line Road; Suite 200; Hatboro, PA 19040
Amendments: You may request amendments to your documented medical information in writing. Amendments agreed to by WEL shall be documented within sixty (60) days of your written request. However, WEL reserves the right to deny requests for amendments when WEL finds that: (1) the existing documented medical information is accurate; (2) WEL is not the author of the medical information requested to be amended; or (3) the request to amend changes or alters the accuracy of the medical information. You may appeal any denial of your request for amendments within thirty (30) days of receipt of WEL’S denial of your requested amendment.
All appeals must be made in writing. Please direct any requests for amendments and appeals in writing to: Suzanne H. Lachman, Corporate Compliance Officer, Wesley Enhanced Living, 101 E. County Line Road; Suite 200; Hatboro, PA 19040
Accounting: Of any and all disclosures made of your medical information for the six (6) years prior to the date of your request shall be available to you within sixty (60) days of the date of your written request. These disclosures do not include those made for certain treatment, payment or operational purposes. The right to an accounting is subject to the effective date of regulatory laws and statutes.
Please direct requests for accountings in writing to: Suzanne H. Lachman, Corporate Compliance Officer, Wesley Enhanced Living, 101 E. County Line Road; Suite 200; Hatboro, PA 19040
Complaints: Alleging inappropriate use or disclosure of your medical information by WEL employees or agents may be directed to the WEL Privacy Officer or to the Secretary of the federal Department of Health and Human Services. Under no circumstances shall WEL retaliate against you for filing a complaint.
If you wish to file a complaint, please contact us and obtain an appropriate complaint form and where to file the complaint form.
Suzanne H. Lachman, Corporate Compliance Officer
Wesley Enhanced Living
101 E. County Line Road; Suite 200
Hatboro, PA 19040
RIGHTS UNDER STATE LAW:
Depending on the type of treatment you are receiving and the nature of the information requested, state law may require that WEL provide greater privacy protection to your medical information or provide you with a greater right of access to the information.
WEL has the non-delegable duty to maintain the privacy of your medical information and to provide you with Notice of its legal obligations and Privacy Practices with respect to your medical information. WEL must date and comply with the Privacy Notice currently in effect. WEL reserves the right to amend and/or update its Privacy Notice from time to time upon change of practices or revision of laws. If its Privacy Notice is revised, copies of the revised and dated Privacy Notice shall be posted in the WEL service areas or be made available by contacting us. WEL hereby reserves the right to implement the changes prior to issuing the revised Privacy Notice.