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 agency is required by law to maintain the privacy of protected health information, to provide you adequate notice of your rights and our legal duties and privacy practices with respect to protected health information and to notify affected individuals following a breach of unsecured protected health information. We will use or disclose protected health information in a manner that is consistent with this notice.

The agency maintains your health records in both paper and electronic files. The agency uses a secure Electronic Medical Record (EMR) system to document and store information about your care. Your record may include physician orders, assessments, medication lists, clinical progress notes, care plans, and billing or insurance information. We maintain these records to provide quality care and to meet federal and state recordkeeping requirements.

As required by law, the agency maintains policies and procedures about our work practices, including how we coordinate care and services provided to our patients. These policies and procedures include how we create, receive, access, transmit, maintain and protect the confidentiality of all health information in our workforce and with contracted business associates and/or subcontractors; security of the agency building and electronic files; and how we educate staff on privacy of patient information.

As our patient, information about you must be used and disclosed to other parties for purposes of treatment, payment and health care operations. Examples of information that must be disclosed:

• Treatment: Providing, coordinating or managing health care and related services, consultation between health care providers relating to a patient or referral of a patient or health care from one provider to another. For example, we meet on a regular basis to discuss how to coordinate care for patients and to schedule visits.
• Payment: Billing and collecting for services provided, determining plan eligibility and coverage, utilization review (UR), precertification, medical necessity review. For example, occasionally the insurance company requests a copy of the medical record be sent to them for a coverage review prior to paying the bill.
• Health Care Operations: General agency administrative and business functions, quality assurance/improvement activities; medical review; auditing functions; developing clinical guidelines; determining the competence or qualifications of health care professionals; evaluating agency performance; conducting training programs with students or new employees; licensing, survey, certification, accreditation and credentialing activities; internal auditing; and certain fundraising activities and with your authorization, marketing activities. For example, our agency periodically holds clinical record review meetings where the consulting professional of our record review committee will audit clinical records for meeting professional standards and utilization review.

Certain uses and disclosures of your Protected Health Information (PHI) are permitted or required by federal and state law and do not require your written authorization. These may include disclosures for treatment, payment, and healthcare operations; to your health insurance plan or other payer for payment purposes; to individuals or entities financially responsible for your healthcare; and as otherwise required or permitted by applicable federal and state laws and regulations.

We are permitted to use or disclose information about you without consent or authorization in the following circumstances:

• In emergency treatment situations, if we attempt to obtain consent as soon as practicable after treatment;
• Where substantial barriers to communicating with you exist and we determine that the consent is clearly inferred from the circumstances;
• Where we are required by law to provide treatment and we are unable to obtain consent;
• Where the use or disclosure of medical information about you is required by federal, state or local law;
• To provide information to state or federal public health authorities, as required by law to: prevent or control disease, injury or disability; report births and deaths; report child abuse or neglect; report reactions to medications or problems with products; notify persons of recalls of products they may be using; notify a person who may have been exposed to a communicable disease or may be at risk for contracting or spreading a communicable disease or condition; and notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence (if you agree or when required or authorized by law);
• Health care oversight activities such as audits, investigations, inspections and licensure by a government health oversight agency as authorized by law to monitor the health care system, government programs and compliance with civil rights laws;
• To business associates regulated under HIPAA that work on our behalf under a contract that requires appropriate safeguards of protected health information;
• Certain judicial administrative proceedings in response to a court or administrative order, a subpoena, discovery request or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order from the Court protecting the information requested;
• Certain law enforcement purposes such as helping to determine whether a crime has occurred, to alert law enforcement to a crime on our premises or of your death if we suspect it resulted from criminal conduct, identify or locate a suspect, fugitive, material witness or missing person, or to comply with a court order or subpoena and other law enforcement purposes;
• To coroners, medical examiners and funeral directors, in certain circumstances, for example, to identify a deceased person, determine the cause of death or to assist in carrying out their duties;
• For cadaveric organ, eye or tissue donation purposes to communicate to organizations involved in procuring, banking or transplanting organs and tissues (e.g., if you are an organ donor);
• For certain research purposes under very select circumstances. We may use your health information for research. Before we disclose any of your health information for such research purposes, the project will be subject to an extensive approval process. We will usually request your written authorization before granting access to your individually identifiable health information;
• To avert a serious threat to health and safety: To prevent or lessen a serious and imminent threat to the health or safety of a particular person or the public, such as when a person admits to participation in a violent crime, causes serious harm to a victim, is an escaped convict or is diagnosed with a communicable disease considered by the Centers for Disease Control and Prevention (CDC) to be serious threat to the general public. Any disclosure, however, would only be to someone able to help prevent the threat;
• For specialized government functions including military and veteran’s activities, national security and intelligence activities protective services for the President, foreign heads of state and others, medical sustainability determinations, correctional institution and custodial situations; and
• For Workers’ Compensation purposes: Workers’ compensation or similar programs provide benefits for work-related injuries or illness.

We are permitted to use or disclose protected health information about you provided you are informed in advance and given the opportunity to individually agree to, prohibit, opt out or restrict the disclosure in the following circumstances.

• Use of a directory (includes name, location, condition described in general terms) of individuals served by our agency;
• Share information to a public or private entity authorized by law or by its charter to assist in disaster relief efforts for purposes of notifying your family, personal representatives or certain others of your location or general condition;
• Provide proof of immunization to a school that is required by state or other law to have such proof with agreement to disclosure by parent, guardian or other person acting in loco parentis if record is of an unemancipated minor; and
•  Provide a family member, relative, friend or other identified person, prior to, or after your death, the information relevant to such person’s involvement in your care or payment for care; to notify a family member, relative, friend or other identified person of your location, general condition or death.
• Other uses and disclosures not covered in this notice will be made only with your authorization. Authorization may be revoked, in writing, at any time, except in limited situations for the following disclosures:
•  Marketing of products or services or treatment alternatives that may be of benefit to you when we receive direct payment from a third party for making such communications;
• Psychotherapy notes under most circumstances, if applicable; and
• Any sale of protected health information resulting in financial gain by the agency unless an exception is met.

COMPLAINTS – If you believe that your privacy rights have been violated, you may complain to the Agency or to the Secretary of the U.S. Department of Health and Human Services. There will be no retaliation against you for filing a complaint. The complaint should be filed in writing, and should state the specific incident(s) in terms of subject, date and other relevant matters. A complaint to the Secretary must be filed in writing within 180 days of when the act or omission complained of occurred, and must describe the acts or omissions believed to be in violation of applicable requirements. For further information regarding filing a complaint or further information about matters covered by this notice, contact: Administrator, MGS Home Health Care, Inc., 8925 Sepulveda Blvd, Suite 202, North Hills, CA 91343; Phone: (818) 655-0300; fax: (818) 334-8453.