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 AND LEGAL DUTY TO YOUR PRIVACY

We are dedicated to maintaining the privacy of your individually identifiable Protected Health Information (PHI). We are required by applicable federal and state law to protect your privacy and to give this Notice about our privacy practices, our legal duties, and your rights concerning your PHI. We must follow the privacy practices that are described in the Notice while it is in effect.

We reserve the right to change our privacy practices and the terms of this Notice at any time, provided such changes are permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our Notice effective for all PHI that we maintain, including PHI we created or received before we make the changes. Before we make a significant change in our privacy practices, we will change this Notice and make the new Notice available upon written request.

You may request a copy of our Notice at any time. For more information about our privacy practices, or for additional copies of this Notice, please contact us using the information listed at the end of this Notice.

USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION (PHI)

The following categories describe the different ways we use and disclose your PHI in connection with our healthcare operations:

“us” or “our” those entities of Comfort Keepers that are based in the United States or Canada (hereinafter designated as “Comfort Keepers”) for all dimensions and activities.

Treatment: We may use or disclose your PHI for treatment purposes, including for the activities of a physician or other healthcare provider providing treatment to you. For example, your PHI may be provided to a physician who is treating you to assist with referral or diagnosis.

Payment: We may use and disclose your PHI to obtain payment for services we provide to you. For example, obtaining approval for third party payor, Medicare, or passport waivers may require that your PHI be disclosed in order to obtain approval for our services.

Healthcare Operations: We may use and disclose your PHI in connection with operating our business. These operating activities may include quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating provider performance, conducting training programs, accreditation, certification or licensing activities. For example, Comfort Keepers may contact you to remind you of your scheduled visit by our Comfort Keepers office. Your PHI will be used and disclosed from Comfort Keepers Franchises to CK Franchising, Inc. as a course of franchising business operations.

Your Authorization: : In addition to our use of your PHI for treatment, payment or healthcare operations, you may give us written authorization to use your PHI or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use of disclosure permitted by our authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your PHI for any reason except those described in this Notice. Release of psychotherapy notes will always require your prior authorization.

To Your Family and Friends: We must disclose your PHI to you, as described in the Patient Rights section of this Notice. We may disclose your PHI to a family member, friend or other person that is involved in your care, who assists in taking care of you assists with payment for your healthcare, but only if you agree that we may do so.

Persons Involved In Care: We may use or disclose PHI, including identifying or locating, to notify, or assist in the notification of a family member, your personal representative or another person responsible for your care, of your location, your general condition, or death. If you are present, then prior to use or disclosure of your PHI, we will provide you with an opportunity to object to such use or disclosures. In the event of your incapacity or emergency circumstances we will disclose PHI based on a determination using our professional and reasonable judgment and only disclosing PHI that is directly relevant to the person’s involvement in your healthcare. We will also use our professional judgment and our experience with common practice to make reasonable inferences of your best interest in allowing a person to pick up filled prescriptions, medical supplies and other similar forms of PHI.

Abuse or Neglect: We may disclose your PHI to appropriate authorities if we reasonably believe that you are a possible victim of abuse, neglect, or domestic violence or the possible victim of other crimes. This information may be disclosed to the extent necessary to avert a serious threat to the health or safety of you or others.

Appointment Reminders: We may use and disclose your PHI to contact you and remind you of an appointment via phone or voicemail messages.

Public Health Risks: We may use and disclose your PHI to public health authorities or other authorized persons to carry out certain activities related to public health.

Marketing Health Related Services: We will not sell or use your PHI for marketing communication without your written authorization.

Fundraising: We may send fundraising information to our clients. If you wish to opt out of receiving fundraising information, you may do so by contacting the Comfort Keepers’ Privacy Officer listed at the bottom of this notice.

Required by Law, Lawsuits and Legal Proceedings: We may use or disclose your PHI when we are required to do so by law, required by a court, in response to subpoenas, discovery requests, or other legal process.

Military and National Security: We may use or disclose your PHI if you are or have been a member of U.S. or foreign military forces and if required by the appropriate authorities. We may also disclose this information to federal officials for intelligence and national security activities authorized by law, as well as, to correctional institution officials in the event of an inmate or an individual taken into custody.

Coroners, Medical Examiners, Funeral Directors: We may use or disclose your PHI to a coroner or medical examiner to identify a deceased person and determine the cause of death, as well as, to funeral directors, as authorized by law, so that they may carry out their jobs.

Organ Donation: We may disclose PHI to organizations involved in organ and tissue donation and transplant.

Research: We may disclose your PHI to researchers when an institutional review board that has reviewed the research proposal and established protocols to insure the privacy of your PHI has approved their research.

Worker’s Compensation: Your protected health information may be disclosed as authorized to comply with Worker’s Compensation laws and other similar legally established programs.

PATIENT RIGHTS

Access: You have the right to look at or obtain electronic or paper copies of your PHI, with limited exceptions. You must make a request in writing to inspect and/or obtain access to your PHI. You may request access by sending us a letter, using the contact information listed at the end of this Notice. We will charge you a reasonable cost-based fee for expenses such as copies and staff time.

Accounting of Disclosures: You have the right to receive a list of instances in which we or our business associates disclosed your PHI for purposes, other than treatment, payment, healthcare operations and certain other activities.

Breach Notification: You have the right to receive notification of breaches of your unsecured PHI.

Restriction: You may request that we note use or disclose your PHI for a particular reason related to treatment, payment, general health care operations, and/or to a particular family member, other relative or close personal friend. Although we will consider your request, please be aware that we are under no obligation to accept it or abide by it, unless it is a request to prohibit disclosures to your health care plan relating to a service for which you have already paid in full out of pocket. If we do agree to a restriction, we will abide by our agreement, except in the event of an emergency. If you fail to pay for services, we have the right to bill your insurance carrier and disclosure your protected health insurance in the course of the claim.

Amendment: You have the right to request, in writing, that we amend your PHI. It must explain why the information should be amended. We may deny your request under certain circumstances.

Confidential Communication: You have the right to request that we communicate with you in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request a confidential communication of your PHI, you must submit a written request to our Privacy Officer (using the contact information at the end of this Notice) stating how or when you would like to be contacted. We will not require you to provide an explanation for your request. We will accommodate all reasonable requests.

Right to a Paper Copy of This Notice: You are entitled to receive a paper copy of our Notice of Privacy Practices. You may ask us to give you a copy of this Notice at any time.

Right to File a Complaint: If you believe your privacy rights have been violated, you may file a complaint with our Comfort Keepers Privacy Officer or with the U.S. Department of Health and Human Services Office for Civil Rights using the contact information at the end of this Notice.

QUESTIONS AND COMPLAINTS 

If you want more information about our privacy practices or have question or concerns, please contact us. If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI or in response to a request you made to amend or restrict the use or disclosure of your PHI, you may discuss it with us using the contact information listed at the end of this Notice. You also may submit a written complaint to Office for Civil Rights: Centralized Case Management Operations, U.S. Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F HHH Bldg., Washington, D.C. 20201 or OCRComplaint2hhs.gov. We support your right to the privacy of your PHI. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services Office for Civil Rights.

Contact Information

Privacy Office: Kristina Butler
Address: 1 Park Plaza, Ste. 300, Irvine, CA 92614