HIPAA-Health Insurance Portability and Accountability Act Privacy Notice

WAYNE CORPORATION-NOTICE OF PRIVACY PRACTICES

EFFECTIVE DATE: 4/7/02

I. THIS NOTICE DESCRIBES HOW PERSONAL HEALTH INFORMATION (PHI) ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

II. WE HAVE A LEGAL DUTY TO SAFEGAURD YOUR PROTECTED HEALTH INFORMATION (PHI)

We are required to protect the privacy of your health information. We call this information “protected health information”, or “PHI” for short and it includes information that can be used to identify you. We must provide you with this notice about our privacy practices that explains how, when and why we use and disclose your PHI. With some exceptions, we may not use or disclose any more of your PHI than is necessary to accomplish the purpose of the use or disclosure.

However, we reserve the right to change the terms of this notice and our privacy policies at any time. Any changes will also apply to the PHI we already have. Before we make an important change to our policies, we will promptly change this notice and make it available to you. You can request a copy of this notice from our front office or your counselor at any time.

III. HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION

We use and disclose health information for many different reasons. For some of these uses or disclosures, we need your prior consent or specific authorization. Below, we describe the different categories of our uses and disclosures and give you some examples of each category.

1. Uses and Disclosures Relating to Treatment, Payment or Health Care Operations that require Your Prior Written Consent. We may use and disclose your PHI with your consent for the following reasons:
   1. For Treatment. We may disclose your PHI to health care personnel who provide you with health care services or are involved in your care.
   2. To obtain payment for treatment. We may use and disclose your PHI in order to bill and collect payment for the treatment and services provided to you. For example, we may provide portions of your PHI to our billing department and your health plan to get paid for the health care services provided to you.
   3. For health care operations. We may use you PHI in order to operate this facility. For example, we may use your PHI in order to evaluate the quality of health care services that you received or to evaluate the performance of the health care professionals who provided health care services to you.
2. Certain Uses and Disclosures That Do Not Require Your Consent. We may use and disclose your PHI without your consent for the following reasons:
   1. When a disclosure is required by federal, state or local law, judicial or administrative proceedings, or law enforcement. For example, we make disclosures when a law requires that we report information to government agencies and law enforcement personnel about victims of abuse, neglect or domestic violence or when ordered in judicial or administrative proceedings.
   2. To avoid harm. In order to avoid a serious threat to the health or safety of a person or the public, we may provide PHI to law enforcement personnel or persons able to prevent or lessen such harm
   3. Appointment reminders and health related benefits or services. We may use PHI to provide appointment reminders or to give you information about treatment alternatives, or other health care services or benefits we offer.
3. Uses and Disclosures That Require You to Have the Opportunity to Object.
   1. Disclosures to family, friends or others. We may provide your PHI to a family member, friend or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or part. The opportunity to consent may be obtained retroactively in emergency.
4. All Other Uses and Disclosures that Require Your Prior Written Authorization. In any other situation not described in section III A, B and C above, we will ask for your written authorization before using or disclosing any of your PHI. If you choose to sign an authorization to disclose your PHI, you can later revoke that authorization in writing to stop any future uses and disclosures (to the extent that we haven’t taken any action relying on the authorization)

IV. WHAT RIGHTS YOU HAVE REGARDING YOUR PHI

You have the following rights with respect to your PHI:

The Right to Request Limits on Uses and Disclosures of Your PHI: You have the right to ask that we limit how we use and disclose your PHI. We will consider your request but are not legally required to accept it. If we accept your request, we will put any limits in writing and abide by them except in emergency situations. You may not limit the uses and disclosures that we are legally required to allow or make.

The Right to Choose How We Send PHI to You. You have the right to ask that we send information to you to an alternate address or by alternate means. We must agree to your request so long as we can easily provide it by the means you requested.

The Right to See and Get Copies of Your PHI. In most cases, you have the right to look at or get copies of your PHI that we have, but you must make the request in writing. In certain situations, we may deny your request. If we do, we will tell you in writing, our reasons for the denial and explain your right to have the denial reviewed. There may be charges for copies made.

The Right to Get a List of the Disclosures We Have Made. You have the right to get a list of instances in which we have disclosed your PHI. The list will not include uses or disclosures that you have already consented to, such as those made for treatment, payment or health care operations, directly to you or your family. The list also won’t include uses and disclosures made to law enforcement personnel.

The Right to Correct or Update your PHI. If you believe there is a mistake in your PHI or that a piece of important information is missing, you have the right to request that we correct the existing information or add the missing information. You must provide the request and your reason for the request in writing. We will respond within 60 days of receiving your request. We may deny your request in writing if the PHI is (I) correct and complete, (II) not created by us, (III) not allowed to be disclosed, or (IV) not part of our records. Our written denial will state the reasons for the denial and explain your right to file a written statement of disagreement with the denial. If you don’t file one, you have the right to request that your request and our denial be attached to all future disclosures of your PHI. If we approve your request, we will make the change to your PHI, tell you that we have done it, and tell others that need to know about the change to your PHI

V. HOW TO COMPLAIN ABOUT OUR PRIVACY PRACTICES

If you think that we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a complaint with the person listed in Section VI below. You may also send a written complaint to the Office for Civil Rights, U.S. Department of Health and Human Services. We will take no retaliatory action against you if you file a complaint about our privacy practices. The address for the OCR is listed below:

Office for Civil Rights

VI. PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE

If you have any questions about this notice or any complaints about our privacy practices, please contact Laura Hecht, Wayne Corporation Privacy Officer, 502-451-8262.