HEALTH INFORMATION PORTABILITY AND ACCOUNTABILITY ACT NOTICE OF PRIVACY PRACTICES
Effective: April 14, 2003
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.
Covered Entities: GO YE VILLAGE.
USES AND DISCLOSURES OF HEALTH INFORMATION
- Treatment. We will use or disclose your health information for treatment purposes, including for the treatment activities of other health care providers. A nurse, physician, or other member of your healthcare team may use this information to determine the course of treatment best for you.
- Payment. We will use or disclose your health information for payment, including for the payment activities of other healthcare providers or payers. For example, a bill may be sent to you or other third-party payers such as health plans, Medicaid, or Medicare. The information sent may contain your health information.
- Healthcare operations. We will use or disclose your health information for our regular healthcare operations. For example, members of the medical staff, risk, or quality improvement, may use your health information to assess the care and outcomes in you and others alike. Health information is used to continually improve the quality and effectiveness of the healthcare and service we provide.
- We may also disclose your health information for certain healthcare operations of other entities. We will only disclose your information under the following conditions:
- a) The other entity must have or have had a relationship with you.
b) The health information used or disclosed must relate to the other entity’s relationship with you.
c) The disclosure must be for either, quality assessment and improvement activities, or population-based activities relating to improving health or reducing healthcare costs, or case management and care coordination, or conducting training programs, or accreditation, licensing, credentialing activities, or for healthcare fraud and abuse detection or compliance.
- a) The other entity must have or have had a relationship with you.
- Business associates. There are services provided in our organization using outside people and entities. For example, these “business associates” include our accountants, consultants, and attorneys. We may disclose your health information to our business associates so that they can perform the job we’ve asked them to do. We require the business associates to appropriately safeguard your information.
- Directory. Unless you notify us that you object, we may use your name, location in the facility, general condition, and religious affiliation for directory purposes. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name. Unless you notify us that you object, we may also use your name on a nameplate near or on your door to identify your room, on a directory board, or on your resident mailbox.
- Notification. We may use or disclose information to notify or assist in notifying a family member, personal representative, or other person responsible for your care, of your location, and general condition. If we are unable to reach your family member or personal representative, we may leave a message requesting a return phone call on an answering machine.
- Communication with family. We may disclose to a family member, other relative, close friend or any other person involved in your healthcare, health information relevant to that person’s involvement in your care or payment related to your care.
- Research. We may disclose information to researchers when certain conditions have been met.
- Transfer of information at death. We may disclose health information to funeral directors, medical examiners, and coroners to carry out their duties consistent with applicable law.
- 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.
- Marketing. We may contact you regarding your treatment, to coordinate your care, or to direct or recommend alternative treatments, therapies, healthcare providers or settings. We may contact you to describe a health-related product or service that may be of interest to you, and the payment for said product.
- Fundraising. We may contact you as a part of a fundraising effort.
- Food and Drug Administration (FDA). We may disclose to the FDA, or to a person or entity subject to the jurisdiction of 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, controlling disease, injury, or disability.
- Correctional institution. Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of others.
- Law enforcement. We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.
- Reports. Federal law makes provisions for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force 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.
- In any other situation, we will ask for your consent or written authorization before using or disclosing any identifiable health information about you. If you choose to sign an authorization to disclose information, you can later revoke that authorization to stop any future disclosures.
You may request that we not use or disclose your information for treatment, payment, or administrative purposes or to persons involved in your care, except when specifically authorized by you, when required by law, in emergency circumstances, or if you are being transferred to another institution. Although we will consider your request regarding the use or disclosure of your health information, please be aware that we are not legally required to accept it. We ask that such requests be made in writing on a form provided by our facility.
You have the right to inspect or get a copy of your health information, which will be provided to you in the time frames established by law. If you request to have copies made, we will charge you a reasonable fee. We ask that such request be made in writing on a form provided by our facility.
You have the right to request a list of instances where we have disclosed health information about you for reason; other than treatment, payment, healthcare operations, disclosures made to you or your legal representative, or any other individual involved with your care, correctional institutions or law enforcement officials, or disclosures made for national security purposes. You will not be charged for the first request in any 12-month period, otherwise there will be a reasonable, cost-based fee. We ask that such request be made in writing on a form provided by our facility.
If you believe that information in your record is incorrect or if important information is missing, you have the right to request that we correct the existing information or add the missing information. We ask that such request be made in writing on a form provided by our facility.
If you are dissatisfied with the manner or the location where you are receiving communications from us that are related to your health information, you may request that we provide you with such information by alternative means or at alternative location. We ask that such request be made in writing on a form provided by our facility. We will attempt to accommodate all reasonable requests.
You have the right to obtain a paper copy of our Notice of Privacy Practices upon request. You may also access and print a copy of our notice from our website: www.goyevillage.org
For each visitor to this webpage, our web server automatically recognizes the visitor’s domain.
We collect only the information volunteered by visitors to this website.
The information we collect is not shared with commercial or other nonprofit organizations.
If you supply us with your postal or email addresses online, you will receive mailings only from Go Ye Village.
If you are concerned that we have violated your privacy rights related to your health information, you may contact the person listed below. Complaints must be filed in writing on a form provided by our facility. You may also send a written complaint to the following address: Corporate Compliance Officer, Go Ye Village, 1201 West 4th Street, Tahlequah, OK 74464 or call at 918.456.4542, or file a written complaint with the Secretary of the Federal Department of Health and Human Services. There will be no retaliation for filing a complaint, and it must be within 180 days of the violation.
OUR LEGAL DUTY
We are required by law to protect the privacy of your information, provide this notice about our information practices, and follow the information practices that are described in this notice.
We may change our policies at any time. Before we make a significant change in our policies, we will change our notice and post the new notice in the front lobby area and on our website. You can also request a copy of our notice at any time. For more information about our privacy practices, contact the person listed below.
If you have any questions, complaints, or need to request any of the above said forms, please contact:
Corporate Compliance Officer
Go Ye Village
1201 West 4th St
Tahlequah, OK 74464