Notice of Privacy Practices
This document is protected by Copyright Laws.
© Copyright 2007, CHOICE Advisory Services, Inc.
This notice describes how medical information about you may be used and disclosed
and how you can obtain access to this information. Please review this
information carefully. If you have additional questions, not answered in this
document, please contact us at:
1-800-361-0138.
A Protected Health Information Communication Form is provide at the end of this
document, should you request or require assistance.
Our commitment to Privacy
CHOICE Advisory Services, Inc. is committed to preserving privacy and
confidentiality of your protected health information that is obtained while
assisting your with locating housing, care or in obtaining other products or
services. State and Federal laws require that we implement policies and
procedures to safeguard health information. Laws also require that we provide
you with this notice regarding our legal responsibilities and privacy practices
with respect to your protected health information.
Protected health information is any information that is created or received by
us that identities you, and that relates to your physical or mental condition. This
notice does not apply to health information that does not identify you or
anyone else.
This notice provides you with information regarding our privacy practices. It
outlines the ways in which we may use or disclose your protected health
information and also describes your rights and our obligations regarding any
such uses or disclosures.
We reserve the right to change this notice and to make the revised or changed
notice effective for protected health information we already have about you as
well as any information we may receive in the future.
How does CHOICE obtain information?
CHOICE Advisory Services, Inc., its employees and representatives, obtain
information from the individual requiring or requesting services and/or
products. If the specific individual is not mentally or physically capable of
providing information, CHOICE Advisory Services, Inc. will accept information
from a legal Guardian or designated Durable Power of Attorney.
With your written permission, CHOICE Advisory Services, Inc. may also obtain
information from family members, friends, neighbors, health care providers or
other individuals who may have an understanding of the needs of an individual.
CHOICE Advisory Services, Inc. reserves the right to speak directly with the
individual receiving products and/or services to verify that the individual
does indeed wish to receive assistance and that the individual does indeed
consent to the information outlined in this document.
How does CHOICE share information with service or
product providers?
With your consent, CHOICE Advisory Services, Inc. primarily speaks with
Providers by telephone or in person. In instances where information is shared
electronically (fax or email), the information is assigned a code number. This
code number ensures anonymity of information when provided to businesses and
agencies that further provide services and/or products. CHOICE Advisory
Services, Inc. requires that all contracted Providers comply with their own
privacy policies and procedures.
How does CHOICE Advisory Services, Inc. use or disclose
your protected health information?
When you request assistance in locating housing, care or other products and
services for older adults, CHOICE Advisory Services, Inc. may contact you by
telephone or may arrange to see you in person. In the process of speaking with
you and assessing your needs, CHOICE is likely to make written notes about your
health condition, your possible mental health and other information about your
physical, financial and psychosocial needs and status. This information may be
transferred to an electronic file, or it may be stored in a standard filing
system. In instances where CHOICE has successfully assisted you in locating
services, or in instances where CHOICE determines the agency cannot be of help
to you, all electronic and physical records may deleted or shred to avoid the
possibility of making such information available to the public.
Communication with individuals involved in your care.
When you ask for CHOICE to assist you in locating appropriate housing, care or
other products or services, we may disclose to a family member, close personal
friend or any other person you identify, protected health information relevant
to that person's involvement in your care, unless you notify us that you
object in whole or part.
Assessment
In instances where you request CHOICE to assist you in defining which housing
and/or care options best meet your specific needs, CHOICE may disclose your
protected health information with doctors, rehab specialists, pharmacists, home
health agencies, private duty aides, nurses, lab technicians, medical supply
providers or other businesses or agencies involved in providing you with
products and/or services. CHOICE may also disclose your protected health
information with a family member, close personal friend or any other person you
identify, protected health information relevant to that person’s
involvement in your care, unless you notify us that you object in whole or
part.
Treatment
In instances where you arrange to have CHOICE Advisory Services, Inc. provide
short-term or on-going care or case management, we may disclose your protected
health information in providing and/or coordinating or in verifying proper
treatment or services for you. We may disclose your protected health
information to doctors, rehab specialists, pharmacists, home health agencies,
private duty aides, nurses, lab technicians, medical supply providers or other
businesses or agencies involved in providing you with products and/or services.
CHOICE may also disclose your protected health information with a family
member, close personal friend or any other person you identify, unless you
notify us that you object in whole or part.
Health Care Operations
We may disclose your protected health information to perform certain functions
of our referral services, marketing functions and/or our private case/care
management services. These uses or disclosures are necessary to provide you
with quality care and service. For example, employees or representatives of
CHOICE Advisory Services, Inc. may review your information in order to
determine what information is relevant or important to share with a housing,
care or service provider.
Business Associates
There are some services provided within our organization that are provided by
affiliate businesses and agencies. These relationships exist to broaden the
scope of services and products offered. Additionally, we contract with service
providers and agencies to provide a continuum of services and products to
assist you. We may disclose your protected health information to our business
associates so they can perform the job we've asked them to do. We do
require the business associate to appropriately safeguard your protected health
information.
Public health activities
We may disclose your protected health information to public health authorities
that are authorized by law to receive and collect health information for the
purpose of preventing or controlling disease, injury or disability.
Judicial or administrative proceedings
We may disclose your protected health information when ordered in judicial or
administrative proceedings are required by state or federal law.
Law Enforcement
We may disclose your protected health information for law enforcement purposes
as required by law, including but not limited to the investigation of possible
abuse, neglect or domestic violence.
Research
We may disclose your protected health information for research purposes under
certain limited circumstances as prescribed by law.
To ensure safety and health
We may disclose your protected health information in instances where possible
harm may exist for you or for another person.
Change of ownership
In the event that CHOICE Advisory Services, Inc. is purchased by another agency
or business, or in the event that CHOICE Advisory Services, Inc. purchases or
merges with another business or agency, your protected health information will
become property of the new owner, although you will maintain the rights under
this notice.
Other uses or disclosures required by law
We may use or disclose your protected health information where such uses or
disclosures are required by federal, state or local law.
You have the right to revoke a written authorization at any time as long as your
revocation is provided to us in writing. If you revoke your written
authorization, we will no longer use or disclose your protected health
information for the purposes identified in the authorization. You understand
that we are unable to retrieve any disclosures, which we have made pursuant to
your authorization prior to its revocation.
Your rights regarding your protected health information
Right to request restrictions. You have the right to request a
restriction or limitation on the protected health information we use or
disclose about you for treatment or health care operations. You also have the
right to request a limit on the protected health information we disclose about
you to someone, such as a family member, friend who is involved in your care or
in the payment of your care and/or for the purposes of general business
operations. For example, you may choose to ask that we not use or disclose
information regarding a specific illness or treatment that you are receiving or
that you have received.
To request restrictions or limits on the uses and disclosures of your protected
health information, you must make your request in writing, on a form provided
by CHOICE Advisory Services, Inc. (See request form at the end of this
document)
- Right to request confidential communications. If you are dissatisfied
with the manner in which or location where you are receiving communications
from us that are related to your protected health information, you may request
that we provide you with such information by alternate means or at alternate
locations. Such request must be made in writing on a form provided by CHOICE
Advisory Services, Inc. We will attempt to accommodate all reasonable requests.
(See request form at the end of this document)
- Rights to inspect a copy. In most cases you have the right to review
or to obtain copies of your protected health information that CHOICE Advisory
Services, Inc. has on file. In certain situations, CHOICE may deny your
request. CHOICE Advisory Services, Inc. will respond within 30 days of receipt
of the request, unless law requires us to respond sooner. If CHOICE Advisory
Services, Inc. denies your request, you will be notified in writing describing
the reasons for the denial. You will receive an explanation of how you may have
your denial reviewed, if applicable. (See request form at the end of this
document)
- Right to request an amendment. If you feel that the protected health
information we have about you in incorrect or incomplete, you may ask us to
amend the information. To request an amendment, your request must be made in
writing on a form provided by CHOICE Advisory Services, Inc. CHOICE Advisory
Services, Inc. will respond to you within 30 days of receipt of your notice. We
may deny your request for an amendment if it is not in writing or does not
include a reason to support the request. In addition, we may deny your request
if you ask us to amend information that was not created by us; is not part of
the health information retained by CHOICE Advisory Services, Inc; is not part
of the information which you would be permitted to inspect and copy; and/or is
accurate and complete. (See request form at the end of this document)
- Right to an accounting of disclosures. You have the right to request
an accounting of all disclosures of your protected health information made by
us during the time period for which you request (not to exceed six years). Your
request must be submitted on a form provided by CHOICE Advisory Services, Inc.
CHOICE Advisory Services, Inc. will respond to your request within 30 days of
receipt of the request. (See request for at the end of this document)
- Right to a paper copy of this notice. If you have received this
notice electronically, you have the right to request a paper copy of this
notice, even if you have agreed to receive this notice electronically. To
obtain a copy, please sent a written request to the corporate address listed
below.
Complaints
If you believe your privacy rights have been violated, you may file a complaint
with the Secretary of CHOICE Advisory Services, Inc. that acts as the Chief
Compliance Officer of the corporation. You may also file a complaint with the
Secretary of the United States Department of Health and Human Services. You
will in no way be penalized for filing a complaint.
CHOICE Advisory Services, Inc.
PO Box 12494
Mill Creek, WA 98082-0494
Protected Health
Information Communication Form (PDF)