THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW CAREFULLY:
Critical Nurse Staffing, Inc. (“CNS”) is required by law to maintain the privacy of your protected health information (“PHI”), to notify you of our legal duties and privacy practices with respect to your health information, and to notify affected individuals following a breach of unsecured health information. This Notice summarizes our duties and your rights concerning your information. CNS’ duties and your rights are set forth more fully in 45 CFR part 164.
- Uses And Disclosures We May Make Without Written Authorization. CNS may use or disclose your PHI for certain purposes without your written authorization, including the following:
Treatment. CNS may use or disclose your PHI for purposes of treating you. For example, we may share your PHI with a doctor that is providing you healthcare services. CNS may share your information with the United States Department of Labor, Office of Workers’ Compensation with regard to the Energy Employees Occupational Illness Compensation Act (“EEOICPA”) and providing ongoing healthcare to you under this Act.
Payment. CNS may use or disclose your PHI to obtain payment for services provided to you. For example, we may disclose PHI to the United States Department of Labor, Office of Workers’ Compensation Program’s third party billing agent to obtain pre-authorization or payment for treatment.
Healthcare Operations. CNS may use or disclose your PHI for certain activities that are necessary to operate our organization and ensure that our patients receive quality care. These operations may include, but are not limited to, audits, inspections, investigations, to train or review the performance of our staff or make decisions affecting our organization.
Other Uses or Disclosures. CNS may also use or disclose your PHI for certain other purposes as allowed by 45 CFR 164.512 or other applicable laws and regulations, including but not limited to the following:
To avoid serious and imminent threat to public health or safety;
As required by state or federal law such as reporting abuse, neglect or certain other events;
As allowed by workers compensation laws for use in workers compensation proceedings;
For certain public health activities such as reporting certain diseases;
For certain public health oversight activities such as audits, investigations, or licensure actions;
To the United States Department of Labor, Office of Workers’ Compensation Energy Employees Occupational Illness Compensation Program for functions including eligibility and program management;
In response to a court order, warrant or subpoena in judicial or administrative proceedings;
To the extent disclosure is required by law and the disclosure complies with and is limited to any requirements under which the disclosure is made;
For certain specialized government functions such as the military or correctional institutions;
For research purposes if certain conditions are satisfied;
In response to certain requests by law enforcement to locate a fugitive, victim or witness, or to report deaths or certain crimes; and
To coroners, funeral directors, or organ procurement organizations as necessary to allow them to carry out their duties.
- Disclosures We May Make Unless You Object. Unless you instruct us otherwise, CNS may disclose your PHI as described below:
To a member of your family, relative, friend, or other person who is involved in your healthcare. We will limit the disclosure to the information relevant to that person’s involvement in your healthcare.
- Uses and Disclosures With Your Written authorization. Other uses and disclosures not described in this Notice will be made only with your written authorization, for marketing purposes or if we seek to sell your information. You may revoke your authorization by submitting a written notice to CNS’ Privacy Officer, at the address listed below. The revocation will not be effective to the extent we have already taken action in reliance on the authorization.
- Your Rights Concerning Your Protected Health Information. You have the following rights concerning your PHI.
Under certain circumstances, you have the right to request that we not use or share your PHI for treatment, payment or healthcare operations. This would include your right to request that we not share your PHI with persons involved in your care except when specifically authorized by you. Your request must be made in writing to the Privacy Officer. We are not legally required to agree to the requested restriction but will consider your request.
You may request that CNS contact you in a specific way. For example, home or office phone, via email or sending mail to a different address. CNS will accommodate reasonable requests. Such a request must be in writing and must be sent to the Privacy Officer.
You may inspect and obtain a copy of records that are used to make decisions about your care, including an electronic copy. We may charge you a reasonable, cost-based fee for providing the records. We may deny your request under limited circumstances, e.g., if we determine that disclosure may result in harm to you or others. A written request must be sent to the Privacy Officer.
You may request that your PHI be amended. We may deny your request for certain reasons, e.g., if we did not create the record or if we determine that the record is accurate and complete. A written request must be sent to the Privacy Officer.
You have the right to a list of those instances in which we have shared your PHI, other than for treatment, payment, and healthcare operations, or other than when you specifically authorized CNS to share your information. Your request must be in writing to the Privacy Officer. You may receive the first accounting within a 12-month period free of charge. We may charge a reasonable, cost-based fee for all subsequent requests during that 12-month period. A written request must be sent to the Privacy Officer.
You may obtain a paper copy of this Notice upon request. You have this right even if you have agreed to receive the Notice electronically. Please contact the Privacy Officer to request a copy.
CNS is required by law to notify you following a breach of your PHI. This notice will describe the circumstances of what happened and the information that was inappropriately used or disclosed. You may receive this notice in the mail, or if you have elected to receive communications from CNS by email, through an email sent to the email address that we have on file for you.
If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. However, we will make sure the person has this authority and can act for you before we take any action.
You may complain to us or to the United States Department of Health and Human Services Office for Civil Rights if you believe your privacy rights have been violated. You may file a complaint with us by notifying our Privacy Officer. All complaints must be in writing. CNS will not retaliate against you for filing a complaint.
- Changes To This Notice. CNS reserves the right to change the terms of this Notice at any time, and to make the new Notice effective for all protected health information that we maintain. If we materially change our privacy practices, we will post a copy of the current Notice in our reception area and on our website. You may obtain a copy of the current Notice from our Privacy Officer.
- Contact Information. If you have any questions about this Notice, or if you want to object to or complain about any use or disclosure or exercise any right as explained above, please contact:
Critical Nurse Staffing, Inc.
ATTN: Privacy Officer
1114 North First Street, Suite 200, Grand Junction, CO 81501
Phone: 970-254-9001 or e-mail at HIPAA@cnscares.com
- Effective Date. This Notice is effective on August 4, 2017.