NOTICE OF PRIVACY PRACTICES
COMMUNITY OF HOPE HEALTH SERVICES
WASHINGTON, DC 20009
Privacy Officer
2250 Champlain Street, NW
Washington, DC 20009
(202) 232-9022
OUR PLEDGE REGARDING MEDICAL INFORMATION:
We are committed to protecting the confidentiality of medical information about you. We create a record of care for the services you receive at Community of Hope Health Services. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records generated by physicians and other personnel.
This notice will tell you about the ways in which we may use the disclosed medical information about you. Also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
We are required by law to:
- Make sure that medical information that identifies you is kept private.
- Give you notice of our legal duties and privacy practices with respect to medical information about you and make a good faith effort to obtain your acknowledgement of receipt of this notice.
- Follow the terms of the notice that is currently in effect for all of your personal health information.
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION:
For Treatment. We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students or personnel who are involved in taking care of you at Community of Hope Health Services. We may disclose medication information about you to other health care providers who request such information for purposes of providing medical treatment to you. They may work at Community of Hope Health Services, at the hospital if you are hospitalized under our supervision, or at another physician’s office, lab, pharmacy or other health care service.
For Payment. We may use and disclose health information about you to bill and collect payment from you, your insurance company, including Medicaid and Medicare, or other third party that may be available to reimburse us for some or all of your health care. We may also disclose health information about you to other health care providers or to your health plan so that they can arrange for payment relating to your care. We may also tell your health plan about treatment that you need to obtain your health plan’s prior approval or to determine whether your plan will cover the treatment.
For Health Care Operations. We may use and disclose health information about you for our day-to-day operations, and may disclose information about you to other health care providers involved in your care or to your health plan for use in their day-to-day operations. These uses and disclosures are necessary to run Community of Hope Health Services and to make sure that all of our patients receive quality care, and to assist other providers and health plans in doing so as well. We may also combine health information about our patients with health information from other health care providers to decide what additional services Community of Hope should offer, what services are not needed, whether new treatments are effective or to compare how we are doing with others and to see where we can make improvements. We will remove information that identifies you from this set of health information so others may use it to study health care delivery without learning who our patients are.
As Required By Law. We will disclose medication information about you when required to do so by federal, state or local law.
Employers. We may release medical information about you to your employer if we provide health care services to you at the request of your employer, and health care services are provided either to conduct an evaluation relating to medical surveillance of the workplace or to evaluate whether you have a work-related illness or injury. In such circumstances, we will give you written notice of such release of information to your employer. Any other disclosures to your employer will be made only if you execute a specific authorization to the release of that information to your employer. We may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work related injuries or illness.
Business Associates. There are some services provided by us through contracts with other companies, who are our business associates. Federal law requires us to enter into a contract with these business associates to ensure that they will appropriately safeguard your PHI. For instance, we may use a billing service for submitting our claims. When these services are contracted for, we may disclose PHI about you to our business associates so that they can perform the job we have asked them to do or bill an insurance company or managed care group for services rendered. But these business associates will be required to protect any PHI they receive in accordance with federal and applicable state laws, regulations and policies.
Disclosures to parents or legal guardians. If you are a minor, we may release PHI about you to your parent or legal guardian when we are permitted to or required to under federal and applicable state law.
Public Health Risks. We may disclose medical information about you for public health activities. These activities generally include the following:
- To prevent or control disease, injury or disability
- To report abuse or neglect; we only make this disclosure when required or authorized by law
- To report reactions to medications or problems with products
- To report births and deaths
- To notify people of recalls of products
- To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition
Health Oversight Activities. We may disclose health information about you to a health oversight agency for activities authorized by law. These oversight activities include audits, investigations, inspections and licensure.
Lawsuits and Disputes. We may disclose health information about you in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request or other lawful process that is not accompanied by a court or administrative order, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Coroners, Health Examiners, and Funeral Directors. We may release health information about our patients to a coroner or health examiner. We may also release health information to funeral directors as may be necessary for them to carry out their duties.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU:
You have the following rights regarding health information we maintain about you:
- Right to inspect and copy. You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes, or notes provided by another facility.
To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to Mariama Samba-Koroma, Privacy Officer, Community of Hope Health Services 2250 Champlain Street NW, Washington DC 20009. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies and services associated with your request.
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by Community of Hope Health Services will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
- Right to Amend. If you believe that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for Community of Hope Health Services. Request for an amendment must be submitted in writing to the Privacy Officer.
- Right to an Accounting of Disclosures. You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of medical information about you, with certain exceptions specifically defined by law. Your request must state a time period, which may not be longer than six years. Your request must be in writing and submitted to Mariama Samba-Koroma, Privacy Officer, Community of Hope Health Services, 2250 Champlain Street NW, Washington DC 20009.
- Right to Request Restrictions. You have the right to request a restriction or limitation on your medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care.
- Right to Request Confidential Communications. You have the right to request that we communicate to you about medical matters in a certain location. For example, you can ask that we only contact you at work or by mail.
- Right to a Paper Copy of this Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time.
COMPLAINTS
If you believe your rights with respect to medical information about you have been violated by Community of Hope Health Services, you may file a complaint with the clinic or with the Secretary of the United States Department of Health and Human Services. All complaints must be in writing and submitted to Mariama Samba-Koroma, Privacy Officer, Community of Hope Health Services, 2250 Champlain Street, N.W., Washington, DC 20009.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the clinic. The notice will contain the effective date on the first page.
ACKNOWLEDGEMENT
You will be asked to provide a written acknowledgement of your receipt of this Notice of Privacy Practices. We are required by law to make a good faith effort to provide you with our Notice of Privacy Practices and obtain such acknowledgement from you. However, your receipt of care and treatment from the Clinic is not conditioned upon your providing the written acknowledgement.
