In
this Privacy Notice, the word "Foundation" means the Mary Lee
Foundation and to include any program operated by the Mary Lee
Foundation.
The
Health Insurance Portability and Accountability Act (HIPAA) is a
federal law. This law will be effective April 14, 2003. This law
gives you important rights; the most important right under this law
is your privacy. We are required by applicable federal and state laws
to maintain the privacy of your personal and health information. Both
under law and our policy, Mary Lee Foundation has a responsibility to
protect the privacy of your personal and health information. Personal
and health information includes both medical information and
individually identifiable information, (whether oral or recorded in
any form or medium) such as your name, address, telephone number or
social security number.
You are
receiving this notice because you receive services from the
Foundation. Because you are a client or consumer of the Mary Lee
Foundation, the Foundation will request certain medical and personal
information about you.
This
notice tells you about your privacy rights, the Foundation's duty to
protect personal and health information that identifies you, and how
the Foundation may use or disclose personal and health information
that identifies you without your permission.
This
notice describes how the Foundation protects you privacy by limiting
who may see your personal and health information, how we may use or
disclose your personal and health information, informs you of our
legal duties with respect to your personal and health information and
explains our privacy policies.
Your Privacy Rights
The
Health Insurance Portability and accountability Act (HIPAA) gives you
the right to:
* Review or
obtain copies of your personal and health information the Foundation
has about you in most situations;
* You have
the right to request that the Foundation correct certain information,
including certain health information about you if you believe the
information is wrong or incomplete. Most of the time, the Foundation
cannot change or delete information, even if it is incorrect.
However, if the Foundation decides it should make a change, it will
add the correct information to the record and note that the new
information takes the place of the old information. The old
information will remain in the record. If the Foundation denies your
request to change the information, you can have your written
disagreement placed in your record. You may submit this request in
writing to your administrator.
* Request a
list of the times the Foundation has disclosed personal and health
information about you;
* Ask the
Foundation to limit the use or disclosure of personal and health
information about you more than the law requires. However, the
privacy law does not make the Foundation agree to that;
* Tell the
Foundation where and how to send your information that includes
personal and health information if sending the information to your
usual address could put you in danger. This request must be put in
writing and be specific regarding where and how to contact you;
* Ask for
and get a paper copy of this Notice from the Foundation;
* Withdraw
permission you have given to the Foundation to use or disclose
personal and health information that identifies you, unless the
Foundation has already provided the information based on your
permission. You must withdraw your permission in writing.
USES AND DISCLOSURES OF MARY LEE FOUNDATION'S CLIENT AND CONSUMER
PERSONAL AND HEALTH INFORMATION
The Foundation
may use and disclose your personal and health information without your
consent/authorization, in the following ways:
Treatment:
We may use or disclose your personal and health information in order
for Foundation staff to provide treatment and services.
Payment:
We may use and disclose your personal and health information in order
for the Foundation to collect payment for your care from the
sponsoring agency and/or agencies as applicable.
Health Care
Operations: The Foundation may use or disclose personal and
health care operations. Health care operations include:
*
Conducting quality assessment and improvement activities;
* Reviewing
the competence, qualifications, and performance of health care
professionals or health care plans;
* Training
health-care professionals and others;
*
Conducting accreditation, certification, licensing, or credentialing
activities;
* Carrying
out activities related to the creation, renewal or replacement of a
contract for health insurance or health benefits;
* Providing
medical review, legal services, or auditing functions including fraud
and abuse detection, and compliance program;
* Engaging
in business management or the general administrative activities of the
Foundation.
Examples of uses
and disclosures for health care operations include facilities and
program surveys.
Family
member, other relative, or close personal friend:
The Foundation may disclose health information about you to a family
member, other relatives or a close personal friend when:
* The
health information is related to that person's involvement with your
care, o0r payment for your care.
The Foundation may
not disclose personal or health information to a family member,
relative, or friend without your written permission or the written
permission of your guardian.
Health
oversight activities: The Foundation
may sometimes use or disclose health information about you for health
oversight activities and then only to another health oversight
agency. For example, health oversight activities may include looking
into Medicaid fraud. A health oversight agency must be a government
agency or someone acting on behalf of a government agency.
Public
Health: The Foundation may disclose health information about you
to:
* A public
health authority for purposes of preventing or controlling disease,
injury or disability
*An
official of a foreign government agency who is acting with the public
health authority; and
*A
government agency allowed to receive reports of child abuse or
neglect.
Victims of
abuse, neglect, or domestic violence: If the Foundation believes
you are the victim of abuse, neglect, or domestic violence, the
Foundation may sometimes disclose health information about you to a
government agency that receives reports of abuse, neglect, or domestic
violence if:
* A law
requires the disclosure;
* You agree
to the disclosure;
* A law
allows the disclosure and the disclosure is needed to prevent serious
harm to you or someone else; or
* The law
allows the disclosure, you are unable to agree or disagree, the
information is needed for immediate action and the information will
not be used against you.
If the Foundation
makes a report under this section, the Foundation will tell you or
your representative unless it believes that telling you would place
you at risk.
Serious
Threat to Health or Safety: The Foundation may use or
disclose health information about you if it believes the use or
disclosure is needed:
* To
prevent or lessen a serious and immediate threat to the health and
safety of a person or the public:
* For law
enforcement authorities to identify or catch an individual who has
admitted participating in a violent crime that resulted in serious
physical harm to the victim, unless the information was learned while
initiating or in the course of counseling or therapy; or
* For law
enforcement authorities to catch an individual who has escaped from
lawful custody.
Process and Proceedings: We may
disclose your personal and health information in response to a court
or administrative order, subpoena, discovery request, or other lawful
process.
Law
Enforcement: We may disclose limited
information to law enforcement officials concerning the personal and
health information of a suspect, fugitive, material witness, crime
victim or missing person and when a law requires the use or
disclosure. We may disclose the personal and health information of an
inmate or other person in lawful custody to a law enforcement official
or correctional institution.
Research: The Foundation may use or
disclose your personal and health information for research purposes in
limited circumstances. The Foundation will ensure that your privacy
is protected when your personal and health information is used for
research.
As
required by Law: The Foundation must
use or disclose personal and health information about you when a law
requires the use or disclosure.
Other
uses and Disclosures: The foundation
may use or disclose health information about you:
* To
create health information that does not identify any specific
individual:
* To the
U.S. military or a foreign military for military purposes, if you are
a member of the group asking for the information;
* For the
purpose of lawful national security activities;
* To
federal officials to protect the President and others;
* To a
prison or jail, if you are an inmate of that prison or jail, or to law
enforcement personnel if you are in custody;
* To
comply with workers' compensation laws or similar laws; and
* To tell
or help in telling a family member or another person involved in your
care about your location, general condition or death. The Foundation
may not share health information about you with a family member or
anyone without your written permission of your guardian.
AUTHORIZING USE
AND DISCLOSURE OF MARY LEE FOUNDATION'S CLIENT AND CONSUMER PERSONAL
AND HEALTH INFORMATION.
The law requires
the Foundation to protect the privacy of personal and health
information that identifies you. It also requires the Foundation to
give you this Notice of its legal duties and privacy practice.
~ In most
situations the Foundation may not use or disclose personal and health
information that identifies you without your written permission. This
Privacy Notice explains when the Foundation may use or disclose
personal and health information that identifies you without your
permission. The Foundation will not use or disclose your personal and
health information for any reason except those described in this
notice without your written authorization.
~ For all
other uses and disclosures, the Foundation must obtain your written
permission, which you may withdraw at any time.
~ The
Foundation reserves the right to change its privacy policies at any
time, as allowed by applicable law, rules and regulations. If the
Foundation changes its privacy practices, it must notify you of the
changes. Foundation employees must protect the privacy of identifying
personal and health information as part of their job with the
Foundation. The Foundation does not give employees access to personal
and health information unless they need it for a business reason.
Business reasons for needing access to personal and health information
include planning the care you need, administrative and financial
decisions and any other information covered by the laws of the United
States Government or the State of Texas.
The Foundation
will counsel and orient employees who do not protect the privacy of
personal and health information that identifies you. Disclosure of
confidential information may be cause for termination of employment
and/or possible legal action.
IF YOU HAVE A
COMPLAINT
If you are
concerned that the Foundation may have violated your privacy rights or
you disagree with a decision we made about access to your personal and
health information, you may file a complaint in writing to your
administrator.
You may also
submit a written complaint to:
~ The U.S.
Secretary of Health and Human Services by mail at 200 Independence
Avenue, S.W. Washington, D.C. 20201, or by telephone at (800)368-1019
~ The
Texas Office of the Attorney General by mail at P.O. Box 12548,
Austin, Texas 78711-2548, or by telephone at (800)806-2092
The Foundation
supports your right to protect the privacy of your personal and health
information. We will not retaliate in any way if you choose to file a
complaint with us or with the U.S. Department of Health and Human
Services or the Texas Attorney General's Office.
If you want more
information regarding our privacy practices, have questions regarding
your privacy rights, you may contact us in the following ways:
E-mail
us at:
marylee@maryleefoundation.org
Mail us : Mary Lee
Foundation Privacy Office,
P.O. Box 3174
Austin, Texas 78764
Telephone Us:
(512)443-5777 Business hours are 8:00am to 5:00pm Mon. - Fri.
