OUR PLEDGE REGARDING MEDICAL INFORMATION

We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at Bona Vista Programs. 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 of your care generated or maintained by Bona Vista Programs.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU

The following categories describe different ways that we use and disclose medical 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, psychologists, nurses, social workers, therapists, technicians, medical students, or other Bona Vista Programs personnel who are involved in taking care of you. Different departments of the Bona Vista Programs also may share medical information about you in order to coordinate the different things you need. We also may disclose medical information about you to people outside Bona Vista Programs, such as other health care providers involved in providing medical treatment for you and to people who may be involved in your medical care, such as family members, clergy or others we use to provide services that are part of your care.
• For Payment: We may use and disclose medical information about you so that the treatment and services you receive at Bona Vista Programs, or other health care providers from whom you receive treatment, may be billed to, and payment may be collected from, you, an insurance company or a third party. For example, we may need to give your health plan information about treatment you received at Bona Vista Programs so your health plan will pay us or reimburse you for your treatment. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
• For Health Care Operations: We may use and disclose medical information about you for Bona Vista Programs operations or to another health care provider or health plan, if you have a relationship with that health care provider or health plan. These uses and disclosures are necessary to run Bona Vista Programs and make sure that all of our Clients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical information about many Clients to decide what additional services Bona Vista Programs should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, social workers, therapists, nurses, psychologists, technicians, medical students, and other personnel for review and learning purposes. We may also combine the medical information we have with medical information from other Health Care Rehabilitation Facilities to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific Clients are.
• Appointment Reminders: We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at Bona Vista Programs.
• Treatment Alternatives: We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
• Health-Related Benefits and Services: We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
• Individuals Involved in Your Care or Payment for Your Care: We may release certain limited information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family or friends your condition. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
• Research: Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all Clients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with Clients’ need for privacy of their medical information. Before we use or disclose medical information for research, the project will have been approved through this research approval process, but we may, however, disclose medical information about you to people preparing to conduct a research project, for example, to help them look for Clients with specific medical needs, so long as the medical information they review does not leave Bona Vista Programs. We may ask for your specific permission if the researcher will have access to your name, address or other personally identifiable health information.
• Fundraising Activities: We may use medical information about you to contact you in an effort to raise money for Bona Vista Programs and its operations. We may disclose medical information to a foundation related to Bona Vista Programs so that the foundation may contact you in raising money for Bona Vista Programs. We would only release contact information, such as your name, address and phone number and the dates you received treatment or services at Bona Vista Programs. If you do not want Bona Vista Programs to contact you for fundraising efforts, please submit your request in writing to the Agency Privacy Officer.
• Marketing: We may ask you to sign an authorization to use or disclose medical information as part of a marketing effort. The authorization will state if Bona Vista Programs received any direct or indirect compensation for the marketing. Your authorization is required by law except for face-to-face communications made by the Bona Vista staff to you or for communications where Bona Vista Programs may provide you with promotional gifts of nominal value. Marketing is generally defined as a communication about a product or service that encourages its recipients to purchase or use it. However this definition exempts communications made: to describe a health-related product or service that is provided by Bona Vista Programs; for the treatment of the individual; or for case management or care coordination of the individual, or to direct or recommend alternative treatments, therapies, providers, or settings of care to the individual.
• Business Associates: We may share your medical information with business associates that assist Bona Vista Programs. Business associates include people or companies outside of Bona Vista who provide services to our programs. For example, health information may be disclosed by Bona Vista Programs to a bill processing company to obtain payment for services rendered. Bona Vista’s business associates must comply with the HIPAA laws, and we have agreements with our business associates to protect the privacy and security of your health information.
• Sale of Medical Information: Bona Vista Programs may not sell your medical information unless authorized by you. An authorization is not needed if the purpose of the exchange is for treatment; public health activities; research purposes where the price charged reflects the cost of preparation and transmittal of the information; health care operations related to the sale, merger, or consolidation of a covered entity; performance of services by a business associate on behalf of a covered entity; or providing the individual with a copy of the medical information maintained about him/her.
• Psychotherapy Notes: Psychotherapy notes are notes by a mental health professional that document or analyze the contents of a conversation during a private counseling session or during a group, joint, or family counseling session. Unless otherwise expressly permitted by the HIPAA privacy Rule, psychotherapy notes cannot be disclosed without your written authorization.

AS REQUIRED BY LAW

We will disclose medical information about you when required to do so by Federal, state or local law.

• To Avert a Serious Threat to Health or Safety: We will use and disclose medical information about you when we have a “Duty to Report” under state or federal law, because we believe that it is necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
• Public Health Risks: We will disclose medical information about you for public health reporting required by federal or state law. These activities generally include the following: to prevent or control disease, injury or disability; notification of exposure to a disease; to report births and deaths; to report child abuse or neglect; to report reactions to medications or problems with products or product recalls.
• Health Oversight Activities: We will disclose medical information as required by law to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
• Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we will disclose medical information about you when properly ordered to do so by a court.
• Law Enforcement: We will release medical information if asked to do so by a law enforcement official, and if permitted by law. This can be in response to a court order; to identify or locate a suspect, fugitive, material witness, or missing person; about criminal conduct at a Bona Vista Programs facility; in emergency circumstances to report a crime; or if required by state or federal law.

SPECIAL SITUATIONS

• Organ and Tissue Donation: If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
• Military and Veterans: If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
• Coroners, Medical Examiners and Funeral Directors: We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about Clients of Bona Vista Programs to funeral directors as necessary to carry out their duties.
• National Security and Intelligence Activities: We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
• Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

OTHER USES AND DISCLOSURES OF MEDICAL INFORMATION

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

OTHER USES AND DISCLOSURES OF MEDICAL INFORMATION

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU

You have the following rights regarding medical 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, unless required by law.To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the Agency Privacy Officer. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies 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, under some circumstances you may request that the denial be reviewed. Another licensed health care professional chosen by Bona Vista Programs 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 feel 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 Bona Vista Programs.To request an amendment, your request must be made in writing and submitted to the Agency Privacy Officer. In addition, you must provide a reason that supports your request.

  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, unless the person or entity that created the information is no longer available to make the amendment; is not part of the information which you would be permitted to inspect and copy; or is accurate and complete.

• 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 for purposes other than treatment, payment, healthcare operations, and certain other activities.To request this list or accounting of disclosures, you must submit your request in writing to the Agency Privacy Officer. Your request must state a time period which may not be longer than six years from the current date. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
• Right to Request Restrictions: You have the right to request a restriction or limitation on the 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, like a family member or friend. For example, you could ask that we not use or disclose information about a specific treatment session you had.To request restrictions, you must make your request in writing to the Agency Privacy Officer. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.

  In most cases we are not required to agree to your request, but if we do, we will comply with your request unless the information is needed for emergency treatment, for public health activities, or disclosures are required by law. We must comply with a request to restrict the disclosure of medical information to a health plan for the purposes of carrying out payment or health care operations if the medical information pertains solely to a heath care item or service for which you, or someone on your behalf, has paid for in full out of pocket.

• Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.To request confidential communications, you must make your request in writing to the Agency Privacy Officer. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
• Right to Notification if a Breach of Your Medical Information Occurs: You have the right to be notified in the event of a breach of your medical information. If a breach occurs, meaning that the information is unsecured, we will notify you promptly with a brief description of what happened and a description of the medical information that was involved. We will recommend steps you can take to protect yourself from harm and what steps we are taking in response to the breach. Contact procedures will also be provided so you can obtain further information.
• Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. To obtain a paper copy of this notice, you may print this page or send a written request to the Agency Privacy Officer.

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 each of our facilities. The effective date will be noted on the first page, in the top right-hand corner. In addition, each time you register at or are admitted to Bona Vista Programs for treatment or health care services as an inpatient or outpatient, we will offer you a copy of the current notice in effect.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with Bona Vista Programs or with the Secretary of the Department of Health and Human Services. To file a complaint with Bona Vista Programs, contact the Agency Privacy Officer. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

If you have any questions about this notice, please contact the Agency Privacy Officer.
Agency Privacy Officer Contact Information:

Bona Vista Programs, Inc.
1220 E Laguna Street
P.O. Box 2496
Kokomo, IN 46904-2496
(765) 457-8273
e-mail: privacyofficer@bonavista.org
This notice was originally effective on April 14, 2003; updated on September 5, 2013