Notice of Privacy Practices

BAUER FAMILY RESOURCES, INC.
NOTICE OF PRIVACY PRACTICES

For a Printable PDF of this document, click here.

This notice describes how medical information about you may be used and disclosed, and how you can get access to this information.  Please review it carefully.  If you have any questions about this Notice, please contact:  Compliance Specialist, Bauer Family Resources Inc., at 765-742-4848.

This notice will tell you how we may use and disclose protected health information about you.  Protected health information means any health information about you that identifies you or for which there is a reasonable basis to believe the information can be used to identify you.  In this notice, we call all of that protected health information, “health information.”  

Bauer is required by law to protect the privacy of your health information and to provide you with a notice of privacy practices.  
This notice also will tell you about your rights and our duties with respect to health information about you.  In addition, it will tell you how to complain to us if you believe we have violated your privacy rights.

HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
Mental health information, including psychological or psychiatric treatment records, and information relating to communicable diseases, including HIV records, are subject to special protections under Indiana law.  We will generally only release such records or information with your written authorization or with an appropriate court order.  Alcohol and drug abuse treatment information is also subject to special protections under federal law.  We will usually need to get your written authorization or an appropriate court order before we release this information.  Except where there are special protections under Indiana law or other federal laws, we may use and disclose your health information without your authorization for the following purposes:
    •     For Treatment.
We may use and disclose your health information to provide, coordinate or manage your mental health care and related services by both us and other health care providers.  We may disclose health information about you to doctors, nurses, hospitals and other mental health facilities which become involved in your care.  We may consult with other health care providers concerning you and as part of the consultation share your health information with them.  Similarly, we may refer you to another health care provider and as part of the referral share medical information about you with that provider.  For example, we may conclude that you need to receive services from a physician with a specialty in psychiatry.  When we refer you to that physician, we also will contact that physician's office and provide health information about you to them so they have information they need to provide services for you.
    •     To obtain payment for health care services.
We may use and disclose your health information in order to bill and collect payment for the treatment and services we provide to you.  For example, we may provide limited portions of your health information to your health insurance plan to get paid for the health care services we provide to you, unless you have paid for the health care service in full, and specifically request us not to disclose information related to that service.  We may bill you, your insurance company, or a third party payor, such as the Department of Child Services, the courts, probation department or local, state or federal grant sources.  We also may need to provide your insurance company or a government program, such as Medicare or Medicaid, with information about your health condition and the health care you need to receive to determine if you are covered by that insurance or program. We may also provide your health information to our business associates who assist us with billing, such as billing companies, claims processing companies, and others that process our health care claims.  We will only disclose the minimum amount of information needed to obtain payment.  
    •     For Health Care Operations.
We may use and disclose your health information to improve and conduct health care operations.  These operations are necessary for us to operate Bauer Family Resources and to maintain quality health care for our clients.  For example, we may use your health information to evaluate the services we provide and the performance of our employees in caring for you.  We may disclose your health information to train our staff, volunteers and students working at Bauer Family Resources.  We also may use the information to study ways to more efficiently manage our organization.  We may also provide your health information to our auditors, attorneys, consultants, and others in order to make sure we are complying with the laws that affect us.  We may use a sign-in sheet at registration or other appropriate areas, and we may call you by name in waiting and service areas.
•    When disclosure is required by federal, state, or local law, judicial or administrative proceedings, or law enforcement.
For example, we make disclosures when a law requires that we report information to government agencies and law enforcement personnel about victims of abuse, neglect, or domestic violence; when dealing with gunshot and other wounds; or when ordered in a judicial or administrative proceeding.
 •    Public health activities.
For example, we report required information about various diseases to government officials in charge of collecting that information, and we may provide coroners with necessary information relating to an individual’s death.

 •     Health oversight activities.
For example, we will provide information to assist the government when it conducts an investigation or inspection of a health care provider or organization.

 •     Research purposes.
In certain limited circumstances, we may provide health information in order to conduct medical research. Use of this information for research is subject to either a special approval process or removal of information which may directly identify you. In most instances, we will require your written authorization prior to using or disclosing health information for research purposes.

•    Avoiding a serious threat of harm.
In order to avoid a serious threat to the health or safety of a person or the public, we may provide health information to law enforcement personnel or persons able to prevent or lessen such harm.

•    Certain government functions.
We may disclose health information of military personnel and veterans in certain situations, as well as for national security purposes or when required to assist with governmental intelligence operations.

 •    Workers’ compensation.
We disclose health information to comply with workers’ compensation laws.

 •      Appointment reminders and health-related benefits or services.
We may use health information to provide appointment reminders, or give you information about treatment alternatives, other healthcare services or benefits we offer.

 •    Business Associates.
We will share your health information with business associates that assist us. Business associates include people or companies outside of Bauer who provide services to us. For example, health information may be disclosed by Bauer to a bill processing company to obtain payment for services rendered. Bauer’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.

 •    Disclosures to family, friends, or others.
In very limited cases, we may provide health information to family members, other relatives, close friends, or other persons identified by you, who are directly involved in your care or the payment for your health care, unless you tell us not to. We also may use or disclose your health information to notify, or assist in notifying, those persons of your location or general condition. We may also contact a family member if you have a serious injury or in other emergency circumstances. We may discuss your health information in the presence of a family member or friend if you are also present and indicate that it is okay to do so.  If there is a family member, other relative, or close personal friend that you do not want us to disclose medical information about you to, please notify Privacy Officer, Bauer Family Resources, P.O. Box 1186, Lafayette, IN 47902-1186, or tell our staff member who is providing care to you.

•    All other uses and disclosures require your prior written authorization.
In any other situation not described above, we will ask for your written authorization before using or disclosing any of your health information. If you do sign an authorization to disclose your health information, you can later revoke that authorization in writing. You may revoke such an authorization at any time by notifying Privacy Officer, Bauer Family Resources, P.O. Box 1186, Lafayette, IN  47902-1186 in writing of your desire to revoke it. This will stop any future uses and disclosures to the extent that we have not taken any action relying on the authorization.
    •     How We Will Contact You.
Unless you tell us otherwise in writing, we may contact you by either telephone or by mail at either your home or your workplace.  At either location, we may leave messages for you on the answering machine or voice mail. If you want to request that we communicate to you in a certain way or at a certain location, see "Right to Receive Confidential Communications" on page 4 of this Notice

RIGHTS YOU HAVE REGARDING YOUR HEALTH INFORMATION

The Right to Request Limits on Uses and Disclosures of Your Health Information.
You have the right to ask that Bauer limit the use and disclosure of your health information. If you have paid Bauer in full for a particular health care service or item and specifically request that we not disclose information about this health care item or service to your health plan for payment or healthcare operations purposes, we will agree to this request. We generally cannot restrict disclosure of information needed for health care treatment purposes.  For other restrictions, we will consider your request but we are not required to accept it. If we do, we will put any limits in writing and abide by them except in emergency situations where the information is needed. You may not limit the uses and disclosures that we are legally required to make. Even if we agree to a restriction, either you or we can later terminate the restriction.
You may request a restriction at any time. We encourage you to make this request in writing to the Privacy Officer, Bauer Family Resources, P.O. Box 1186, Lafayette, IN  47902-1186. In your request, please provide:  (a) what information you want to limit; (b) whether you want to limit use or disclosure or both; and, (c) to whom you want the limits to apply (for example, disclosures to your spouse).  

Right to Receive Confidential Communications.
You have the right to request that we communicate medical information about you to you in a certain way or at a certain location.  For example, you can ask that we only contact you by mail or at work.  We will not require you to tell us why you are asking for the confidential communication.
If you want to request confidential communication, you must do so in writing to Privacy Officer, Bauer Family Resources, P.O. Box 1186, Lafayette, IN  47902-1186.  Your request must state how or where you can be contacted.
We will accommodate your request.  However, we may, when appropriate, require information from you concerning how payment will be handled.  We also may require an alternate address or other method to contact you.

The Right to See and Get Copies of Your Health Information.
With a few very limited exceptions, such as psychotherapy notes, you have the right to inspect and obtain a copy of health information about you.

To inspect or copy health information about you, you must submit your request in writing to Clinical Records Manager, Bauer Family Resources, P.O. Box 1186, Lafayette, IN  47902-1186. Your request should state specifically what health information you want to inspect or copy. Instead of providing the health information you requested, we may provide you with a summary or explanation of the health information. We will only do this if you agree to receive information in that form and if you agree to pay the cost in advance.  If Bauer maintains an electronic health record, you may request the copy in an electronic format or to be transmitted electronically to an entity or person designated by you. If we do not have your health information but we know who does, we will tell you how to get it.

If you request a copy of the information, we may charge a reasonable fee for the costs of copying and, if you ask that it be mailed to you, the cost of mailing.
In certain situations, we may deny your request.  If we deny your request, we will inform you in writing of the basis for the denial, and explain how you may have our denial reviewed.  

The Right to Get a List of Certain Disclosures We Have Made.
You have the right to request a list of instances in which we have disclosed your health information. The list will not include uses or disclosures made for treatment, payment, and health care operations, or information given to your family or friends with your permission or in your presence without objection. It will also not include disclosures made directly to you or when you have given us a written authorization for the release of health information. The list will also not include information released for national security purposes or given to correctional institutions. Under certain circumstances your right to an accounting of disclosures to a law enforcement official or a health oversight agency may be suspended.  Should you request an accounting during the period of time your right is suspended, the accounting would not include the disclosure or disclosures to a law enforcement official or to a health oversight agency.

To request an accounting of disclosures, you must submit your request in writing to Privacy Officer, Bauer Family Resources, P.O. Box 1186, Lafayette, IN  47902-1186.  Your request must state a time period for the disclosures.  The list we will give you will include disclosures made in the last six years unless you request a shorter time.  It will not include dates before April 14, 2003.  We will provide the list to you upon request once each year at no charge.

The Right to Amend or Update Your Health Information.
If you believe that there is a mistake in your health information or that a piece of important information is missing, you have the right to request that we amend the existing information. To request an amendment, you must submit your request in writing to Privacy Officer, Bauer Family Resources, P.O. Box 1186, Lafayette, IN  47902-1186. Your request must state the amendment desired and provide a reason in support of that amendment.

We may deny your request in writing if the health information is: 1) correct and complete; 2) not created by us; 3) not allowed to be disclosed; or 4) not part of our records. Our written denial will state the reasons for the denial and explain your right to file a written statement of disagreement with the denial. If you do not file a statement of disagreement, you have the right to ask that your request and our denial be attached to all future disclosures of your health information. If we approve your request, we will make the change to your health information, tell you that we have done it, and tell others that need to know about the change to your health information.

The Right to Receive Breach Notification.
If Bauer or any of its Business Associates experiences a breach of your health information (as defined by HIPAA laws) that compromises the security or privacy of your health information, you will be notified of the breach and about any steps you should take to protect yourself from potential harm resulting from the breach.

The Right to Get Copy of This Notice.
You have the right to get a copy of this Notice by e-mail. Even if you have agreed to receive this Notice via e-mail, you also have the right to request a paper copy of this Notice. To obtain a paper copy of this notice, contact Privacy Officer, Bauer Family Resources, P.O. Box 1186, Lafayette, IN  47902-1186. You may also obtain a copy of this Notice at our website, www.bauerfamilyresources.org.  

CHANGES TO THIS NOTICE
Bauer is required to abide by the terms of this Notice of Privacy Practices. However, we may change our notice at any time. The new notice will be effective for all protected health information maintained by Bauer. A copy of our current Notice of Privacy Practices will be posted in the lobby of Bauer Family Resources, and may be requested from the Privacy Officer, Bauer Family Resources, P.O. Box 1186, Lafayette, IN  47902-1186.

WHAT TO DO IF YOU BELIEVE YOUR PRIVACY RIGHTS HAVE BEEN VIOLATED
If you think that we may have violated your privacy rights, or you disagree with a decision we made about your health information, you may file a complaint with our Privacy Officer at the address listed below. You also may send a written complaint to the Secretary of the Department of Health and Human Services. To file a complaint with us, contact Privacy Officer, P.O. Box 1186, Lafayette, IN  47902-1186.  All complaints should be submitted in writing. Further information about how to file a complaint is available from the Privacy Officer.  We will not punish you or retaliate against you if you file a complaint about our privacy practices.

EFFECTIVE DATE OF THIS NOTICE

This notice applies to uses and disclosures of your protected health information beginning on October 11, 2011.

592916.1

HIPAA Complaint Form

Business Associate Form

Business Associate Form Addendum

Client Problem Resolition Procedure