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Notice of Privacy Practices (HIPAA)

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TOTHIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This Notice is effective April 14, 2003.

USE AND DISCLOSURE OF YOUR HEALTH INFORMATION
        Midland Care Connection, Inc. may use and disclose your health information for the purpose of providing you treatment, obtaining payment for your care, conducting health care operations, or as permitted by law. Your health information may be used or disclosed only after Midland has obtained your written authorization, or as authorized by state or federal law. Midland has established a policy to guard against unnecessary disclosure of your health information.

THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED:
        To Provide Treatment. Midland may use your health information to coordinate care and treatment within Midland and with others involved in your care and treatment activities, such as: your attending physician, members of Midland’s Interdisciplinary Team consisting of physicians, social workers, chaplains, nurses, home health aides, volunteers, or other health care professionals who have agreed to assist Midland in coordinating your care. One example is physicians involved in your care will need
information about you to prescribe appropriate medications. Midland may disclose your health care information to individuals outside of Midland involved in your care and treatment activities including family members, designated clergy, pharmacists, suppliers of medical equipment, or other health care professionals that Midland uses to coordinate your care.
       To Obtain Payment. Midland may disclose your health information to collect payment from third parties for the care you receive from Midland. For example, Midland may be required by your health insurer to provide invoices or information regarding your health care status so that the insurer will reimburse you or Midland. Midland may need to obtain prior approval from your insurer and may need to explain to the insurer your need for care and the services that will be provided to you. Midland may also disclose your health information to a health care provider outside of Midland for that health care provider’s payment activities.
       To Conduct Health Care Operations. Midland may use and disclose your health care information for its own operations in order to facilitate the function of Midland and as necessary to provide quality care to all of Midland patients. Health care operations include activities such as:
         - Quality assessment and improvement activities.
         - Activities designed to improve health or reduce health care costs.
         - Protocol development, case management and care coordination.
         - Contacting health care providers and patients with information about treatment
           alternatives and other related functions that do not include treatment.
         - Professional review and performance evaluation.
         - Training programs including those in which students, trainees, or practitioners in
            health care learn under supervision.
         - Training of non-health care professionals.
         - Accreditation, certification, licensing, or credentialing activities.
         - Review and auditing, including compliance reviews, medical reviews, legal
           services, and compliance programs.
         - Business planning and development, including cost management, planning-
           related analyses, and formulary development.
         - Business management and general administrative activities of Midland.
         - Fundraising for the benefit of Midland and certain marketing activities.

Midland may disclose your health information to another health care provider for the health care operations of that health care provider if Midland and that health care provider has or had a relationship with you. The information disclosed will relate to that relationship and is for very limited purposes as permitted by law.

Midland may use your health information to evaluate staff performance, combine your health information with other patients in evaluating how to more effectively serve all patients, disclose your health information to Midland staff and contracted personnel for training purposes, use your health information to contact you as a reminder regarding a visit to you, or contact you or your family as part of general fundraising and community information mailings. Please inform us if you do not want to be contacted.

      For Midland Directory Purposes and to Family and Friends. Midland may disclose
certain information to people inquiring about you by name, including your name, your general health status, your location in our facility or your location while you are under our care, or your religious affiliation. Your religious affiliation will only be provided to members of clergy and clergy do not have to ask for you by name. This information will be maintained in the Midland directory. Please inform us if you do not want your information to be given to others.
      For Fundraising Activities. Midland may use information about you including your
name, address, phone number, and the dates you received care at Midland in order to contact you or your family to raise money for Midland. Midland may also release this information to a related foundation. If you do not want Midland to contact you or your family, notify the contact person identified at the end of this document and indicate that you do not wish to be contacted.

USE AND DISCLOSURE OF YOUR PROTECTED HEALTH INFORMATION WITHOUT YOUR PERMISSION: Federal privacy rules allow Midland to use or disclose your health information without your permission or authorization for the following reasons:
       When Legally Required. Midland will disclose your health information when it is required to do so by any Federal, State, or local law.
       When There Are Risks to Public Health. Midland may disclose your health information for public activities and purposes in order to:
         - Prevent, control, or report disease, injury, or disability, vital events such as birth
           or death, and the conduct of public health surveillance, investigations, and
           interventions.
         - To report adverse events, product defects, to track products or enable product
           recalls, repairs, and replacements, and to conduct post-marketing surveillance
           and compliance with requirements of the Food and Drug Administration.
         - To notify a person who has been exposed to a communicable disease, or who
           may be at risk of contracting or spreading a disease.
         - To an employer about an individual who is a member of the workforce as legally
           required.
      To Report Abuse, Neglect, or Domestic Violence. Midland is allowed to notify
government authorities if Midland believes a patient is the victim of abuse, neglect, or domestic violence. Midland will make this disclosure only when specifically required or authorized by law, or when the patient agrees to the disclosure.
      To Conduct Health Oversight Activities. Midland may disclose your health
information to a health oversight agency for activities including audits, civil, administrative, or criminal investigations, inspections, licensure, or disciplinary action. Midland, however, may not disclose your health information if you are the subject of an investigation and your health information is not directly related to your receipt of health care or public benefits.
      In Connection With Judicial and Administrative Proceedings. Midland may disclose your health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order, or in response to a subpoena, discovery request, or other lawful process, but only when Midland makes reasonable efforts to either notify you about the request or to obtain an order protecting your health information or as permitted by law.
      For Law Enforcement Purposes. Midland may disclose your health information to an official of the law for law enforcement purposes as follows:
         - As required by law for reporting certain types of wounds or other physical injuries
           pursuant to the court order, warrant, subpoena, summons, or similar process.
         - For the purpose of identifying or locating a suspect, fugitive, material witness, or
           missing person.
         - Under certain limited circumstances, when you are the victim of a crime.
         - If Midland has a suspicion that your death was the result of criminal conduct,
           including criminal conduct at Midland.
         - In an emergency to report a crime.
     To Coroners and Medical Examiners. Midland may disclose your health information to
coroners and medical examiners for purposes of determining your cause of death or for other duties as authorized by law.
     To Funeral Directors. Midland may disclose your health information to funeral
directors consistent with applicable law and, if necessary, to carry out their duties with respect to your funeral arrangements. Midland may disclose your health information prior to and in reasonable anticipation of your death.
     For Organ, Eye, or Tissue Donation. Midland may use or disclose your health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs, eyes, or tissue for the purpose of facilitating the donation and transplantation.
     For Research Purposes. Midland may, under very select circumstances, use your health information for research. Before Midland discloses any of your health information for such research purposes, the project will be subject to an extensive approval process. Midland will ask your permission if any researcher will be granted access to your individually identifiable health information.
     In the Event of a Serious Threat to Health or Safety. Midland may, consistent with applicable law and ethical standards of conduct, disclose your health information if Midland, in good faith, believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety, or to the health and safety of the public.
     For Specified Government Functions. In certain circumstances, Federal regulations authorize Midland to use or disclose your health information to facilitate specified government functions relating to military and veterans, national security and intelligence activities, protective services for the President and others, medical suitability determinations, and inmates and law enforcement custody.
     For Worker's Compensation. Midland may release your health information for worker's compensation or similar programs.

AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION
Other than what is stated above, Midland will not disclose your health information without your written authorization. If you, or your representative, authorize Midland to use or disclose your health information, you may revoke that authorization in writing at any time.

YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
You have the following rights regarding your health information that Midland maintains:
         - Right to Request Restrictions. You may request restrictions on certain uses and
           disclosures of your health information.  You have the right to request a limit on
           disclosures of your health information to those who are involved in your care or
           the payment of your care. However, Midland is not required to agree to your
           request. If you do not want certain information shared with others, you must
           make a request for a restriction. If you wish to make a request for restrictions,
           please contact the person listed at the end of this document.
         - Right to Receive Confidential Communications by Alternative Means or
           Location. You have the right to request that Midland communicate with you
           confidentially. For example, you may ask that Midland only conduct
           communications pertaining to your health information with you privately, with
           no other family members present. If you wish to receive confidential 
           communications, notify the contact person listed at the end of this document.
           Midland will not request that you provide any reasons for your request, and will
           attempt to honor your reasonable requests for confidential communications.
         - Right to Inspect and Copy Your Health Information. You have the right to 
           inspect and obtain a copy of your health information, including billing records,
           maintained in your designated record set. A request to inspect and copy records
           containing your health information may be made to the contact person listed at
           the end of this document. If you request a copy of your health information,
           Midland may charge a reasonable fee for copying and assembling your health
           records. In certain circumstances, we may deny your request to inspect and
           obtain a copy of your records.
         - Right to Amend Health Care Information. If you, or your representative, believe
           that your health information records are incorrect or incomplete, you may request
           that Midland amend the records. That request may be made as long as the
           information is maintained by Midland. A request for an amendment of records
           must be made in writing to the contact person listed at the end of this document.
           Midland may deny the request if it is not in writing or does not include a reason
           for the amendment. The request may also be denied if your health information
           records were not created by Midland, if the records you are requesting are not
           part of Midland’s records, if the health information you wish to amend is not part
           of the health information you or your representative are permitted to inspect and
           copy, or if, in the opinion of Midland, the records containing your health
           information are accurate and complete.
         - Right to An Accounting. You, or your representative, have the right to request
           an accounting of disclosures of your health information made by Midland for any
           reason other than for treatment, payment, or health operations. The request for
           an accounting must be made in writing to the contact person listed at the end
           of this document. The request should specify the time period for the accounting
           starting on April 14, 2003. Accounting requests may not be made for periods of
           time in excess of six years. Midland will provide the first accounting you request
           during any 12-month period without charge. Subsequent accounting requests
           may be subject to a reasonable cost-based fee. This accounting will contain
           only the information as required by law.
         - Right to a Paper Copy of This Notice. You, or your representative, have a right
           to a separate paper copy of this Notice at any time, even if you or your
           representative has received this Notice previously. To obtain a separate paper
           copy, please contact our contact person listed at the end of this document.
           You or a representative may also obtain a copy of the current version of the
           Midland Notice of Privacy Practices at our website, www.midlandcare.org.

DUTIES OF MIDLAND
Midland is required by law to maintain the privacy of your health information and to provide to you and your representative this Notice of its duties and privacy practices. Midland is required to abide by terms of this Notice, as may be amended from time to time. Midland reserves the right to change the terms of its Notice and to make the new Notice provisions effective for all health information that it maintains. If Midland changes its Notice, Midland will provide a copy of the revised Notice to you or your appointed representative if you request a copy. A copy of our current notice is also posted in each of our operating facilities. You, or your personal representative, have the right to express complaints to Midland and to the Secretary of Health and Human Services if you, or your representative, believe that your privacy rights have been violated. Any complaints to Midland should be made in writing to our contact person identified at the end of this document. Midland encourages you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.

CONTACT PERSON
Midland's contact person for all issues regarding patient privacy and your rights under the Federal Privacy Standards is the Privacy Official (or designee) at (785) 232-2044.