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.
The privacy practices described in this notice applies to Comfort Home Care (“Company”). The Company is required by the
federal law known as the Health Insurance Portability and Accountability Act (referred to as the HIPAA Privacy Rule) to
take reasonable steps to ensure the privacy of your personally identifiable health information (Protected Health
Information) and to inform you about:
Except as otherwise provided in this notice or otherwise permitted under the HIPAA Privacy Rule, uses and disclosures of
Protected Health Information will be made only with your written authorization subject to your right to revoke such
authorization. If you provide the Company authorization to use or disclose PHI about you, you may revoke that
permission, in writing, at any time by sending a notice of revocation to the Privacy Officer at the address provided
below. If you revoke your permission, the Company will no longer use or disclose PHI about you for the reasons covered
by your written authorization. The Company will not be able to reverse any disclosures made prior to your revocation.
The Company may contact you to provide appointment reminders or information about treatment
alternatives or other health-related benefits and services that may be of interest to you.
Note: Special rules may apply with respect to the use and disclosure of genetic and HIV testing information. You may
contact the Privacy Officer for more information about these rules.
The HIPAA Privacy Rule permits the Company and its respective Business Associates to use and disclose Protected Health
Information without your consent, authorization, or opportunity to agree or object, to carry out Treatment, Payment and
Health Care Operations.
Treatment is the provision, coordination or management of health care and related services. For example, the Company may
disclose your Protected Health Information to your primary care provider to assist in the coordination of your care.
Payment includes but is not limited to actions to make coverage determinations and payment (including Medicare/insurance
eligibility and coverage, and billing). For example, the Company may submit its charges for payment to your insurance
carrier or Medicare for payment.
Health Care Operations include but are not limited to quality assessment and improvement, reviewing competence or
qualifications of health care professionals, and working with vendors to coordinate your care. For example, the Company
may share your medical records with peer review committees to assess and improve the level of care you are receiving.
Disclosure of your Protected Health Information to family members, other relatives and your close personal friends is
the information is directly relevant to the family or friend’s involvement with your care or payment for that care; and
you have either agreed to the disclosure or have been given an opportunity to object and have not objected.
Use and disclosure of your Protected Health Information is allowed without your consent, authorization or request under
the following circumstances:
Upon your request, the Company is required to give you access to certain Protected Health Information in order to
inspect and copy it. Under certain circumstances, however, the Company may deny your request.
Use and disclosure of your Protected Health Information may be required by the Secretary of the Department of Health and
Human Services to investigate or determine the Company’s compliance with the privacy regulations.
In the event any of the following provisions require you to submit a written request to exercise such right, you must
submit such request to the Privacy Officer, 147 Pelham Street Methuen, MA 01844
You may request that the Company restrict uses and disclosures of your Protected Health Information to carry out
Treatment, Payment or Health Care Operations, or to restrict uses and disclosures to persons identified by you who are
involved in your care or payment for your care. The Company is not required to agree to your request, however, unless
otherwise required by law, the Company must permit a request for a restriction on disclosures to another health plan for
purposes of payment or health care operations where the PHI pertains solely to a health care item or service for which
the health care provider involved has been paid out of pocket in full.
The Company will accommodate reasonable requests to receive communications of Protected Health Information by
alternative means or at alternative locations.
You or your personal representative will be required to complete a form to request restrictions on uses and disclosures
of your Protected Health Information or to request confidential communications of Protected Health Information.
Your clinical record established by our home health agency is the property of our agency, but you have the right to
access your record at any time. You must submit your request in writing. A summary of your health information will be
provided and there may be a fee for copying and mailing and the supplies used to send you the information.
We may deny your request to review or copy you clinical record in certain limited circumstances. If you are denied
access to your record you may request that the denial be reconsidered.
You have the right to request the Company amend your Protected Health Information or a record about you in a Designated
Record Set for as long as the Protected Health Information is maintained in the Designated Record Set.
The Company has 60 days after the request is made to act on the request. A single 30-day extension is allowed. If the
request is denied in whole or part, the Company must provide you with a written denial that explains the basis for the
denial. You or your personal representative may then submit a written statement disagreeing with the denial and have
that statement included with any future disclosures of your Protected Health Information.
You or your personal representative will be required to complete a form to request amendment of the Protected Health
Information in your Designated Record Set. Any request for an amendment must be in writing and provide a reason to
support a requested amendment.
In the event that a breach occurs with regard to your Protected Health Information, you have the right to be notified of
You may exercise your rights through a personal representative. Your personal representative will be required to produce
evidence of his/her authority to act on your behalf before that person will be given access to your Protected Health
Information or allowed to take any action for you.
The Company retains discretion to deny access to your Protected Health Information to a personal representative to
provide protection to those vulnerable people who depend on others to exercise their rights under these rules and who
may be subject to abuse or neglect.
The Company is required by law to maintain the privacy of Protected Health Information and to provide patients with
notice of its legal duties and privacy practices. This notice is effective beginning 09/01/2013 and the Company is
required to comply with the terms of this notice. However, the Company reserves the right to change its privacy
practices and to apply the changes to any Protected Health Information received or maintained by the Company prior to
If a privacy practice is changed, a revised version of this notice will be posted in our agency’s office with the
effective date. In the event the revised notice is mailed to you, it shall be provided by first class mail to your last
known address. Any revised version of this notice will be distributed/published within 60 days of the effective date of
any material change to the uses or disclosures, the individual’s rights, the duties of the Company or other privacy
practices stated in this notice.
When using or disclosing Protected Health Information or when requesting Protected Health Information from another
Covered Entity, the Company will make reasonable efforts not to use, disclose or request more than the minimum amount of
Protected Health Information necessary to accomplish the intended purpose of the use, disclosure or request, taking into
consideration practical and technological limitations. However, the minimum necessary standard will not apply in the
If you believe that your privacy rights have been violated, you may complain to the Company in care of the following
Comfort Home Care
ATTN: Privacy Officer
147 Pelham Street
Methuen, MA 01844
or you may call (978) 685-4700.You may file a complaint with the Secretary of the U.S. Department of Health and Human
Services, Hubert H. Humphrey Building, 200 Independence Avenue S.W., Washington, D.C. 20201.
The Company will not retaliate against you for filing a complaint.
If you have any questions regarding this notice or the subjects addressed in it, you may contact the following officer:
Privacy Officer, 147 Pelham Street Methuen, MA 01844, or you may call (978) 685-4700.
The HIPAA Privacy Rule is set out at 45 Code of Federal Regulations Parts 160 and 164. These regulations and additional
information about the HIPAA Privacy Rule are available at http://www.hhs.gov/ocr/hipaa/.