1114 Bradshaw Drive

Florence, Alabama 35630

 

Phone (256) 246-9972

Fax (256) 246-0324

We accept:

  • Medicare A

  • Most HMO's

  • TriCare

  • Private Pay

On-Call Clinician 24/7
(256) 246-9972

A property of Preston Health Services © 2019

Privacy Policy

As a patient, I also understand I have a responsibility to:
  1. Provide accurate and complete information to the Agency regarding my medical history and current condition, any payers which may cover my care, financial information and to promptly inform the Agency of changes in this information.

  2. Agree to accept caregivers regardless of age, race, color, national origin, religion, sex, disability, being a qualified disabled veteran, being a qualified veteran of the Vietnam era, or any other category protected by law.

  3. Select a physician; remain under medical supervision and to notify the Agency of changes in my physician, medication, treatment, or symptoms (when medical supervision is required).

  4. Maintain an adequate and safe environment for homecare.

  5. Protect my valuables by storing them carefully in an appropriate manner.

  6. Participate in planning, evaluating and revising my care plans to the degree that I am able to do so.

  7. Adhere to the plan of care, which I participated in developing.

  8. Ask the Agency's personnel what to expect regarding pain and pain management, discuss pain relief options with them, work with them to develop a pain management plan, ask for pain relief when pain begins, help the Agency's personnel assess your pain, tell them if your pain is not relieved, and tell them about any worries you have about taking pain medications.

  9. Arrange for supplies, equipment, medications, and other services which the Agency can not provide which are necessary for provision of care and my safety.

  10. Notify the Agency prior to the scheduled visit if l will not be available, do not want service, or wish to discontinue with the Agency.

  11. Treat the Agency's staff with respect, courtesy, and consideration.

  12. Pay for services as agreed in my Home Care Consent.

  13. Accept the consequences for any refusal of treatment or choice of noncompliance, including, changes in reimbursement eligibility.

NOTICE OF INFORMATION & PRIVACY PRACTICE (HIPAA)

This notice describes how medical information about your care by be used and disclosed and how you can get access to this information.

Please review it carefully.

Understanding your health record/information:

Each time you visit a hospital, physician, or each time a healthcare professional visits your home a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnosis, treatment and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a basis for planning your care and treatment and serves as a means of communication among the many health professionals who contribute to your care. Understanding what is in your record and how your health information is used helps you to ensure its accuracy, better understand who, what, when, where, and why others may access your health information, and make more informed decisions when authorizing disclosure to others.

Your health information rights:

Unless otherwise required by law your health record is the physical property of the healthcare practitioner or facility that compiled it, but the information belongs to you. You have the right to:

  • Request in writing a restriction on certain uses and disclosures of your information. The Agency is not required to agree to comply with your requested restriction.

  • Request in writing amendments to your health record, either clinical or demographic.

  • Inspect and request in writing a copy of your health record.

  • Obtain an accounting of disclosures of your health information.

  • Request communications of your health information by alternative means or at alternative locations.

  • Revoke your authorization to use or disclose health information except to the extent that action has already been taken.

Our responsibilities:

 

The Agency is required to maintain the privacy of your health information. In addition, we will:

  • Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you and will abide by the terms of this notice.

  • Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

  • Post any new notices on our website shoalshh.com. We reserve the right to change our practices and to make the new provision effective for all protected health information we maintain. Should our information practices change, we will mail a revised notice to the address you have supplied us.

For more information or to report a problem:

If you believe your privacy rights have been violated, you can file a complaint with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.

We will use your health information for treatment:

Information obtained by the assessment professional will be recorded in your record and used to determine the course of treatment that should work best for you. By way of example, members of your healthcare team will then record the actions they took, their observations and education provided. We will also provide other practitioners involved with your care with copies of various reports that should assist them in treating you as well as enabling your physician to provide orders for your home care.

We will use your health information for payment:

Your information will be utilized to obtain payment for services provided. A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, services provided and supplies used. Outside collection agencies may also be utilized.

We will use your healthcare information for regular healthcare operations:

We may use and disclose health information in order to facilitate operations and as necessary to provide quality care to all patients. Examples include:

  • Physician

  • Quality assessment and improvement activities.

  • Activities designed to improve health or reduce healthcare costs.

  • Protocol development, case management and care coordination.

  • Employee performance and evaluation.

  • Training programs including those in which students, trainees or practitioners in healthcare learn under supervision.

  • Accreditation, certification, licensing or credentialing activities.

  • Review and auditing, including compliance reviews, medical reviews, legal services and compliance programs.

  • Business planning and development.

  • Patient satisfaction surveys.

  • In coordination of emergency and disaster planning and implementation.

For treatment alternatives:

We may use and disclose your health information to tell you about or recommend possible treatment

options or alternatives that may interest you.

Business Associates:

There may be some services provided in our organization through contracts with Business Associates. Examples may include: therapy services, laboratory tests, supply distribution, and audit services. When these services are contracted, we may disclose some or all of your health information to our Business Associate so that they can perform the job we've asked them to do. To protect your health information, however, we require the Business Associate to properly safeguard your information.

Communication with family:

Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friends or any other person you identify, health information relevant to that person's involvement in your care or payment related to your care.

Research:

 

We may disclose information to researchers when a review board that has reviewed the research proposal, and established protocols to ensure the privacy of your health information has approved their research.

Marketing:

 

We may contact you to provide information about your treatment alternatives or other health related benefits and services that may be of interest to you.

Food and Drug Administration (FDA):

 

As required by law, we may disclose to the FDA health information relative to adverse events with respect to food, supplements, products and product defects or post marketing surveillance information to enable product recalls, repairs or replacement.

Workers compensation:

 

We may disclose health information to the extent authorized by state or other laws and to the degree necessary to comply with those laws relating to workers compensation or other similar laws.

Home Health Agency

Outcome and Assessment Information Set (OASIS)

STATEMENT OF PATIENT PRIVACY RIGHTS

 
As a home health patient, you have the privacy rights listed below.
  • You have the right to know why we need to ask you questions.

We are required by law to collect healthcare information to make sure:

  1. you get quality healthcare

  2. payment for Medicare and Medicaid patients is correct

  • You have the right to have your personal healthcare information kept confidential.

    • You may be asked to tell us information about yourself so that we will know which home health service is best for you.

    • We will keep anything we learn about you confidential. This means, only those who are legally authorized to know, or who have a medical need to know, will see your personal health information.

  • You have the right to refuse to answer questions.

    • We may need your help in collecting your health information. If you choose not to answer, we will fill in the information as best we can.

    • You do not have to answer every question to get services.

 

  • You have the right to look at your personal health information.

    • We know how important it is that the information we collect about you is correct. If you think we made a mistake, ask us to correct it.

    • If you are not satisfied with our response, you can ask the Centers for Medicare & Medicaid Services, the federal Medicare and Medicaid agency, to correct your information.

You can ask the Center for Medicare & Medicaid Services to see, review, copy, or correct your personal health information which the Federal agency maintains in its HHA OASIS System of Records. CLICK for CONTACT INFORMATION. If you want a more detailed description of your privacy rights, see the below:  PRIVACY ACT STATEMENT-HEALTHCARE RECORDS.

This is a Medicare & Medicaid Approved Notice.

CMS Centers for Medcare & Medicaid Services
Department of Health & Human Servces, USA
PRIVACY ACT STATEMENT- HEALTHCARE RECORDS

THIS STATEMENT GIVES YOU ADVICE REQUIRED BY LAW  (the Privacy Act of 1974). THIS STATEMENT IS NOT A CONSENT FORM. IT WILL NOT BE USED TO RELEASE OR TO USE YOUR HEALTHCARE INFORMATION.

I. AUTHORITY FOR COLLECTION OF YOUR INFORMATION, INCLUDING YOUR SOCIAL SECURITY NUMBER,AND WHETHER OR NOT YOU ARE REQUIRED TO PROVIDE INFORMATION FOR THIS ASSESSMENT. Sections 1102(a), 1154, 1861(0), 186l(z), 1863, 1864,

1865, 1866, 1871, 189l(b) of the Social Security Act.

Medicare and Medicaid participating home health agencies must do a complete assessment that accurately reflects your current health and includes information that can be used to show your progress toward your health goals. The home health agency must use the [Outcome and Assessment Information Set] (OASIS) assessment, it is protected under the federal Privacy Act of 1974 and the [Home Health Agency Outcome and Assessment Information Set] (HHA OASIS) System of Records. You have the right to see, copy, review,

and request correction of your information in the HHA OASIS System of Records.

 

II. PRINCIPAL PURPOSES FOR WHICH YOUR INFORMATION IS INTENDED TO BE USED

 

The information collected will be entered into the Home Health Agency Outcome and Assessment Information Set (HHA OASIS) System No. 09-70-9002. Your healthcare information in the HHA OASIS System of Records will be used for the following purposes:

  • Support litigation involving the Centers for Medicare & Medicaid Services;

  • Support regulatory, reimbursement, and policy functions performed within the Centers for Medicare & Medicaid

  • Services for or by a contractor or consultant;

  • Study the effectiveness and quality of care provided by those home health agencies;

  • Survey and certification of Medicare and Medicaid home health agencies;

  • Provide for development, validation, and refinement of a Medicare prospective payment system; enable regulators to provide home health agencies with data for their internal quality improvement activities; support research, evaluation, or epidemiological projects related to the prevention of disease or disability, or the restoration or maintenance of health, and for healthcare payment related to projects;

  • Support constituent requests made to a Congressional representative.

 
ROUTINE USES

These "routine uses" specify the circumstances when the Centers for Medicare & Medicaid Services may release your information from the HHA OASIS System of Records without your consent. Each prospective recipient must agree in writing to ensure the continuing confidentiality and security of your information.

Disclosures of the information may be to:

  1. The Federal Department of Justice for litigation involving the Centers of Medicare & Medicaid Services

  2. Contractors or consultants working for the Centers for Medicare & Medicaid Services to assist in the performance of a service related to this system of records and who need to access these records to perform the activity;

  3. An agency of a State government for purposes of determining, evaluating, and/or assessing cost, effectiveness, and/or quality of healthcare services provided in the state; for developing and operating Medicaid reimbursement systems; or for the administration of Federal/State home health agency program within the State;

  4. Another Federal or State agency to contribute to the accuracy of the Centers for Medicare & Medicaid Services' health insurance operations (payment, treatment and coverage) and/or to support State agencies in the evaluations and monitoring of care provided by HHAs;

  5. Quality Improvement Organizations to perform title XI or XVII functions relating to assessing and improving home health agency quality of care;

  6. An individual or organization for a research, evaluation, or epidemiological project related to the prevention of disease or disability, the restoration or maintenance of health, or payment related projects;

  7. A congressional office in response to a constituent injury made at the written request of the constituent about whom the record is maintained.

EFFECT ON YOU, IF YOU DO NOT PROVIDE INFORMATION

The home health agency needs the information contained in the Outcome and Assessment Information Set in order to give you quality care. It is important that the information be correct. Incorrect information could result in payment errors. Incorrect information also could make it hard to be sure that the agency is giving you quality services. If you choose not to provide information, there is no federal requirement for the home health agency to refuse you services.

 

NOTE: This statement may be included in the admission packet for all new home health agency admissions. Home health agencies may request you or your representative to sign this statement to document that this statement was given to you. Your signature is NOT required. If you or your representative sign the statement, the signature merely indicates that you received this statement. You or

your representative must be supplied with a copy of this statement.

 

CONTACT INFORMATION

If you want to ask the Centers for Medicare & Medicaid Services to see, review, copy, or correct your personal information that the Federal agency maintains in its HHA OASIS System of Records: Call 1-800-MEDICARE, toll free, for assistance in contacting the HHA OASIS System Manager. TTY for the hearing and speech impaired: l-877-486-2048.

 

THANK YOU

Thank you for choosing Shoals Home Healthcare as your preferred homecare provider. Our highly skilled team of caring professionals looks forward to working with you, your family, and your physician to provide you with the best home health services possible.

 

You and your family are encouraged to participate in your home healthcare. Your nurse or therapist will be teaching and guiding you and your family to achieve your home healthcare goals.

 

We are dedicated to improving the health and well being of our patients and families, while providing value to our associates, patients, and shareholders.

 

Again, thank you for letting us meet your home health needs.