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Privacy Policy
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Easter Seals Online Network Privacy Policy Last Updated April 3, 2006Notification of Change Welcome to the Easter Seals Online Network, the Web site of Easter Seals, Inc. (Easter Seals headquarters) and participating Easter Seals affiliates across the country. Because Easter Seals values the privacy of constituents visiting the Easter Seals Online Network, users of the Easter Seals Online Network have the right to manage their own personal information. You can contact Easter Seals for more information related to the privacy of the information you provide online:
Notification of Change The Information We Collect Easter Seals has partnered with Convio, Inc. to power the Web content, email and transaction processing capabilities to serve our constituents and fulfill our mission on the Internet. Convio, Inc. is an Internet software and services company that provides online electronic Constituent Relationship Management (eCRM) solutions for nonprofit organizations and higher education institutions. Convio will not disclose your name or other personally identifiable information (such as your e-mail address or phone number) to any party other than Easter Seals. Neither Easter Seals nor Convio store sensitive information such as credit card numbers. When an online transaction is completed through the Easter Seals Online Network, such as a charitable contribution, credit card information is used solely for the purpose of completing that specific transaction and is not retained in the Easter Seals or Convio database. Easter Seals will not sell, share or exchange personal contact information collected from this Web site with other organizations. If a user has a previous relationship with Easter Seals through another channel (i.e., mail, phone), Easter Seals will occasionally rent or exchange those names and addresses with other organizations as a way of providing extra funds to help support services. If you do not want to participate in this program, please let us know. Visitors to the Easter Seals Online Network are not required to share any personally identifiable information. Users who do not wish to share personal information when visiting the Easter Seals Online Network can still access the Network's Web pages and the valuable information provided. Opting Out If you would like to opt-out of receiving email communications please update your user profile. Email unsubscribe requests are processed immediately. To discontinue the receipt of postal mail, please contact Easter Seals. Shortly, Easter Seals will be adding the capability to remove your name from our postal mailing list online. You'll need to register as user of the Easter Seals Online Network. Please note: there is a 8-12 week lapse period due to the fact that a subsequent mailing may already be in production. If you do receive another mailing, please disregard it. Your California Privacy Rights Correct/Update Your Profile Easter Seals reserves the right to maintain information on users who have had their access to the Easter Seals Online Network blocked. Aggregate Information Cookies Your browser is probably set to accept cookies. If you would like to turn this feature off, you will need to change the settings of your Internet browser. Security of Your Information Easter Seals also protects account information by placing it on a secure portion of the Easter Seals Online Network that is only accessible by certain qualified employees of Easter Seals. Unfortunately, no data transmission over the Internet is 100% secure. Easter Seals strives to protect your information, however cannot ensure or warrant the security of such information. Tell-A-Friend, Ecards and Personal Fundraising Pages Links to Other Web Sites In addition, please be aware that Easter Seals is not responsible for the privacy practices of such other Web sites. Easter Seals encourages you to read the privacy statements of each and every Web site that requests personal information from you. Information from Children Transmission of Health-Related Data |
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NOTICE OF PRIVACY PRACTICES CONTACT: Privacy Officer John Martin johnm@esgw.org or (406) 761-3680
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.
Understanding Your Health Record/Information
As a client of Easter Seals-Goodwill records of your medical information related to the services we provide are kept. Depending on the services you receive, this record may contain information about health conditions, medications, examinations, test results, diagnoses, treatment, and a plan for future care or treatment. This information serves as a:
Understanding what is in your record and how your health information is used helps you to:
Your Health Information Rights
Although your health record is the physical property of the provider or healthcare practitioner that compiled it, the information belongs to you. You have the right to:
Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights. You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information. A "designated record set" contains medical and billing records and any other records that your physician and the practice uses for making decisions about you. Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be open to review. In some circumstances, you may have a right to have this decision reviewed. Please contact John Martin ((406) 761-3680) if you have questions about access to your medical record. You have the right to request a restriction of your protected health information. You may request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply. Your physician is not required to agree to a restriction that you may request. If physician believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. If your physician does agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your physician. You may request a restriction by contacting John Martin. However, we are not required to agree with your request. You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to John Martin. You may have the right to amend your protected health information. This means you may request an amendment of protected health information about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact John Martin if you have questions about amending your medical record. You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, for a facility directory, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. You may request a shorter timeframe. The right to receive this information is subject to certain exceptions, restrictions and limitations. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically. Our Responsibilities Easter Seals-Goodwill Northern Rocky Mountain, Inc. is required to:
We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will mail a revised notice to the address you've supplied us.
We will not use or disclose your health information without your authorization, except as described in this notice.
For More Information or to Report a Problem
If you have questions and would like additional information, you may contact Dept Head, or our Privacy Officer, John Martin at 406-761-3680.
If you believe your privacy rights have been violated, you can file a complaint with our Privacy Officer, John Martin and Human Services. There will be no retaliation for filing a complaint.
Examples of Disclosures for Treatment, Payment and Health Operations
We will use your health information for treatment.
For example: Information obtained by employees of Easter Seals-Goodwill or other member of your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your healthcare team. Members of your healthcare team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment.
We will also provide your physician or a subsequent healthcare provider with copies of various reports that should assist him or her in treating you once you're discharged from this hospital.
We will use your health information for payment.
For example: 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, procedures, and supplies used.
We will use your health information for regular health operations.
For example: Members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide.
Business associates: There are some services provided in our organization through contacts with business associates. Examples include physician services in the emergency department and radiology, certain laboratory tests, copy or document destruction services, and pager services, when these services are contracted, we may disclose your health information to our business associate so they can perform the job we asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.
Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition.
Communication with family: Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend 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 their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.
Funeral directors: We may disclose health information to funeral directors consistent with applicable law to carry out their duties.
Organ procurement organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
Marketing: We 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.
Fund raising: We may contact you as part of a fund-raising effort.
Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product 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 and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
Public health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
Correctional institution: Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.
Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.
Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.
This Notice is effective April 14, 2003.
IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT DEPARTMENT HEAD OR PRIVACY OFFICER, JOHN MARTIN AT johnm@esgw.org or 406-761-3680.
RECEIPT OF NOTICE OF PRIVACY PRACTICES
Client Name: _______________________________________ Medical Record Number: ______________________________ Date of Admission: ___________________________________
My signature on this form acknowledges that I have received a copy of Easter Seals-Goodwill Northern Rocky Mountain, Inc., (ES-GW NRM, Inc.) Notice of Privacy Practices. I understand that this document provides an explanation of the ways in which my health information may be used or disclosed by ES-GW NRM, Inc., and of my rights with respect to my health information.
I have been provided with the opportunity to discuss concerns I may have regarding the privacy of my health information.
____________________________ __________________________ Patient's Signature Date
____________________________ __________________________ Signature of Patient's Representative Date if patient is unable to sign
TO BE COMPLETED BY CLINICIAN IF FORM IS NOT SIGNED
1. Was the patient provided with a copy of the Notice of Privacy Practices? _____ Yes ______ No
2. Briefly describe efforts made to obtain the patients acknowledgment of receipt of the Notice and explain why the patient or representative was not able or willing to sign this form:
____________________________ ___________________________
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