Notice of Privacy Practices

LifeLine Home Health Care, Inc. and LifeLine Hospice, Inc.
1701 W Iowa
Chickasha, Ok 73018


LifeLine may use your health information for purposes of providing you treatment, obtaining payment and conducting health care operations.  Your health information may be used or disclosed for these purposes while you are our patient.  We have established policies to guard against unnecessary disclosure of your health information.
LifeLine is mandated by law to maintain the privacy of your health information, and to provide you (or your representative this Notice informing you of our duties and privacy practices. We are required to abide by the terms of this Notice, which is subject to occasional amendment.  We reserve the right to change the terms of our Notice and to make any changes effective for all health information in our possession.  If LifeLine changes this Notice, a copy of the revised Notice will be provided to you or your representative.  You or your representative has the right to express complaints to this office and to the Secretary of Health and Human Services if you or your representative believes that your privacy rights have been violated.  Any complaints regarding privacy violations should be made in writing to LifeLine’s privacy official.  We encourage you to express and 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
Our contact person for all issues regarding privacy and your rights under the Federal privacy standards is the Privacy Official.  The Privacy Official may be contacted by mail at PO Box 1348, Chickasha Ok 73023 or in person at 1701 W Iowa Avenue, Chickasha, Ok.  FOR QUESTIONS REGARDING THIS NOTICE, OR TO REGISTER A COMPLAINT, PLEASE CONTACT THE PRIVACY OFFICIAL OR THE ADMINISTRATOR.

EFFECTIVE DATE:  September 23, 2013

Uses and Disclosures: We will use and disclose elements of your protected health information (PHI) in the following ways:
Without your signed authorization

  • Treatment [We may use your health information to coordinate care within LifeLine, and with others involved in your care, such as specialists and other health care professionals.  For example, doctors involved in your care will need information regarding your symptoms in order to prescribe appropriate medications and treatments.  We may also disclose your health care information to individuals outside of LifeLine involved in your care, including family members and others you have designated, pharmacists, suppliers of medical equipment and supplies, health care professionals and others involved in the coordination of your care.].
  • Payment [Upon receiving care, LifeLine may include health information about you in invoices sent for the purpose of collecting payment from your health plan.  For example we may be required by your insurance company to provide information about your care and status so that reimbursement may be made.  We also may need to obtain prior approval from your insurance company or may need to explain to them your need for the services we will be providing.].
  • Health care operations [LifeLine may use and disclose health care information for our own operations in order to assist in everyday functions, and as necessary to provide quality care to all of our patients.  We have defined our health care operations include :
  • Health assessments and quality improvement activities
  • Activities designed to improve wellness and improve quality of  life
  • Care coordination between patient and other health care professionals
  • Contact of health care professionals and patients about treatments, alternatives, and other related areas
  • Professional review and performance evaluation
  • Training programs including those which student interns or practitioners in health care learn under our supervision and guidance
  • Training of non-health care professionals
  • Accreditation, certification, licensing or credentialing activities
  • Review and auditing, including compliance reviews, medical reviews, legal services, financial services and compliance programs
  • Business planning and development including cost management and planning related analyses and formulary development
  • Business management and general administrative activities of the company.

For example, LifeLine may use your health information in combination with our other patients in evaluating how to more effectively serve our entire network of patients.  We may disclose your health information to our professional staff and contracted personnel for training purposes, or to evaluate staff performance.  We may contact you or your family regarding an upcoming appointment, or as a reminder of our services available to you.  (Unless you tell us you do not want to be contacted)

  • When release is required or permitted by law, including in judicial settings in response to a court order and to health oversight regulatory agencies and law enforcement.
  • To outside companies that assist in operating our health services, including but not limited to, accounting, auditing and other services provided by these “business associates.”
  • In emergency situations, public health activities and health oversight or to avert serious health/safety situations or report abuse and neglect.
  • To medical examiners, coroners or funeral directors to aid in identifying you or to help them in performing their duties.
  • To organ, tissue and other donations organization, upon or proximate to your death, if we have no indication on hand about your donation preferences (or a positive indication).
  • To a family member, relative or other involved in your health care or payment thereof, unless you object, which you have the right to do.
  • To contact you about appointment reminders, treatment alternatives and other health related benefits and services.
  • To the sponsor of your health plan

All other uses and disclosure by us will require us to obtain from you a written authorization in addition to any other permission you will provide us. For example, we need written authorization before we sell your PHI or in most instances, market a third party’s services to you, if we’re receiving remuneration for that marketing.
Your rights: You have the following rights concerning your PHI:

  • Restrictions: To request restricted access to all or part of your PHI. To do this, [You must send your requests for restrictions in writing  to LifeLine Privacy Official at PO Box 1348, Chickasha Ok, 73023]. We are not required to grant your request and we may say no if it would affect your care.  If you pay for a service out of pocket in full, you can ask us not to share that information for the purposes of payment or our operations with your health insurer.  We will say “yes” unless a law requires us to share that information.
  • Confidential communications: You may ask us to contact you in a specific way (for example, home, office, or cell phone) or send mail to a different address.  You must send this request in writing to the Privacy Official at PO Box 1348 Chickasha Ok, 73023.  We will say yes to all reasonable requests
  • Access: To inspect or receive copies of your protected health information. To do this, [Send request in writing to the Privacy Official at PO Box 1348 Chickasha Ok 73018 or request in person at our office at 1701 W Iowa Chickasha Ok 7318].  We will provide you with a copy or a summary of your health information, usually within 30 days of your request.  We may charge a reasonable, cost based fee.
  • Breach notification: To be notified in the event that we or one of our business associates discovers a breach of unsecured PHI involving your medical information.
  • Revocation of an authorization: To revoke an authorization you’ve provided [Send your written request to the Privacy Official at PO Box 1348 Chickasha Ok, 73023].
  • Amendments: To request changes be made to your PHI. To do this, [Send your request in writing to Privacy Official at PO Box 1348 Chickasha Ok 73023].
    We are not required to grant your request.
  • Accounting: To receive an accounting of the disclosures by us of your PHI in the six years prior to your request. To do this, [Request in writing to the Privacy Official at PO Box 1348 Chickasha Ok 73023]. We will include all disclosures except for those about treatment, payment, and health care operations, and certain disclosures (such as any you asked us to make).  We will provide one accounting per year for free but will charge a reasonable, cost based fee if you ask for another one within 12 months.
  • This notice: To get updates or reissue of this notice, at your request.
  • Choose someone to act for you:  If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information
  • Complaints: To complain to us or the U.S. Dept. of Health & Human Services if your feel your privacy rights have been violated. To register a complaint with us, [Contact LifeLine Administrator and or the Privacy Officer in writing at PO Box 1348 Chickasha Ok 73023]. You can file a written complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to:  200 Independence Avenue, S.W., Washington, D.C. 20201, or by calling 1-877-696-6775.  The law forbids us from taking retaliatory action against you if you complain.

Our duties: We are required by law to maintain the privacy of your PHI. We must abide by the terms of this notice or any update of this notice.