Magic City Enterprises
"Serving people
      with developmental disabilities
           since 1971."
1780 Westland Road
Cheyenne, WY 82001
Phone: (307) 637-8869
Fax: (307) 638-0467

Notice of HIPAA Privacy practices

Effective: April 14, 2003

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.

This notice will tell you how we may use and disclose protected health information about you. Protected health information means any health information about you that identifies you or for which there is a reasonable basis to believe the information can be used to identify you. In the header above, that information is referred to as “medical information.” In this notice, we call all of that protected health information, “medical information.”

This notice also will tell you about your rights and our duties with respect to health information about you. In addition, it will tell you how to complain to us if you believe we have violated your privacy rights.

Who Is Bound By This Notice

This Notice of Privacy Practices describes the practices of Magic City Enterprises, Inc.

This notice applies to the following delivery sites: 1700, 1704, 1710, 1720, 1750, 1780 Westland Road, 2600 Missile Drive, 301 Deming Drive, Commissary F.E. Warren A.F.B.

We all will follow what is stated in this Notice.

How We May Use and Disclose Health Information About You

We will share health information about you with each other as necessary to carry out treatment, payment, or our health care operations.

We use and disclose health information about you for a number of different purposes. Each of those purposes is described below.

We may use health information about you to provide, coordinate or manage the services, supports, and health care you receive from us and other providers. We may disclose health information about you to doctors, nurses, qualified mental retardation professionals (QMRPs), psychologists, social workers, direct support staff and other agency staff, volunteers and other persons who are involved in supporting you or providing care.. We may consult with other health care providers concerning you and, as part of the consultation, share your health information with them. For example, staff may discuss your information to develop and carry our your individual service plan. Staff may share information to coordinate needed services, such as medical tests, transportation to a doctor’s visit, physical therapy, etc. Staff may need to disclose health information to entities outside of our organization (for example, another provider or a state/local agency) to obtain new services for you.

We may use and disclose health information about you so we can be paid for the services we provide to you. This can include billing a third party payor, such as Medicaid or other state agency (for example, the state’s Office of Mental Retardation), or your insurance company. For example, we may need to provide the State Medicaid program information about the services we provide to you so we will be reimbursed for those services. We also may need to provide the state Medicaid program with information to ensure you are eligible for the medical assistance program.

We may use and disclose health information about you for our own operations. These are necessary for us to operate Magic City Enterprises, Inc. and to maintain quality health for our patients. For example, we may use health information about you to review the services we provide and the performance of our employees supporting you. We may disclose health information about you to train our staff and volunteers. We also may use the information to study ways to more efficiently manage our organization, for accreditation or licensing activities, or for our compliance program.

Unless you tell us otherwise in writing, we may contact you by either telephone or by mail at either your home or your workplace. At either location, we may leave messages for you on the answering machine or voice mail. If you want to request that we communicate to you in a certain way or at a certain location, see “Right to Receive Confidential Communications” on page 29 of this Notice.

We may use and disclose health information about you to contact you to remind you of an appointment for treatment or services.

We may use and disclose health information about you to contact you about treatment and service alternatives that may be of interest to you.

We may use and disclose health information about you to contact you about health-related benefits and services that may be of interest to you.

We may use and disclose health information about you to communicate with you about a product or service to encourage you to purchase the product or service. This may be:

To describe a health-related product or service that is provided by us;

We may communicate to you about products and services in a face-to-face communication by us to you. We also may communicate about products or services in the form of a promotional gift of nominal value.

All other use and disclosure of health information about you by us to make a communication about a product or service to encourage the purchase or use of a product or service will be done only with your written authorization.

We may use and disclose health information about you to raise funds for Magic City Enterprises, Inc. We may disclose health information to a business associate of Magic City Enterprises, Inc. or a foundation related to Magic City Enterprises, Inc. so that business associate or foundation may contact you to raise money for the benefit of Magic City Enterprises, Inc. We will only release demographic information, such as your name and address, and the dates you received treatment or services from Magic City Enterprises, Inc. If you do not want Magic City Enterprises, Inc. or its foundation to contact you for fundraising, you must notify Business Manager, Privacy Officer, 1780 Westland Rd. Cheyenne, WY 82001 in writing.

We may include your name, your location in our facility, your condition described in general terms, and your religious affiliation in our directory while you receive services. This information, except for your religious affiliation may be released to people who ask for you by name. Your religious affiliation may be given to members of the clergy, such as a minister, priest or rabbi, who ask for you by name. If you do not want included in our facility directory, or you want to restrict the information we include in the directory, you must notify Business Manager, Privacy Officer, 1780 Westland Rd. Cheyenne, WY 82001 of your objection.

We may disclose to a parent/guardian, personal representative, family member, other relative, a close personal friend, or any other person identified by you, health information about you that is directly relevant to that person’s involvement with the services and supports you receive or payment for those services and supports. We also may use or disclose health information about you to notify, or assist in notifying, those persons of your location, general condition, or death. If there is a family member, other relative, or close personal friend that you do not want us to disclose health information about you to, please notify Business Manager, Privacy Officer, 1780 Westland Rd. Cheyenne, WY 82001 or tell our staff member who is providing care to you.

We may use or disclose health information about you to a public or private entity authorized by law or by its charter to assist in disaster relief efforts. This will be done to coordinate with those entities in notifying a parent/guardian, personal representative, family member, other relative, close personal friend, or other person identified by you of your location, general condition or death.

We may use or disclose health information about you when we are required to do so by law.

We may disclose health information about you for public health activities and purposes. This includes reporting health information to a public health authority that is authorized by law to collect or receive the information for purposes of preventing or controlling disease. Or, one that is authorized to receive reports of child abuse and neglect. It also includes reporting for purposes of activities related to the quality, safety or effectiveness of a United States Food and Drug administration regulated product or activity.

We may disclose health information about you to a government authority authorized by law to receive reports of abuse, neglect, or domestic violence, if we believe you are a victim of abuse, neglect, or domestic violence. This will occur to the extent the disclosure is: (a) required by law; (b) agreed to by you or your personal representative; or, (c) authorized by law and we believe the disclosure is necessary to prevent serious harm to you or to other potential victims, or, if you are incapacitated and certain other conditions are met, a law enforcement or other public official represents that immediate enforcement activity depends on the disclosure.

We may disclose health information about you to a health oversight agency for activities authorized by law, including audits, investigations, inspections, licensure or disciplinary actions. These and similar types of activities are necessary for appropriate oversight of the health care system, government benefit programs, and entities subject to various government regulations.

We may disclose health information about you in the course of any judicial or administrative proceeding in response to an order of the court or administrative tribunal. We also may disclose health information about you in response to a subpoena, discovery request, or other legal process but only if efforts have been made to tell you about the request or to obtain an order protecting the information to be disclosed.

We may disclose health information about you to a law enforcement official for law enforcement purposes:

  1. As required by law.
  2. In response to a court, grand jury or administrative order, warrant or subpoena.
  3. To identify or locate a suspect, fugitive, material witness or missing person.
  4. About an actual or suspected victim of a crime and that person agrees to the disclosure. If we are unable to obtain that person’s agreement, in limited circumstances, the information may still be disclosed.
  5. To alert law enforcement officials to a death if we suspect the death may have resulted from criminal conduct.
  6. About crimes that occur at our facility.
  7. To report a crime in emergency circumstances.

We may disclose health information about you to a coroner or medical examiner for purposes such as identifying a deceased person and determining cause of death.

We may disclose health information about you to funeral directors as necessary for them to carry out their duties.

To facilitate organ, eye or tissue donation and transplantation, we may disclose health information about you to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs, eyes or tissue.

We may use or disclose protected health information about you if we believe the use or disclosure is necessary to prevent or lessen a serious or imminent threat to the health or safety of a person or the public. We also may release information about you if we believe the disclosure is necessary for law enforcement authorities to identify or apprehend an individual who admitted participation in a violent crime or who is an escapee from a correctional institution or from lawful custody.

We may disclose health information about you to authorized federal officials for the conduct of intelligence, counter-intelligence, and other national security activities authorized by law.

We may disclose health information about you to authorized federal officials so they can provide protection to the President of the United States, certain other federal officials, or foreign heads of state.

We may disclose health information about you to a correctional institution or law enforcement official having custody of you. The disclosure will be made if the disclosure is necessary: (a) to provide health care to you; (b) for the health and safety of others; or, (c) the safety, security and good order of the correctional institution.

We may disclose health information about you to the extent necessary to comply with workers’ compensation and similar laws that provide benefits for work-related injuries or illness without regard to fault.

Other uses and disclosures will be made only with your written authorization. You may revoke such an authorization at any time by notifying Business Manager, 1780 Westland Rd. Cheyenne, WY 82001 in writing of your desire to revoke it. However, if you revoke such an authorization, it will not have any affect on actions taken by us in reliance on it.

Your Rights With Respect to Health Information About You

You have the following rights with respect to health information that we maintain about you.

You have the right to request that we restrict the uses or disclosures of health information about you to carry out treatment, payment, or health care operations. You also have the right to request that we restrict the uses or disclosures we make to: (a) a family member, other relative, a close personal friend or any other person identified by you; or, (b) for to public or private entities for disaster relief efforts. For example, you could ask that we not disclose health information about you to your brother or sister.

To request a restriction, you may do so at any time. If you request a restriction, you should do so to Business Manager, 1780 Westland Rd. Cheyenne, WY 82001. (307)637-8869 and tell us: (a) what information you want to limit; (b) whether you want to limit use or disclosure or both; and, (c) to whom you want the limits to apply (for example, disclosures to your spouse).

We are not required to agree to any requested restriction. However, if we do agree, we will follow that restriction unless the information is needed to provide emergency treatment. Even if we agree to a restriction, either you or we can later terminate the restriction.

You have the right to request that we communicate health information about you to you in a certain way or at a certain location. For example, you can ask that we only contact you by mail or at work. We will not require you to tell us why you are asking for the confidential communication.

If you want to request confidential communication, you must do so in writing to: Business Manager 1780 Westland Rd. Cheyenne, WY 82001 . Your request must state how or where you can be contacted.

We will accommodate your request. However, we may, if necessary, require information from you concerning how payment will be handled. We also may require an alternate address or other method to contact you.

With a few very limited exceptions, such as psychotherapy notes, you have the right to inspect and obtain a copy of health information about you.

To inspect or copy health information about you, you must submit your request in writing to Business Manager, 1780 Westland Rd. Cheyenne, WY 82001. Your request should state specifically what health information you want to inspect or copy. If you request a copy of the information, we may charge a fee for the costs of copying and, if you ask that it be mailed to you, the cost of mailing.

We will act on your request within thirty (30) calendar days after we receive your request. If we grant your request, in whole or in part, we will inform you of our acceptance of your request and provide access and copying.

We may deny your request to inspect and copy health information if the health information involved is:

  1. Psychotherapy notes;
  2. Information compiled in anticipation of, or use in, a civil, criminal or administrative action or proceeding;

If we deny your request, we will inform you of the basis for the denial, how you may have our denial reviewed, and how you may complain. If you request a review of our denial, it will be conducted by a licensed health care professional designated by us who was not directly involved in the denial. We will comply with the outcome of that review.