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Patient Privacy Notices

For Medicare and Medicaid Patients:

HHAs must incorporate into their admission process for Medicare/Medicaid patients Attachments A and B. Please refer to Attachment A - Statement of Patient Privacy Rights (front), and Attachment B - Privacy Act Statement (back) of this notice for this document.

Note: Files are in Adobe Acrobat format (*.pdf) and require the Adobe Acrobat Reader to be viewed.

• Attachment A (att_a.pdf - English (PDF - 28K)), (span_a.pdf - Spanish (PDF - 141K)) - Statement of Patient Privacy Rights for Medicare and Medicaid patients
• Attachment B - Privacy Act Statement (att_b.pdf - English (PDF - 126K)), (span_b.pdf - Spanish (PDF - 137K)) - the legal notice required for Medicare and Medicaid patients

HHAs who continue to collect OASIS information for private pay patients must incorporate into their admission process for non-Medicare and non-Medicaid patients Attachment C - Notice About Privacy for Patients Who Do Not Have Medicare or Medicaid Coverage. This is the notice that HHAs must incorporate into their admission process for non-Medicare /non-Medicaid patients.

HHAs who suspend collection of OASIS information on private pay patients are not required to use Attachment C - Notice About Privacy for Patients Who Do Not Have Medicare or Medicaid Coverage.

Note: File is in Adobe Acrobat format (*.pdf) and requires the Adobe Acrobat Reader to be viewed.

• Attachment C (att_c.pdf - English (PDF - 28K)), (span_c.pdf - Spanish (PDF - 35K)) - Notice About Privacy for Patients Who Do Not Have Medicare or Medicaid Coverage

The appropriate patient notice must be given to each new patient admitted to the HHA on or after July 19, 1999, as applicable. The HHA may not change the language or words in the notices; however, the HHA may alter the font size to post these notices on their agency letterhead. (January 22, 2004)