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In accordance with the Health Insurance Portability and Accountabilty Act (HIPAA) of
1996 we hereby provide notice of our privacy practices for protected health information.
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PLEASE REVIEW IT CAREFULLY.
If
you have any questions about this notice, please contact the Building Administrator.
WHO WILL FOLLOW THIS NOTICE.
This notice describes our facility/agency’s practices and that
of:
 | all departments and units of the facility/agency;
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| any member of a volunteer group we allow to help you while you are
in the facility/agency; and
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| all employees, staff and other facility/agency personnel.
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OUR PLEDGE REGARDING YOUR
HEALTH INFORMATION
We understand that information about you
and your health is personal. We are committed
to protecting your health information. We
create a record of the care and services you receive at the facility/agency, as well as
records regarding payment for those services. We
need these records to provide you with quality care and to comply with certain legal
requirements. This notice applies to all of
the records of your care generated by the facility/agency, whether made by facility/agency
personnel or your personal doctor. Your
personal doctor may have different policies or notices regarding the doctor’s use and
disclosure of your medical information created in the doctor’s office or
clinic.
This notice will tell you about the ways
in which we may use and disclose medical information about you. We also describe your rights and certain
obligations we have regarding the use and disclosure of medical information.
We are required by law to:
| make sure that medical information that
identifies you is kept private;
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| give you this notice of our legal duties
and privacy practices with respect to medical information about you; and
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| follow the terms of the notice that is
currently in effect.
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HOW
WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
The following categories describe
different ways that we use and disclose health information.
For each category of uses or disclosures we will explain what we mean and
try to give some examples. Not every use or
disclosure in a category will be listed. However,
all of the ways we are permitted to use and disclose information will fall within one of
the categories.
| For
Treatment. We may use health
information about you to provide you with medical treatment or services. We may disclose medical information about you to
doctors, nurses, technicians, medical students, or other facility/agency personnel who are
involved in taking care of you at the facility/agency.
For example, a doctor treating you for a broken leg may need to know if you
have diabetes because diabetes may slow the healing process. In addition, the doctor may need to tell the
dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments of the facility/agency also
may share medical information about you in order to coordinate the different things you
need, such as prescriptions and lab work.
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| For
Payment. We may use and disclose
health information about you so that the treatment and services you receive at the
facility/agency may be billed, and that payment may be collected from you, an insurance
company or another third party. For example,
we may need to give your health plan information about services that you received at the
facility/agency so your health plan will pay us or reimburse you for the services. We may also tell your health plan about a
treatment you are going to receive to obtain prior approval or to determine whether your
plan will cover the treatment.
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| For
Health Care Operations. We may use
and disclose medical information about you for health care operations. These uses and disclosures are necessary to run
the facility/ agency and to make sure that all residents receive quality care. For example, we may use medical information to
review our treatment and services and to evaluate the performance of our staff in caring
for you. We may also combine medical
information about many facility/agency residents to decide what additional services the
facility/agency should offer, what services are not needed, and whether certain new
treatments are effective. We may also
disclose information to doctors, nurses, therapists, consultants, technicians, medical
students, and other facility/agency personnel for review and learning purposes. We may also combine the medical information we
have with medical information from other facilities/agencies to compare how we are doing
and see where we can make improvements in the care and services we offer. We may remove information that identifies you
from this set of medical information so others may use it to study health care and health
care delivery without learning who the specific residents/patients are.
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| Treatment
Alternatives. We may use and disclose
medical information to tell you about or recommend possible treatment options or
alternatives that may be of interest to you.
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| Health-Related
Benefits and Services. We may use and
disclose medical information to tell you about health-related benefits or services that
may be of interest to you.
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| Name
Placement. We may place your name on
the door to your room, on your meal tray, and on pieces of equipment that you might use,
including a wheelchair. This aids our staff
in identifying your items in order to provide you the best possible care. Further, this practice will assist you in locating
your room and equipment.
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| Individuals
Involved in Your Care or Payment for Your Care.
Unless you object, we may release medical information about you to a
friend or family member who is involved in your medical care. We may also give information to someone who helps
pay for your care. We may also tell your
family or friends of your condition. In
addition, we may disclose medical information about you to an entity assisting in a
disaster relief effort.
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| As
Required By Law. We will disclose
medical information about you when required to do so by federal, state or local law.
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| To
Avert a Serious Threat to Health or Safety. We
may use and disclose medical information about you when necessary to prevent a serious
threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone
able to help prevent the threat.
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| To
Those Involved in Your Care. We may
disclose medical information about you to people who may be involved in your care, such as
your family members, close personal friends and, if applicable, a private sitter. If, at any time you do not want such people
involved in your care, you may instruct us not to make any disclosures to them.
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| Private
Sitters. If you hire a private
sitter, we will disclose medical information about you to aid your sitter in caring for
you. There may be private sitters working for
other residents of the facility/agency. These
sitters may hear incidental information about you.
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SPECIAL SITUATIONS
| Organ
and Tissue Donation. If you are an
organ donor, we may release medical information to organizations that handle organ
procurement or organ, eye or tissue transplantation or to an organ donation bank, as
necessary to facilitate organ or tissue donation and transplantation.
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| Military
and Veterans. If you are a member of
the armed forces, we may release medical information about you as required by military
command authorities. We may also release
medical information about foreign military personnel to the appropriate foreign military
authority.
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| Workers’
Compensation. If applicable, we may
release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related
injuries or illness.
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| Public
Health Risks. We may disclose medical
information about you for public health activities. These activities generally include the
following:
 | to prevent or control disease, injury or
disability;
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| to report deaths;
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| to report reactions to medications or
problems with products;
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| to notify people of recalls of products
they may be using;
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| to notify a person who may have been
exposed to a disease or may be at risk for contracting or spreading a disease or
condition; and/or
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| to notify the appropriate government
authority if we believe you have been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or
when required or authorized by law.
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| Health Oversight Activities. We may disclose medical information to a
health oversight agency for activities authorized by law.
These oversight activities include, for example, audits, investigations,
inspections, and licensure. These activities
are necessary for the government to monitor the health care system, government programs,
and compliance with applicable civil rights laws.
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| Lawsuits and Disputes. If you are involved in a lawsuit or a dispute,
we may disclose medical information about you in response to a court or administrative
order. We may also disclose medical
information about you in response to a subpoena, discovery request, or other lawful
process by someone else involved in the dispute, but only if we
receive satisfactory assurances that the party seeking the information has made efforts to
tell you about the request or to obtain an order protecting the information requested.
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| Law Enforcement.
We may release medical information if asked to do so by a law enforcement
official:
| In response to
a court order, subpoena (after we attempt to notify you), warrant, summons or similar
process?
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| to identify or
locate a suspect, fugitive, material witness, or missing person;
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| about the
victim of a crime if, under certain limited circumstances, we are unable to obtain your
agreement;
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| about a death
we believe may be the result of criminal conduct;about criminal conduct at our offices;
and
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| in emergency
circumstances to report a crime; the location of the crime or victims; or the identity,
description or location of the person who committed the crime.
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| Coroners, Medical Examiners and Funeral Directors. We may release medical information to a coroner or
medical examiner. This may be necessary, for
example, to identify a deceased person or determine the cause of death. We may also release medical information about
patients of the facility/agency to funeral directors as necessary to carry out their
duties.
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| National Security and Intelligence Activities. We may release medical information about you
to authorized federal officials for intelligence, counterintelligence, and other national
security activities authorized by law.
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| Protective Services for the President and Others. We may disclose medical information about you
to authorized federal officials so they may provide protection to the President, other
authorized persons or foreign heads of state or conduct special investigations.
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YOUR
RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You have the following rights regarding
medical information we maintain about you:
| Right
to Inspect and Copy.
| You or your legal representative have
the right to inspect and copy medical information that may be used to make decisions about
your care. Usually, this includes medical and
billing records, but does not include psychotherapy notes.
We must provide you with access to your records within 24 hours of your
request, not including weekends or holidays. We
must provide you with a copy of your records within two (2) working days following your
request.
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| To inspect and copy medical information
that may be used to make decisions about you, submit your request orally or in writing to your
Bldg Administrator. If you request a
copy of the information, we may charge a fee for the costs of copying, mailing or other
supplies associated with your request.
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| We may deny your request to inspect and
copy in certain very limited circumstances. If
you are denied access to medical information, you may request that the denial be reviewed
if the denial is made for certain reasons. Another
licensed health care professional chosen by the facility/agency will review your request
and the denial. The person conducting the
review will not be the person who denied your request.
We will comply with the outcome of the review.
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| Right
to Amend.
| If you feel that medical information we
have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as
long as the information is kept by or for the facility/agency.
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| To request an amendment, your request
must be made in writing and submitted to your Bldg Administrator. In addition, you must provide a reason that
supports your request.
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| We may deny your request for an
amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask
us to amend information that:
 | was not created by us, unless the person
or entity that created the information is no longer available to make the amendment;
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| is not part of the medical information
kept by or for the facility/agency;
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| is not part of the information which you
would be permitted to inspect and copy; or
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| is accurate and complete.
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| Right to an Accounting of Disclosures. You have the right to request an
“accounting of disclosures.” This
is a list of certain disclosures we made of medical information about you.
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request this list or accounting of disclosures, you must submit your request in writing to
your Bldg Administrator. Your
request must state a time period which may not be longer than six years and may not
include dates before April 14, 2003. Your
request should indicate in what form you want the list (for example, on paper,
electronically). The first list you request
within a 12-month period will be free. For
additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you
may choose to withdraw or modify your request at that time before any costs are incurred.
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| Right
to Request Restrictions.
| You have the right to request a
restriction or limitation on the medical information we use or disclose about you for
treatment, payment or health care operations purposes. You may also request a limit on the
medical information we disclose about you to someone who is involved in your care or the
payment for your care, like a family member or friend.
For example, you could ask that we not use or disclose information to your
daughter, or that we not use your information in any quality assurance activities.
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| We are not required to agree to your request. If we do agree, we will comply with your
request unless the information is needed to provide you emergency treatment.
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| To request restrictions, you must make
your request in writing to your Bldg Administrator. In your request, you must tell us (1) what
information you want to limit; (2) whether you want to limit our use, disclosure or both;
and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
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| Right
to Request Confidential Communications. You
have the right to request that we communicate with you about medical matters in a certain
way or at a certain location. For example,
you can ask that we only contact you at work or by mail.
| To request confidential communications,
you must make your request in writing to your Bldg Administrator. We will not ask you the reason for your request. We will accommodate reasonable requests. Your request must specify how or where you wish to
be contacted.
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| Right
to a Paper Copy of This Notice. You
have the right to a paper copy of this notice. You may ask us to give you a copy of this
notice at any time. Even if you have agreed
to receive this notice electronically, you are still entitled to a paper copy of this
notice.
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CHANGES TO THIS NOTICE
We reserve the right to change this
notice. We reserve the right to make the
revised or changed notice effective for medical information we already have about you as
well as any information we receive in the future. We
will post a copy of the current notice in the facility/agency. The notice will contain on the first page, in the
top right-hand corner, the effective date.
COMPLAINTS
If you believe your privacy rights
have been violated, you may file a complaint with the facility/agency or with the
Secretary of the Department of Health and Human Services.
To file a complaint with the agency, contact your Bldg Administrator.
All complaints must be submitted in
writing. A complaint may be filed with the Secretary of the Department of Health and Human
Services at:
Secretary
The
U.S. Department of Health and Human Services
200
Independence Avenue, S.W.
Washington,
D.C. 20201
Telephone: 202-619-0257
Toll
Free: 1-877-696-6775
You will not be penalized in any way for filing a
complaint.
OTHER
USES OF MEDICAL INFORMATION
Other
uses and disclosures of medical information not covered by this notice or the laws that
apply to us will be made only with your written permission.
If you provide us permission to use or disclose medical information about
you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer
use or disclose medical information about you for the reasons covered by your written
authorization. You understand that we are
unable to take back any disclosures we have already made with your permission, and that we
are required to retain our records of the care that we provided to you.
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