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.
If you have any questions about this notice, please contact our Privacy Contact,
Mr. Michael Green.
This Notice of
Privacy Practices describes how we may use and disclose your protected health
information to carry out treatment, payment or health care operations and for
other purposes that are permitted or required by law. It also describes your rights to access and control your
protected health information. “Protected
health information” is information about you, including demographic
information, that may identify you and that relates to your past, present or
future physical or mental health or condition and related health care services.
We are required
to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice at any time.
The new notice will be effective for all protected health information
that we maintain both before and after the change.
Upon your request, we will provide you with any revised Notice of Privacy
Practices by calling the office and requesting that a revised copy be sent to
you in the mail or asking for one at the time of your next appointment.
1.
Uses
and Disclosures of Protected Health Information
Uses and Disclosures of Protected
Health Information
You will be asked by our Facility to sign this Notice of Privacy Practices.
We will make a good faith effort to obtain a written acknowledgement that
you received this Notice of Privacy Practices for Protected Health Information
the first time we provide services to you after April 14, 2003 or as soon as
reasonably practicable under the circumstances.
Your protected health information may be used and disclosed by the
Nursing Facility, our staff and others outside of our nursing facility that are
involved in your care and treatment for the purpose of providing health care
services to you. Your protected
health information may also be used and disclosed to obtain payment for your
health care bills and to support the operation of the Nursing Facility.
Following
are examples of the types of uses and disclosures of your protected health care
information that the Nursing Facility is permitted to make.
These examples are not meant to be exhaustive, but to describe the types
of uses and disclosures that may be made by our nursing facility.
Treatment.
We will use and disclose your protected health information to provide,
coordinate or manage your health care and any related services.
This includes the coordination or management of your health care with a
third party that has already obtained your permission to have access to your
protected health information. For
example, we would disclose your protected health information, as necessary, to a
home health agency that provides care to you.
We will also disclose protected health information to physicians who may
be treating you. For example, your
protected health information may be provided to a physician to whom you have
been referred to ensure that the physician has the necessary information to
diagnose or treat you.
In
addition, we may disclose your protected health information from time-to-time to
another nursing facility or health care provider (e.g., a physician or
laboratory) who, at the request of your physician or the Nursing Facility,
becomes involved in your care by providing assistance with your health care
diagnosis or treatment.
Payment.
Your protected health information will be used, as needed, to obtain
payment for your health care services. This
may include certain activities that your health insurance plan may undertake
before it approves or pays for the health care services we recommend for you
such as: making a determination of eligibility or coverage for insurance
benefits, reviewing services provided to you for medical necessity and
undertaking utilization review activities.
For example, obtaining approval for a hospital stay may require that your
relevant protected health information be disclosed to the health plan to obtain
approval for the hospital admission.
Healthcare Operations.
We may use or disclose, as needed, your protected health information in
order to support the business activities of the Nursing Facility.
These activities include, but are not limited to, quality assessment
activities, employee review activities, training of medical students, licensing,
and conducting or arranging for other business activities.
For example, we may disclose your protected health information to medical school
students or volunteers that see patients at our Nursing Facility.
In addition, we may use a scheduling sheet at the registration desk where
you may be asked to sign your name. We
may also call you by name in public areas for treatment or service
opportunities. We may use or
disclose your protected health information, as necessary, to contact you to
remind you of your appointment.
We will share your protected health information with third party “business
associates” that perform various activities (e.g., billing, transcription
services) for the Nursing Facility. Whenever
an arrangement between our Nursing Facility and a business associate involves
the use or disclosure of your protected health information, we will have a
written contract that contains terms that will protect the privacy of your
protected health information.
We may use or disclose your protected health information, as necessary, to
provide you with information about treatment alternatives or other
health-related benefits and services that may be of interest to you.
We may also use and disclose your protected health information for other
marketing activities. For example,
your name and address may be used to send you a newsletter about our Nursing
Facility and the services we offer. We
may also send you information about products or services that we believe may be
beneficial to you. You may contact
our Privacy Contact to request that these materials not be sent to you.
We may use or disclose your demographic information and the dates that you
received treatment from the Nursing Facility, as necessary, in order to contact
you for fundraising activities supported by our Nursing Facility.
If you do not want to receive these materials, please contact our Privacy
Contact and request that these fundraising materials not be sent to you.
Uses and Disclosures of Protected
Health Information Based Upon Your Written Authorization
Other uses and disclosures of your
protected health information will be made only with your written authorization,
unless otherwise permitted or required by law as described below. You may revoke this authorization, at any time, in writing,
except to the extent that the Nursing Facility has taken an action in reliance
on the use or disclosure indicated in the authorization.
Other Permitted and Required Uses
and Disclosures that may be made with Your Authorization or Opportunity to
Object
We may use and disclose your protected
health information in the following instances.
You have the opportunity to agree or object to the use or disclosure of
all or part of your protected health information. If you are not present or able to agree or object to the use
or disclosure of the protected health information, then our facility may, using
professional judgment, determine whether the disclosure is in your best
interest. In this case, only the
protected health information that is relevant to your health care will be
disclosed.
Facility Directories.
Unless you object, we will use and disclose in our facility directory
your name, the location at which you are receiving care, your condition (in
general terms), and your religious affiliation.
All of this information, except religious affiliation, will be disclosed
to people that ask for you by name. Members
of the clergy will be told your religious affiliation.
Others Involved in Your Healthcare.
Unless you object, we may disclose to a member of your family, a
relative, a close friend or any other person you identify, your protected health
information that directly relates to that person’s involvement in your health
care. If you are unable to agree or
object to such a disclosure, we may disclose such information as necessary if we
determine that it is in your best interest based on our professional judgment.
We may use or disclose protected health information to notify or assist
in notifying a family member, personal representative or any other person that
is responsible for your care of your location, general condition or death.
Finally, we may use or disclose your protected health information to an
authorized public or private entity to assist in disaster relief efforts and to
coordinate uses and disclosures to family or other individuals involved in your
health care.
Emergencies.
We may use or disclose your protected health information in an emergency
treatment situation. If this happens, the Nursing Facility shall try to obtain
your acknowledgement of our Privacy Practices as soon as reasonably practicable
after the delivery of treatment. If
the Nursing Facility or a physician in the Nursing Facility is required by law
to treat you and the Nursing Facility has attempted to obtain your
acknowledgement, but is unable, he or she may still use or disclose your
protected health information for treatment, payment, and health care operations.
Communication Barriers.
We may use and disclose your protected health information if we or your
physician in the Nursing Facility attempts to obtain an acknowledgement of our
Privacy Practices from you, but is unable to do so due to substantial
communication barriers.
Other
Permitted and Required Uses and Disclosures that may be made without Your
Consent, Authorization or Opportunity to Object
We may use or disclose your protected health information in the following
situations without your acknowledgement or authorization.
These situations include:
Required By Law.
We may use or disclose your protected health information to the extent
that the use or disclosure is required by law.
The use or disclosure will be made in compliance with the law and will be
limited to the relevant requirements of the law.
You will be notified, as required by law, of any such uses or
disclosures.
Public Health.
We may disclose your protected health information for public health
activities and purposes to a public health authority that is permitted by law to
collect or receive the information. The
disclosure will be made for the purpose of controlling disease, injury or
disability. We may also disclose
your protected health information, if directed by the public health authority,
to a foreign government agency that is collaborating with the public health
authority.
Communicable Diseases.
We may disclose your protected health information, if authorized by law,
to a person who may have been exposed to a communicable disease or may otherwise
be at risk of contracting or spreading the disease or condition.
Health Oversight.
We may disclose protected health information to a health oversight agency
for activities authorized by law, such as audits, investigations, and
inspections. Oversight agencies
seeking this information include government agencies that oversee the health
care system, government benefit programs, other government regulatory programs
and civil rights laws.
Abuse or Neglect.
We may disclose your protected health information to a public health
authority that is authorized by law to receive reports of child abuse or
neglect. In addition, we may
disclose your protected health information if we believe that you have been a
victim of abuse, neglect or domestic violence to the governmental entity or
agency authorized to receive such information.
In this case, the disclosure will be made consistent with the
requirements of applicable federal and state laws.
Food and Drug Administration.
We may disclose your protected health information to a person or company
required by the Food and Drug Administration to report adverse events, product
defects or problems, biologic product deviations; track products; to enable
product recalls; to make repairs or replacements; or to conduct post marketing
surveillance, as required.
Legal Proceedings.
We may disclose protected health information in the course of any
judicial or administrative proceeding, in response to an order of a court or
administrative tribunal (to the extent such disclosure is expressly authorized),
in certain conditions in response to a subpoena, discovery request or other
lawful process.
Law Enforcement.
We may also disclose protected health information, so long as applicable
legal requirements are met, for law enforcement purposes.
These law enforcement purposes include: (1) legal processes and otherwise
required by law, (2) limited information requests for identification and
location purposes, (3) pertaining to victims of a crime, (4) suspicion that
death has occurred as a result of criminal conduct, (5) in the event that a
crime occurs on the premises of the Nursing Facility, and (6) medical emergency
(not on the Nursing Facility’s premises) and it is likely that a crime has
occurred.
Coroners, Funeral Directors, and Organ Donation.
We may disclose protected health information to a coroner or medical
examiner for identification purposes, determining cause of death or for the
coroner or medical examiner to perform other duties authorized by law.
We may also disclose protected health information to a funeral director,
as authorized by law, in order to permit the funeral director to carry out
his/her duties. We may disclose
such information in reasonable anticipation of death.
Protected health information may be used and disclosed for cadaveric
organ, eye or tissue donation purposes.
Research.
We may disclose your protected health 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 protected health information.
Criminal Activity.
Consistent with applicable federal and state laws, we may disclose your
protected health information if we believe that the use or disclosure is
necessary to prevent or lessen a serious and imminent threat to the health or
safety of a person or the public. We
may also disclose protected health information if it is necessary for law
enforcement authorities to identify or apprehend an individual.
Military Activity and National Security.
When the appropriate conditions apply, we may use or disclose protected
health information of individuals who are Armed Forces personnel: (1) for
activities deemed necessary by appropriate military command authorities; (2) for
the purpose of a determination by the Department of Veterans Affairs of your
eligibility for benefits; or (3) to foreign military authority if you are a
member of that foreign military services. We
may also disclose your protected health information to authorized federal
officials for conducting national security and intelligence activities,
including for the provision of protective services to the President or others
legally authorized.
Workers’ Compensation.
Your protected health information may be disclosed by us as authorized to
comply with workers’ compensation laws and other similar legally established
programs.
Inmates.
We may use or disclose your protected health information if you are an
inmate of a correctional facility and your physician created or received your
protected health information in the course of providing care to you.
Required Uses and Disclosures.
Under the law, we must make disclosures to you and when required by the
Secretary of the Department of Health and Human Services to investigate or
determine our compliance with the requirements of federal regulations that
protect the privacy of your protected health information.
2.
Your
Rights
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 the Nursing Facility 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 reviewable. In some
circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Contact if you have questions
about access to your medical record.
You have the right to request a restriction
of your protected health information.
This means you may ask us not to use or disclose any part of your
protected health information for the purposes of treatment, payment or
healthcare operations. You may also
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.
The Nursing Facility is not required to agree to a restriction that you may
request. If the Nursing Facility
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 the Nursing Facility
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 the Nursing Facility. You
may request a restriction by submitting a written request to our Privacy
Contact.
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 our Privacy Contact.
You may have the right to have the Nursing
Facility 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 our Privacy Contact 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 as part of an approved authorization, 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.
3.
Complaints
You may complain to us or to the Secretary of Health and Human Services if you
believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Privacy
Contact of your complaint. We will
not retaliate against you for filing a complaint.
You may contact our Privacy Contact, Mr. Michael Green, at 330-279-2801 for
further information about the complaint process.
This notice was
published and becomes effective on April 14, 2003.