Effective 09/2013
NOTICE OF PRIVACY PRACTICES
PLEASE REVIEW IT CAREFULLY.
This notice describes how this facility may use and disclose your medical information. The facility is required by law to provide you with this notice regarding our legal obligations with respect to your protected health information and to adhere to the terms of the notice currently in effect.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
Each time you receive treatment at the facility, a record of your treatment is made and may be maintained in an electronic format. Typically, this record contains information about your condition and the services that we provide. The following categories describe the ways that we may use and disclose your medical information. (Not every use or disclosure in a category will be listed. However, the ways we are permitted to use and disclose information typically fall into one of the categories. Also, in some cases state law limits us from disclosing special types of health information. For example, state law usually requires that the facility get your permission before disclosing mental health, alcohol/drug use and abuse, and HIV/AIDS information.)
For Treatment. We may use your medical information to treat you. We may disclose your medical information to doctors, nurses, therapists or facility personnel who are involved in taking care of you at the facility. 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. Also, the doctor may need to tell the dietitian if you have diabetes so that we can plan your meals. Other treatment uses or disclosures of your information include sharing your medical information to provide you with medication, lab work, x-rays and other healthcare services.
For Payment. We keep track of the treatment, services and supplies you receive at the facility so we can bill you, your insurance company or other third-party payer. For example, in order to be paid, we may need to share information with your health plan about services that the facility provided to you. We may also tell your health plan about a treatment you are going to receive in order to obtain pre-approval or to determine whether your plan will cover the treatment.
For Health Care Operations. We use and disclose your medical information for health care operations. For example, we may use your medical information to review the treatment/services provided to you and evaluate the performance of the doctors and staff that treat you. This helps to improve our services to be sure we are providing good care. We may also combine medical information about many facility patients/residents to decide what additional services to should offer, what services are not needed, and whether certain new treatments are effective.
Business Associates. The facility provides some services by using outside vendors (also called business associates). The facility may share your medical information with them so that they can perform the job we have asked them to do including bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.
Treatment Alternatives. We may use and disclose your medical information in order to tell you about possible treatment options or alternatives that may be of interest to you.
Health-Related Benefits and Services. We may use and disclose your medical information in order to tell you about health-related benefits or services that may be of interest to you.
Facility Directory. With your consent, we may use or disclose your information in the facility’s directory.
Individuals Involved in Your Care or Payment for Your Care. With your consent, we may disclose your medical information to a friend or family member who is involved in your care or for payment for your care. In addition, we may disclose your medical information to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
As Required By Law. We will disclose your medical information when required to do so by federal, state or local law.
Public Health Activities. We may use and disclose your medical information to assist in public health activities like tracking diseases or medical devices.
Abuse. We may disclose your medical information to state or federal authorities so that they can protect victims of abuse, neglect or domestic violence.
Health Oversight Activities. We may disclose your medical information to a health oversight agency for activities authorized by law such as audits, investigations, and inspections.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose your medical information in response to a court or administrative order. We may also disclose your medical information in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Law Enforcement. We may disclose your medical information to a law enforcement official.
Coroners, Medical Examiners and Funeral Directors. We may disclose your medical information to a coroner/medical examiner or to funeral directors.
Organ and Tissue Donation. If you are an organ donor, we may disclose your medical information to organizations that handle organ procurement in order to facilitate donation and transplantation.
Research. Under certain circumstances, we may use and disclose your medical information for research purposes.
To Avert a Serious Threat to Health or Safety. We may use and disclose your medical information to prevent a serious threat to your health and safety or the health and safety of the public or another person.
Military and Veterans. If you are a member of the armed forces, we may disclose your medical information as required by military authorities. We may also disclose medical information about foreign military personnel to the appropriate foreign military authority.
National Security and Intelligence Activities. We may disclose your medical information to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law.
Inmates. We may use or disclose your medical information to inform a correctional institution if you are an inmate.
Workers' Compensation. We may disclose your medical information for workers' compensation or similar programs.
Disaster Relief. We may disclose your medical information to disaster relief organizations in order to coordinate your care, or notify family and friends of your location or condition in a disaster. We will provide you with an opportunity to agree or object to such a disclosure whenever practical.
All Other Uses and Disclosures. Uses and disclosures of your medical information not covered by this notice, including uses and disclosures of protected health information for marketing purposes and disclosures that constitute a sale of protected health information, may be made only with your written authorization. You may revoke that authorization, in writing, at any time; however we are unable to take back any disclosures we have already made with your permission, and that we are required to retain for our records of the care that we provided to you.
State Law. In some cases we are limited by state law from releasing certain categories of your medical information, such as mental health, alcohol/drug use and abuse, and HIV/AIDS information.
Disclosures of your medical information as described above may be made in an electronic form.
YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION
Although your health record is the property of the facility, the information belongs to you. Federal law gives you the rights described below regarding your medical information.
Right to Inspect and Copy. With some exceptions, you may review and copy your medical information. Access to your medical information must be provided in a timely manner. If your medical information is maintained in an electronic format, you have the right to request an electronic copy of your record. We will make every effort to provide your medical information in the form or format you request, if it is readily producible in such form or format. In addition, we may charge you a reasonable fee for the costs of copying, mailing or other supplies associated with your request. *
Right to Amend. You may ask us to amend your medical information if you feel it is incorrect or incomplete. However, we may deny your request under certain circumstances. *
Right to an Accounting of Disclosures. You may request an "accounting of disclosures." This is a list of certain disclosures we made of your medical information, other than those made for purposes such as treatment, payment, or health care operations. Your request must be for a period not to exceed six (6) years from the request date and may not include dates before April 14, 2003. *
Right to Request Restrictions. You may request a reasonable restriction on the uses or disclosures of your medical information including certain disclosures to your health plan where you have paid out of pocket in full for the health care item or service.*
Right to Request Alternate Communications. You may request that we communicate with you about medical matters in a confidential manner or at a specific location. For example, you may ask that we only contact you via mail to a post office box. *
Right to a Paper Copy of This Notice. You may request a copy of this notice at any time. To obtain a paper copy of this notice, contact the facility’s Administrator or Privacy Designee. You may obtain an electronic copy of this notice at our facility’s website if applicable.
Right to Receive Notice of a Breach. You have the right to be notified upon a breach of any of your unsecured protected health information.
* To exercise any of these rights you must: submit your request in writing to the facility’s Administrator or Privacy Designee, provide a reason for your request and, if applicable, clearly indicate the action you want the facility to take. We may charge a fee for the costs of copying, mailing or other supplies associated with your request. We will notify you of the cost involved and you may choose to change or take back your request at that time before any costs are incurred.
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 and on the facility’s website if applicable. In addition, if material changes are made to this notice, the notice will contain an effective date for the revisions and copies can be obtained by contacting the facility’s Administrator or Privacy Designee.
COMPLAINTS & CONTACT INFORMATION
If you believe your privacy rights have been violated, you may file a complaint with the facility or with the Office for Civil Rights (see the website: www.hhs.gov/ocr/hipaa for details). For further information or to file a complaint with the facility, contact the Administrator or Privacy Designee or you may call the InTouch Hotline at 1(800) 255-4730 to report your concerns. All complaints to the facility’s Administrator or Privacy Designee must be submitted in writing. You will not be penalized for filing a complaint.