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NOTICE OF PRIVACY PRACTICE

The Center respects the confidentiality of medical information and will protect that information in a responsible manner. We have a comprehensive privacy program in place that meets the requirement of the Health Insurance Portability and Accountability Act (HIPA) Privacy Regulations, the government legislation that sets standards for the privacy of medical information.

The Center will follow all privacy laws to which we are subject that do not conflict with the HIPPA Privacy Regulations. However, if a State privacy law conflicts with the HIPPA Privacy Regulations yet provided greater privacy rights or protections that the HIPPA Privacy Regulations, we will follow that state law.

We must follow the privacy practices that are described in our “Notice of Privacy Practice” while it is in effect. We reserve the right to change our privacy practices and the terms of the notice at any time, as long as the changes are permitted by law. Before we make a significant change to our privacy practices, we will change our “Privacy Practices Notice” and it will be made available to Residents or Designated Representatives upon request. This new notice will be effective for all medical information that we maintain, including medical information e created or received before the changes were made.

Additionally, the Center is required by law to maintain the privacy of a Resident’s protected health information and to give the Resident or the Resident’s Designated Representative, at the time of admission or shortly thereafter, our “Notice of Privacy Practices” which address the Resident’s rights, our privacy practices and legal duties concerning a Resident’s protected health information.

Therefore, effective April 14, 2003 the Resident or the Resident’s Designated Representative will receive a copy of the attached “Notice of Privacy Practices” at the time of admission or shortly thereafter. The “Notice of Privacy Practices” will be explained to the Resident/Designated Representative by the Admission Coordinator and a signature as proof of receipt of same, will be obtained.

NOTICE OF PRIVACY PRACTICES

Effective Date: April 14, 2003/Reviewed: 08/2017
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.

The Center respects the confidentiality of your medical information and will protect that information in a responsible manner. We have a comprehensive privacy program in place that meets the requirements of the Health Insurance Portability and Accountability Act (HIPAA) Privacy Regulations, the government legislation that sets standards for the privacy of medical information.

We follow all State privacy laws to which we are subject that do not conflict with the HIPAA Privacy Regulations. However, if a State privacy law conflicts with the HIPAA Privacy Regulations yet provides greater privacy rights or protections than the HIPAA Privacy Regulations, we will follow that State law.

We must follow the privacy practices that are described in this notice while it is in effect. We reserve the right to change our privacy practices and the terms of this notice at any time, as long as the changes are permitted by law. Before we make a significant change to our privacy practices, we will change this notice and it will be made available to you upon request. This new notice will be effective for all medical information that we maintain, including medical information we created or received before the changes were made.

Additionally, please know that the Center is required by law to maintain the privacy of your medical information and to give you this notice regarding your rights, our privacy practices and legal duties concerning your medical information.

Definition of Medical Information

When the Center refers to medical information in this notice, we mean information that is individually identifiable health information. This includes demographic information collected from you or created or received by a health care provider, a health plan, or your employer.

Typically, our records contain your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information is often referred to as your medical record. This information could be used as:

  • basis for planning your care and treatment
  • means of communication among the many health professionals who contribute to your care
  • legal document describing the care you received
  • means by which you or a third party payer can verify that services billed were actually provided
  • a source of information for public health officials who oversee the delivery of health care.

Uses and Disclosures of Medical Information

This section provides you with a general description and examples of the ways your medical information is used and disclosed. As a rule, only the minimum necessary protected health information should be disclosed to insure good care of Residents, payment for services rendered or appropriate operations of the Center. The Center’s uses and disclosures are not limited to these examples.

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 other physicians who may be treating you when we have the necessary permission from you to disclose your protected health information. 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 physician or health care provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance to your physician 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 from either yourself or third party payers such as Medicaid and Medicare. 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 Operation: We may use or disclose, as needed, your protected health information in order to support the business activities of our Center. These activities include, but are not limited to, quality assessment activities, employee review activities, and conducting or arranging for other business activities.

We will share your protected health information with third party “Business Associates” that perform various activities (e.g., billing, transcription services) for the Center. Whenever an arrangement between our office 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.

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 Center 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 the Center may use professional judgment to 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.

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 related 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 situation. If this happens, your physician shall try to obtain your authorization as soon as reasonably practicable after the delivery of treatment. If your physician or another physician in the Center is required by law to treat you and the physician has attempted to obtain your authorization but is unable to obtain your authorization, he or she may still disclose your protected health information to treat you.

Center Directory: Except when an objection is expressed by the Resident or their Designated Representative, the Center may use the following information to maintain a directory of Residents in the Center

  • Resident’s name
  • Room number or location
  • The Resident’s condition described in general terms, which does not communicate medical information about the Resident
  • The Resident’s religious affiliation may be communicated to members of the clergy, unless the Resident of Designated Representative objects.

Except for religious affiliation the above information will be disclosed to other persons who ask for the Resident by name.

Unless the Resident objects the Resident’s photograph and name will be posted on the Residents room door. Without objection, the Resident’s name may appear on various lists use by the Center e.g. monthly birthday list.

Communication Barriers: We may use and disclose your protected health information if your physician or another physician in the Center attempts to obtain authorized consent from you but is unable to do so due to substantial communication barriers and the physician determines, using professional judgment, that you would have consented to use or disclosure under the circumstances.

Other Permitted and Required Uses and Disclosures That May Be Made Without Your Authorization or Opportunity to Object.

We may use or disclose your protected health information in the following situations without your 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 purpose 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 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 subpoena, discovery request or other lawful process.

Legal 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 Center and (6) medical emergencies (not on the Center’s premises) when it is likely that a crime has occurred.

Coroners, Funeral Directors and Organ Donations: We may disclose protected health information to a coroner or medical examiner for identification purpose, 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 their 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.

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 Force by personnel (1) for activities deemed necessary by appropriate military command authorities (2) for the purpose of a determination by the Department of Veteran’s 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 protected services to the President or others legally authorized.

Worker’s Compensation: Your protected health information may be disclosed by us as authorized to comply with workers’ compensation laws and other similar legally established programs.

Your Written Authorization Is Required:

Other uses and disclosures of your medical information that are not described above will only be made with your written authorization. You may give us written authorization to use or to disclose your medical information to anyone for any purpose.

You may revoke your authorization at any time. However, your revocation will not affect any use or disclosure that you permitted prior to your revocation.

YOUR INDIVIDUAL RIGHTS

Access to Your Information: You have the right to inspect or obtain a copy of the medical information about you that is contained in a “designated record set” except for psychotherapy notes and certain other information. A “designated record set” generally contains medical and billing records as well as other records that are maintained by or for us, or used by or for us to make decisions about you.

We may ask you to submit your request in writing and to provide us with the specific information we need in order to fulfill your request. We reserve the right to charge a reasonable fee for the cost of producing and mailing the copies to you. In certain situations, we may deny your request to inspect or obtain a copy of the requested information. If we deny your request, we will notify you in writing and may provide you with an opportunity to have the denial reviewed.

Accounting of Disclosures: You have the right to receive a list of instances in which we or our Business Associates disclosed your medical information for purposes other than treatment, payment, health care operations or those authorized by you as well as for certain other activities that occurred up to six years before the date of your request. However, you will not be able to obtain a list of disclosure instances that occurred prior to April 14, 2003; the date this notice is effective. Any list we send you will include the date(s) of the disclosure, to whom it was made, their address, a brief description of the information disclosed and the purpose of the disclosure. If you request this accounting list more than once in a 12-month period, we may charge you a reasonable administration fee for these additional requests.

Restrictions on Use or Disclosure: You have the right to request that we restrict the use or disclosure of your medical information in connection with treatment, payment and health care operations. You also have the right to request that we restrict disclosures to persons involved in your health care or payment for your health care. We may ask you to submit your request in writing. We will review your request, but we are not required to comply with it.

Confidential Communication: You have the right to request that we communicate with you about your medical information by a different means or location. You must make your request in writing and state that the information could endanger you if it is not communicated by a different means or location. We must accommodate your request if it is reasonable and specifies the new means or location of contact. It must also allow us to collect payment for services rendered. Once your request for confidential communications is in effect, all of your medical information will be communicated in accordance with your instructions.

Amending Your Medical Information: If you believe that the medical information contained in your “designated record set” is not correct or complete, you have the right to request that we amend it. We require your request be in writing and that it explains why the information should be changed. If we make the amendment, we will notify you. In addition, if we make the change, we will make reasonable efforts to inform others, including people you name, of the amendment and to include the changes in any future disclosures of that information.

If your request is denied, you will be notified in writing of the reason for the denial and the letter will explain how to file a written statement of disagreement. The Center has the option to rebut your statement. You have the right to ask that your original request, our denial and your statement of disagreement be included with any future disclosures of your information.