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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,
Robin Burleson, LSW.
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, Robin Burleson, LSW, at 937-492-6900 for
further information about the complaint process.
This notice
was published and becomes effective on April 14, 2003.
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