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This notice describes how we use your health information within the Facility and disclose it outside of the Facility and why.
This notice covers:
• Uses or disclosures which do not require your written authorization.
• Treatment, payment and health care operations.
• Uses or disclosures of your health information to which you may object.
• Uses or disclosures required or permitted.
• Uses of disclosures which require your written authorization.
• Your rights as a resident regarding privacy of your health information.
• Our duties in protecting your health information.
• Complaints, contact person, effective date and acknowledgement.
We may use or disclose your health information for the following purposes, unless you ask us not to.
• Facility directories: We maintain a resident directory including, for each resident, name, location in our Facility, health condition in general terms, and religious affiliation. We may disclose this information to people who may ask for you by name. We will make known your religious affiliation only to clergy.
• Informing family and friends. We may disclose your health information to family, friends or other identified by you who are involved in your care.
• Assistance in disaster relief efforts.
• For fundraising activities: We may contact you or your family for fundraising purposes. If you do not wish to be contacted for this purpose, please contact the Privacy Officer and indicate that you do not wish to receive fundraising communication from us.
• Confirming appointments.
• Informing you about treatment alternatives or other health-related benefits and services that may be of interest to you.
If you object to our use of your health information for any of these purposes, please contact the Privacy Officer.
Where we are required or permitted to do so, we may use or disclose your health information in the following circumstances without your written authorization.
• Federal government investigation, when required by the Secretary of Health and Human Services, to investigate or determine our compliance with federal regulation.
• Federal, state and local law requirements.
• Public health activities, for example, to report communicable diseases or death, or for matters involving the Food and Drug Administration.
• Reporting of abuse, neglect or domestic violence.
• Health oversight activities by a health oversight agency. (A health oversight agency is an organization authorized by the government to oversee eligibility and compliance and to enforce civil rights laws.)
• Judicial or administrative proceedings, for example, responding to a court order or subpoena.
• Law enforcement purposes, for example, to report certain types of wounds or other physical injuries or to identify or locate a suspect, fugitive, material witness, or missing person.
• Use by coroners, medical examiners or funeral directors. • Facilitating organ, eye or tissue donation.
• Research, provided that very strict controls are enforced.
• Averting a serious threat to health or safety or that of the public.
• Specialized government functions such as military or veterans’ affairs, national security and intelligence activities.
• Workers’ Compensation.
Your written authorization (in writing) which may revoke; is required, if we use or disclose your health information for any purpose, in particular:
• Our use of psychotherapy notes beyond treatment, payment and health care operations.
• Marketing of goods or services to you.
YOUR RIGHTS AS A RESIDENT TO PRIVACY OF YOUR HEALTH INFORMATION
• Right to Request Restrictions: You have the right to request restrictions on our uses and disclosures of your health information, however, we may refuse to accept the restriction.
• Right to Request Confidential Communications: You have the right to request that we communicate with you confidentially, for example, to speak with you only in private; to send mail to an address you designate or to telephone you at a number you designate (however, your request must be in writing). We will make every attempt to honor your request.
• Right to Access Your Health Information: You have the right to request access to your health information in order to inspect or copy it. Your request must be in writing. We may deny your request and, if so, you may request a review of the denial. However, we will make every attempt to honor your request.
• Right to Request an Amendment of Your Health Information: You have the right to request an amendment to your health information. Your request must be in writing and must provide a reason for the amendment. We may deny your request and, if so, may submit a statement of disagreement. However, we will make every attempt to honor your request.
• Right to Request an Accounting of Disclosures of Your Health Information: You have the right to request an accounting of our disclosures of your health information for purposes other than treatment, payment, and healthcare operations. We will make every attempt to honor your request. We are not required to provide an account for disclosures before August 14, 2003 or for more than six years prior to the date of your request.
To exercise any of these rights, please write or call the Privacy Officer.
OUR DUTIES IN PROTECTING YOUR HEALTH INFORMATION
• We are required by law to maintain the privacy of your health information.
• We must inform residents or their legal representatives of our legal duties and privacy practices with respect to health information. This Notice discharges that duty.
• We must abide by the terms of the Notice currently in effect.
• We reserve the right to change the terms of this notice and to make the new notice provisions effective for all health information that we maintain. At any time, you may obtain a copy of the current notice from the Privacy Officer.
COMPLAINTS, CONTACT PERSON, EFFECTIVE DATE AND ACKNOWLEDGEMENT
• You may complain to us and to the Secretary of Health and Human Services, if you believe your privacy rights have been violated.
• You will not be retaliated against for filing a complaint.
• You may file your complaint with our Facility by writing to the Privacy Officer. This is posted throughout the Facility.
• You may file a complaint with the Secretary of Health and Human Services by writing to:
Secretary of Health and Human Services U.S.
Department of Health and Human Services
200 Independence Avenue S.W.
Washington, DC 20201 (Source: www.hhs.gov)
• For further information, you may write or call the Privacy Officer: Administrator
• The information and practices in this Notice are effective as of September 1, 2014 and are subject to later amendments.
• When you sign your Admission Agreement, you will be acknowledging that you have received and understand this HIPAA Notice of Privacy Practices.
