NOTICE OF PRIVACY PRACTICES

This notice of Privacy Practices (the “Notice”) describes the Facility’s practices and those of Facility employees, staff, volunteers, and other personnel who are involved in your or your loved one’s care.

The Facility’s Pledge Regarding Medical Information

The facility understands that medical information about you or your loved one is personal. The facility is committed to protecting medical information about you or your loved one. To provide you with quality care and to comply with certain state and federal legal requirements, the Facility creates a record of the services you or your loved one will receive at the facility. This notice applies to all of the records of your care generated by the Facility.

The Facility is required by law to:

• Make sure that medical information that identifies you or your loved one is kept private
• Give you or your loved one this Notice of its legal duties and privacy practices concerning medical information about you or your loved one
• Follow the terms of the Notice that are currently in effect
• Notify you in case there is an unauthorized use of disclosure of your unsecured medical information.

How the Facility may use and disclose medical information about you or your loved one

The following categories describe different ways that the Facility may use or disclose protected medical information.

• Treatment – The facility may use medical information about you or your loved one to provide you or your loved one with medical treatment and to coordinate of manage you or your loved one’s medical treatment and any related services.
• For Payment – The facility may use and disclose medical information about you or your loved one so that the facility can get paid for the treatment and services you or your loved one received at the Facility.
• For Health Care Operations – The facility may use and disclose medical information about you to carry out activities that are necessary for Facility Operations.
• Facility Directory – If you or your loved one chooses, the facility may list your name, room number, general description of your condition (excluding medical information), and your religious affiliation in the Facility’s Directory of Residents (if applicable)
• To Individuals or Family Members Involved in Your Health Care – Unless you or your loved one objects, the facility may disclose medical information about you to a member of your family, a relative, close friend, or any other person that you identify who is involved in your care, of your location, general condition or death, unless you object
• Emergencies – The facility may disclose medical information about you or your loved one to a public or private entity assisting in disaster relief so that your family can be notified about your condition, status, or location.
• As Required by low – The facility will disclose your health information when required to do so by federal, state or local law.
• For Public Health Activities – The facility may disclose medical information about you or your loved one for public health activities. These proposes generally include the following:
  • To prevent or control disease, injury or disability
  • To report deaths
  • To report abuse or neglect of children, elders and dependent adults
  • To report reactions to medications or problems with products
  • To notify people of recalls of products they may be using
  • To notify a person who may have been exposed to a disease or who may be at risk for contracting of spreading a disease of condition.
• For Health Oversight Activities – the facility may disclose medical information about you to a health oversight agency for activities authorized by law.
• For Lawsuits and Disputes – The facility may disclose medical information about you or your loved one in response to a court or administrative order, subpoena, discovery request or other lawful process.
• Disclosure to Law Enforcement – The facility may release medical information to:
  • Identify or locate a suspect, fugitive, material witness, or mission person
  • About a suspected victim of a crime if under certain limited circumstances, we are unable to obtain the person’s agreement
  • About a death suspected to be the result of criminal conduct
  • About criminal conduct at the facility
  • In case of a medical emergency, to report a crime, the location of the crime or victims or the identity, description or location of the person who committed the crime.
• Decedents – The facility may release medical information about you or your loved one to a coroner, or medical examiner.
• For Specialized Government Functions – The facility may disclose medical information about you to authorized federal officials for intelligence, counterintelligence and other national security activities.
• Information about inmates/Individuals in Custody – If you are an inmate or under the custody of a law enforcement official, the Facility may release medical information about you to the correctional institution or law enforcement official responsible for you as authorized or required by law.
• Disclosure for Threats to Health and Safety – the facility may be required to disclose medical information to avert a serious threat to your health and safety or the health and safety of another person as required by law enforcement.  The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law.

Changes to this Notice

The facility reserves the right to change the terms of this notice at any time.

Questions and Complaints

If you have any questions or believe that your privacy rights have been violated, you may contact the Facility’s HIPPA Privacy Officer in person or mail a written summary of your concern.

You may also file a written complaint with the Department of Health and Human Services at the following address:

U.S. Department of Health and Human Services

Office of Civil Rights

Centralized Case Management Operations

200 Independence Ave., S.W.

Suite 515F, HHH Building

Washington, D.C. 20201

Phone: 800-368-1019 Fax: 202-619-3818

You will not be penalized or retaliated against for filing a complaint.