OUR LADY OF PEACE NURSING CARE RESIDENCE
Notice of Privacy Practices
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.
We respect the privacy of your personal health information and are committed to maintaining our patients’ confidentiality. This Notice applies to all information and records related to your care that our facility has received or created. It extends to information received or created by our employees, staff, volunteers and physicians. This Notice informs you about the possible use and disclosures of your personal health information. It also describes your rights and obligations regarding your personal health information. Please read it carefully.
We are required by law to:
· maintain the privacy of your protected health information;
· provide to you this detailed Notice of our legal duties and privacy practices relating to your personal health information; and
· abide by the terms of the Notice that are currently in effect.
I. WITH YOUR CONSENT, WE MAY USE AND DISCLOSE YOUR PERSONAL HEALTH INFORMATION FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS
You will be asked to sign a Consent allowing us to use and disclose your personal health information for purposes of treatment, payment and health operations. We have described these uses and disclosures below and provide examples of the types of uses and disclosures we may make in each of these categories.
For Treatment. We will use and disclose your personal health information in providing you with assessing your condition, treatment and care planning services. We may disclose or share your personal health information to facility and non-facility personnel who may be involved in your care, such as physicians, nurses, nurses aides, consultants, and physical, occupational and speech therapists. We may also share information with other nursing homes, hospitals, ambulance, labs, x-ray service, pharmacy, family or designated representative of choice. We may also use your information in the facility’s directory, birthdays, photographs, expirations, and be shared with your church/temple. For example, a nurse caring for you will report any change in your condition to your physician. We also may disclose personal health information to individuals who will be involved in your care after you leave the facility, such as home health care agencies.
For Payment. We may use and disclose your personal health information so that we can bill and receive payment for the treatment and services you receive at the facility. For billing and payment purposes, we may disclose your personal health information to your representative, an insurance or managed care company, Medicare, Medicaid, HMO, workman’s compensation, insurance operations or other third party payor. For example, we may contact Medicare or your health plan to confirm your coverage or to request prior approval for a proposed treatment or service.
For Health Care Operations. We may use and disclose your personal health information for facility operations. These uses and disclosures are necessary to manage the facility and to monitor our quality of care. For example, we may use personal health information to evaluate our facility’s services, including the performance of our staff.
We require that you sign a Consent, as described above, as a condition of our providing treatment to you because the uses and disclosures of your personal health information are essential to our ability to care for you.
II. WE MAY USE AND DISCLOSE PERSONAL HEALTH INFORMATION ABOUT YOU FOR OTHER SPECIFIC PURPOSES
Facility Directory. We will include certain limited information about you in our facility directory while you are a resident of Our Lady of Peace Nursing Care Residence. This information will include your name, your location in the facility and your religious affiliation. The directory information, except for your religiou affiliation, will also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest, rabbi or minister, or a lay person who has been appointed by your priest or minister as a pastoral visitor, even if they do not ask for you by name. This is so your family, friends and clergy can visit you and generally know how you are going. If you do not wish to be included in the facility directory for clergy visits, please notify us at the time of admission. If you do not wish information to be provided to your family or friends, please notify us at the time of admission.
Photos. We may disclose your photo for in-house identification purposes and as needed for medical care/treatment.
Individuals Involved in Your Care or Payment for Your Care. We may release health information about you to a family member, other relative, or any other person identified by you who is involved in your health care. We may also give information to someone who helps pay for your care. We may also tell your family, friends, personal representative or other person responsible for your health care your condition and that you are at the facility. In addition, we may disclose health information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
Disaster Relief. We may disclose your personal health information to an organization assisting in a disaster relief effort.
As Required By Law. We may disclose your personal health information, when required, to law enforcement, military, regulatory, national security, accrediting agency, board of directors, statistical research.
Public Health Activities. We may disclose your personal health information for public health activities. This information may be shared with the facility’s ombudsman. While there may be others, public health activities generally include the following:
· Reporting to a public health or other government authority for preventing or controlling disease, injury or disability, or reporting abuse or neglect;
· Reporting to the federal Food and Drug Administration (FDA) concerning adverse events or problems with products for tracking products in certain circumstances, to enable product recalls or to comply with other FDA requirements;
· to notify a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition; or
· for certain purposes involving workplace illness or injuries.
Health Oversight Activities. We may disclose your personal health information to a health oversight agency for oversight activities authorized by law. These may include, for example, audits, investigations, inspections and licensure actions or other legal proceedings. These activities are necessary for government oversight of the health care system, government payment or regulatory programs, and compliance with civil rights laws.
Judicial and Administrative Proceedings. We may disclose your personal health information in response to a court or administrative order. We also may disclose information in response to a subpoena, discovery request, or other lawful process; efforts must be made to contact you about the request or to obtain an order or agreement protecting the information.
Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute. This disclosure will be made after Our Lady of Peace Nursing Care Residence receives satisfactory assurances that a reasonable effort has been made either to give you notice of the request or to secure a qualified protective order.
Law Enforcement. We may disclose your personal health information for certain law enforcement purposes, including
· as required by law to comply with reporting requirements;
· to comply with a court order, warrant, subpoena, summons, investigative demand or similar legal process;
· to identify or locate a suspect, fugitive, material witness, or missing person;
· when information is requested about the victim of a crime if the individual agrees or under other limited circumstances;
· to report information about a suspicious death;
· to provide information about criminal conduct occurring at the facility;
· to report information in emergency circumstances about a crime; or
· where necessary to identify or apprehend an individual in relation to a violent crime or an escape from lawful custody.
Research. We may allow personal health information of patients from our facility to be used for disclosed for research purposes provided that the researcher adheres to certain privacy protections. Your personal health information may be used for research purposes only if the privacy aspects of the research have been reviewed and approved by a special Privacy Board or Institutional Review Board, if the researcher is collecting information in preparing a research proposal, if the research occurs after your death, of if you authorize the use or disclosure.
Coroners, Medical Examiners, Funeral Directors, Organ Procurement Organizations. We may release your personal health information to a coroner, medical examiner, funeral director or, if you are an organ donor, to an organization involved in the donation of organs and tissue.
To Avert a Serious Threat to Health or Safety. We may use and disclose your personal health information when necessary to prevent a serious threat to your health or safety or the health or safety of the public or another person. However, any disclosure would be made only to someone able to help prevent the threat.
Military and Veterans. If you are a member of the armed forces, we may use and disclose your personal health information as required by military command authorities. We may also use and disclose personal health information about foreign military personnel as required by the appropriate foreign military authority. We may also use and disclose personal health information to the Department of Veteran’s Affairs for purposes related to receiving benefits.
National Security and Intelligence Activities; Protective Services for the President and Others. We may disclose personal health information to authorized federal officials conducting national security and intelligence activities or as needed to provide protection to the President of the United States, certain other persons or foreign heads of states or to conduct certain special investigations.
Fundraising Activities. We may disclose health information to a foundation related to Our Lady of Peace Nursing Care Residence so that the foundation may contact you to raise money for Our Lady of Peace Nursing Care Residence and its operations. In these cases, we would release only contact information, such as your name, address and phone number and the dates you were here. If you do not want us to contact you for fundraising efforts, you must notify the Privacy Officer, Our Lady of Peace Nursing Care Residence, 5285 Lewiston Road, Lewiston, N.Y. 14092, in writing.
Appointment Reminders. We may use or disclose personal health information to remind you about appointments.
Treatment Alternatives. We may use or disclose personal health information to inform you about treatment alternatives that may be of interest to you.
Health-Related Benefits and Services. We may use or disclose personal health information to inform you about health-related benefits and services that may be of interest to you.
III. YOUR AUTHORIZATION IS REQUIRED FOR OTHER USES OF PERSONAL HEALTH INFORMATION
We will use and disclose personal health information (other than described in this Notice or required by law) only with your written Authorization. You may revoke your Authorization to use or disclose personal health information in writing, at any time. If you revoke your Authorization, we will no longer use or disclose your personal health information for the purposes covered by the Authorization, except where we have already relied on the Authorization.
IV. YOUR RIGHTS REGARDING YOUR PERSONAL HEALTH INFORMATION
Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care.
We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
To request restrictions, you must make your request in writing to: Privacy Officer, Our Lady of Peace Nursing Care Residence, 5285 Lewiston Road, Lewiston, N.Y. 14092. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply.
Right to Request Confidential Communications. You have the right to request that we communicate with you or your responsible party about your health care in an alternative way or at a certain location. For example, you may ask that we use an address other than your home address for billing purposes, or that we do not leave a message on your telephone voice mail.
To request confidential communications, you must make your request in writing to Privacy Officer, Our Lady of Peace Nursing Care Residence, 5285 Lewiston Road, Lewiston, N.Y. 14092. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to Inspect and Copy. In most circumstances, you have the right to inspect and obtain a copy of your health information that may be used to make decisions about your care.
To inspect and copy health information that may be used to make decisions about you, you can submit your request in writing to Director of Health Information Management, Our Lady of Peace Nursing Care Residence, 5285 Lewiston Road, Lewiston, N.Y. 14092. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
We may deny your request to inspect and copy in certain circumstances. If you are denied access to health information, you may request that the denial be reviewed. If your request is reviewed, another licensed health care professional chosen by Our Lady of Peace Nursing Care Residence will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Right to Amend. If you feel that health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to ask us to amend your health and/or billing information for as long as the information is kept by us. This means you may add additional information to your file, it does not mean we will agree to remove documentation from your file.
To request an amendment, your request must be made in writing and submitted to the Health Information Coordinator, Our Lady of Peace Nursing Care Residence, 5285 Lewiston Road, Lewiston, N.Y. 14092. In addition, you must provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
· Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
· Is not part of the health information kept by or for Our Lady of Peace Nursing Care Residence;
· Is not part of the information which you would be permitted to inspect and copy; or
· Is accurate and complete.
Right to an Accounting of Disclosures. You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of health information about you. The list will not include any of the uses and disclosures for treatment, payment and health care operations or for certain other limited reasons.
To request this list of disclosures, you must submit your request in writing to Health Information Coordinator, Our Lady of Peace Nursing Care Residence, 5285 Lewiston Road, Lewiston, N.Y. 14092. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a twelve-month period will be free. For additional lists, during such twelve-month period, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time.
· You may obtain a copy of this Notice at our web site at www.ourladyofpeace.org.
· To obtain a paper copy of this Notice, contact Privacy Officer, Our Lady of Peace Nursing Care Residence, 5285 Lewiston Road, Lewiston, N.Y. 14092.
V. COMPLAINTS
· If you believe that your privacy rights have been violated, you may file a complaint in writing with the facility or with the Office of Civil Rights in the U.S. Department of Health and Human Services. To file a complaint with the facility, contact the Privacy Officer, Our Lady of Peace Nursing Care Residence, 5285 Lewiston Road, Lewiston, N.Y. 14092.
You will not be penalized for filing a complaint.
VI. CHANGES TO THIS NOTICE
We will promptly revise and distribute this Notice whenever there is a material change to the uses or disclosures, your individual rights, our legal duties, or other privacy practices stated in this Notice. We reserve the right to change this Notice and to make the revised or new Notice provisions effective for all personal health information already received and maintained by the facility as well as for all personal health information we receive in the future. We will post a copy of the current Notice in the facility. In addition, we will provide a copy of the revised Notice to all residents. A hard copy of the revised Privacy Notice will be provided to all residents, family members or responsible party.
VII. FOR FURTHER INFORMATION
· If you have any questions about this Notice or would like further information concerning your privacy rights, please contact Privacy Officer, Our Lady of Peace Nursing Care Residence, 5285 Lewiston Road, Lewiston, N.Y. 14092.
VIII. YOUR RIGHTS REGARDING YOUR PERSONAL HEALTH INFORMATION
You have the following rights regarding your personal health information at the facility:
We are required to agree to your requested restrictions unless you are being transferred to another health care institution, the release of records is required by law, or the release of information is needed to provide you emergency treatment.
Right of Access to Personal Health Information. You have the right to request your medical or billing records or other written information that may be used to make decisions about your care. This request should be sent to the Privacy Officer, Our Lady of Peace Nursing Care Residence, 5285 Lewiston Road, Lewiston, N.Y. 14092. We must allow you to inspect your records within 24 hours of your request. If you request copies of your records, we must provide you with copies within 2 days of that request. We may charge a reasonable fee for our costs in copying and mailing your requested information.
