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Notice of Privacy Practices THIS NOTICE DECRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. As an organization we respect the privacy of your personal health information and are committed to maintaining our patients'/ residents' confidentiality. This Notice applies to all information and records related to your care that our entities have received or created. It extends to information received or created by our employees, staff, volunteers, and physicians belonging to Absolut Organized Health Care Arrangement (OHCA). The OHCA includes Absolut provider facilities located in New York and BILLit Accounting and Information Technology, LLC., which provides consulting and financial services, located in New York. This Notice informs you about the possible uses and disclosures of your personal health information by this OHCA. It also describes your rights and our obligations regarding your personal health information. We are required by law to: I. WE MAY USE AND DISCLOSE YOUR PERSONAL HEALTH INFORMATION FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS: For Treatment. We will use and disclose your personal health information in providing you with treatment and services. We may disclose your personal health information to facility and non-facility personnel who may be involved in your care, such as physicians, nurses, nurse aides, and physical therapists. 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. 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 or another 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 operational purposes. These uses and disclosures are necessary to manage and monitor our quality of care. For example, we may use personal health information to evaluate our facilities’ services, including the performance of our staff. II. WE MAY USE AND DISCLOSE PERSONAL HEALTH INFORMATION ABOUT YOU FOR OTHER SPECIFIC PURPOSES: Facility Directory. Unless you object, we may include certain limited information about you in the facility directory. Our directory will not include specific medical information. This information may include your name, your location in the facility and your general condition and your religious affiliation. We may release information in our directory, except your religious affiliation, to people who ask for you by name. We may provide the directory information, including your religious affiliation, to any member of the clergy. If you have any objection to such use, please put it in writing and deliver to the facility administrator. Unless you object, we may use and display name tags or badges and resident photographs in the facility for activity programs and safety concerns. We may also label resident property for identification reasons. Make any such objection in writing and deliver to the facility administrator. Individuals Involved in Your Care or Payment for Your Care. Unless you object, we may disclose your personal health information to a family member or close friend, including clergy, who is involved in your care. Make any such objection in writing and deliver to the facility administrator. Disaster Relief. We may disclose your personal health information to an organization assisting in a disaster relief effort. As Required By Law. We will disclose your personal health information when required by law. Public Health Activities. We may disclose your personal health information for public health activities. These activities may include, for example Reporting Victims of Abuse, Mistreatment, Neglect or Domestic Violence. If we believe that you have been a victim of abuse, mistreatment, neglect or domestic violence, we may use and disclose your personal health information to notify a government authority if required or authorized by law, or if you agree to the report. 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. Law Enforcement. We may disclose your personal health information for certain law enforcement purposes, including Research. We may allow personal health information of patients from our facility to be used or 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, or 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. Workers’ Compensation. We may use or disclose your personal health information to comply with laws relating to workers’ compensation or similar programs. National Security and Intelligence Activities; Protected 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. Appointment Reminders and Follow Up Service After Discharge. We may use or disclose personal health information to remind you about appointments. We may use or disclose personal health information to follow up with you on the care provided while at the facility. 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 as 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: You have the following rights regarding your personal health information at the facility: Right to Request Restrictions. You have the right to request restrictions on our use or disclosure of your personal health information for treatment, payment or health care operations. You also have the right to restrict the personal health information we disclose about you to a family member, friend or other person who is involved in your care or the payment for your care. Make any such request in writing, delivered to the facility administrator. Right of Access to Personal Health Information. You have the right to inspect and obtain a copy of your medical or billing records or other written information that may be used to make decisions about your care. We may charge a reasonable fee for our costs in copying and mailing your requested information. Right to Request Amendment. You have the right to request the facility to amend any personal health information maintained by the facility for as long as the information is kept by or for the facility. You must make your request in writing and must state the reason for the requested amendment. Deliver such a request to the facility administrator. We may deny your request for amendment if the information If we deny your request for amendment, we will give you a written denial including the reasons for the denial and the right to submit a written statement disagreeing with the denial. Right to an Accounting of Disclosures. You have the right to request an “accounting” of our disclosures of your personal health information. This is a listing of certain disclosures of your personal health information made by the facility or by others on our behalf, but does not include disclosures for treatment, payment and health care operations or certain other exceptions. To request an accounting of disclosures, you must submit a request in writing to the administrator, stating a time period beginning after April 13, 2003 that is within six years from the date of your request. An accounting will include, if requesting: the disclosure date; the name of the person or entity that received the information and address, if known; a brief description of the information disclosed; a brief statement of the purpose of the disclosure or a copy of the authorization or request; or certain summary information concerning multiple similar disclosures. The first accounting provided within a 12-month period will be free; for further requests, we may charge you our costs. Right to a Paper Copy of This Notice. You have the right to obtain a paper copy of this notice, even if you have agreed to receive this Notice electronically. You may request a copy at any time. [You may obtain a copy of this Notice at our website, www.absolutcare.com .] Right to Request Confidential Communications. You have the right to request that we communicate with you concerning personal health matters in a certain manner or at a certain location. For example, if you receive outpatient services you can request that we contact you only at a certain phone number. We will accommodate your reasonable requests. V. COMPLAINTS: If you believe that your privacy rights have been violated, you may file a complaint in writing to the Privacy Contact at our facility, the Privacy Officer at Absolutcare or with the Office of Civil Rights in the U.S. Department of Health and Human Services. To file a complaint about a facility, contact the Privacy Officer by calling 1-800-388-2820, enter extension number 2633 and use the "#" sign for direct access. We will not retaliate against anyone who files 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 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. VII. FOR FURTHER INFORMATION: If you have any questions about this Notice or would like further information concerning your privacy rights, please contact our Privacy Officer at the following address or phone number: |
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