PRIVACY NOTICE- USES AND DISCLOSURES OF HEALTH INFORMATION

“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.”

GENERAL INFORMATION:  When you are admitted, receive treatment or diagnostic services at this Facility a record of visits/services is made.  The record will generally include a history, physical, consultations, assessment by nursing, social services, dietary, diagnostic reports, such as x-ray and laboratory results, the Minimum Data Set, medications, treatments, care plan/plan of care, authorizations, consents, progress notes by the physician, nursing, social services and others involved in the treatment services.  This information is included in your health record either manual and/or computerized and is issued as a:

• Source for documenting assessment, planning care and treatment, recording informed consent, recording progress, ongoing assessment of health status/progress/needs
• Means of communicating among health professionals who evaluate you and/or provide care and treatment, copies are provided for continuity of care to consultants, hospitals, emergency room or other Health Facility where you might be transferred
• Source to support billing for services and to meet the requirements of third party payers
• Legal document supporting the care, services and treatment provided
• A resource during surveys by the state, federal and other review agencies
• A tool with which we can assess and continually work to improve care
• A source to be used by students and a tool in educating health professionals

Understanding what is in your record ands how your health information is used will assist you to:  ENSURE ACCURACY, BETTER UNDERSTAND who, what, when, where, and why others may need access to your health information, MAKE INFORMED DECISIONS when authorizing disclosure to others.

YOUR RIGHTS:  The health record is the physical property the Facility that compelled it.  The information belongs to you.  YOU HAVE THE RIGHT TO:

• Request restriction on certain uses and disclosures of your information provided by 45 CFR 164.522.
• Restriction may be terminated in writing or orally and then documented in the record.
• Inspect and copy your health record as provided in 45 CFR 164.528.
• Request alternate means of communication to obtain your health information 45 CFR 164.522(b).
• Request an accounting of disclosures of Protected Health Informed 45 CFR 164.528.
• Request receipt of the notice electronically and/or to obtain a paper copy of the notice 164.52(b)(1)(lv)(f)
  Revoke authorization to use or disclose health information except to the extent that action has already been taken 45 CFR 164.508(b)(5)
• Report a problem- or if you have a question or desire additional information, you may contact the Medical Records Department, at (209) 956-3444, or if not satisfied, contact the Privacy Officer/Administrator at the same number.
• File a complaint if you think your privacy rights have been violated.  If you are not satisfied with the response to your concern, you may file a written or oral complaint with the Administrator.  If your response is still a concern, you may file a complaint with O’Connor Woods. (209) 956-3400.
• You are also notified that you may file a complaint with the Secretary of Health and Human Services, Office for Civil Rights.

FACILITY RESPONSIBILITY

The facility is responsible to:
Maintain the privacy of your health information, to use and disclose information only with your authorization, unless there are exceptions described in this notice or otherwise allowed by related laws, rules and regulations.

• Provide you with a notice as to our legal duties and privacy practices with respect to information we collect, maintain, use, and disclose about you.
• Abide by this notice
• Provide any amendment record along with other documents when information is disclosed
  Notify you if we are unable to agree to requested restriction(s)
• Accommodate reasonable requests you may have to communicate health information by alternate means of to alternate locations
• Use or disclose your health information as required for statistical and funding purposes by the Offices to Statewide Health Planning and Development, the Centers for Medicare and Medicaid Services CMS)
• The facility reserves the right to change our privacy practices and to make new Practices known to you through our routine methods of communications to the latest address/contact provided.

EXAMPLES OF DISCLOSURE FOR TREATMENT, PAYMENT AND HEALTH OPERATIONS

Your health information will be used for the following: 
We will use your information for treatment.  Information obtained by the physician(s), nursing, social, administrative staff or other providers of service will be recorded in your record.  This information is used to plan your treatment and services as well as to document progress, events, plans of care, observations and evaluation of care and treatment, information for consultants, diagnostic services or for other providers on transfer to another Facility or Hospital.  We will use your Health Information for payment.  A bill may be sent to a third party such as Medicare.  Health Maintenance Organizations (HMO), and Insurance Companies or to you.  At least some health information may be provided to the payee that identifies your demographic information, the diagnoses and additional health information to support the billing.

We will use your health information for health care operations.
The facility and Corporation and staff will use the health/medical record information as needed to carry out the regular operations of the Facility and the respective clinical needs of the treatment staff including the

• Collecting and reporting to the Office of Statewide Health Planning & development
• Use for specific quality assurance processes, committee meetings, on-site reviews for management, internal survey’s
• Health record information needed for administrative reporting usually for internal Facility use and/or the Corporation.  Uses of this information may or may not be specific to a patient’s name i.e. collecting information regarding incidents and trending information.

Business Associates:  The Facility may use outside providers for some of the services that we provide through contracts/agreements.  Some examples of these services are the use of specialty consultants; i.e. psychiatry, podiatry, radiology, etc., certain diagnostic tests that are not carried
out by the Facility, or consultant educators who many use the specific information to carry out training for the Facility staff.

Patient Location:  Patient location will be provided (unless there is an opposing designation in writing) to those individuals who are determined to be legally authorized to obtain information, i.e., responsible party, emergency contact, designated alternates.

Notification and Communication:  the Facility may use or disclose health information to notify or assist on notifying representatives as identified as a responsible party, emergency contact, designated alternate.   The latest available address will be utilized.  It is understood the information may be provided to you for appointments, results of test, general information that would not be confidential via telephone, including voice mail message, email, fax, and written.  The Facility may notify the responsible representative of the appointments, special meetings to discuss care and treatment, at other times related to the condition/status of the patient.  The Facility or the Corporation is not responsible for assuring the information is retained private once it is provided through agreed upon communication methods or when submitted to the parties names as contacts.

Research:  Disclosure of the health information for the purposes of the research shall only be made after a documented approval for the research.  Names of the individuals will not be included unless there is a specific authorization.

Funeral Directors and Coroner’s Office:  In the event it is necessary we may disclose health information to funeral directors and coroner’s office consistent with applicable laws as required for them to carry out their duties.

Food and Drug Administration, Public Health and other required reporting:  We may disclose health information to the extent that is required by law and in the best interest of the client and the requirements of the requesting agency.

Worker’s Compensation and Employee Actions:  Information may be disclosed to the extent only as required to carry out the required activities.  The privacy or the resident/patient will be protected within the legal parameters of the state.

Law Enforcement:  Disclosure of the health information will be provided to the extent necessary to carry out the health and safety of the individual, i.e., general description of the person, applicable health condition, special marks, clothing type, other identification data, and information as required by law based on the situation.

Facility Postings:  the facility posts names for identification at the rooms; a bed list is created daily to identify the location of each resident; birthdays are posted.

Effective Date:  April 14, 2003