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 have summarized our responsibilities and your rights in the two following sections. For a complete description of our privacy practices, please review this entire notice.

Our Responsibilities

We are required to:

Your Rights

You have several rights with regard to your health information, including the following:

We reserve the right to change our privacy practices and to make the new provisions effective for all health information we maintain. Should our privacy practices change, we will post the changes in our facility, and on our web site. A copy of the revised notice will be available after the effective date of the changes upon request.

We will not use or disclose your health information without your authorization, except as described in this notice.

If you have questions and would like additional information, you may contact the facility’s Privacy Officer or Security Officer.  Click here for contact information for each of our facilities.

Who Will Follow This Notice

This notice describes the practices of our nursing facility and of the following persons and entities:

All of the persons and entities noted above will follow the terms of this notice with regard to your health information for services provided in our nursing facility or to you while you are a guest in our facility regardless of where the services are actually provided.  In addition, these persons and entities may share your health information with each other for treatment, payment or other health care operations purposes as described in this notice.

Understanding Your Health Record/Information

Each time you are a guest in our nursing facility, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:

Understanding what is in your record and how your health information is used helps you to: ensure its accuracy, better understand who, what, when, where, and why others may access your health information, and make more informed decisions when authorizing disclosure to others.

How We Will Use or Disclose Your Health Information

(1)  Treatment: We will use or disclose your health information for treatment purposes, including for the treatment activities of other health care providers. For example, information obtained by a nurse, physician, or other member of your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician, nurse practitioner, and/or physician’s assistant will document in your record his or her expectations of the members of your healthcare team. Members of your healthcare team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment. We will also provide your physician or a subsequent healthcare provider with copies of various reports that should assist him or her in treating you once you are discharged from our nursing facility.

(2)  Payment: We will use or disclose your health information for payment, including for the payment activities of other health care providers or payers. For example, a bill may be sent to you or a third-party payer, including Medicare or Medicaid. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.

(3)  Health care operations:   We will use or disclose your health information for our regular health operations. For example, members of the medical staff, the quality assurance risk manager, or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the health care and service we provide.  In addition, we will disclose your health information for certain health care operations of other entities.

(4)  Business associates:  There are some services provided in our organization through the use of outside people and entities. Examples of these “business associates” include our medical records consultants and attorneys. We may disclose your health information to our business associates so that they can perform the job we have asked them to do. To protect your health information, however, we require the business associates to appropriately safeguard your information.

(5)   Directory:  Unless you notify us that you object, we may use your name, location in the facility, general condition, and religious affiliation for directory purposes. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name. We may also use your name on the nameplate next to or on your door in order to identify your room, unless you notify us that you object.

(6)   Photos and Personal Information:  Unless you notify us that you object, we may use photographs and/or videos and other non-medical personal information such as your name, birthday, or home town within the facility’s social, dining, or activities programs.  

(7)  Notification:  We may use or disclose information to notify or assist in notifying a family member, personal representative, or other person responsible for your care, of your location and general condition. If we are unable to reach your family member or personal representative, then we may leave a message for them at the phone number that they have provided us, e.g., on an answering machine.

(8)  Communication with family:  We may disclose to a family member, other relative, close personal friend or any other person involved in your health care, health information relevant to that person’s involvement in your care or payment related to your care.

(9)  Research:  We may disclose information to researchers when certain conditions have been met.

(10)  Transfer of information at death:  We may disclose health information to funeral directors, medical examiners, and coroners to carry out their duties consistent with applicable law.

(11)  Organ procurement organizations:  Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

(12)  Marketing:  We may contact you regarding your treatment, to coordinate your care, or to direct or recommend alternative treatments, therapies, health care providers or settings. In addition, we may contact you to describe a health-related product or service that may be of interest to you, and the payment for such product or service.

(13)  Fund raising:  We may contact you as part of a fund-raising effort.

(14)  Food and Drug Administration (FDA): We may disclose to the FDA, or to a person or entity subject to the jurisdiction of the FDA, health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

(15)  Workers compensation:  We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

(16)  Public health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

(17)  Correctional institution:  Should you be an inmate of a correctional institution, we disclose to the institution or agents thereof health information necessary for you health and the health and safety of other individuals.

(18)   Law enforcement:  We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.

(19)   Reports:  Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more guests, workers or the public.

(20)   Medicare and Medicaid surveys:  We participate in the Medicare and Medicaid programs and are surveyed by the government to ensure that we are in compliance with the requirements of participation.  These surveys are conducted at least every fifteen (15) months.  During the survey, government employees look through guest records, and we are not informed of all of the records that are reviewed.  It is therefore possible that a government surveyor will review your health information. 

(21)   Lawsuits and disputes:  We may disclose your health information in response to a court or administrative subpoena, a discovery request, or other lawful process.

(22)   As required by law:  We will disclose health information about you when required to do so by local, state, or federal law.

Your Health Information Rights

Although your health record is the physical property of the nursing facility, the information in your health record belongs to you. You have the following rights:

For More Information or to Report a Problem

If you have questions and would like additional information, you may contact the facility’s Privacy Officer or Security Officer.  Click here to access contact information for individual locations

If you believe that your privacy rights have been violated, you may file a complaint with us. These complaints must be filed in writing on a form provided by our facility. The complaint form may be obtained at our nurses’ station, from our facility’s Privacy Officer or our Security Officer and when completed should be returned to our Privacy Officer or Security Officer. You may also file a complaint with the secretary of the federal Department of Health and Human Services. There will be no retaliation for filing a complaint.


Effective Date: March 15, 2003