|
LUTHERAN HAVEN’S
NOTICE OF PRIVACY INFORMATION PRACTICES
Effective date: 4/14/2003
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.
Please contact Ron Hollerand, Nursing Home Administrator, at phone
number 407-365-3456 if you have any questions regarding this notice.
A. General description and
purpose of notice.
This notice describes our information privacy practices and that of:
1. Any health care professional authorized to enter information into
your medical record created and/or maintained at our facility;
2. Any member of a volunteer group which we allow to help you while
receiving services at our clinic; and
3. All facility employees, staff, and other personnel.
All of the individuals or entities identified above will follow the
terms of this notice. These individuals or entities may share your
health information with each other for purposes of treatment,
payment, or health care operations, as further described in this
notice.
B. Our facility’s policy
regarding your health information.
We are committed to preserving the privacy and confidentiality of
your health information created and/or maintained at our facility.
Certain state and federal laws and regulations require us to
implement policies and procedures to safeguard the privacy of your
health information.
This notice will provide you with information regarding our privacy
practices and applies to all of your health information created
and/or maintained at our facility, including any information that we
receive from other health care providers or facilities. The notice
describes the ways in which we may use or disclose your health
information and also describes your rights and our obligations
regarding any such uses or disclosures. We will abide by the terms
of this notice, including any future revisions that we may make to
the notice as required or authorized by law.
We reserve the right to change this notice and to make the revised
or changed notice effective for health information we already have
about you as well as any information we receive in the future. We
will post a copy of the current notice in our facility. The first
page of the notice contains the effective date and any dates of
revision.
C. Uses or disclosures of
your health information.
We may use or disclose your health information in one of following
ways:
(1) Pursuant to your written consent (for purposes of treatment,
payment or health care operations)
(2) Pursuant to your written authorization (for purposes other than
treatment, payment or health care operations)
(3) Pursuant to your verbal agreement (for use in our facility
directory or to discuss your health condition with family or friends
who are involved in your care);
(4) As permitted by law
(5) As required by law
The following describes each of the different ways that we may use
or disclose your health information. Where appropriate, we have
included examples of the different types of uses or disclosures.
While not every use or disclosure is listed, we have included all of
the ways in which we may make such uses or disclosures.
1. Uses or disclosures made pursuant to your written consent.
We may use or disclose your health information for purposes of
treatment, payment, or health care operations upon obtaining your
written consent. We may condition our delivery of services to you
upon receiving your consent.
a. Treatment. We may use your health information to provide you with
health care treatment and services. We may disclose your health
information to doctors, nurses, nursing assistants, medication
aides, technicians, medical and nursing students, rehabilitation
therapy specialists, or other personnel who are involved in your
health care. For example, your physician may order physical therapy
services to improve your strength and walking abilities. Our nursing
staff will need to talk with the physical therapist so that we can
coordinate services and develop a plan of care. We also may disclose
your health information to people outside of our facility who may be
involved in your health care, such as family members, social
services, or home health agencies.
i. Appoxntment reminders. We may use or disclose your health
information for purposes of contacting you to remind you of a health
care appointment.
ii. Treatment alternatives, Health-related benefits and services. We
may use or disclose your health information for purposes of
contacting you to inform you of treatment alternatives or
health-related benefits and services that may be of interest to you.
b. Payment. We may use or disclose your health information so that
we may bill and collect payment from you, an insurance company, or
another third party for the health care services you receive at our
facility. For example, we may need to give information to your
health plan regarding the services you received from our facility so
that your health plan will pay us or reimburse you for the services.
We also may tell your health plan about a treatment you are going to
receive in order to obtain prior approval for the services or to
determine whether your health plan will cover the treatment.
c. Health care operations. We may use or disclose your health
information to perform certain functions within our facility. These
uses or disclosures are necessary to operate our clinic and to make
sure that our residents receive quality care. For example, we may
use your health information to review our treatment and services and
to evaluate the performance of our staff in caring for you. We may
combine health information about many of our residents to determine
whether certain services are effective or whether additional
services should be provided. We may disclose your health information
to physicians, nurses, nursing assistants, medication aides,
rehabilitation therapy specialists, technicians, medical and nursing
students, and other personnel for review and learning purposes. We
also may combine health information with information from other
health care providers or facilities to compare how we are doing and
see where we can make improvements in the care and services offered
to our residents. We may remove information that identifies you from
this set of health information so that others may use the
information to study health care and health care delivery without
learning the specific identities of our residents.
i. Fundraising activities. We may use a limited amount of your
health information for purposes of contacting you to raise money for
our facility and its operations. We may disclose this health
information to a foundation related to the facility so that the
foundation may contact you to raise money for our facility. The
information which we may use or disclose will be limited to your
name, address, phone number, and dates for which you received
treatment or services at our facility. If you do not want our
facility or affiliated foundation to contact you for these
fundraising purposes, you must notify the Executive Director or
Nursing Home Administrator in writing.
2. Uses or disclosures made pursuant to your written authorization.
We may use or disclose your health information pursuant to your
written authorization for purposes other than treatment, payment or
health care operations and for purposes which are not permitted or
required law. You have the right to revoke a written authorization
at any time as long as your revocation is provided to us in writing.
If you revoke your written authorization, we will no longer use or
disclose your health information for the purposes identified in the
authorization. You understand that we are unable to retrieve any
disclosures which we may have made pursuant to your authorization
prior to its revocation. Examples of uses or disclosures that may
require your written authorization include the following:
a. A request to provide certain health information to a
pharmaceutical company for purposes of marketing
b. A request to provide your health information to an attorney for
use in a civil litigation claim
c. A request to provide your health information for purposes of
including you on a mailing list
3. Uses or disclosures made pursuant to your verbal agreement.
We may use or disclose your health information, pursuant to your
verbal agreement, for purposes of including you in our facility
directory or for purposes of releasing information to persons
involved in your care as described below.
a. Facility directory. We may use or disclose certain limited health
information about you in our facility directory while you are a
resident at our facility. This information may include your name,
your assigned unit and room number, your religious affiliation, and
a general description of your condition. Your religious affiliation
may be given to a member of the clergy. The directory information,
except for religious affiliation, may be given to people who ask for
you by name.
b. Individuals involved in your care. We may disclose your health
information to individuals, such as family and friends, who are
involved in your care or who help pay for your care. We also may
disclose your health information to a person or organization
assisting in disaster relief efforts for the purpose of notifying
your family or friends involved in your care about your condition,
status and location.
4. Uses or disclosures permitted by law
Certain state and federal laws and regulations either require or
permit us to make certain uses or disclosures of your health
information without your permission. These uses or disclosures are
generally made to meet public health reporting obligations or to
ensure the health and safety of the public at large. The uses or
disclosures which we may make pursuant to these laws and regulations
include the following:
a. Public health activities. We may use or disclose your health
information to public health authorities that are authorized by law
to receive and collect health information for the purpose of
preventing or controlling disease, injury or disability. We may use
or disclose your health information for the following purposes:
i. To report births and deaths
ii. To report suspected or actual abuse, neglect, or domestic
violence involving a child or an adult
iii. To report adverse reactions to medications or problems with
health care products
iv. To notify individuals of product recalls
v. To notify an individual who may have been exposed to a disease or
may be at risk for spreading or contracting a disease or condition
b. Health oversight activities. We may use or disclose your health
information to a health oversight agency that is authorized by law
to conduct health oversight activities. These oversight activities
may include audits, investigations, inspections, or licensure and
certification surveys. These activities are necessary for the
government to monitor the persons or organizations that provide
health care to individuals and to ensure compliance with applicable
state and federal laws and regulations.
c. Judicial or administrative proceedings. We may use or disclose
your health information to courts or administrative agencies charged
with the authority to hear and resolve lawsuits or disputes. We may
disclose your health information pursuant to a court order, a
subpoena, a discovery request, or other lawful process issued by a
judge or other person involved in the dispute, but only if efforts
have been made to (i) notify you of the request for disclosure or
(ii) obtain an order protecting your health information.
d. Worker’s compensation. We may use or disclose your health
information to worker’s compensation programs when your health
condition arises out of a work-related illness or injury.
e. Law Enforcement official. We may use or disclose your health
information in response to a request received from a law enforcement
official for the following purposes:
i. In response to a court order, subpoena, warrant, summons or
similar lawful process
ii. To identify or locate a suspect, fugitive, material witness, or
missing person
iii. Regarding a victim of a crime if, under certain limited
circumstances, we are unable to obtain the person’s agreement
iv. To report a death that we believe may be the result of criminal
conduct
v. To report criminal conduct at our facility
vi. In emergency situations, to report a crime—the location of the
crime and possible victims; or the identity, description, or
location of the individual who committed the crime
f. Coroners, medical examiners, or funeral directors. We may use or
disclose your health information to a coroner or medical examiner
for the purpose of identifying a deceased individual or to determine
the cause of death. We also may use or disclose your health
information to a funeral director for the purpose of carrying out
his/her necessary activities.
g. Organ procurement organizations or tissue banks. If you are an
organ donor, we may use or disclose your health information to
organizations that handle organ procurement, transplantation, or
tissue banking for the purpose of facilitating organ or tissue
donation or transplantation.
h. Research. We may use or disclose your health information for
research purposes under certain limited circumstances. Because all
research projects are subject to a special approval process, we will
not use or disclose your health information for research purposes
until the particular research project for which your health
information may be used or disclosed has been approved through this
special approval process. However, we may use or disclose your
health information to individuals preparing to conduct the research
project in order to assist them in identifying residents with
specific health care needs who may qualify to participate in the
research project. Any use or disclosure of your health information
which may be done for the purpose of identifying qualified
participants will be conducted onsite at our facility. In most
instances, we will ask for your specific permission to use or
disclose your health information if the researcher will have access
to your name, address or other identifying information.
i. To avert a serious threat to health or safety. We may use or
disclose your health information when necessary to prevent a serious
threat to the health or safety of you or other individuals. Any such
use or disclosure would be made solely to the individual(s) or
organization(s) that have the ability and/or authority to assist in
preventing the threat.
j. Military and veterans. If you are a member of the armed forces,
we may use or disclose your health information as required by
military command authorities.
k. National security and intelligence activities. We may use or
disclose your health information to authorized federal officials for
purposes of intelligence, counterintelligence, and other national
security activities, as authorized by law.
l. Inmates. If you are an inmate of a correctional institution or
under the custody of a law enforcement official, we may use or
disclose your health information to the correctional institution or
to the law enforcement official as may be necessary (i) for the
institution to provide you with health care; (ii) to protect the
health or safety of you or another person; or (iii) for the safety
and security of the correctional institution.
5. Uses or disclosures required by law
We may use or disclose your information where such uses or
disclosures are required by federal, state or local law.
D. Your rights regarding your health information
You have the following rights regarding your health information
which we create and/or maintain:
1. Right to inspect and copy. You have the right to inspect and copy
health information that may be used to make decisions about your
care. Generally, this includes medical and billing records, but does
not include psychotherapy notes.
To inspect and copy your health information, you must submit your
request in writing to the Nursing Home Administrator. 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 your health information
in certain limited circumstances. If you are denied access to your
health information, you may request that the denial be reviewed.
Another licensed health care professional selected by our facility
will review your request and the denial. The person conducting the
review will not be the person who initially denied your request. We
will comply with the outcome of this review.
2. Right to request an amendment. If you feel that the health
information we have about you is incorrect or incomplete, you may
ask us to amend the information. You have the right to request an
amendment for as long as the information is kept by or for our
facility.
To request an amendment, your request must be made in writing and
submitted to Nursing Home Administrator. In addition, you must
provide us with 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
a. was not created by us, unless the person or entity that created
the information is no longer available to make the amendment
b. is not part of the health information kept by or for our facility
c. is not part of the information which you would be permitted to
inspect and copy
d. is accurate and complete
3. Right to an accounting of disclosures. You have the right to
request an accounting of the disclosures which we have made of your
health information. This accounting will not include disclosures of
health information that we made for purposes of treatment, payment,
or health care operations.
To request an accounting of disclosures, you must submit your
request in writing to Nursing Home Administrator. Your request must
state a time period which may not be longer than six (6) years prior
to the date of your request and may not include dates before April
14, 2003. Your request should indicate in what form you want to
receive the accounting (for example, on paper or via electronic
means). The first accounting that you request within a twelve
(12)-month period will be free. For additional accountings, we may
charge you for the costs of providing the accounting. 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.
4. 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, such as a family
member or friend, who is involved in your care or in the payment of
your care. For example, you could ask that we not use or disclose
information regarding a particular treatment that you received.
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 emergency treatment to you.
To request restrictions, you must make your request in writing to
Nursing Home Administrator. In your request, you must tell us (a)
what information you want to limit; (b) whether you want to limit
our use, disclosure or both; and (c) to whom you want the limits to
apply (for example, disclosures to a family member).
5. Right to request confidential communications. You have the right
to request that we communicate with you about your health care in a
certain way or at a certain location. For example, you can ask that
we only contact you at work or by mail.
To request confidential communications, you must make your request
in writing to Nursing Home Administrator. 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.
6. Right to a paper copy of this notice. You have the right to
receive a paper copy of this notice. You may ask us to give you a
copy of this Notice at any time. Even if you have agreed to receive
this notice electronically, you are still entitled to a paper copy
of this notice.
To obtain a paper copy of this notice, contact Social Services.
E. Complaints
If you believe your privacy rights have been violated, you may file
a complaint with our facility or with the secretary of the
Department of Health and Human Services.
Address: Office of Civil Rights
Department of Health and Human Services
61 Forsyth Street, S.W., Suite 3B 70
Atlanta, GA 30323 Phone: 1-800-368-1019
To file a complaint with our facility, contact the Nursing Home
Administrator. All complaints must be submitted in writing.
You will NOT be penalized for filing a complaint.
Lutheran Haven, Oviedo, Florida
|
www.lutheranhaven.org
| 2007 All Rights Reserved
|
Privacy Policy
|
Affiliates
|
