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. YOU DO NOT NEED TO RESPOND TO THIS NOTICE.

Our Responsibilities.  We are required by law to maintain the privacy of your protected health information in our custody. We will let you know promptly if a breach occurs that may have compromised the privacy or security of your protected health information. We must follow the duties and privacy practices described in this notice and give you a copy of it. We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see:  http://www.hhs.gov/hipaa/for-individuals/notice-privacy-practices/index.html

How We Use and Safeguard your Health Information.

We typically use or share your health information in the following ways:

• To treat you (Example: in participation with physicians involved in your care, contracted pharmacy, lab and therapy companies)
• To run our healthcare operations (Example: quality reviews, compliance, legal services, administrative activities, et al).
• To bill for services provided to you (Example: We give information about you to your health insurance plan).
• State and federal laws strictly limit releasing psychiatric information, even to you or your representative.

We are allowed or required to share your health information in other ways, such as:

• Helping with public health and safety issues (Examples: preventing disease, helping with product recalls).
• Health research and health oversight activities
• Complying with the law, including information about victims of abuse, neglect or domestic violence
• Responding to organ and tissue donation requests or to work with a medical examiner or funeral director
• Addressing workers’ compensation, law enforcement, and other government requests
• Responding to lawsuits and legal actions
• To avert a serious threat to health or safety, and in accordance with a limited data set

Uses of Your Health Information to Which You May Object.

We are also allowed to use or disclose your health information for the following purposes unless you ask us not to:

• We maintain a resident directory including for each resident: name, location in our facility, health condition in general terms, and religious affiliation. We may disclose this information to people who ask for you by name. We will make known your religious affiliation only to clergy.

• Informing family and friends. We may disclose your health information to family, friends, or others identified by you.
• Assistance in disaster relief efforts
• Limited PHI for raising funds for our own purposes

If you object to our use of your health information for any of these purposes, please contact our Privacy Officer.

Your Health Information Rights.  You have the following rights with respect to your protected health information:

• To obtain an electronic or paper copy of your medical record.  We may charge a reasonable fee.
• To request that we amend your medical record to correct health information that you believe is incorrect or incomplete. We are not required to agree to your request.
• To request a list of disclosures we have made of your health information. This will include all disclosures except those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
• To request confidential communications and to request a paper copy of this notice.
• To request that we limit the use and disclosure of your health information.  We are not required to agree to your request.
• Choose someone to act for you. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

Filing a HIPAA Complaint / Contact Information.  If you have any questions regarding this notice or wish to make a request regarding your health information, contact us at the address or phone number below. If you believe we have violated your privacy rights under this notice, you may submit a complaint to us and/or the U.S. Department of Health and Human Services at the addresses below. You will not be retaliated against for filing a complaint.

Privacy Officer Secretary
Department of Health and Human Services
200 Independence Ave. SW 
Washington, D.C. 20201 
(877) 696-6775

Future Changes to the Notice of Privacy Practices We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, from our office.