Friendship Group – 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.
IF YOU HAVE ANY QUESTIONS ABOUT THIS NOTICE PLEASE CONTACT OUR PRIVACY CONTACT WHO IS BARBARA H. JOHNSON AT (540) 265-2250 or firstname.lastname@example.org.
“Friendship Group” is an Affiliated Care Entity comprised of Friendship Health and Rehab Center, Inc.; Eastwood Assisted Living, Inc.; Friendship Apartment Village Corporation; Friendship Outpatient & Wellness Services, Inc.; Professional Healthcare Services d/b/a Care Unlimited; and Friendship Pharmacy, Inc.; all of whom are parties to this Notice.
As a company responsible for your confidential medical information, your privacy is of utmost importance to us. This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control of your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
We are required by law to maintain the privacy of your protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information, which are set out in this Notice of Privacy Practices.
We are required to abide by the terms of this Notice of Privacy Practices. We reserve the right to change the terms of our notice at any time. The new notice will be effective for all protected health information that we maintain at that time. Copies of any new notices will be posted at various public locations at our facilities and on our website at www.friendship.us and will be available to be picked up at our facilities. Upon your request, we will provide you with any revised Notice of Privacy Practices by calling and requesting that a revised copy be sent to you in the mail.
1. Uses and Disclosures of Protected Health Information
Uses and Disclosures of Protected Health Information for Treatment, Payment, and Healthcare Operations
You will be asked to sign a consent form upon admission or when you first become a resident or customer. We will use or disclose your protected health information as described in this Section 1. Your protected health information may be used and disclosed by members of our staff that are involved in your care and treatment for the purpose of providing health care services to you. Your protected health information may also be used and disclosed to pay your health care bills and to support the operation of the facility.
Following are examples of the types of uses and disclosures of your protected health care information that we are permitted to make. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by us.
Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you. We will also disclose protected health information to physicians who may be treating you. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.
In addition, we may disclose your protected health information from time-to-time to another physician or health care provider (e.g., a specialist or hospital) who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment to your physician.
Payment: Your protected health information will be used and disclosed, as needed, for payment practices related to your health care services such as billing, claims management, collection activities, review of services for medical necessity and utilization review activities. This may include certain activities that Medicare, Medicaid, or your health insurance plan may undertake before approving or paying for the health care services we provide for you such as making a determination of eligibility or coverage for insurance benefits. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.
Healthcare Operations: We may use or disclose, as needed, your protected health information in order to support the business activities of our facility. These activities include, but are not limited to, quality assessment activities, employee review activities, training of new staff, licensing, marketing and fundraising activities, business planning and development, protocol development, care coordination and general management activities.
We will share your protected health information with third party “business associates” that perform various activities (e.g., management consultants, information management consultants, billing and collection services, etc.) for the facility. Whenever an arrangement between our facility and business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.
We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. We may also use and disclose your protected health information for other marketing activities. For example, your name and address may be used to send you information about our facility and the services we offer. We may also send you information about products or services that we believe may be beneficial to you. You may contact our Privacy Contact to request that these materials not be sent to you.
Uses and Disclosures of Protected Health Information Based upon Your Written Authorization
Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization, at any time, in writing, except to the extent that the facility has taken an action in reliance on the use of disclosure indicated in the authorization.
Other Permitted and Required Uses and Disclosures That May be Made With Your Consent, Authorization or Opportunity to Object.
We may use and disclose your protected health information in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information.
Facility Directories: Unless you object, we will use and disclose in our facility directory your name, your location, and your religious affiliation. All of this information, except religious affiliation, will be disclosed to people that ask for you by name. Members of the clergy will be told your religious affiliation. You have the right to restrict or prohibit some or all of these uses or disclosures.
Others Involved in Your Healthcare: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your health care or payment related to your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death.
Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object
We may use or disclose your protected health information in the following situations without your consent or authorization. These situations include:
Required By Law: We may use or disclose your protected health information to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law.
Public Health: We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability.
Communicable Diseases: We may disclose protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
Health Oversight: We may disclose your protected health information to a health oversight agency for activities authorized by law, such as licensure, audits, investigations, disciplinary actions, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
Abuse or Neglect: We may disclose your protected health information to a public health authority that is authorized by law to receive reports of abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.
Food and Drug Administration: We may disclose your protected health information to a person or company required by the Food and Drug Administration, for the purpose of activities related to the quality, safety or effectiveness of FDA regulated products or activities; to report adverse events, product defects or problems, or biologic product deviations; to track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing observation, as required.
Legal Proceedings: We may disclose your protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions where we receive satisfactory assurances that reasonable efforts have been made to give you notice of the request in response to a subpoena, discovery request or other lawful process.
Law Enforcement: We may disclose your protected health information, so long as applicable legal requirements are met, for law enforcement purposes. Disclosures will be made in response to an enforcement official’s request for information to identify or locate a suspect, fugitive, material witness or missing person.
Coroners, Funeral Directors, and Organ Donation: We may disclose your protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may disclose protected health information consistent with applicable law as necessary to permit the funeral director to carry out its duties. We may disclose such information in reasonable anticipation of death. Protected health information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.
Research: We may disclose your protected health information to researchers when their research has been approved by an institutional review board and appropriate privacy board that have reviewed the research proposal and have established protocols to ensure the privacy of your protected health information.
Criminal Activity: Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
Workers’ Compensation: Your protected health information may be disclosed by us, as authorized, to comply with workers’ compensation laws and other similar legally-established programs.
Required Uses and Disclosures
Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of the Health Insurance Portability and Accountability Act (HIPAA).
2. Your Rights
Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.
You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information. A “designated record set” contains medical and billing records and any other records that the facility uses for making decisions about you.
Under federal law, however, you may not inspect or copy the following records; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Contact if you have questions about access to your medical record.
You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must be in writing directed to our Privacy Contact and must state the specific restriction requested and to whom you want the restriction to apply.
We are not required to agree to a restriction that you may request. If the facility believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. If the facility does agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment or unless it is required by the Department of Health and Human Services , by law, for public health activities, for judicial and administrative proceedings, or for law enforcement activities.
You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Privacy Contact.
You may have the right to amend your protected health information. This means you may make a written request for an amendment of protected health information about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Privacy Contact to determine if you have questions about amending your medical record.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, for a facility directory, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. The right to receive this information is subject to certain exceptions, restrictions and limitations.
You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.
3. Our Privacy Practices and Procedures. We are dedicated to protecting your personal information. We have, therefore, instituted a number of policies and practices to help insure the security of this information. We require our employees to protect the confidentiality of resident information through written policies and procedures and encourage access to information on a limited basis.
You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our privacy contact of your complaint. We will not retaliate against you for filing a complaint.
You may contact our Privacy Contact, Barbara H. Johnson at (540) 265-2250 or email@example.com for further information about the complaint process.
This notice was first published and became effective on April 1, 2003.