SILVER BLUFF
NOTICE OF PRIVACY PRACTICES
EFFECTIVE
DATE: April 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.
WHO
WILL FOLLOW THIS NOTICE.
This notice
describes Silver Bluff’s (hereafter referred to as “Nursing Home”) practices at
all its locations and that of:
Ø
Any independent health care
professional who treats or cares for Residents at the Nursing Home and is
authorized to enter information into your medical record.
Ø
All departments and units of
Nursing Home.
Ø
All employees of Nursing Home.
Ø
Any volunteers we allow to help
you while you are in Nursing Home.
Ø
Any vendors or independent
contractors who have access to protected health information of Residents at
Nursing Home.
Ø
All students or trainees.
Ø
Any Nursing Home corporate office
staff.
Ø
All the above listed persons,
entities, sites and locations follow the terms of this notice. In addition, these persons, entities, sites
and locations may share medical information with each other for your treatment
or Nursing Home operations purposes and the purposes described in this
notice. The independent health care
professionals, who provide care at Nursing Home and have agreed to follow the
terms of this notice, are not employees or agents of Nursing Home and Nursing
Home is not responsible for how they fulfill their professional responsibilities.
THE
MEDICAL INFORMATION TO WHICH NOTICE APPLIES:
We are
required by law to:
Ø
make sure that medical
information that identifies you is kept private;
Ø
give you this notice of our legal
duties and privacy practices at Nursing Home with respect to medical
information about you; and
Ø
follow the terms of the notice
that is currently in effect.
HOW WE
MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU.
Ø
For
Treatment.
We may use medical information about you to provide you with medical
treatment or services. We may disclose
medical information about you, to persons who are involved in taking care of
you at Nursing Home, such as independent doctors and other independent health
care professionals who are permitted to treat or care for Residents of Nursing
Home, nurses, nurses aides and other Nursing Home personnel or to students and
faculty who are participating in clinical teaching experiences at Nursing
Home. For example, a doctor treating you
for a broken leg may need to know if you have diabetes because diabetes may
slow the healing process. In addition,
the doctor may need to tell the dietitian if you have diabetes so that we can
arrange for appropriate meals. Different
departments of the Nursing Home also may share medical information about you in
order to coordinate what you need, such as therapy, lab work and
activities. We also may need to disclose
medical information about you to people outside Nursing Home who may be
involved in your medical care before, during or after you leave Nursing Home,
such as family members, or others who provide services, such as hospitals,
therapists, or medical specialists, that are part of your care. We may provide, without your consent, medical
information about you in connection with any transfer of you to obtain health
care elsewhere. We will otherwise only
disclose medical information about you to people outside Nursing Home, who are
not currently involved in your care at Nursing Home, with your consent, except
for disclosures that are required or permitted by law.
Ø
For
Payment.
We may need to use and disclose medical information about you so that
the treatment and services you receive at Nursing Home or as given by other
providers may be billed to and payment may be collected from you, Medicare and
Medicaid, an insurance company/health plan, or a third party. For example, we may need to give Medicare or
Medicaid information about lab work or therapy you received at Nursing Home so
Medicare or Medicaid will pay us or reimburse you for the lab work or
therapy. We are permitted by law to
disclose the amount of medical information necessary for us to obtain payment
for the care and services provided to you.
Our disclosure of medical information for the purpose of obtaining
payment for the care and services provided to you, may also include our giving
information to your family members who are involved in your care, insureds on
your policy or help pay for your care.
Ø
For
Health Care Operations.
We may use and disclose medical information about you for Nursing Home
operations. These uses and disclosures
are necessary to run the Nursing Home and make sure that all of our Residents
receive quality care. For example, we
may use medical information to review our treatment and services and to evaluate
the qualifications and performance of our staff in caring for you. We may also combine medical information about
many Nursing Home Residents to decide what additional services the Nursing Home
should offer, what services are not needed, and whether improvements can be
made. We may also disclose information
to nurses, technicians and other Nursing Home personnel, independent doctors
and health care professionals who are involved in treatment of Residents at
Nursing Home or faculty and students who are having clinical education
experiences at Nursing Home for review and learning purposes. We will only disclose, with your consent,
medical information about you that identifies you to people outside Nursing
Home, who are not currently involved in your care, except for disclosures that
are required or permitted by law.
Ø
Treatment
Alternatives.
We may use and disclose medical information to tell you about or
recommend different ways to treat you.
Ø
Health-Related
Benefits and Services.
We may use and disclose medical information to tell you about health-related
benefits or services that may be of interest to you.
Ø
Fundraising
Activities.
We will not share information about you with people or
organizations that are involved in general fund-raising activities. We may share information about you with people
or organizations that are involved in fund-raising activities by or for the
benefit of Nursing Home. We only
would release contact information, such as your name and room number. If
you do not want the Nursing Home to contact you for fundraising efforts, you
must notify a Social Worker in writing.
Ø
Nursing
Home Roster or Directory. Unless
you tell us otherwise, we will include certain limited
information about you in the Nursing Home roster or directory while you are a
Resident at Nursing Home. This
information may include your name, room number and religious affiliation. This directory information, except for your
religious affiliation, may be released to people who ask for you by name. Your religious affiliation may be given to a
member of the clergy, such as a priest or rabbi, even if they do not ask for
you by name. This is so your family,
friends and clergy can visit you in the Nursing Home and generally know how you
are doing. If you choose not to
be listed in the directory, then we may not be able to acknowledge that you are
in the Nursing Home to your family, friends, clergy or delivery people. If you do not want anyone to know this
information about you must notify a Social Worker in writing or indicate your
choice on the Nursing Home’s Resident Directory Instruction Form.
Ø
Individuals
Involved in Your Care.
Except as explained above concerning information furnished in connection
with the Nursing Home Roster or Directory, we may disclose medical information
about you to a friend or family member who is involved in your medical care,
unless you are able to and object. In
addition, we may disclose medical information about you to an entity assisting
in a disaster relief effort so that your family can be notified about your
condition, status, and location. You can
object to these disclosures by telling us that you do not wish any or all
individuals involved in your care to receive this information. If you cannot agree or object, we will use
our professional judgment to decide whether it is in your best interest to
disclose relevant information to someone who is involved in your care or to an
entity assisting in a disaster relief effort.
Ø Research. Under rare circumstances, we may use and
disclose medical information about you for research purposes. For example, a research project may involve
comparing the health and recovery of all Residents who received one medication
to those who received another for the same condition. All research projects, however, will require
your written consent if the researchers will know who you are. Medical information about you that has had
identifying information removed may be used for research without your
consent.
Ø
As
Required By Law.
We will disclose medical information about you when required to do so by
federal, state, or local law.
Ø
To
Avert a Serious Threat to Health or Safety. We may use and disclose medical information
about you when necessary to prevent a serious threat to your health and safety
or the health and safety of the public or another person. Any disclosure, however, would only be to
someone able to help prevent the threat and limited to the information
needed.
SPECIAL SITUATIONS:
Ø
Organ
and Tissue Donation.
If you are an organ or tissue donor, we are required by law to provide
medical information about you to the person or entity who receives the organ or
tissue donation.
Ø
Public
Health Risks.
We may disclose without your consent medical information about you for
public health activities. These
activities generally include the following:
·
to prevent or control disease,
injury, or disability;
·
to report cancer, deaths or other
items required to be reported;
·
to report suspected abuse or
neglect as required by law;
·
to report reactions to
medications or problems with products;
·
to notify people of recalls of
products they may be using; and
·
to notify a person who may have
been exposed to a disease or may be at risk for contracting or spreading a
disease or condition.
Ø
Surveys
and Other Health Oversight Activities. We may disclose without your consent medical
information to a health oversight agency when authorized by law. These oversight activities include, for
example, audits, investigations, inspections, and licensure. These activities are necessary for the
government to monitor the health care system, government programs, and
compliance with applicable laws. The
Department of Health and Human Services has authority to inspect nursing homes
and to review any records of the current or former Residents of the nursing
home unless you object in writing to review of your records. The state ombudsman can review your records
with your consent or the consent of your legal representative. Some professional licensing boards, such as
the board that governs licensing of physicians, have the right to review your
records when investigating a particular physician.
Ø Lawsuits and
Disputes.
If you are involved in a lawsuit or a dispute, we must disclose medical
information about you in response to a court or administrative order. We also may disclose medical information
about you in response to a subpoena or other lawful process from someone
involved in a dispute by furnishing your medical records or information under
seal to the court. The copies of your
medical record under seal may only be opened by the judge, the parties to the
case, or their attorneys unless a judge orders otherwise.
Ø
Law
Enforcement.
We may release without your consent medical information to a law
enforcement official:
·
In response to a court order,
grand jury demand, or search warrant;
·
To report a death or injury we
believe may be the result of criminal conduct; or
·
To report criminal conduct
committed at the Nursing Home.
Ø
Coroners,
Medical Examiners, and Funeral Directors. We may release without your consent medical
information to a coroner or medical examiner.
This may be necessary, for example, to identify a deceased person or
determine the cause of death. We may
also release medical information about the identity of Residents at Nursing
Home to funeral directors as necessary to carry out their duties.
Ø
Behavioral Health Care. Regardless of the other parts of this Notice,
any information relating to alcohol and drug treatment or other behavioral
health care treatment, including psychotherapy notes, will not be disclosed
outside the Nursing Home except as authorized by you in writing, pursuant to a
court order, or as required by law.
Psychotherapy notes about you will not be disclosed to personnel working
within the Nursing Home, other than to the person who wrote the notes, except
for training purposes or to defend a legal action brought against the Nursing
Home, unless you have properly authorized such disclosure in writing.
YOUR
RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU.
You
have the following rights regarding medical information we maintain about you:
Ø
Right
to Inspect and Copy.
If you are a current Resident, you or your representative have the right
to inspect your records within 24 hours of your request, excluding weekends and
holidays. If you are a current Resident,
you or your legal representative have a right to purchase copies of your
records or any portions of your records on two working days’ advance notice to
the Nursing Home. If you are no longer a
current Resident at the time of your request to inspect or copy your records,
the Nursing Home has a longer time within which to respond to your request up
to 60 days from the date of your request.
To
inspect or receive a copy of your records, you must submit your request in
writing to the Business Office. If you
request a copy of the information, we may charge a fee not to exceed the
community standard rate for the costs of copying, mailing, or other supplies
associated with your request and may collect the fee before providing the copy
to you. If you agree, we may provide you
with a summary of the information instead of providing you with access to it,
or with an explanation of the information instead of a copy. Before providing you with such a summary or
explanation, we first will obtain your agreement to pay and will collect the
fees, if any, for preparing the summary or explanation.
Ø
Right
to Amend.
If you feel that medical 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 Nursing Home.
To
request an amendment, your request must be made in writing and submitted to the
Medical Records Department. In addition,
you must provide 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:
·
Was created by a provider other
than the Nursing Home, unless the provider who created the information is no
longer available to consider or make the amendment;
·
Is not part of the medical
information kept by or for Nursing Home;
·
Is not part of the information
that you would be permitted to inspect and copy; or
·
Has been determined to be
accurate and complete.
Ø Right to an
Accounting of Disclosures. You have the right to request a list of
certain disclosures we have made of medical information about you.
To
request this list or accounting of disclosures, you must submit your request in
writing to Nursing Home’s Privacy Officer.
Your request must state a time period that may not be longer than six
years prior to the request and may not include dates before April 14, 2003. Your request should indicate in what form you
want the list (for example, on paper, or electronically). The first list you request within a 12-month
period will be free. For additional
lists, we may charge you for the costs of providing the list. 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. We may collect the fee before
providing the list to you.
Ø
Right
to Request Restrictions.
Except where we are required to disclose the information by law, you have
the right to request a restriction or limitation on the medical information we
use or disclose about you. For example,
you could ask that we not use or disclose information about a treatment you had
to a family member or friend.
We are not required to agree to your request
to restrict use or disclosure of your information within Nursing Home or among
the health care professionals currently involved in your care at Nursing Home
except with regard to psychotherapy notes. If we do agree, we will comply with your
requested restriction unless the information is needed to provide you emergency
treatment. Except as permitted or required by law, we will only disclose your
confidential medical information to persons outside Nursing Home who are not
currently involved in your care at Nursing Home, in accordance with your
written authorization.
To request restrictions, you must make
your request in writing to the Medical Records Department. In your request, you must tell us (1) what
information you want to limit; (2) whether you want to limit our use,
disclosure, or both; and (3) to whom you want the limits to apply, for example,
disclosures to your spouse.
Ø
Right
to Request Alternative Communications. You or your representative have the right to
request that we communicate with you about medical matters in a certain way or
at a certain location. For example, you
can ask that we only contact you by speaking with you in a certain location or
contacting your representative at work or at a certain mailing address.
To request communications by certain
means, you must make your request in writing to the Medical Records Department
and specify how or where you wish to be contacted. We will not ask you the reason for your
request. We will accommodate all
reasonable requests.
Ø
Right
to a Paper Copy of This Notice. You have the right to a paper copy of this
notice or any revised 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.
You may obtain a copy of this notice at
our website, silverbluffvillage.com
To obtain a paper copy of this notice,
contact the Business Office at (828) 648-2044.
OTHER USES OF MEDICAL
INFORMATION.
Other uses and disclosures of medical
information not covered by this notice will be made only with your written
permission or as required by law. If you
provide us permission to use or disclose medical information about you, you may
revoke that permission, in writing, at any time. If you revoke your permission, we will no
longer use or disclose medical information about you for the purposes that you
had authorized in writing. You understand that we are unable to take
back any disclosures we have already made with your permission, and that we are
required to retain our records of the care that we provided to you.
CHANGES
TO THIS NOTICE.
We reserve the right to change this
notice. We reserve the right to make the
revised or changed notice effective for medical 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
the Nursing Home. The notice will remain in effect for each subsequent visit
unless changed. If the notice changes, a
copy will be made available to you upon request.
COMPLAINTS.
If you believe your privacy rights have
been violated, you may file a complaint with Nursing Home or with the Secretary
of the United States Department of Health and Human Services. To file a complaint with Nursing Home,
contact the Privacy Officer, at (828) 648-2044.
All complaints must be submitted in writing.
You will not be penalized for filing a complaint.