NOTICE OF INFORMATION PRACTICES

Understanding Your Health Record/Information
Each time you visit a hospital, physician, nursing facility or other healthcare provider a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and plan for future care or treatment. This information, often referred to as your health or medical record, serves as:

• Basis for planning your care and treatment,
• Means of communication among the many health professionals who contribute to your care,
• Legal document describing the care you received,
• Means by which you or a third-party payer can verify that services billed were actually provided,
• A tool in educating health professionals,
• A source for information for public health officials charged with improving the health of the nation,
• A source of data for facility planning and marketing,
• A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.

Understanding what is in your record and how your health information is used helps you to

• Ensure it is accurate,
• Better understand who, what, when, where, and why others may access your health information,
• Make more informed decisions when authorizing disclosure to others.

Your Health Information Rights
Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you.

· You may request that we not use or disclosure your health information for a particular reason related to treatment, payment, the facility’s general health care operations, and/or to a particular family member, other relative or close personal friend. Although we will consider your requests with regard to the use of your information, please be aware that we are under no obligation to accept it or to abide by it.

· You may obtain a paper copy of this notice of information practices upon request.

· If you are dissatisfied with the manner in which or the location where you are receiving communications from us that are related to your health information, you may request that we provide you with such information by alternative means or at alternative locations. We will attempt to accommodate all reasonable requests.

· You may request to inspect and/or obtain copies of your health information. You may make such requests orally or in writing; however, in order to better respond to your request, we ask that you make such request in writing on our facility’s form. If you request to have copies made, we will charge you a fee of 25 cents a page.

· If you believe that any health information in your record is incorrect or if you believe that important information is missing, you may request that we correct the existing information or add the missing information.

· You may request that we provide you with a written accounting of disclosures made by us during the time period for which you request (not too exceed 6 years). Please note that we are not required to record certain disclosures such as for payment and treatment purposes. You may be charged a reasonable fee for the accounting.

· You may revoke an authorization to use or disclose health information except to the extent that action has already been taken.

Facility Responsibilities
This organization is required to:

• Maintain the privacy of your health information,
• Provide you with a notice as to your legal duties and privacy practices with respect to information we collect and maintain about you,
• Abide by the terms of this notice,
• Notify you if we are unable to agree to a requested restriction,
• Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will mail you a notice to the address you have supplied us.
We will not disclose your health information without your authorization, except as described in this notice.

Examples of disclosures for Treatment, Payment and Health Operations
We will use your information for treatment.
For example: Information obtained by a nurse, physician, or other member of your healthcare team will be recorded in your record to be used to determine the course of treatment that would work best for you.

We may use your health information for discharge planning.
For example: If your physician feels you are ready for discharge or you request transfer or discharge, we will use your information to assist you in obtaining appropriate care after discharge

We will use your health information for payment.
For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.

We will use health information for regular health operations.
For example: Members of the nursing staff, and/or 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 services we provide.

Incidental Use and Disclosure: While we make every effort not to discuss residents’ condition where information can be overheard by others, it is entirely possible that conversations might be overheard when nurses and doctors talk to residents in semi-private rooms or when care givers, nurses, and doctors confer at the nurse’s stations.

Business Associates: There are some services provided in our organization through contacts with business associates. Examples include x-ray and laboratory services we may contract with. To protect your health information, however, we require the business associate to appropriately safeguard your information.

Directory: Unless you notify us that you object, we will use your name, location in the facility, general condition, and religious affiliation to other people who ask for you by name.

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, your location, and general condition.

Communication with family: Health professionals, using their best judgement, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care.

Research: We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.

Funeral directors: We may disclose health information to funeral directors consistent with applicable law to carry out their duties.

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.

Food and drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplementation, product and product defects, or post marketing surveillance information to enable product recalls, repairs and replacement.

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.

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.

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

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

Abuse & Neglect/Mandatory Reporting: State law requires us to report any incidents of suspected or alleged sexual, physical or psychological abuse or neglect. The state is required to follow up and investigate all incidents reported to them. All records and files related to such complaints and investigations must remain confidential unless disclosure is authorized by the resident or his/her legal representative.

Oversite agencies: We are required to release the health care information of our residents to governmental oversite agencies such as the Department of Social and Health Services (DSHS) and the Center for Medicare and Medicaid Services (CMS) for inspection/survey/regulatory purposes.

For More Information or to Report a Problem:
If you have questions and would like additional information, you may contact the administrator of this facility.
If you believe your privacy rights have been violated, you can file a complaint with the administrator or with the secretary of Health and Human services. There will be no retaliation for filing a complaint.

Effective 4/14/03