STEUBEN COUNTY HEALTH
CARE FACILITY
PRIVACY NOTICE
Effective Date: 04/14/2003
A printed version of this Privacy Notice can be obtained from our receptionist.
If you have any questions about this notice, please contact our Privacy Officer at (607) 776-7651.
This notice describes our skilled nursing facility's practices and that of:
Any health care professional authorized to enter information into your medical chart.
All departments and units of the skilled nursing facility.
Any member of a volunteer group we allow to help you while you are in the skilled nursing facility.
All employees, staff and other skilled nursing facility personnel.
OUR PLEDGE REGARDING MEDICAL INFORMATION
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at the skilled nursing facility. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by the skilled nursing facility, whether made by skilled nursing facility personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor's use and disclosure of your medical information created in the doctor's office, or clinic.
This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
We are required by law to:
make sure that medical information that identifies you is kept private;
give you this notice of our legal duties and privacy practices with respect to medical information about you; and
follow the terms of the notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following categories describe different ways that we may use and disclose medical information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
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 doctors, nurses, technicians, or other skilled nursing facility personnel who are involved in taking care of you at the skilled nursing facility. For example, a dentist may need to know your diagnoses, medications, or lab work in order to perform the needed dental work. We also may disclose medical information about you to people outside the skilled nursing facility who may be involved in your medical care after you are discharged, such as family members per your designation, or others we or your physician use to provide services that are part of your care.
For Payment. We may use and disclose your medical information so that the treatment and services you receive at the skilled nursing facility may be billed and payment collected from you, an insurance company, or a third party payor. For example, we may need to give your health plan information about services you receive at the skilled nursing facility, so that your health plan will pay us or reimburse you for your care. We may also tell your health plan about treatment you are going to receive, to obtain prior approval or to determine whether your plan will cover the treatment.
For Health Care Operations. We may use and disclose medical information about you for skilled nursing facility operations. These uses and disclosures are necessary to run the skilled nursing facility 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 performance of our staff in caring for you. We may also combine medical information about many skilled nursing facility residents to decide what additional services the skilled nursing facility should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians. and other skilled nursing facility personnel for review and learning purposes.
Appointment Reminders. We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at another health care provider.
Treatment Alternatives. We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
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.
Skilled Nursing Facility Directory. We may include certain limited information about you in the skilled nursing facility directory while you are a resident at this facility. This information may include your name, unit and room number. You may object to some or all of these. The directory information may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, even if they don't ask for you by name. This is so your family, friends, and clergy can visit you in the skilled nursing facility.
Individuals Involved in Your Care or Payment for Your Care. We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who handles your finances. We may also tell your family or friends that; you are in the hospital, and, in certain circumstances, your condition. 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.
Research. Under certain 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, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with residents' need for privacy of their medical information. Before we use or disclose medical information for research, the project will have been approved through this research approval process. However, we may disclose medical information about you to people preparing to conduct a research project, for example, to help them look for residents with specific medical needs, so long as the medical information they review does not leave the skilled nursing facility. We will always ask for your specific permission if the researcher will have access to your name, address, or other information that reveals who you are, or will be involved in your care at the skilled nursing facility.
As Required By Law. We will disclose medical information about you when required to do so by federal, state, or local law.
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.
Organ and Tissue Donation. If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Military and Veterans. If you are a veteran, dependent, or a member of the Armed Forces, we may release medical information about you as required by military command authorities. We may also disclose medical and/or financial information about you to the Department of Veterans Affairs. This disclosure is necessary for the Department of Veterans Affairs to determine if you are eligible for certain benefits.
Workers' Compensation. We may release medical information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Public Health Risks. We may disclose medical
information about you for public health activities. These activities generally
include the following:
to prevent or control disease, injury or disability;
to report births and deaths;
to report abuse or neglect;
to report reactions to medications or problems with products;
to notify people of recalls of products they may be using;
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;
to notify the appropriate government authority if we believe a resident has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree, when required or authorized by law.
Health Oversight Activities. We may disclose medical information to a health oversight agency for activities 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 civil rights laws.
Professional Training. In some instances, students may be involved in your care and have access to your protected medical information. You may select to have care only from an employee of the skilled nursing facility, rather than a student.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Law Enforcement. We may release medical
information if asked to do so by a law enforcement official:
In response to a court order, subpoena, warrant, summons or similar process;
To identify or locate a suspect, fugitive, material witness; or missing person;
About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement;
About a death we believe may be the result of criminal conduct;
About criminal conduct at the skilled nursing facility; and
In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
Coroners, Medical Examiners and Funeral Directors. We may release medical information to a coroner or medical examiner. For example, this may be necessary to determine cause of death. We may also release medical and/or financial information about residents of the skilled nursing to funeral directors as necessary to carry out their duties.
National Security and Intelligence Activities. We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Protective Services for the President and Others. We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state or conduct special investigations.
Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the skilled nursing facility to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. 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 reasons covered by your written authorization. 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 medical records of the care that we provided to you, in accordance with regulations of the federal. state, and/or local government.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You have the following rights regarding medical information we maintain
about you:
Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy (process) notes. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to Medical Records. 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 in certain very limited circumstances. If you are
denied access to medical information, you may
request that the denial be reviewed.
Another licensed health care professional chosen by the skilled nursing
facility will review your request and
and the denial. The person conducting
the review will not be the person who denied your request. We will comply with
the outcome of the
review.
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 the skilled nursing facility.
To
request an amendment. your request must be made in writing and submitted to
Medical Records. 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 not created by us, unless the person or entity that created the information is no longer available to make the amendment;
Is not part of the medical information kept by or for the skilled nursing facility;
Is not part of the information which you would be permitted to inspect and copy; or
Is accurate and complete.
Right to an Accounting of Disclosures. You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of medical information about you.
To request this
list or accounting of disclosures, you must submit your request in writing to
Medical Records. Your request must state a time
period, which may not be longer than
six years and may not include dates before April 14, 2003. Your request should
indicate in what form
you want the list, for example,
electronically or on paper. The first list you request within a twelve-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.
Right to Request Restrictions. You have the right to request a restriction or limitation on the medical 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 medical information we disclose about you to someone who is involved in your care or the payment for your care. For example, you could ask that we not use or disclose information about a treatment that you had.
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 you
emergency
treatment.
To request restrictions, you must make your request in writing to Medical
Records. 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.
Right to Request Confidential Communications. You 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 your Power of Attorney at home.
To request
confidential communications, you must make your request in writing to the
Privacy Officer. We will not ask you the reason for the
request. We will accommodate all
reasonable requests. Your request must specify how or where you wish to be
contacted.
Right to a Paper Copy of This Notice. You have the right to 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.
You may obtain a copy of this notice at our web site www.schcf.org
You may obtain a paper copy of this notice from our Privacy Officer.
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 skilled nursing facility. The notice will contain the effective date on the first page, in the upper right hand corner. In addition, each time you are admitted to the skilled nursing facility for treatment or health care services, we will offer you a copy of the current notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with the skilled nursing facility or with the Secretary of the Department of Health and Human Services. To file a complaint with the skilled nursing facility, contact our Director of Nursing at (607) 776-7651. All complaints must be submitted in writing.
There will be no action of retribution for filing a complaint.
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