Notice of Privacy Practice
THE FOLLOWING NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW THE INFORMATION CAREFULLY.
The Health Information Portability and Accountability Act (HIPAA) requires that Signature HealthCARE LLC and this location maintain the privacy of your medical information and provide you with a notice to assist you to understand how we may use or disclose your medical information and our legal duties and privacy practices relative to your medical information. We are required to follow the terms of the notice that is currently in effect. In the event of a breach of unsecured protected health information, affected individuals will be notified in writing.
If you have questions regarding this notice, please contact the HIPAA Coordinator at your location or the Signature Compliance Officer at the Home Office.
YOUR MEDICAL RECORD
When you enter or receive services from a Signature location, documentation is entered into your health/medical record. This record typically contains information about your condition and the treatment we provide. We can use and disclose this information to:
- Plan your care and treatment
- Document your care
- Educate health professionals
- Provide information for medical research
- Provide data for the operations of our organization
- Assist with your transition of care to persons arranging for or directly providing care to you following
- Communicate with other health care professionals involved in your care
- Provide information to insurance companies for payment of services you received
- Provide information to public health officials
- Assess and improve the care we provide
HOW WE MAY USE AND DISCLOSURE YOUR MEDICAL INFORMATION
The following categories explain how we might use or disclose your medical information. We cannot describe every possible way your medical information may be used or disclosed under these categories however all the ways we are permitted or required to use and disclose information will fall into one of these categories.
We can use your health information and share it with other professionals who are treating you to provide, coordinate or manage your treatment. This may include doctors, nurses, therapists, or others involved in your care. Different departments within this location may share information about you in order to coordinate your care. Information may also be shared with individuals outside this location who may assist with transitioning your care or direct community providers who may be involved with your care after discharge. We may also disclose medical information about you to your healthcare providers after you are discharged.
For example, a physician treating you may ask for a copy of your medical record from the facility.
We can use and disclose your medical information to bill and receive payment from you, from an insurance company or any other third party entities for the treatment and services you received. Your information may also be shared with your health plan to obtain prior approval for or to determine if your plan will cover a proposed treatment.
For example, we give information about you to your health insurance plan in order to receive payment for your services.
FOR HEALTH CARE OPERATIONS
We can use and disclose your health information for health care operations such as quality assessments and improvement activities, outcomes evaluation and clinical guideline development, case management and care coordination. This is necessary to ensure that all of our residents/patients receive quality care. Your health information may be reviewed by health care professionals within the organization for learning purposes, for compliance activities, or review or for quality assurance purposes. We may remove information that identifies you in order that others may study it without learning the identities of individuals involved.
We may disclose protected health information to another covered entity for health care operations activities of the entity that receives the information, if that entity provided or will be providing services to you. These disclosures may be made when the protected health information pertains to the treatment, and the disclosure is for health operations related to those providers, or for the purpose of health care fraud and abuse detection or compliance.
For example, we use your health information to manage your treatment and your care, as well as to improve the care of others in our facility.
OTHER ALLOWABLE USES OF YOUR MEDICAL INFORMATION
INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE
With your written approval, we may disclose medical information about you to a friend or family member who is involved in your care. We may also give information to someone who helps pay for your care. We will only disclose the information which is directly relevant to the person’s involvement in your care or payment related to your care.
We may disclose medical information about you to an entity assisting in a disaster relief effort in order to facilitate the notifications to your family about your condition, status, and location.
We may display your birthday or other special events on a bulletin board or on a calendar that is available for public viewing.
We may use your name and/or photo in an internal newsletter or other publication, including information regarding your admission or discharge. An additional consent will be obtained for activates that are consider marketing.
We may display your photo on a bulletin board at this location. We will not give photographs or post images of you on to anyone’s outside this location unless we have your permission.
We may post your name on our facility directory or on the outside of your door
In our organization, some services are provided through contracts with business associates. When we contract with a business associate to provide services, we may disclose your medical information to them so they can perform the job we’ve contracted with them to perform. We require business associates to protect and safeguard your information under the same guidelines that we follow.
Unless you tell us that you object, we will use your name, room number at the facility, general condition, and religious affiliation for our facility directory. This information may be provided to clergy and except for religious affiliation, to people who ask for you by name.
We may disclose information about you for research purposes under certain circumstances. A special approval process evaluates a proposed research project before it is implemented. The project will be approved through this process before we disclose any of your health information for research. We may disclose medical information about you to individuals preparing to conduct a research study as long as the medical information does not leave this location. We will not use your health information or disclose it outside of Signature HealthCARE for reasons of research without either getting your prior written approval or determining that your privacy is protected.
HEALTH INFORMATION EXCHANGE
If we participate in a Health Information Exchange or HIE, which is permitted under law, we may share your health information electronically with this exchange to provide faster access to information and improved coordination of care to assist providers and others in making more informed decisions. If we participant in an HIE, you will have the option to opt out or you may be asked to consent to the exchange of information. If you opt out or withhold your consent to the exchange of information through the HIE, your personal health information will continue to be used in accordance with this Notice and the law however it will not be made available through the HIE. If we participate in the HIE, we will act in a manner that protects the confidentiality, privacy and security of your information.
HEALTH CARE BENEFITS AND REMINDERS
We may contact you to schedule appointments, provide treatment alternatives or to provide information regarding health-related benefits or services that you might be interested in learning about.
We may disclose medical information to the extent necessary to comply with laws relating to workers compensation or similar programs. These programs provide benefits for work-related illness or injuries.
- Federal and state laws may require or permit this location to disclose certain medical information related to the following:
- Public health risks:
- Prevention or control of disease, injury or disability
- Product recalls
- Reporting adverse reactions to medications
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to someone’s safety or health
- Reporting abuse, neglect, or domestic violence: Notifying the appropriate government agency if we believe a
resident/patient has been the victim of abuse, neglect or domestic violence.
- Health Oversight: We may disclose medical information to a health oversight agency for activities such as audits, investigations, inspections and licensure.
- Judicial and Administrative proceedings: If you are involved in a lawsuit or dispute, we may disclose medical information about
We may disclose your medical information for law enforcement purposes as required by law, in response to a court or administrative order, or in responses to a valid subpoena.
FUNERAL DIRECTORS, MEDICAL EXAMINERS, AND CORONERS
We may disclose medical information to a coroner or medical examiner if necessary to identify a deceased person or determine the cause of death. We may disclose medical information to funeral directors as necessary.
ORGAN AND TISSUE DONATION
If you are an organ donor, we may disclose medical information to organizations that handle organ procurement to facilitate donation and transplantation.
REQUIRED BY LAW
We may use or disclose medical information if the use or disclosure is required by law and the use or disclosure complies with and is limited to the relevant requirements of the law.
We may, in accordance with the law, disclose medical information that it believes in good faith is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We would disclose such information to a person reasonably able to prevent or lessen the serious and imminent threat.
OTHER USES OF MEDICAL INFORMATION REQUIRING WRITTEN PERMISSION
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 consent. This includes most disclosures of psychotherapy notes, the use of your medical information for marketing purposes, disclosures that constitute the sale of medical information, and other uses and disclosures not described in this Notice.
If you provide us with permission to use or disclose your medical information, 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 previous consent. We are unable to take back any disclosures we have already made with your consent, and we are required to retain our records of the care we provided you. You will be unable to revoke written consent to disclose medical information that you gave as a condition of securing insurance coverage where the law allows the insurer to contest a claim under the policy or the policy itself.
We may contact you for fundraising efforts, but you can tell us not to contact you again.
YOUR MEDICAL INFORMATION RIGHTS
Your health record is the physical property of the organization however the information in your health record belongs to you. You have the following rights:
RIGHT TO OBTAIN AN ELECTRONIC OR PAPER COPY OF YOUR MEDICAL RECORD (INSPECT AND COPY)
You have the right to review and obtain a copy of your medical record. You have the right to request an electronic copy of your medical record. This includes medical and billing records; however, this does not include psychotherapy reports, information compiled in anticipation of legal proceedings, information prohibited under the Clinical Laboratory Act (CLIA) or information held by certain research laboratories. You have the right to request that we send a copy of your medical record directly to another person. Your request must be submitted in writing.
In certain situations, we may deny access if we believe that access could cause harm to you or others. You may request a review of the denial, if access is denied.
We will provide a copy or a summary of your health information, within 30 days of your request, unless state law dictates a shorter time frame. We may charge a reasonable, cost-based fee if permitted by state law.
RIGHT TO AMEND YOUR MEDICAL RECORD
You can ask us to correct health information about you that you think is incorrect or incomplete. This right exists for as long as we have your information. If you ask for an amendment, you must provide a reason to support your request. Your request must be submitted in writing.
We may say “no” to your request, but we’ll tell you why in writing within 60 days.
We cannot amend information we did not create, do not retain, or information that is not incorrect or incomplete.
RIGHT TO ALTERNATE LOCATIONS OR CONFIDENTIAL COMMUNICATIONS
We will communicate with you during the course of your treatment. As explained above, we will only disclose to other authorized people the information which is directly relevant to that person’s involvement in your care or payment for your care. You have the right to request that we communicate with you about medical matters in a confidential manner or at a specific location. We will say “yes” to all reasonable requests. Your request must be submitted in writing.
RIGHT TO REQUEST RESTRICTIONS REGARDING WHAT WE USE OR DISCLOSE
You can ask us not to use or disclose certain health information for treatment, payment, operations, or to a relative or close friend about your general condition, location, or death. We must comply with this request if you pay for your care entirely out-of-pocket and the disclosure is not required by law. We are not required to agree to your request, and we may say “no” if it would affect your care. If we agree we will abide by the agreed restrictions, except in the case of an emergency. You must submit your request in writing.
RIGHT TO AN ACCOUNTING OF DISCLOSURES
You can ask for a written accounting of all disclosures of your health information we have made for six years prior to the date you ask, who we have shared it with, and why. The first disclosure in a 12 month period is free. A charge may be associated with requests for subsequent disclosure within the same 12 month period. We will include all disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as those you asked us to make). Your request must be submitted in writing.
RIGHT TO A PAPER COPY OF THIS PRIVACY NOTICE
You can ask for a paper copy of this Notice at any time, even if you have agreed to receive the Notice electronically. You can obtain a paper copy from the HIPAA Coordinator at this location.
RIGHT TO 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. We will make sure the person has this authority and can act for you before we take any action.
If you believe your rights have been violated, you can file a complaint with Signature HealthCare or with the Secretary of the Department of Health and Human Services. To file a complaint with Signature HealthCare, you may call the Signature CareLine at 888-392-8886 or email the Compliance Officer at email@example.com. You may file a complaint with the U.S. Department of Health and Human Services Office for civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
We will not retaliate against you for filing a complaint.
CHANGES TO THIS NOTICE
This organization reserves the right to change its privacy practices as set forth in this Notice and to make the new provisions effective for all medical information we maintain. We will post a copy of the current notice in each location. The Notice will specify the effective date. If material changes are made to this Notice, the Notice will contain an effective date of the revisions and copies can be obtained by contacting the HIPAA Coordinator at each location.
It is a requirement of the law that we maintain and protect the privacy of protected health information, provide you with a copy of our Notice of Privacy Practices as they relate to protected health information, and inform you if a breach of unsecured protected health information occurs which affects you.
We must abide by the terns of this Notice of Privacy Practices while it is in effect. We have the right to revise the terms of our notice and make the new provisions effective for all protected health information maintained by the organization. If changes are made to our Notice of Privacy Practices, a copy will be made available to you by being posted in a prominent place within our facilities and updated on our website.
We will not use or share your information other than as described in this Notice of Privacy Practices unless you tell us we can in writing. If you tell us we can, you may change your mind at any time, but you must let us know in writing.
STATE LAW REQUIREMENTS
Some states have health laws and regulations that are more stringent than the federal laws. In these cases, the uses and disclosures listed above may be more limited.
CONTACT INFORMATION FOR QUESTIONS, ADDITIONAL INFORMATION, OR TO REPORT A PROBLEM
If you have questions or would like additional information regarding the Notice of Privacy Practices, you may contact the HIPAA Coordinator at the location providing your care or the Compliance Department at firstname.lastname@example.org than the federal laws. In these cases, the uses and disclosures listed above may be more limited.