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.
This facility is required by law to provide you with this notice so that you will understand how we may use or share your medical information. We are required to adhere to the terms outlined in this notice. If you have any questions about this notice, please contact the HIPAA Designee.
This notice describes the practices of this facility and its affiliates (together “the affiliated covered entity”). This facility is required by law to provide you with this notice regarding our legal obligations with respect to your protected health information and to adhere to the terms of the notice currently in effect.
UNDERSTANDING YOUR HEALTH RECORD AND INFORMATION
Each time you visit a facility; a record of your visit and payment information is made. Typically, this record contains information about your condition and the treatment that we provide. We use and/or disclose this information, called protected health information or “PHI” to:
- Plan your care and treatment
- Communicate with other health professionals involved in your care
- Document the care you receive
- Educate health professionals
- Provide information for medical research
- Provide information to public health officials
- Evaluate and improve the care we provide
Understanding what is in your record and how your health information is used helps you to:
- Ensure it is accurate
- Better understand who may access your health information
- Make more informed decisions when authorizing disclosure to others
We are required to notify you of a breach of your unsecured PHI in writing should it occur.
HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOU
The following categories describe the ways that we use and disclose protected health information. 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 into one of the categories. We may use and disclose your PHI for treatment, payment, and health care operations, as explained below, without your consent or authorization.
For Treatment. We may use PHI about you to provide you with medical treatment. We may disclose medical information about you to doctors, nurses, therapists or other facility personnel who are involved in taking care of you at a facility. These individuals may include a medical doctor, podiatrist, dentist, optometrist, physical therapist, occupational therapist, speech therapist, and psychologist. 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 plan your meals. Different departments of a facility also may share medical information about you in order to coordinate your care and provide you medication, lab work and x-rays. We may also disclose medical information about you to people outside the facility who may be involved in your medical care after you leave a facility. This may include family members, or visiting nurses to provide care in your home.
For Payment. We may use and disclose PHI about you so that the treatment and services you receive at a facility may be billed to you, an insurance company or a third party. For example, in order to be paid, we may need to share information with your health plan or other third party about services provided to you. We may also tell your health plan about a 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 PHI about you for health care operations. This is necessary to ensure that all of our residents receive quality care. For example, we may use medical information to review our services and to evaluate the performance of our staff. We may also combine medical information about many residents to decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, therapists, and other personnel for review and learning purposes. We may remove information that identifies you so others may use it to study health care and health care delivery without learning the identities of residents.
OTHER ALLOWABLE USES OF YOUR PROTECTED HEALTH INFORMATION THAT DO NOT REQUIRE AN AUTHORIZATION
Business Associates. There are some services provided in our facility through contracts with business associates. Examples include medical directors, outside attorneys and a copy service we use when making copies of your health record. When these services are contracted, we may disclose your health information so that they can perform the job we’ve asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.
Treatment Alternatives. We may use and disclose PHI to tell you about possible treatment options or alternatives that may be of interest to you.
Health-Related Benefits and Services. We may use and disclose PHI to tell you about health-related benefits or services that may be of interest to you.
Fundraising Activities. We may use limited protected health information about you to contact you in an effort to raise money as part of a fundraising effort. We may disclose PHI to a foundation related to the facility so that the foundation may contact you in raising money for the facility. We will only release contact information, such as your name, address and phone number and the dates you received treatment or services at the facility. You have the right to opt out of receiving fundraising communications. To opt out, you may notify the facility’s HIPAA Designee that you do not wish to receive these communications. Any fundraising communication will also provide you information regarding the process for opting out.
As Required By Law. We will disclose PHI 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 PHI about you to prevent a serious threat to your health and safety or the health and safety of the public or another person. We would do this only to help prevent the threat.
Organ and Tissue Donation. If you are an organ donor, we may disclose PHI to organizations that handle organ procurement to facilitate donation and transplantation.
Military and Veterans. If you are a member of the armed forces, we may disclose PHI about you as required by military authorities. We may also disclose medical information about foreign military personnel to the appropriate foreign military authority.
Research. Under certain circumstances, we may use and disclose PHI 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. We may, however, disclose medical information about you to people preparing to conduct a research project so long as the medical information they review does not leave a facility.
Workers’ Compensation. We may disclose PHI about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Public Health Activities for the Purpose of Preventing or Controlling Disease, Injury or Disability. We may disclose your PHI when we are required to collect information about diseases or injuries (e.g. your exposure to a disease or your risk for spreading or contracting a communicable disease or condition, product recalls (e.g. reactions to medications or problems with products), or to report vital statistics (e.g. births/deaths) to the public health authority.)
Health Oversight Activities. We may disclose PHI to a health oversight agency for activities authorized by law. These oversight activities may include 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.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose PHI 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 disclose PHI when requested 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 you, the victim of a crime if, under certain limited circumstances, we are unable to obtain your agreement;
- About a death we believe may be the result of criminal conduct;
- About criminal conduct at the 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 disclose PHI to a coroner or medical examiner. This may be necessary to identify a deceased person or determine the cause of death. We may also disclose medical information to funeral directors as necessary to carry out their duties.
- National Security and Intelligence Activities. We may disclose PHI about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
- Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose PHI about you to the correctional institution or law enforcement official. This disclosure would be necessary (1) for the institution 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.
USES OF YOUR PROTECTED HEALTH INFORMATION AFTER YOU HAVE A CHANCE TO OBJECT
In the following situations, we may disclose a limited amount of your PHI if we provide you with an advance opportunity to object to such release or if such release is not otherwise prohibited by law. However, if there is an emergency situation and you are unable to object (because you were not present or you were incapacitated, etc.) disclosure may be made if it is consistent with any prior expressed wishes and disclosure is determined to be in your best interest. You may make your objection to the Facility’s HIPAA Designee.
Facility Directory. We may include information about you in the facility directory while you are a resident. This information may include your name, location in the facility, your general condition (e.g., fair, stable, etc.) and your religion. The directory information, except for your religion, may be disclosed to people who ask for you by name. Your religion may be given to a member of the clergy, such as a priest or rabbi, even if they don’t ask for you by name. This is so your family, friends and clergy can visit you in the facility and generally know how you are doing.
Individuals Involved in Your Care or Payment for Your Care. We may disclose PHI 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 may also tell your family or friends your condition and that you are in the facility. 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.
OTHER USES OF PROTECTED HEALTH INFORMATION
Other uses and disclosures of PHI not covered by this notice or the laws that apply to us will be made only with your written authorization. For example, uses or disclosures requiring an authorization include psychotherapy notes, marketing communications, and disclosures constituting a sale of your PHI, unless authorized by law. If you provide us an authorization to use or disclose PHI about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose PHI 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 authorization, and we are unable to revoke the authorization if it was obtained as a condition of obtaining insurance coverage.
YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION ABOUT YOU
Although your health record is the property of the facility, the information belongs to you. You have the following rights regarding your PHI:
Right to Inspect and Copy. With some exceptions, you have the right to review and copy your PHI. If we maintain electronic records of your PHI you have the right to receive this information in electronic form if it is readily producible or in an electronic form as agreed to by you and the facility.
You must submit your request in writing to the Facility HIPAA designee. We may charge a fee for the costs of copying, mailing or other supplies associated with your request.
Right to Amend. If you feel that medical information in your record is incorrect or incomplete, you may ask us to amend the information. You have this right for as long as the information is kept by or for the facility.
You must submit your request in writing to the Facility HIPAA designee. In addition, you must provide a reason for 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 facility; 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 certain disclosures we made of your PHI, other than those made for purposes such as treatment, payment, or health care operations.
- You must submit your request in writing to the Facility HIPAA Designee. Your request must state a time period, which may not be longer than six (6) years from the date the request is submitted. 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.Right to Request Restrictions. You have the right to request a restriction or limitation on the PHI we use or disclose about you. For example, you may request that we limit the PHI we disclose to someone who is involved in your care or the payment for your care. You could ask that we not use or disclose information about a surgery you had to a family member or friend.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.You must submit your request in writing to the Facility HIPAA Designee. 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.We are required to restrict disclosure of your PHI to a health plan upon your written request if the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law, and the PHI pertains solely to a health care item or service for which you, or a person other than the health plan on behalf of you, has paid the facility in full.
Right to Request Alternate Communications. You have the right to request that we communicate with you about medical matters in a confidential manner or at a specific location. For example, you may ask that we only contact you via mail to a post office box.
You must submit your request in writing to the Facility HIPAA Designee. We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests.
Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice even if you have agreed to receive the notice electronically. You may ask us to give you a copy of this notice at any time.
You may obtain a copy of this notice at our website, www.twdcc.com.
To obtain a paper copy of this notice, contact the Facility HIPAA Designee.
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 facility and on the website. The notice will specify the effective date on the first page, in the top right-hand corner. In addition, if material changes are made to this notice, the notice will contain an effective date for the revisions and copies can be obtained by contacting the facility executive director.
If you believe your privacy rights have been violated, you may file a complaint with the facility or with the Secretary of the Department of Health and Human Services at 200 Independence Ave., S.W., Washington, DC 20201, telephone number (1-877-696-6775 FREE). To file a complaint with the facility, contact the Executive Director. All complaints must be submitted in writing. You will not be penalized or retaliated against for filing a complaint.
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