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Effective April 14, 2003
This notice describes how your protected health information: (includes medical and financial) may be used and disclosed and how you may receive access to this information. Please review it careful. This privacy policy and notice is being provided to you as required of a federal law, the Health Insurance Portability and Accountability Act. (HIPAA)
Understanding Your Health Record/Information:
Your health/medical record at this facility is composed of much information specific to you – for example it includes your diagnosis, examination and test results, physician and staff notes regarding your plan of care, etc. This record serves a variety of uses. It is a legal document that services as a planning document for your care and a way of communication for all the professionals involved in providing you the best quality care. The information and data in this record is for public health officials and third party payers, as well as for potential medical research and planning/marketing.
By understanding what is in your record and how your health information is used, you can make informed decisions regarding disclosures and can feel comfortable with its comprehensiveness and accuracy.
Your Health Information Rights:
Although your health record is the physical property of the healthcare practitioner of facility that compiles it, you may do the following:
• Obtain a copy of protected health information in a designated record set (medical and billing records, etc.) except for those items exempted in the law, the most common example being psychotherapy notes and information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action of proceeding. This request for access and copies are to be made in writing following the procedure of the National Lutheran Home & Village. There will be a fee for copying. Please see the head nurse regarding the procedure.
• Request a restriction on certain uses and disclosures of your information, in writing; however, the facility is not required to agree to a restriction.
• Request an amendment to the designated record set in writing; however, if the facility verifies the information requested to be amended is indeed correct it will deny the request.
• Make a reasonable request to have heath information provided by alternative means or at an alternate location. Requests must be made in writing to the Privacy Officer.
• Request a paper copy of this notice upon request.
• Receive an accounting of certain disclosures other than treatment, payment, of health care operations and as otherwise described here after April 14, 2003.
The National Lutheran Home & Village has the right to and will do the following:
• Maintain the privacy of your health information.
• Explain via this privacy notice use of your health information. 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.
• 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 post a notice on the bulletin board by Resident Care. Please be sure to take note of this often so that if you have any questions, you can contact the Privacy Officer.
• We will note use of disclose your health information without your written authorization which you can revoke at any time, except as described in this notice.
For More Information on to Report a Problem:
• If you have questions and would like additional information, you may contact the Privacy Official at (301) 424-9560 ext. 200.
• If you believe your privacy rights have been violated, you can file a complaint with the Privacy Officer, located in the Executive Offices, or with the Secretary of Health and Human Services, There will be no retaliation for filing a complaint.
Examples of Disclosures for Treatment, Payment and Health Operations
not Requiring your Written Authorization:
• We will use and convey your health information in person, by phone or via electronic methods for treatment; this information then is available to everyone that is part of the healthcare team and necessary business associates.
• We will provide the physicians as well as the relevant ancillary providers with copies of various reports needed to assist them in complete their tasks. Business associates will take steps to safe guard your information as well.
• We will use your health information for reimbursement of services rendered.
• We will use your health information for routine health operations.
• We will use your health information for quality assurance purposes.
• We will use your name, location in the facility, religious affiliation, and general condition for directory purposes: you do, however, have the opportunity to object to this disclosure. This information may be provided to members of the clergy (including religious affiliations). We may use or disclose information for notification purposes to designated contacts.
• Health professionals, using their best judgment, may disclose designated responsible party health information relevant to that person’s involvement in your care or payment related to your care in person, by phone or via electronic methods.
• We may disclose information to researchers when their research has been properly approved by an institution’s review board.
• We may disclose health information to funeral directors and organ procurement organizations consistent with applicable law to care out their duties.
• We may use information for basic marketing purposes limited to communications involving a face to face encounter between us.
• We will disclose information as necessary to comply with workman’s compensation or similar programs.
• We may contact you as part of a fund-raising effort and to provide general mailings from the Home.
• We will disclose to any federal, state, or local agencies or departments information requested by law.
• Students doing their training will have limited access to Protected Health information (PHI) as deemed necessary by their approved preceptor.
• We will disclose health information for law enforcement purposes as required by law and in connection with judicial and administrative proceedings.
• Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member of business associate believed in good faith that we have engaged in unlawful conduct have otherwise violated professional or clinical standards and are potentially endangering one of more patient workers or the public.
• We will disclose information as necessary to report suspected abuse, neglect, or domestic violence or in general, as legally required.
• No ongoing list will be kept of these regular disclosures, only specifically requested information made in writing to the Facility by you or your agent. You may receive a history of this if records have not been kept.
ACKNOWLEDGMENT OF NOTICE AND PRIVACY POLICY
I understand that my health/medical record at this facility is composed of much information specific to me and serves a variety of uses. It is a legal document that serves as a planning document for my care, a way to communication for all the professionals involved in providing me the best quality care, and as a tool for routine healthcare operations and all that entails, including directory listings. While not an all inclusive list, the information and data in this record is also for public health officials and third party payers as well as for potential medical research and planning/marketing.
I understand and have been provided with the Privacy Policy Use of Information document that provides a description of information uses and disclosures and that I understand the contents of said policy.
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