Privacy Practices
The Friendly Home is committed to protecting the
confidentiality and security of our Members' health-related
information. We are required by law to maintain the privacy of a
Member's medical information and to provide each Member with notice
of our legal duties and privacy practices with respect to
individual health information. Below is The Friendly Home's
Notice of Privacy Practices.
NOTICE OF PRIVACY PRACTICES
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.
Our facility uses your Protected Health Information for your
treatment, to obtain payment for our services and for our
operational purposes, such as improving the quality of care we
provide to you. We are committed to maintaining your
confidentiality and protecting your health information. We
are required by law to provide you with this Notice which describes
our health information privacy practices and those of affiliated
health care providers that provide care at our facility.
This Notice applies to all information and records related to
your care that our facility workforce members and Business
Associates have received or created. It also applies to
health care professionals, such as physicians, and organizations
that provide care to you at our facility. It informs you
about the possible uses and disclosures of your Protected Health
Information and describes your rights and our obligations regarding
your Protected Health Information.
We are required by law to:
- maintain the privacy of your Protected Health Information;
- provide to you this detailed Notice of our legal duties and privacy practices relating to your Protected Health Information; and
- abide by the terms of the Notice that are currently in effect. We reserve the right to change the terms of this Notice, and will notify you or your personal representative by
letter if we make any material changes to the Notice.
I.
WITH YOUR CONSENT WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH
INFORMATION FOR TREATMENT, PAYMENT AND HEALTH CARE
OPERATIONS
You will be asked to sign a Consent allowing us to use and
disclose your Protected Health Information to others to provide you
with treatment, obtain payment for our services, and run our health
care operations. Here are examples of how we may use and
disclose your health information.
For Treatment. Our staff and affiliated health
care professionals may review and record information in your record
about your treatment and care. We will use and disclose this health
information to health care professionals in order to treat and care
for you. For example, a physician may consult with another
physician located at another location to determine how to best
diagnose and treat you.
For Payment. Our facility may use and
disclose your Protected Health Information to others in order for
the facility to bill for your health care services and receive
payment. For example, we may include your health information
in our claim to Blue Cross/Blue Shield or Medicare in order to
receive payment for services provided to you. We may also
disclose your health information to other health care providers so
that they can receive payment for their services.
For Health Care Operations. We may use and
disclose your Protected Health Information to others for our
facility's business operations. For example, we may use
Protected Health Information to evaluate our facility's
services, including the performance of our staff, and to educate
our staff.
II.
WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION FOR OTHER SPECIFIC PURPOSES
Business Associates.
We may share your Protected Health Information with our vendors
and agents who help us with obtaining payment or carrying out our
business functions. These are called our "Business
Associates." For example, we may give your health
information to a billing company to assist us with our billing for
services, or to a law firm or an accounting firm that assists us in
complying with the law and or improving our services.
Facility Directory. The Friendly Home does
not publish a directory of Members for use by the public.
Unless you object, we may release your room number to people who
ask for you by name. Your religious affiliation may be given
to any member of the clergy even if they don't ask for you by
name.
Family and Friends Involved in Your Care
Unless you object, we may disclose your Protected Health
information to a family member or close personal friend, including
clergy, who is involved in your care or payment for that care.
Disaster Relief. We may disclose your
Protected Health Information to an organization assisting in a
disaster relief effort.
Public Health Activities. We may disclose
your Protected Health Information for public health activities
including the reporting of disease, injury, vital events, and the
conduct of public health surveillance, investigation and/or
intervention. We may also disclose your information to
notify a person who may have been exposed to a communicable disease or
may otherwise be at risk of contracting or spreading a disease or
condition if a law permits us to do so.
Health Oversight Activities. We may disclose
your Protected Health Information to health oversight agencies
authorized by law to conduct audits, investigations, inspections
and licensure actions or other legal proceedings. These
agencies provide oversight for the Medicare and Medicaid programs,
among others.
Reporting Victims of Abuse, Neglect or Domestic
Violence. If we have reason to believe that you have
been a victim of abuse, neglect or domestic violence, we may use
and disclose your Protected Health Information to notify a
government authority if required or authorized by law, or if you
agree to the report.
Law Enforcement. We may disclose your Protected
Health information for certain law enforcement purposes or other
specialized governmental functions.
Judicial and Administrative Proceedings. We
may disclose your Protected Health Information in the course of
certain judicial or administrative proceedings.
Research. In general, we will request that
you sign a written authorization before using your Protected Health
Information or disclosing it to others for research purposes.
However, we may use or disclose your health information without
your written authorization for research purposes provided that the
research has been reviewed and approved by the Clinical
Investigation Projects Review Board.
Coroners, Medical Examiners, Funeral Directors, Organ
Procurement Organizations. We may release your health
information to a coroner, medical examiners, funeral director or,
if you are an organ donor, to an organization involved in the
donation of organs and tissue.
To Avert a Serious Threat to Health or
Safety. We may use and disclose your Protected Health
Information when necessary to prevent a serious threat to your
health or safety or the health or safety of the public or another
person. However, any disclosure would be made only to someone
able to help prevent the threat.
Military and Veterans. If you are a member
of the armed forces, we may use and disclose your Protected Health
Information as required by military command authorities. We
may also use and disclose Protected Health Information about
foreign military personnel as required by the appropriate foreign
military authority.
Workers' Compensation. We may use or
disclose your Protected Health Information to comply with laws
relating to workers' compensation or similar programs.
National Security and Intelligence Activities; Protective
Services. We may disclose health information to
authorized federal officials who are conducting national security
and intelligence activities or as needed to provide protection to
the President of the United States, or other important
officials.
As Required By Law. We will disclose your
Protected Health Information when required by law to do so.
Treatment Alternatives and Health-Related Benefits
The facility may contact you to provide information about
treatment alternatives or other health-related benefits and
services that may be of interest to you.
Fundraising
The facility may contact you or your personal representative to
raise money to help us operate. You have the opportunity to
opt out or restrict your receiving fundraising communications.
III.
YOUR AUTHORIZATION IS REQUIRED FOR OTHER USES OF YOUR PROTECTED HEALTH INFORMATION
We will use and disclose your Protected Health Information other
than as described in this Notice or required by law only with your
written Authorization. You may revoke your Authorization to
use or disclose Protected Health Information in writing, at any
time. To revoke your Authorization, contact the Medical
Records staff. If you revoke your Authorization, we will no
longer use or disclose your Protected Health Information for the
purposes covered by the Authorization, except where we have already
relied on the Authorization.
IV. YOUR RIGHTS
REGARDING YOUR HEALTH INFORMATION
You have the following rights with respect to your health
information. If you wish to exercise any of these rights, you
should make your request to the Medical Records Coordinator or the
Director of Health Services.
Right of Access to Protected Health
Information. You have the right to request, either
orally or in writing, to inspect and obtain a copy of your
Protected Health Information, subject to some limited
exceptions. We must allow you to inspect your records within
24 hours of your request. If you request copies of the records, we
must provide you with copies within 2 days of that request.
We may charge a reasonable fee for our costs in copying and mailing
your requested information.
In certain limited circumstances, we may deny your request to
inspect or receive copies. If we deny access to your Protected
Health Information, we will provide you with a summary of the
information, and you have a right to request review of the
denial. We will provide you with information on how to
request a review of our denial and how to file a complaint with us
or the Secretary of the Department of Health and Human
Services.
Right to Request Restrictions. You have the
right to request restrictions on the way we use and disclose your
Protected Health Information for our treatment, payment or health
care operations. You also have the right to request
restrictions on our disclosures of your Protected Health
Information to a family member, friend or other person who is
involved in your care or the payment for your care.
We may not be required to agree to your requested restriction,
and in some cases, the law may not permit us to accept your
restriction. However, if we do agree to accept your
restriction, we will comply with your restriction in most
situations. We may not be required to honor your restriction
in the following situations: (1) you are being transferred to
another health care institution; (2) the release of records is
required by law, or (3) the release of information is needed to
provide you emergency treatment.
Right to an Accounting of Disclosures. You
have the right to request an "accounting" of our
disclosures of your Protected Health Information. This is a
listing of certain disclosures of your Protected Health Information
made by the facility or by others on our behalf, but does not
include disclosures made for treatment, payment and health care
operations or certain other purposes.
You must submit a request in writing, stating a time period
beginning after April 13, 2003 that is within six years from the
date of your request. For example, you may request a list of
disclosures the facility made between May 1, 2003 and May 1,
2004. You are entitled to one free accounting within one
12-month period. For additional requests, we may charge
you our costs.
We will usually respond to your request within 60 days.
Occasionally, we may need additional time to prepare the
accounting. If so, we will notify you of our delay, the
reason for the delay, and the date when you can expect the
accounting.
Right to Request Amendment. If you think
that your Protected Health Information is not accurate or complete,
you have the right to request that the facility amend such
information for as long as the information is kept in our
records. Your request must be in writing and state the reason
for the requested amendment. We will usually respond within
60 days, but will notify you within 60 days if we need additional
time to respond, the reason for the delay and when you can expect
our response. We may deny your request for amendment, and if
we do so, we will give you a written denial including the reasons
for the denial and an explanation of your right to submit a written
statement disagreeing with the denial.
Right to a Paper Copy of This Notice. You
have the right to obtain a paper copy of this Notice, even if you
have agreed to receive this Notice electronically. You may
request a copy of this Notice at any time. [You may obtain a
copy of this Notice at our website, www.friendlyhome.org.]
Right to Request Confidential
Communications. You have the right to request that we
communicate with you concerning personal health matters in a
certain manner or at a certain location. For example, you can
request that we speak to you only at certain private locations in
the facility. We will accommodate your reasonable
requests.
V.
COMPLAINTS
If you believe that your privacy rights have been violated, you
may file a complaint in writing with us or with the Office of Civil
Rights in the U.S. Department of Health and Human Services.
To file a complaint with the facility, contact Dave Anisansel,
Privacy Officer at 585-385-0218 or the Compliance Hot Line at
585-218-8888. No one will retaliate or take action against
you for filing a complaint.
VI.
CHANGES TO THIS NOTICE
We will promptly revise and distribute this Notice whenever
there is a material change to the uses or disclosures, your
individual rights, our legal duties, or other privacy practices
stated in this Notice. We reserve the right to change this
Notice and to make the revised or new Notice provisions effective
for all Protected Health Information already received and
maintained by the facility as well as for all Protected Health
Information we receive in the future. We will post a copy of
the current Notice in the facility. In addition, we will
provide a copy of the revised Notice to all residents by delivering
a hard copy to them or their personal representatives.
VII. FOR FURTHER
INFORMATION
If you have any questions about this Notice or would like
further information concerning your privacy rights, please contact
Dave Anisansel, Privacy Officer at 585-385-0218.
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