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.
If you have any questions about this notice, please contact our Privacy Officer/Human Resources Director, at 513-272-5555.
This Notice of Privacy Practices describes how we may use and disclose your Protected Health Information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your Protected Health Information. “Protected Health Information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. This Notice of Privacy Practices applies to Episcopal Retirement Services, which operates Marjorie P. Lee, The Deupree House, and The Deupree Cottages.
1. Uses and Disclosures of Protected Health Information
You will be asked by us to sign this Notice of Privacy Practices. We will make a good faith effort to obtain a written acknowledgement that you received this Notice of Privacy Practices for Protected Health Information the first time we provide services to you or as soon as reasonably practicable under the circumstances. Your Protected Health Information may be used and disclosed by us and others outside of ERS that are involved in your care and treatment for the purpose of providing health care services to you. Your Protected Health Information may also be used and disclosed to obtain payment for your health care bills and to support the operation of ERS.
Following are examples of the types of uses and disclosures of your Protected Health Information that we are permitted to make. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by us.
Treatment. We will use and disclose your Protected Health Information to provide, coordinate or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, we would disclose your Protected Health Information, as necessary, to a home health agency that provides care to you. We will also disclose Protected Health Information to physicians who may be treating you. For example, your Protected Health Information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.
In addition, we may disclose your Protected Health Information from time-to-time to another nursing facility or health care provider (e.g., a physician or laboratory) who, at the request of your physician or ERS, becomes involved in your care by providing assistance with your health care diagnosis or treatment.
Payment. Your Protected Health Information will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we recommend for you such as: making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity and undertaking utilization review activities.
For example, obtaining approval for a Medicare stay may require that your relevant Protected Health Information be disclosed to the hospital to get necessary information.
Healthcare Operations. We may use or disclose, as needed, your Protected Health Information in order to support our business activities. These activities include, but are not limited to, quality assessment activities, staff review activities, training of nursing students, licensing, and conducting or arranging for other business activities.
For example, we may disclose your Protected Health Information to nursing school students or volunteers that see residents at our facility. In addition, we may use or disclose your Protected Health Information to our Social Workers or Chaplain for their responsibilities in your care. We may also use or disclose your Protected Health Information to Dietary Staff in the operation of the Dining Services Program.
We will share your Protected Health Information with third party “business associates” that perform various activities (e.g., billing, transcription services) for us. Whenever an arrangement between a business associate and us involves the use or disclosure of your Protected Health Information, we will have a written contract that contains terms that will protect the privacy of your Protected Health Information.
We may use or disclose your Protected Health Information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. We may also use and disclose your Protected Health Information for referral development and other marketing activities. For example, your name and address may be used to send you a newsletter about us and the services we offer. You may contact our Privacy Officer to request that these materials not be sent to you.
We may use or disclose your demographic information and the dates that you received treatment from us, as necessary, in order to contact you for fundraising activities supported by us. If you do not want to receive these materials, please contact our Privacy Officer and request that these fundraising materials not be sent to you.
Uses and Disclosures of Protected Health Information Based Upon Your Written Authorization
Other uses and disclosures of your Protected Health Information will be made only with your written authorization, unless otherwise permitted or required by law as described below. We will not share your information, unless you give us written authorization for marketing purposes (except as noted above), for the sale of your information or for most uses of your psychotherapy notes. You may revoke this authorization, at any time, in writing, except to the extent that we have taken an action in reliance on the use or disclosure indicated in the authorization.
Other Permitted and Required Uses and Disclosures that may be made without Your Authorization or Opportunity to Object
We may use and disclose your Protected Health Information in the following instances.
You have the opportunity to agree or object to the use or disclosure of all or part of your Protected Health Information. If you are not present or able to agree or object to the use or disclosure of the Protected Health Information, then your physician may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the Protected Health Information that is relevant to your health care will be disclosed.
Facility Directories. Unless you object, we will use and disclose in our facility directory your name, the location at which you are receiving care, your condition (in general terms), and your religious affiliation. All of this information, except religious affiliation, will be disclosed to people that ask for you by name. Members of the clergy will be told your religious affiliation.
Others Involved in Your Healthcare. Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your Protected Health Information that directly relates to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose Protected Health Information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your Protected Health Information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.
Emergencies. We may use or disclose your Protected Health Information in an emergency treatment situation. If this happens, we shall try to obtain your acknowledgement of our Privacy Practices as soon as reasonably practicable after the delivery of treatment. If we are required by law to treat you and we have attempted to obtain your acknowledgement, but are unable, we may still use or disclose your Protected Health Information for treatment, payment, and health care operations.
Communication Barriers. We may use and disclose your Protected Health Information if we attempt to obtain an acknowledgement of our Privacy Practices from you, but are unable to do so due to substantial communication barriers.
Other Permitted and Required Uses and Disclosures that may be made without Your Consent, Authorization or Opportunity to Object
We may use or disclose your Protected Health Information in the following situations without your acknowledgement or authorization. These situations include:
Required by Law
Abuse or Neglect
Military Activity & National Security
Coroners, Funeral Directors & Organ Donation
Food and Drug Administration
Required Users and Disclosures
2. Your Rights
Following is a statement of your rights with respect to your Protected Health Information and a brief description of how you may exercise these rights.
You have the right to inspect and copy your Protected Health Information. This means you may inspect and obtain a copy of Protected Health Information about you that is contained in a designated record set for as long as we maintain the Protected Health Information. You may also request an electronic copy, which we will provide if we maintain the record in the electronic form and format that you request. A “designated record set” contains medical and billing records and any other records that we use for making decisions about you.
Under federal law, however, you may not inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding; and Protected Health Information that is subject to law that prohibits access to Protected Health Information. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Officer if you have questions about access to your medical record.
You have the right to request a restriction of your Protected Health Information. This means you may ask us not to use or disclose any part of your Protected Health Information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your Protected Health Information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.
We are not required to agree to a restriction that you may request. If we believe it is in your best interest to permit use and disclosure of your Protected Health Information, your Protected Health Information will not be restricted. If we do agree to the requested restriction, we may not use or disclose your Protected Health Information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with us. You may request a restriction by submitting a written request to our Medical Records Manager.
You have the right not to have your health plan be notified. If you pay out-of-pocket in full (i.e., you have request that we not bill your health plan) for a specific item or service, you have the right to ask that your protected health information with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations, and we will honor that request.
You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Medical Records Manager.
You may have the right to have us amend your Protected Health Information. This means you may request an amendment of Protected Health Information about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Medical Records Manager if you have questions about amending your medical record.
You have the right to receive an accounting of certain disclosures we have made, if any, of your Protected Health Information. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, for a facility directory, to family members or friends involved in your care, as part of an approved authorization, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred within the six years prior to the date of your request. You may request a shorter timeframe. The right to receive this information is subject to certain exceptions, restrictions and limitations.
You have the right to be notified of a breach. You have the right to be notified in the event that we (or a Business Associate) discover a breach of your unsecured Protected Health Information.
You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.
3. Our Duties
We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice at any time. The new notice will be effective for all Protected Health Information that we maintain both before and after the change. We will provide you with any revisions to the Notice of Privacy Practices.
You may complain to us or to the U.S. Department of Health and Human Services if you believe your privacy rights have been violated by us. You can contact 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, by calling 1-877-696-6775, or by visiting www.hhs.gov/ocr/privacy/hipaa/complaints.
You may file a complaint with us by notifying our Privacy Officer of your complaint. We will not retaliate against you for filing a complaint.
For further information about the complaint process, you may contact our Privacy Officer/Human Resources Director, at 513-272-5555 or by writing 3870 Virginia Avenue, Cincinnati, OH 45227.
This notice was revised effective September 23, 2013.