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PINE VALLEY HEALTHCARE AND |
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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. USE AND
DISCLOSURE OF HEALTH INFORMATION Pine Valley Healthcare and Rehabilitation
Center (PVHRC) may use your health information, that is, information that
constitutes protected health information as defined in the Privacy Rule of
the Administrative Simplification provisions of the Health Insurance
Portability and Accountability Act of 1996, for purposes of providing you
treatment, obtaining payment for your care and conducting health care
operations. PVHRC has established a
policy to guard against unnecessary disclosure of your health information. THE
FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR
WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED: To Provide
Treatment. PVHRC may use
your health information to provide care to you and disclose your health
information to others who provide care to you, such as your attending
physician and other health care professionals who are involved in your
care. For example, physicians involved
in your care will need information about your symptoms in order to prescribe
appropriate medications. PVHRC also
may disclose your health care information to individuals outside of the PVHRC
involved in your care including family members/contacts, pharmacists,
suppliers of medical equipment or other health care professionals. To Obtain
Payment. PVHRC may include
your health information in invoices to collect payment from third parties for
the care you may receive from PVHRC.
For example, PVHRC may be required by your health insurer to provide
information regarding your health care status so that the insurer will
reimburse you or PVHRC. PVHRC also may
need to obtain prior approval from your insurer and may need to explain to
the insurer your need for health care and the services that will be provided
to you. To Conduct
Health Care Operations.
PVHRC may use and disclose health information for its own operations
in order to facilitate the function of PVHRC and as necessary to provide
quality care to all of PVHRC's residents. Health care operations include activities
such as: - Quality assessment and improvement
activities. - Activities designed to improve health or
reduce health care costs. - Protocol development, case management and
care coordination. - Contacting health care providers and
residents with information about treatment alternatives and other related
functions that do not include treatment. - Professional review and performance
evaluation. - Training programs including those in which
students, trainees or practitioners in health care learn under supervision. - Training of non-health care professionals ie. business office, beauticians
. - Accreditation, certification, licensing or
credentialing activities. - Review and auditing, including compliance
reviews, medical reviews, legal services and compliance programs. - Business planning and development
including cost management and planning related analyses and formulary
development. - Business management and general
administrative activities of PVHRC. -
Fundraising for the benefit of PVHRC and certain marketing
activities ie. PVHRC foundation. For
example, PVHRC may use your health information to evaluate its staff
performance, combine your health information with other PVHRC residents in
evaluating how to more effectively serve all of PVHRC residents, disclose your
health information to PVHRC staff and contracted personnel for training
purposes, use your health information to contact you or your family as part
of general fundraising and community information mailings (unless you tell us
you do not want to be contacted). For the Facility Directory. PVHRC may disclose certain information about you including your name, your
religious affiliation and where you are located in a facility directory while
you are in PVHRC. PVHRC may disclose
this information to people who ask for you by name. However, religious affiliation will only be
disclosed to clergy. If you do
not want PVHRC to include your information in the directory, you must notify the
social worker at 608- 647-2138. For
Fundraising Activities.
PVHRC may use information about you including your name, address and
telephone number to contact you or your family to raise money for PVHRC. If you do not want PVHRC to contact you or
your family, you must notify the social worker at 608- 647-2138 and
indicate that you do not wish to be contacted. For
Treatment Alternatives.
PVHRC may use and disclose your health information to tell you about
or recommend possible treatment options or alternatives that may be of
interest to you. THE
FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR
WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED WITHOUT YOUR WRITTEN
CONSENT OR AUTHORIZATION: When Legally Required. PVHRC will disclose your health information
when it is required to do so by any Federal, State or local law. When There Are Risks to Public Health. PVHRC may disclose your health information
for the following public activities and purposes: - To prevent or control disease, injury or
disability, report disease, injury, vital events such as birth or death and
the conduct of public health surveillance, investigations and interventions. - To report adverse events, product defects,
to track products or enable product recalls, repairs and replacements and to
conduct post-marketing surveillance and compliance with requirements of the
Food and Drug Administration. - To notify a person who has been exposed to
a communicable disease or who may be at risk of contracting or spreading a
disease. - To an employer about an individual who is
a member of the workforce as legally required. To Report
Abuse, Neglect Or Domestic Violence. PVHRC is allowed to notify government
authorities if PVHRC believes a resident is the victim of abuse, neglect or
domestic violence. PVHRC will make
this disclosure only when specifically required or authorized by law or when
the resident agrees to the disclosure. To Conduct
Health Oversight Activities.
PVHRC may disclose your health information to a health oversight
agency for activities including audits; civil, administrative or criminal
investigations; inspections; licensure or disciplinary action. PVHRC, however, may not disclose your
health information if you are the subject of an investigation and the
investigation does not arise out of and is not directly related to your
receipt of health care or public benefits. In
Connection With Judicial And Administrative Proceedings. As permitted or required by State law,
PVHRC may disclose your health information in the course of any judicial or
administrative proceeding in response to an order of a court or
administrative tribunal as expressly authorized by such order or in response
to a subpoena, discovery request or other lawful process, but only when PVHRC
makes reasonable efforts to either notify you about the request or to obtain
an order protecting your health information. For Law
Enforcement Purposes. As permitted or
required by State law, PVHRC may disclose your health information to a law
enforcement official for certain law enforcement purposes, including, under certain
limited circumstances, if you are a victim of a crime or in order to report a
crime. To Coroners
And Medical Examiners.
PVHRC may disclose your health information to coroners and medical
examiners for purposes of determining your cause of death or for other
duties, as authorized by law. To Funeral
Directors. PVHRC may
disclose your health information to funeral directors consistent with
applicable law and if necessary, to carry out their duties with respect to
your funeral arrangements. If necessary
to carry out their duties, PVHRC may disclose your health information prior
to and in reasonable anticipation, of your death. For Organ,
Eye Or Tissue Donation.
PVHRC (if specified on POAHC form, or by you or your family) may use
or disclose your health information to organ procurement organizations or
other entities engaged in the procurement, banking or transplantation of
organs, eyes or tissue for the purpose of facilitating the donation and
transplantation. For Research
Purposes. PVHRC may, under very
select circumstances, use your health information for research. Before PVHRC discloses any of your health
information for such research purposes, the project will be subject to an
extensive approval process. PVHRC will
request your written authorization before granting access to your
individually identifiable health information.
Ie. Pain control, wound care studies, etc. In the Event
of A Serious Threat To Health Or Safety. PVHRC may, consistent with applicable law
and ethical standards of conduct, disclose your health information if PVHRC,
in good faith, believes that such disclosure is necessary to prevent or
lessen a serious and imminent threat to your health or safety or to the
health and safety of the public. For Specified Government Functions. In certain circumstances, the Federal
regulations authorize PVHRC to use or disclose your health information to
facilitate specified government functions relating to the military and
veterans, national security and intelligence activities, protective services
for the President and others, medical suitability determinations and inmates
and law enforcement custody. For Worker's
Compensation. PVHRC may release your health information for worker's
compensation or similar programs. AUTHORIZATION
TO USE OR DISCLOSE HEALTH INFORMATION Other than
is stated above, PVHRC will not disclose your health information other than
with your written authorization. If
you or your representative authorizes PVHRC to use or disclose your health
information, you may revoke that authorization in writing at any time. YOUR RIGHTS
WITH RESPECT TO YOUR HEALTH INFORMATION You have the
following rights regarding your health information that PVHRC maintains: Right to
Request Restrictions. You may request
restrictions on certain uses and disclosures of your health information. You have the right to request a limit on
PVHRC disclosure of your health information to someone who is involved in
your care or the payment of your care.
However, PVHRC is not required to agree to your request. If you wish to make a request for
restrictions, please contact the social worker at 608-647-2138. Right to
Receive Confidential Communications. You have the right to request that PVHRC
communicate with you in a certain way.
For example, you may ask that PVHRC only conduct communications
pertaining to your health information with you privately with no other family
members present. If you wish to
receive confidential communications, please contact the social worker at
608-647-2138. PVHRC will
not request that you provide any reasons for your request and will attempt to
honor your reasonable requests for confidential communications. Right to
Inspect and Copy Your Health Information. You have the right to inspect and copy your
health information, including billing records. A request to inspect and copy records
containing your health information may be made to the social worker at
608-647-2138. If you request a copy of your health
information, PVHRC may charge a reasonable fee for copying and assembling costs
associated with your request. Right to Amend Your Health
Information. You or your
representative have the right to request that PVHRC amend your records, if
you believe your health information records are incorrect or incomplete. That request may be made as long as the
information is maintained by PVHRC. A
request for an amendment of records must be made in writing to the
social worker at Right to an
Accounting. You or your
representative have the right to request an accounting of disclosures of your
health information made by PVHRC for any reason other than for treatment,
payment or health operations. The
request for an accounting must be made in writing to the social worker at Right to a
Paper Copy of this Notice.
You or your representative have a right to a
separate paper copy of this Notice at any time even if you or your
representative have received this Notice previously. To obtain a separate paper copy, please
contact the social worker at 608-647-2138. DUTIES OF
FACILITY PVHRC is
required by law to maintain the privacy of your health information and to
provide to you and your representative this Notice of its duties and privacy
practices. PVHRC is required to abide
by the terms of this Notice as may be amended from time to time. PVHRC reserves the right to change the
terms of its Notice and to make the new Notice provisions effective for all
health information that it maintains.
If PVHRC changes its Notice, PVHRC will provide a copy of the revised
Notice to you or your appointed representative. You or your representative
have the right to express complaints to PVHRC and to the Secretary of
Health and Human Services if you or your representative believe that your
privacy rights have been violated. Any
complaints to PVHRC should be made in writing to the social worker at CONTACT
PERSON PVHRC has
designated the social worker as its contact person for all issues regarding
resident privacy and your rights under the Federal privacy standards. You may contact this person at 25951
Circle EFFECTIVE DATEThis Notice is effective IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE,
PLEASE CONTACT THE SOCIAL WORKER AT 25951 CIRCLE |
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