Lourdes-Noreen McKeen Residence
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 regarding this notice, please contact Lourdes-Noreen McKeen Community Privacy Officer at (561) 655-8544 ext. 3001.
Privacy is a Sacred Treasure—upheld by our Mission and Philosophy and the Law.
We respect the Privacy of your Personal Health Information and are committed to maintaining our Residents’ Confidentiality. This notice applies to all information and medical records related to your care that our Facility has received or created. It extends to information received or created by our Employees, Staff, Volunteers, Consultants, Therapists, and Physicians. This Notice informs you about the possible uses and disclosures and your rights and our obligations regarding your Personal Health Information. (Henceforth identified by the abbreviation: PHI)
We are required by law to:
- Maintain the Privacy of your PHI;
- Provide you with a copy of this detailed Notice of our Legal Duties and Privacy Practices relating to your PHI and are required to obtain a Written Acknowledgment or document a “good faith effort” to obtain an Acknowledgment that individuals have received a Notice of Lourdes-Noreen McKeen Community’s Privacy Practices;
- Abide by the terms of this Notice that are currently in effect.
We reserve the right to change this Notice and make the revised or changed Notice effective for Health Information we already have about you as well as any information we receive in the future.
OUR POLICY FOR USE OR DISCLOSURE OF YOUR PHI
You will be asked to sign an Acknowledgment that you have received a copy of our Notice of Privacy Practices.
Your PHI can be used and disclosed for purposes of Treatment, Payment and Health Care Operations.
Below are brief descriptions for the uses and disclosures we may make in each of these categories:
We will use and disclose your PHI in providing you with Treatment and Services. We may disclose your PHI to Facility and non-Facility Personnel who may be involved in your care, such as Physicians, Nurses, Therapists, etc., including individuals who would be involved in your care if/after you leave the Facility.
We may use and disclose your PHI so that we can bill and receive payment for any Treatments and Services you receive at the Facility. For billing and payment purposes, we may disclose your PHI to your Representative, Insurance or Managed Care Company, Medicare, Medicaid or other Third Party Payor. For example, we may contact Medicare or your Health Plan to confirm your coverage or request prior approval for a proposed Treatment or Service.
For Health Care Operations
We may use and disclose your PHI for Facility Operations. These uses and disclosures are necessary to manage the Facility and to monitor our Quality of Care. For example, we may use PHI to evaluate our Facility’s Services, including the performance of our Staff.
We may use a limited amount of your Health Information for purposes of contacting you or your family members to raise money for our Facility and its Operations. The information, which we may use or disclose, will be limited to name, address, phone number, and dates for which you received Treatment or Services at our Facility. If you do not want our Facility to contact you for these Fundraising Purposes, you must notify us in writing.
WE MAY USE OR DISCLOSE PHI ABOUT YOU FOR OTHER SPECIFIC PURPOSES
Unless you give us a Written Notice of Objection, we will include certain Limited Information about you in our Facility Directory.
This information may include your Name, your Assigned Room/Apartment Number, your Telephone Number, your Religious Affiliation, and a General Description of your Condition. Our Directory contains no specific medical information about you. We may release information in our Directory, except for your Religious Affiliation, to people who ask for you by name. We may provide Directory Information, including your Religious Affiliation to any member of the Clergy or their representatives.
Individuals involved in your care or payment for your care
Unless you give us a Written Notice of Objection, we may disclose your PHI to a family member or close personal friend, including clergy, who is involved in your care.
We may disclose your PHI to organizations assisting our Facility in a Disaster Relief Effort.
As required by law
Public Health Activities
We will disclose your PHI when required by law to do so.
We may disclose your PHI for Public Health Activities, including but not limited to:
Reporting Victims of Abuse, Neglect, or Mistreatment
- Disclosure to a Public Health or other Government Authority for preventing or controlling disease, injury or disability, or reporting any suspected or actual abuse, neglect or mistreatment;
- Disclosure to the Food and Drug Administration (FDA) regarding adverse events or problems with products for tracking products in certain ircumstances, to enable Product Recalls or to comply with other FDA Requirements;
- To notify a person whom may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition;
- For specific purposes involving workplace illness or injuries.
If it is our belief that you have been a victim of abuse, neglect or mistreatment while under the auspices of the Facility, we may use and disclose your PHI to notify a Government Authority as required by law, or if you agree to the report.
Government Oversight Activities
We may disclose your PHI to Governmental Agencies overseeing Health Activities authorized by law. These may include, but are not limited to, Audits, Investigations, Inspections, Licensure Actions, other legal proceedings, or other activities necessary for governmental oversight of the Health Care System, Payment or Regulatory Programs, and in compliance with Civil Rights Laws.
Judicial and Administrative Proceedings
We may disclose PHI responding to a Court or Administrative Order, including but not limited to, Subpoena, Discovery Request, or other lawful process; every effort will be made to contact you, or your representative, regarding the request.
We may disclose your PHI for Law Enforcement Purposes including, but not limited to:
- In compliance with Regulatory Reporting Requirements;
- In compliance with a Court Order, Warrant, Subpoena, Summons, Investigative Demand or similar legal process;
- When requested for information about a victim of a crime, if the individual agrees or under other limited circumstances;
- Reporting information about a questionable death;
- Providing information about criminal conduct occurring at the Facility;
- Reporting information in emergency circumstances about a crime;
- When it is necessary to identify or apprehend an individual relative to a violent crime or escape from justice.
We may permit PHI to be used or disclosed for Research Projects/Programs or Proposals, Private, Public or Grant Funded, provided the Researcher adheres to Privacy Protections, referred to as the “Limited Data Set” which permits disclosure of Dates of Admission, Discharge, Birth, Death, and Geographical Information, other than Street Address, without Authorization. Any information, which could directly identify you, will not be used unless you or your Representative authorizes such disclosure.
Medical Examiners, Coroners, Funeral Directors, Organ Donor Organizations
We may release your PHI to a Medical Examiner, Coroner, Funeral Director or, if you are an Organ Donor, to the Organization involved in the procurement of tissue, organs, or body.
To avert a serious threat to health or safety
We may use or disclose PHI if and when it is necessary to prevent a serious threat to your health or safety, or to the health and safety of others or the public. Any disclosure that would be sanctioned would be to Government, Medical, or other Officials with the ability to help prevent the threat.
We may use or disclose PHI in compliance with laws relative to Worker’s Compensation or similar Governmental Programs.
We may use or disclose PHI in matters dealing with issues of National Security.
Reminders of Medical Appointments
We may use or disclose PHI for outside appointments relating to your health.
We may use or disclose PHI to inform you of alternative treatments which may be of benefit to you.
Health-Related Benefits and Services
We may use or disclose PHI to inform you of Health Related Benefits and/or Services that may be of interest to you.
FOR OTHER USES OF PHI—YOUR AUTHORIZATION IS REQUIRED
If directed by you, and only with your Written Authorization, will we use and disclose PHI other then as described in this Notice or as required by law. You may revoke your authorization, in writing, to use or disclose PHI at any time.
YOUR RIGHTS REGARDING PHI
The following are your rights regarding PHI while you are a Resident:
Right to Request Restrictions
You have the right to request restrictions on the use and disclosure of PHI by the Facility, for Treatment, Payment, or Health Care Operations. Additionally, you have the right to restrict the PHI we disclose about you to a Family Member, Friend, or other person who is involved in your care or in the payment of your care.
We will adhere to your Requested Restriction unless you are being transferred to another Health Care Facility, if it is required by law or if the release of PHI is needed to provide you with Emergency Treatment.
Right of Access to PHI
You have the right to request access to your Medical, Billing or other Written Information that may be used to make decisions about your care, either verbally or in writing. We must allow you to inspect your records within 24-hours of your request (excluding weekends and holidays). If you wish copies of the records, we must provide them to you within 2 working days of your request. However, we may charge reasonable fees for our cost of copying and, if requested, mailing your requested information.
Right to Request Amendment of PHI
You have the right to amend any PHI maintained by the Facility for as long as it is kept by the Facility. The Request for Amendment must be made in writing with reason given for the requested amendment.
We reserve the right to deny a Request for Amendment of PHI if the PHI:
- Was not created by our Facility;
- Is not part of the PHI maintained by or for the Facility;
- Is not part of the information to which you have a Right of Access;
- Is already determined by the Facility to be accurate and complete.
If your request for amendment is denied, the denial will be given to you in writing with the reason/s for the denial. You have the right to submit a written statement as to why you disagree with the denial.
Right to an Accounting of Disclosures
You have the right to request an Accounting of all Disclosures of PHI. This accounting will list certain disclosures of your PHI made by the Facility, or others on our behalf, but does not include disclosures for Treatment, Payment, Health Care Operations, or certain other exceptions.
After April 13, 2003 any request for an Accounting of PHI Disclosures for any period after April 13, 2003, must be made in writing (to a maximum of six years). If requested, an accounting will include the following:
The first accounting provided within a 12-month period will be free; for further requests you will be charged our costs.Right to a Paper Copy of this Notice
- The Disclosure Date;
- The name of the person or entity (and address if known) that received the information;
- A brief description of information disclosed;
- A short statement addressing the Purpose of the Disclosure or a copy of the Authorization or Request;
- Summary Information regarding multiple similar requests.
You have the right to obtain a paper copy of this Notice, even if you have agreed to receive it electronically. You can request a copy of this Notice at any time.
Right to Request Confidential Communications
You have the right to request that we communicate with you in a particular manner or at a certain location regarding PHI. For example, you can request that we contact you only at a particular phone number or in person. Any reasonable request will be accommodated.
If you believe that your Privacy Rights have been violated, you may file a Written Complaint with the Facility or with the Office of Civil Rights, in the U.S. Department of Health and Human Services. To file a Written Complaint with the Facility, please contact our Privacy Officer at (561) 655-8544 ext. 3001 .
All complaints will be investigated. No personal issue will be raised for filing a complaint with the Facility.
Whenever there is a material change to the Uses or Disclosures, your Individual Rights, our Legal Duties, or other Privacy Practices as stated in this Notice, it would be promptly revised and distributed. Lourdes-Noreen McKeen Community reserves the right to amend, change or revise this Notice effective for all PHI already received or maintained, or to be received or maintained in the future in the Facility. A current copy of this Notice will be posted in the Facility. The Facility will post any revised Notice of Privacy Practices Facility. Revised notices will not be provided to Residents, however will be made available upon request.
FOR ADDITIONAL INFORMATION
Any additional information, clarifications, or questions can be addressed to our Privacy Officer at (561) 655-8544, ext 3001.
This Notice is effective as of April 14, 2003.
- Notice of Privacy Practices Effective Date: April 14, 2003
- Copyright ©Carmelite System Carmelite System for the Aged and Infirm, Inc.
- Revised Date: 5/12/04