Notice of Privacy Practices – HIPAA Confidentiality Statement
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:
Title: Privacy Officer
Address: 7373 East 29th Street North, Wichita, KS 67226
Phone: (316) 636-1000
Fax: (316) 636-5790
This retirement community (“Community” hereafter) is committed to protecting and promoting the rights of each of its residents. This Notice of Privacy Practices (“Notice” hereafter) has been prepared to notify you of the uses and disclosures of protected health information that may be made by this Community, your rights with respect to protected health information, and this Community’s responsibilities with respect to protected health information.
A. WHO WILL FOLLOW THIS NOTICE.
This Notice describes our Community’s practices and that of:
- Any health care professional authorized to enter information into your Community chart.
- All departments and units of the Community.
- Any member of a volunteer group we allow to help you while you are in the Community.
- All employees, staff and other Community personnel.
We respect the privacy of the information relating to you and the treatment and services you receive. This is called protected health information. We are committed to maintaining the confidentiality of our Residents’ protected health information. This Notice applies to all information and records related to your care that our retirement Community receives or creates. It extends to information received or created by our employees, staff, volunteers, and physicians. This Notice informs you about the possible uses and disclosures of your protected health information.
We are required by law to:
- make sure that protected health information that identifies you is kept private;
- give you this Notice of our legal duties and privacy practices with respect to your personal protected health information; and
- abide by the terms of the Notice that are currently in effect.
B. OUR PLEDGE REGARDING PROTECTED HEALTH INFORMATION.
We understand that health information about you and your health is personal. We are committed to protecting your health information. We create a record of the care and services you receive at the Community. We need this record to provide you with quality care and to comply with certain legal requirements. This Notice applies to all of the records of your care generated by the Community, whether made by Community personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your protected health information created, or maintained in the doctor’s office or clinic. Therefore, you should ask your doctor about his/her policies and procedures.
C. HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOU WITHOUT YOUR AUTHORIZATION.
The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed, but the ways we are permitted to use and disclose information without your authorization will fall within one of the following categories.
- For Care. We may use your protected health information to provide you with medical treatment, care, or services. We may disclose protected health information about you to doctors, nurses, certified nurse aides, certified medical aides, technicians, students, or other Community personnel who are involved in taking care of you at the Community. For example, if you are treated for a fall, it may be necessary to know if you have diabetes because diabetes may slow the healing process. In addition, the dietitian may need to be told if you have diabetes so that we can arrange for appropriate meals. Different departments of the Community also may share protected health information about you in order to coordinate the different services you need, such as prescriptions, therapy, etc.
- For Payment. We may use and disclose your protected health information so that the treatment and services you receive at the Community may be billed to and payment may be collected from you, a government payer, or a third party. For example, we may need to give your health plan or Medicare information about services you receive at our Community so Medicare or the health plan will pay us for the services. We may also tell Medicaid, Medicare or your health plan about a treatment you are going to receive to obtain prior approval or to determine whether they will cover the treatment. We may also provide information about you to other health care providers or health plans so they can obtain or arrange for payment for treatment and services provided to you. However, if you pay out of pocket for your treatment and make a specific written request that we not send information to your insurance company for that treatment, we will not send that information to your insurer.
- For Health Care Operations. We may use and disclose your protected health information for health care operations in our Community. These uses and disclosures are necessary to run the Community and make sure that our residents receive quality care. For example, we may use protected health information to review our care and services and to evaluate the performance of our staff in caring for you. We may also combine protected health information about many residents to decide what additional services the Community should offer, what services are not needed, and whether certain new services are warranted. We may also disclose information to doctors, nurses, technicians, certified nurse or medical aides, students, and other Community personnel for review and learning purposes. We may also combine the protected health information we have with protected health information from other communities to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of protected health information so others may use it to study health care and health care delivery without knowing the identity of specific residents.
- Appointment Reminders. We may use and disclose protected health information to contact you as a reminder that you have an appointment for medical care or services, including leaving a voicemail message.
- Service Alternatives. We may use and disclose protected health information to tell you about or recommend possible service options or alternatives that may be of interest to you. In some cases, we may receive payment for these activities. We will give you the opportunity to let us know if you no longer wish to receive this type of information.
- Health-Related Benefits and Services. We may use and disclose protected health information to tell you about health-related benefits or services that may be of interest to you. In some cases, we may receive payment for these activities. We will give you the opportunity to let us know if you no longer wish to receive this type of information.
- Fund-raising Activities. We may use protected health information about you to contact you in an effort to raise money for the Community and its operations. We may disclose protected health information to a foundation related to the Community so that the foundation may contact you in raising money for the Community. We only release contact information, such as your name, address and phone number and the dates you received care or services at the Community. We will give you the opportunity to let us know if you no longer wish to receive this type of information.
- Community Directory. We may include certain limited information about you in the Community directory while you are a resident. This information may include your name and room number. The directory information may also be released to people who ask for you by name. This is so your family, friends and clergy can visit you in the Community.
- Individuals Involved in Your Care or Payment for Your Care. We may release protected health information about you to a friend or family member who is involved in your care. We may also give protected health information to someone who helps pay for your care. We may also tell your family or friends your condition.
- Disaster Relief. We may disclose your protected health information to an organization assisting in a disaster relief effort (such as the Red Cross or FEMA), so that your family can be notified about your condition, status, and location. Unless you inform us that you do not want any information released, we may tell individuals who ask your location and provide a general statement of your condition.
- Research. Under certain circumstances, we may use and disclose information about you for research purposes. For example, a research project may involve comparing the health and recovery of all residents who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of protected health information, trying to balance the research needs with residents’ need for privacy of their protected health information. Before we use or disclose protected health information for research, the project will have been approved through this research approval process, but we may, however, disclose protected health information about you to people preparing to conduct a research project, for example, to help them look for residents with specific medical needs, so long as the protected health information they review does not leave the Community. We will almost always ask for your prior permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at the Community.
- As Required By Law. We will disclose your protected health information when required to do so by federal, state or local law.
- 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 and safety or the health and safety of another person or the public at large. Any such disclosure will only be to a person or agency able to prevent the threat.
- Surveys. We may use and disclose your protected health information to conduct surveys to assess resident satisfaction with the services we provide.
- Business Associates. In the event we arrange for our business associates to provide some of the services we perform, such as having a printing company photocopy your medical record, we may be required to disclose your protected health information to enable the associates to provide the services. When we do this, the business associate agrees in the contract to protect your protected health information.
D. SPECIAL SITUATIONS OF (USE AND DISCLOSE OF YOUR PROTECTED HEALTH INFORMATION WITHOUT AUTHORIZATION).
- Organ and Tissue Donation. If you are an organ donor, we may release your protected health information to organizations involved in organ procurement or transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
- Military and Veterans. If you are a member of the U.S. or foreign armed forces, we may release your protected health information as required by the appropriate military authorities.
- Employers. If you are employed and we provide health care services to you at the request of your employer to provide an evaluation of your ability to do a job or in connection with a work-related illness or injury, we may disclose protected health information to your employer. If so, we will inform you in writing. No protected health information will be given to your employer for any other purpose unless you authorize us to do so.
- Workers’ Compensation. We may release your protected health information for workers’ compensation or similar programs that provide benefits for work-related injuries or illness.
- Public Health Risks. We may disclose your protected health information for public health activities. These activities generally include the following:
- to prevent or control disease, injury or disability;
- to report deaths;
- to report reactions to medications or problems with products;
- to notify people of recalls of products they may be using;
- to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
- to notify the appropriate government authority if we believe a resident has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when otherwise required or authorized by law.
- Health Oversight Activities. We may disclose your protected health information to a health oversight agency for activities authorized by law. These oversight activities include, such things as audits, investigations, surveys, and the licensure process. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
- Lawsuits and Disputes. If you are involved in a lawsuit or a legal dispute, we may disclose your protected health information in response to a court or administrative order. We may also disclose protected health information about you in response to a subpoena, discovery request, or other lawful process initiated by someone else involved in the dispute. If there is no court order or judicial subpoena, the requesting attorneys must make an effort to tell you about the request for your protected health information.
- Law Enforcement. We may release protected health information if asked to do so by a law enforcement official under these circumstances:
- In response to a court order, subpoena, warrant, summons or similar process;
- To identify or locate a suspect, fugitive, material witness, or missing person;
- About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
- About a death we believe may be the result of criminal conduct;
- About possible criminal conduct at the Community; and
- In emergency circumstances to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.
- Coroners, Medical Examiners and Funeral Directors. We may release protected health information to a coroner or medical examiner. This may be necessary to identify a deceased person or determine the cause of death. We may also release health information about residents of the Community to funeral directors so that they may carry out their duties.
- National Security and Intelligence Activities. We may release your protected health information to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
E. OTHER USES OF PROTECTED HEALTH INFORMATION.
Other uses and disclosures of protected health information not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you provide us an authorization to use or disclose your protected health information, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose protected health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your authorization, and that we are required to retain our records of the care that we provide to you. We will obtain your authorization to disclose psychotherapy notes, in some circumstances when we will obtain a financial benefit, or for some marketing activities.
F. REMUNERATION FOR USES AND DISCLOSURES.
There are some circumstances when we directly or indirectly receive a financial benefit from a disclosure of your protected health information.
G. YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION ABOUT YOU.You have the following rights regarding protected health information we maintain about you:
- Right to Inspect and Copy. You have the right to inspect and copy protected health information that may be used to make decisions about your care. This includes medical and billing records, but does not include any psychotherapy notes.
To inspect and copy protected health information that may be used to make decisions about you, you must submit your request in writing to our Privacy Officer. You may request that your records be provided in an electronic format or a paper copy. If you request a copy of the information, we may charge a reasonable fee for the costs of copying, mailing or other supplies associated with any portion of your request.
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to inspect and/or copy your protected health information, in some circumstances, you may request that the denial be reviewed. Another licensed health care professional chosen by the Community will review your request and the denial. The reviewer will not be the person who denied your request. We will comply with the outcome of the review.
- Right to Amend. If you feel that protected health information we have about you is incorrect or incomplete, you may ask us to amend the information for as long as the information is kept by or for the Community.
To request an amendment, your request must be made in writing and submitted to our Privacy Officer. In addition, you must provide the reasons you are requesting the amendment.
We may deny your request if it is not in writing or does not include a reason to support the request. We may also deny your request if you ask us to amend information that:
- Was not created by the Community, unless the person or entity that created the information is no longer available to make the amendment;
- Is not part of the protected health information kept by or for the Community;
- Is not part of the information that you would otherwise be permitted to inspect and copy; or
- Is accurate and complete.
- Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures” we have made of your protected health information, with certain exceptions.
To request an accounting of the disclosures, you must submit your request in writing to our Privacy Officer, who has forms for the request. Your request must state the time period for which you want an accounting, however, the period may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). The first accounting you request within any 12-month period will be free. For additional accountings, we may charge you for the reasonable costs of providing them. We will notify you of the costs in advance and you may choose to withdraw or modify your request at that time before any costs are incurred.
- Right to Request Restrictions. You have the right to request a restriction or limitation on the protected health information we use or disclose about you for care, payment or health care operations. You also have the right to request a limit on the protected health information we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or a friend. For example, you might ask that we not use or disclose information about a surgery you had to your friends.
We are not required to agree to your request (unless it is a request that we not send information to a non-governmental health care payer when you have personally paid for that treatment), but if we do, we will comply with your request unless the information is needed to provide emergency treatment to you.
To request restrictions, you must make your request in writing to our Privacy Officer. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, (for example, no disclosures to your spouse).
- Right to Request Communication Accommodations. You have the right to request that we communicate with you about health-related matters in a certain way or at a certain location. For example, you can ask that we contact you only at some address other than your home address or by mail.
To request confidential communications, you must make your request in writing to our Privacy Officer. We will not ask you the reason for your request. We will accommodate all reasonable requests. You must specify how or where you wish to be contacted.
- Right to a Paper Copy of This Notice. You have the right to receive a paper copy of this Notice at any time upon request. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice. You may obtain a copy of this Notice at our website, www.larksfield.org.
To obtain a paper copy of this Notice, contact our Privacy Officer.
H. CHANGES TO THIS NOTICE.
We reserve the right to change this Notice at any time. We reserve the right to make the revised or changed Notice effective, at any time, for your protected health information that we already have, as well as any we receive in the future. We will post a copy of the current Notice in the Community. The Notice will show the effective and revised date on the first page, in the lower left-hand corner of the first page. In addition, each time you are admitted as a resident, we will offer you a copy of the Notice then in effect.
If you believe that your privacy rights as described in this Notice have been violated by the Community, you may file a written complaint with the Community or with the U.S. Department of Health and Human Services-Office for Civil Rights (Regional Office at Kansas City), 601 East 12th Street, Room 248, Kansas City, MO 64106, 816.426.7277, or through www.hhs.gov/ocr/privacy/hipaa/complaints/index.html. To file a complaint with the Community, contact Privacy Officer, (316) 636-1000. All complaints must be in writing.
You will not be penalized in any way for filing a complaint.
You will be asked to provide a written acknowledgment that you received your own copy of this Notice of Privacy Practices. We are required by law to make a good faith effort to provide you with our Notice of Privacy Practices and obtain an acknowledgment of receipt from you. However, your care and treatment by this Community is not conditioned upon your providing the written acknowledgment.