Privacy Notice - Harbor Hill Care Center, Inc.

Water's Edge Care Center, Inc.

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL/HEALTH INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO
THIS INFORMATION. PLEASE REVIEW IT CAREFULLY

Water's Edge Care Center, Inc. and affiliated providers, who follow these Privacy Practices as an Organized Health Care Arrangement (OHCA), respect the privacy and confidentiality of your health information. This Notice of Privacy Practices ("Notice") describes how we may use and disclose your personal medical/health information and how you can get access to this information. This Notice applies to uses and disclosures we may make of your personal health information whether created or received by us.

I. OUR RESPONSIBILITIES TO YOU

We are required by law to:

Maintain the privacy of your protected health information
Provide you with this notice of our legal duties and privacy practices
Abide by the terms of our Notice that is currently in effect.

II. WHO WILL FOLLOW THIS NOTICE

This Notice applies to this Facility and other direct treatment providers who provide medical services on site, who are considered only for the purposes of this Notice an Organized Health Care Arrangement (OHCA) including all members of the Medical Staff, Contracted Physicians, Rehabilitation Service providers and any other direct treatment providers such as Nurse Practitioners and Physician Assistants while they provide services to you at this Facility. Water's Edge Care Center, Inc. and members of the OHCA may share health information with each other as necessary to coordinate your care and treatment and for other purposes described in this Notice including payment and health care operations of the members of the OHCA. The members of the OHCA are not to be considered to be acting jointly for any purpose other than the sharing of health information for the purposes of each OHCA member's own health care operations.

III. HOW WE MAY USE AND DISCLOSURE YOUR PERSONAL HEALTH INFORMATION
FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS

We may use and disclose your personal health information for purposes of treatment, payment for treatment and health care operations as described below.

For Treatment. We may use and disclose your personal health information to provide you with treatment and services and to coordinate your continuing care and treatment with other health care providers. Your health information may be used by doctors, therapists, nurses and other staff members, as well as by laboratory and x-ray technicians, dieticians, or other individuals involved in your care, both within the Facility and by other health care providers outside the Facility who are involved in your care. For example, we may disclose certain health information about you to a pharmacist who needs that information to fill a prescription ordered by your doctor. We may also disclose your personal health information to outside providers or entities that will be involved in your care and treatment after you leave the Facility.

For Payment. We may use and disclose your personal health information so that we can bill and receive payment for the treatment and services you receive. For billing and payment purposes, we may disclose your personal health information to an insurance or managed care company, Medicare, Medicaid or another third party payor. For example, we may contact Medicare or your health plan to confirm your coverage or to request approval for a proposed treatment or service.

For Health Care Operations. We may use and disclose your health information as necessary for our internal operations or for the operations of any members of the OHCA, such as for general administration and management activities, evaluating our employees, reviewing the practices of the OHCA and other health care providers, and to monitor the quality of care being provided. For example, we may use your health information in internal newsletters unless you object, to evaluate and improve the quality of care, for education and training purposes, and for planning for services. We may also disclose personal health information to other health care providers or entities that have or have had in the past a relationship with you for use for certain limited healthcare operations of those health care providers or health plans, in compliance with the privacy laws.

IV. WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
FOR OTHER SPECIFIC PURPOSES WITHOUT YOUR WRITTEN AUTHORIZATION

As Required By Law. We may disclose your health information when required by law to do so.
Facility Directory. Unless you object, we may use and disclose certain limited information about you in our Directory while you are a resident. This information may include your name, location in the Facility, your general condition and religious affiliation. Our Directory does not include specific medical information about you. We may release Directory information, except for your religious affiliation, to people who ask for you by name. We may provide the Directory information, including your religious affiliation, to a member of the clergy even if the clergy does not ask for you by name.
Persons Involved in Your Care or Payment for Your Care or for Notification Unless you object, we may disclose health information about you to a family member, close friend or other persons you identify, including clergy, who are involved in your care. These disclosures are limited to information relevant to the person's involvement in your care or in arranging payment for your care. If we are unable to reach a family member, personal representative or other persons involved in your care or payment, we may leave a message for them at the phone number they have provided.
Public Health Activities. As required by law, we may disclose your personal health information to public health or legal authorities charged with preventing or controlling disease, injury or disability. These activities may also include disclosures to the Food and Drug Administration about the quality, safety or effectiveness of an FDA regulated product or activity; and to notify a person who may have been exposed to or may otherwise be at risk of contracting or spreading a communicable disease, if authorized by law.
Reporting Victims of Abuse, Neglect or Domestic Violence. If we believe that you have been a victim of abuse, neglect or domestic violence, your personal health information may be used or disclosed to notify a government authority, if required or authorized by law, or if you agree to the report.
Health Oversight Activities. We may disclose your personal health information to a health oversight agency for activities authorized by law. A health oversight agency is a state or federal agency that oversees the health care system including regulatory programs or government payments and compliance with civil rights laws. Some of the activities include, for example, audits, investigations, inspections and licensure actions or other legal proceedings.
Judicial and Administrative Proceedings. We may disclose your health information in response to a court or administrative order or in response to a subpoena, discovery request, or other lawful process.
Law Enforcement. We may disclose your health information for certain law enforcement purposes, including, for example, to file reports required by law or to report emergencies or suspicious deaths; to comply with a court order, or other legal process; to identify or locate a suspect or missing person; to answer certain requests for information concerning crimes; or to report criminal activity at the Facility.
Coroners, Medical Examiners, Funeral Directors, Organ Procurement Organizations. We may release your health information to a coroner, medical examiner, or funeral director and, if you are an organ donor, to an organization involved in the donation of organs and tissue.
Research. Your health information may be used or disclosed for research purposes provided the researcher adheres to certain privacy protections, and only if: (1) the privacy aspects of the research have been reviewed and approved by a special Privacy Board or Institutional Review Board and the Board can legally waive resident authorizations otherwise required by the Privacy Regulations; (2) the researcher is collecting information preparing for a research proposal; (3) the research occurs after your death; or (4) if you give a valid written authorization for the use or disclosure.
To Avert a Serious Threat to Health or Safety. When necessary to prevent a serious threat to your health or safety, or the health or safety of the public or another person, we may use or disclose your health information to someone able to help lessen or prevent the threatened harm.
Military and Veterans. If you are a member of the armed forces, we may use and disclose your health information as required by military command authorities. We may also use and disclose health information about foreign military personnel as required by the appropriate foreign military authority.
National Security, Intelligence Activities; Protective Services for the President and Others. We may disclose health information to authorized federal officials conducting national security and intelligence activities or as needed to provide protection to the President of the United States, certain other persons or foreign heads of states or to conduct certain special investigations.
Inmates/Law Enforcement Custody. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose your health information to the institution or official for certain purposes including your own health and safety as well as that of others.
Workers' Compensation. We may use or disclose your health information to comply with laws relating to workers' compensation or similar programs.
Disaster Relief. Unless you object, we may disclose health information about you to an organization assisting in a disaster relief effort.
Treatment Alternatives and Health-Related Benefits and Services. We may use or disclose your health information to inform you about alternative treatments, providers, therapies or settings and health-related benefits and services that may be of interest to you.
Business Associates. Some services in our organization are provided by outside people and entities. Examples of these "business associates" include our accountants, consultants and attorneys. We may disclose your health information to our business associates so they can perform the work we've asked them to do. Our business associates are required by contract to appropriately safeguard your information.

V. YOUR WRITTEN AUTHORIZATION IS REQUIRED FOR ALL OTHER USES
OR DISCLOSURES OF YOUR HEALTH INFORMATION

We will obtain your written permission (known as an "Authorization") prior to making any use or disclosure other than those described in this Notice.
The Authorization must specify the use or disclosure, other than those set forth above, that you may request or that we plan to make of your health information. The Authorization will describe the particular health information to be used or disclosed and the purpose of the use or disclosure. Where applicable, the Authorization will also specify the name of the person or entity to whom the health information is being disclosed, and it will be limited to an expiration date or event.
You may revoke a written Authorization previously given by you at any time but you must do so in writing. If you revoke your Authorization, we will no longer use or disclose your health information for the purposes specified in that Authorization except where we have already taken actions in reliance on your Authorization.

VI. YOUR RIGHTS REGARDING YOUR PERSONAL HEALTH INFORMATION

You have the following rights regarding your health information (which can be exercised on behalf of a resident by the resident's legally authorized personal representative):

Right to Request Restrictions. You have the right to request in writing that we restrict the way we use or disclose your personal health information for treatment, payment or health care operations and /or to restrict the health information we may disclose to a particular family member, personal friend or other person who is involved with your care or payment for your care. However, we are not required to agree to restrictions regarding the use of your health information.
We are required to agree to restrictions regarding disclosures outside the Facility including while you are competent, restrictions on disclosures to family members and friends, unless you are being transferred to another health care institution, the release of information is needed to provide you emergency treatment or the disclosure of health information is required by law.
Right to Request Confidential Communications. You have the right to request in writing that we communicate with you concerning your health matters in a certain more confidential manner or at a certain location. For example, you can request that we forward or send mail to you at a specific address. We will accommodate your reasonable requests.
Right of Access to Personal Health Information. You have the right to inspect and, upon written request, obtain a copy of your personal health information that may be used to make decisions about your care. We may charge a reasonable fee not to exceed applicable state law for copying including the cost of any postage incurred.
Right to Request Amendment. You have the right to request that we amend any personal health information maintained by us for as long as the information is kept by or for the Facility. Your request must be made in writing on a form provided by the Facility and you must provide the reason for the requested amendment.
(a) We may deny your request for amendment if the information was not created by us, unless you provide reasonable information that the originator of the information is no longer available to act on your request; is not part of the health information maintained by or for us; or is already accurate and complete, as determined by us.
(b) If we deny your request for amendment, we will give you a written denial notice, including the reasons for the denial. You have the right to submit a written statement disagreeing with the denial and your letter of disagreement will be retained with your record set.
Right to an Accounting of Disclosures. You have the right to request an "accounting" of certain disclosures of your personal health information. This is a listing of disclosures made by us or by others on our behalf, but does not include disclosures for treatment, payment and health care operations or certain other exceptions including but not limited to disclosures made to you or your Authorized Representative, or individuals involved with your care or payment.
(a) All requests for an accounting must be in writing and you must state the time period beginning after 4/14/03 that is within [6] years from the date of the request for which you would like the accounting. The accounting will include the disclosure date; the name of the person or entity that received the information and address, if known; a brief description of the information disclosed; and a brief statement of the purpose of the disclosure. The first accounting provided within a 12-month period will be free; for further requests, we may charge you a reasonable fee based on our costs for completing the accounting.

VII. REGULATIONS REGARDING DISCLOSURE OF PSYCHIATRIC AND HIV-RELATED INFORMATION

For disclosures concerning certain health information such as HIV-related information or records regarding psychiatric care that have been sent to us by another provider, special restrictions may apply. Other than for purposes of treatment or payment for treatment, we will if required by state law, disclose HIV and psychiatric records only with a specific authorization that specifies that psychiatric or HIV records may be released, or as otherwise required by law, such as a court order.

VIII. CHANGES TO THIS NOTICE

We reserve the right to change our Notice of Privacy Practices and to make the new provisions effective for all personal health information we maintain, including health information we already have and health information we create or receive in the future. Should we make material changes, we will post it in a clear and prominent location and make the revised Notice available to you upon request. The effective date of this Notice is 4/01/03.

IX. COMPLAINTS

If you believe that your privacy rights have been violated, you may file a complaint directly or in writing by contacting the Administrator or Social Services at Water's Edge Care Center, Inc., or with the Office of Civil Rights in the U.S. Department of Health and Human Services at 200 Independence Avenue, S.W., Room 509 F, HHH Building, Washington D.C. 20201.

To file a complaint in person or to request a complaint form, please contact: Social Services or the Administrator at Water's Edge Care Center, Inc. We will not retaliate against you in any way for filing a complaint.

FOR FURTHER INFORMATION

If you have any questions about this Notice or if you would like to exercise any of the rights in this Notice or would like further information regarding your privacy rights, please contact, Social Services at (860) 347-7286.