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.
PURPOSE OF THE NOTICE.
Apex Oaks of Cypress is committed to preserving the privacy and confidentiality of your health information that is created and/or maintained by our staff. State and federal laws and regulations require us to implement policies and procedures to safeguard the privacy of your health information. This Notice will provide you with information regarding our privacy practices and applied to all of your health information created and/or maintained by us, including any information that we receive from other health care providers or facilities. The Notice describes the ways in which we may use or disclose your health information and also describes your rights and our obligations concerning such uses or disclosures.
We will abide by the terms of this Notice. We reserve the right to change this Notice and to 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. We will post a copy of the current Notice, which will identify its effective date, in our offices and on our website at www.autumngrovecottage.net
The privacy practices described in this Notice will be followed by any health care professional authorized to enter information in your medical record created and/or maintained by us AND all employees and other service providers who have access to your health information for purposes of treatment, payment, and heath care operations ,as further described in this Notice.
USES AND DISCLOSURES OF HEALTH INFORMATION FOR TREATMENT, PAYMENT, AND HEALTHCARE OPERATIONS.
Treatment, Payment, and Healthcare Operations: The following section describes different ways that we may use and disclose your health information for purposes of treatment, payment, and health care operations.
Treatment: We may use your health information to provide you with healthcare treatment and services. We may disclose your health information to doctors, nurses, nursing assistants, medication aides, technicians, medical and nursing students, rehabilitation therapy specialists, or other personnel who are involved in your health care.
For example, your physician order physical therapy services to improve your strength and walking abilities. We will need to talk with the physical therapist so that we can coordinate services and develop a plan of care. We also may need to refer you to another health care provider to receive certain services. We will share information with that health care provider in order to coordinate your care and services.
Payment: We may a use or disclose your health information so that we may bill and receive payment from you, an insurance company, or another third party for the health care services you receive from us. We also may disclose health information about you in you health plan in order to obtain prior approval for the services we provide to you, or to determine that your health plan will pay for the treatment.
For example, we may use your health information to evaluate the performance of our staff, or to evaluate whether certain treatment or services are effective. We also may disclose your health information to other physicians, practitioners, nurses, technicians, or health professionals for continuing care.
C. USES AND DISCLOSURES OF HEALTH INFORMATION IN SPECIAL SITUATIONS.
We may use or disclose your health information in certain special situations as described below. For these situations, you have the right to request that we limit these uses and disclosures as provided for in Section F of this Notice.
Appointment Reminders. We may use your health information for purposes of contacting you, or your family members, to remind you of a health care appointment.
Treatment Alternatives and Health-Related Products and Services. We may use or disclose your health information for purposes of contacting you to inform you of treatment alternatives or health-related products or services that may be of interest to you. For example, if you are diagnosed with a diabetic condition, we may contact you to inform you of a new diabetic treatment that is available.
Family Members and Friends. We may disclose your health information to individuals, such as family members and friends, who are involved in your care or who help pay for your care. We may make such disclosures when: (a) we have your verbal agreement to do so; (b) we make such disclosures and you do not object; or, (c) we can infer from the circumstances that you would not object to such disclosures. For example, if your spouse comes into the Cottage, we will assume that you agree to our disclosure of your information while your spouse is present in the room.
We also may disclose your health information to family members or friends in instances when you are unable to agree or object to such disclosures, provided that we feel it is in your best interests to make such disclosures and the disclosures relate to that family member or friend’s involvement in your care. For example, if you have a significant change in your health status and a family member or friend is with you, we may share information about your condition or health status with them. We also may share your health information with a family member or friend who calls us to request information on your health status.
OTHER PERMITTED OR REQUIRED USES AND DISCLOSURES OF HEALTH INFORMATION
There are certain instances in which we may be required or permitted by law to use or disclose your health information without your permission. These instances are:
As Required by Law: We may disclose your health information when required by federal, state, or local law to do so. For example, we are required by the Department of Health and Human Services (DHHS) to disclosure your health information in order to allow DHHS to evaluate whether we are in compliance with the federal privacy regulations.
Public Health Activities: We may disclose your health information to public health authorities that are authorized by law to receive and collect health information for the purpose of preventing or controlling disease, injury, or disability; to report births, deaths, or suspected of use or neglect; to report reaction to medications; or to facilitate product recalls.
Health Oversight Activities: We may disclose your health information to a health oversight agency that is authorized by law to conduct health oversight activities, including audits, investigations, inspections, or licensure and certification surveys. These activities are necessary for the government to monitor persons or organizations that provide health care to individuals and to ensure compliance with applicable state and federal laws and regulations.
Judicial or Administrative Proceedings: We may disclose your health information to courts or administrative agencies charged with the authority to hear and resolve lawsuits or disputes. We may disclose your health information pursuant to a court order or pursuant to a subpoena, a discovery request may by your counsel, or other lawful process, but only if efforts have been made to (i) notify you of the request for disclosure, or (ii) obtain an order protecting your health information.
Workers Compensation: We may disclose your health information to workers compensation programs when your health condition arises out of a work-related illness or injury.
Law Enforcement Official: We may disclose your health information in response to a request received from a law enforcement agency in response to a subpoena, court order, warrant, summons, or similar process.
Coroners, Medical Examiners, or Funeral Directors: We may disclose your health information to a coroner or medical examiner for the purpose of identifying a deceased individual or to determine the cause of death. We also may disclose your health information to a funeral director for the purpose of carrying out his/her activities.
Organ Procurement Organizations or Tissue Banks: If you are an organ donor, we may disclose your health information to organizations that handle organ procurement, transplantation or tissue banking.
Research: We may use or disclose your health information for research purposes when reviewed and approved by our Chief Medical Officer. In most instances, we will ask for your specific permission to use or disclose your health information if the researcher will have access to your name, address, or other identifying information.
To Avert a Serious Threat to Health or Safety: We may use or disclose your health information when necessary to prevent a serious threat to the health or safety of you or other individuals.
Military and Veterans: If you are a member of the armed forces, we may use or disclose your health information, as required by military command authorities.
National Security and Intelligence Activities: We may use or disclose your health information to authorized federal officials for purposes of intelligence, counterintelligence, and other national security activities, as authorized by law.
E. USES AND DISCLOSURES PURSANT TO YOUR WRITTEN AUTHORIZATION
Except for the purposes identified in Sections B though D, we will not use or disclose your health information for any other purposes unless we have your specific written authorization. You have the right to review a written authorization at any time as long as you do so in writing. If you revoke your authorization, we will no longer use or disclose your health information for the purposes identified in the authorization, except to the extent that we have already taken some action in reliance upon your authorization.
F. YOUR HEALTH INFORMATION RIGHTS
You have the following rights regarding your health information. You may exercise each of these rights, in writing, by providing us with a completed form that you can obtain from our staff. In some instances, we may charge you for the cost(s) associated with providing you with the requested information. Additional information regarding how to exercise your rights, and the associated costs, can be obtained from our Cottage manager.
Right to Inspect and Copy. You have the right to inspect and copy health information that may be used to make decisions about your care. We may deny your request to inspect and copy your health information in certain limited circumstances. If you are denied access to your health information, you may request that the denial be reviewed.
Right to Amend. You have the right to request an amendment of your health information that is maintained by us and is used to make health care decisions about you. We may deny your request if it is not properly submitted or does not include a reason to support your request. We may also deny your request if the information sought to be amended was not created by us or is accurate and complete.
Right to an Accounting of Disclosures. You have the right to request an accounting of the disclosures of your health information made by us. This accounting will not include disclosures of health information that we made for purposes of treatment, payment or health care operations or pursuant to a written authorization that you have signed.
Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations, You also have the right to request a limit on the health information we disclose abut you to someone, such a family member or friend, who is involved in your care or in the payment of your care. We are not required to agree to your request. If we do agree, that agreement must be in writing and signed by you and us.
Right to Request Confidential Communications. You have the right to request that we communicate with you about your health care in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
Right to a Paper Copy of this Notice. You have the right to receive a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this notice.
G. QUESTIONS OR COMPLAINTS
If you have any questions and would like additional information or if you believe your privacy rights have been violated, you may file a complaint with the Compliance Officer by calling the Compliance Hotline toll free at (877-717-7575). You may also file a complaint with the Secretary of the Department of Health and Human Services at www.OSDHHS.gov. You will not be penalized for filing a complaint.
Resident/Legal Representative Signature Date