| Gurwin
Jewish Nursing & Rehabilitation Center
Notice
of Privacy Practices
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.
We respect the
privacy of your personally identifiable health information, 'personal health information',
and are committed to maintaining our patients' confidentiality. This Notice applies
to all your personal health information and records related to your medical care
that our facility has received or created. This Notice informs you about the
possible uses and disclosures of your personal health information. It also describes
your rights and our obligations regarding your personal health information.
We are required by law
to:
. maintain
the privacy of your personal health information;
. provide
to you this detailed Notice of our legal duties and privacy practices relating
to your personal health information; and
.
abide by the terms of the Notice that are currently in effect.
I.
WE MAY USE AND DISCLOSE 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 and health
care operations without your consent. We have described these uses and disclosures
below and provide examples of the types of uses and disclosures we may make in
each of these categories.
For Treatment.
We will use and disclose your personal health information in providing you with
treatment and services. We may disclose your personal health information to facility
and non-facility personnel who may be involved in your care, such as physicians,
nurses, nurse aides, and physical therapists. For example, a nurse caring for
you will report any change in your condition to your physician. We also may disclose
personal health information to individuals who will be involved in your care 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 at the facility. For
billing and payment purposes, we may disclose your personal health information
to your representative, 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 prior approval for a proposed treatment
or service.
For Health Care Operations.
We may use and disclose your personal health information 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 personal health information to evaluate
our facility's services, including the performance of our staff.
II.
WE MAY USE AND DISCLOSE PERSONAL HEALTH INFORMATION ABOUT YOU FOR OTHER SPECIFIC
PURPOSES
Facility Directory.
Unless you object, we will include certain limited information about you in our
facility directory. This information may include your name, your location in the
facility, and your general condition and your religious affiliation. Our directory
does not include 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 the directory information, including your religious
affiliation, to any member of the clergy.
Individuals Involved in
Your Care or Payment for Your Care. Unless you object, we
may disclose your personal health information to a family member, relative, or
close personal friend, including clergy, who is involved in your care.
Disaster Relief.
We may disclose your personal health information to an organization assisting
in a disaster relief effort.
As Authorized or Required
By Law. We will disclose your personal health information
when authorized or required by federal, state or local law to do so.
Public Health Activities.
We may disclose your personal health information for public health activities.
These activities may include, for example
. reporting
to a public health or other government authority for preventing or controlling
disease, injury or disability, or reporting child abuse or neglect;
. reporting
to the federal Food and Drug Administration (FDA) concerning adverse events or
problems with products for tracking products in certain circumstances, to enable
product recalls or to comply with other FDA requirements;
. to notify
a person who may have been exposed to a communicable disease or may otherwise
be at risk of contracting or spreading a disease or condition; or
. for certain
purposes involving workplace illness or injuries.
Reporting Victims of Abuse,
Neglect or Domestic Violence. If we believe that you
have been a victim of abuse, neglect or domestic violence, we may use and disclose
your personal health information 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 oversight activities authorized by law. These may include, for example, audits,
investigations, inspections and licensure actions or other legal proceedings.
These activities are necessary for government oversight of the health care system,
government payment or regulatory programs, and compliance with civil rights laws.
Judicial and Administrative
Proceedings. We may disclose your personal health information
in response to a
court or administrative
order. We also may disclose information in response to a subpoena, discovery request,
or other lawful process.
Law Enforcement.
We may disclose your personal health information for certain law enforcement purposes,
including
. as required
by law to comply with certain reporting requirements;
.
to comply with a court order, court-ordered warrant, and/or under certain circumstances,
a subpoena, summons, investigative demand or similar legal process;
.
to identify or locate a suspect, fugitive, material witness, or missing person;
.
when information is requested about the victim of a crime if the individual agrees
or under other limited circumstances;
. to report information
about a suspicious death;
.
to provide information about criminal conduct occurring at the facility; or
.
to report information in emergency circumstances about a crime.
Research. We may allow personal
health information of patients from our own facility to be used or disclosed for
research purposes provided that the researcher adheres to certain privacy protections.
Your personal health information may be used for research purposes only if the
privacy aspects of the research have been reviewed and approved by a special Privacy
Board or Institutional Review Board, if the researcher is collecting information
in preparing a research proposal, if the research occurs after your death, or
if you authorize the use or disclosure.
Coroners. Medical Examiners
Funeral Directors. Organ Procurement Organizations. We may release your personal
health information to a coroner, medical examiner, funeral director or, if you
are an organ donor, to an organization involved in the donation of organs and
tissue.
To Avert a Serious Threat
to Health or Safety. We may use and disclose your personal
health information when necessary to prevent a serious threat to your health or
safety or the health or safety of the public or another person. However, any disclosure
would be made only to someone able to help prevent the threat.
Military and Veterans.
If you are a member of the armed forces, we may use and disclose your personal
health information as required by military command authorities. We may also use
and disclose personal health information about foreign military personnel as required
by the appropriate foreign military authority.
Workers' Compensation.
We may use or disclose your personal health information to comply with laws relating
to workers' compensation or similar programs.
National Security and Intelligence
Activities: Protective Services for the President and Others.
We may disclose personal 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.
Fundraising Activities.
We may use certain personal health information to contact you in an effort to
raise money for the facility and its operations. We may disclose personal health
information to a foundation related to the facility so that the foundation may
contact you in raising money for the facility. In doing so, we would only release
contact information, such as your name, address and phone number and the dates
you received treatment or services at the facility. Any fundraising materials
you receive will give you the option of "opting out" of receiving further fundraising
communications.
Business Associates.
We may disclose your personal health information to a contractor or business associate
who needs the information to perform services for our facility. We require that
our business associates be committed to preserving the confidentially of your
personal health information disclosed to them.
Inmates. If
you are under the custody of a law enforcement official or a correctional institution,
we may disclose your personal health information to the institution or official.
Appointment Reminders.
We may use or disclose personal health information to remind you about appointments.
If you have an answering machine we may leave the reminder in a message.
Treatment Alternatives.
We may use or disclose personal health information to inform you about treatment
alternatives that may be of interest to you.
Health-Related Benefits
and Services.
We may use or disclose personal health information to inform you about health-related
benefits and services that may be of interest to you.
III. YOUR
AUTHORIZATION IS REQUIRED FOR OTHER USES OF PERSONAL HEALTH INFORMATION
We will use and disclose
your personal health information (other than as described in this Notice or required
by law) only with your written Authorization. You may revoke your Authorization
to use or disclose personal health information in writing, at anytime. If you
revoke your Authorization, we will no longer use or disclose your personal health
information for the purposes covered by the Authorization, except where we have
already relied on the Authorization.
IV. YOUR
RIGHTS REGARDING YOUR PERSONAL HEALTH INFORMATION
You have the following
rights regarding your personal health information at the facility:
Right to Request Restrictions.
You have the right to request restrictions on our use or disclosure of your personal
health information for treatment, payment or health care operations. You also
have the right to restrict the personal health information we disclose about you
to a family member, friend or other person who is involved in your care or the
payment for your care.
We are not required to
agree to your requested restriction (except that while you are competent you may
restrict disclosures to family members or friends). If we do agree to accept your
requested restriction, we will comply with your request except as needed to provide
you emergency treatment.
Right of Access to Personal
Health Information. You have the right to inspect and obtain a copy
of your medical or billing records or other written information that may be used
to make decisions about your care, subject to some limited exceptions. We may
charge a reasonable fee for our costs in copying and mailing your requested information.
We may deny your request
to inspect or receive copies in certain limited circumstances. If you are denied
access to personal health information, in some cases you will have a right to
request a review of the denial. This review would be performed by a licensed health
care professional designated by the facility who did not participate in the initial
decision to deny access.
Right to Request Amendment.
You have the right to request the facility to amend any personal health information
maintained by the facility for as long as the information is kept by or for the
facility. You must make your request in writing and must state the reason for
the requested amendment.
We may deny your request
for amendment if the information
. was not
created by the facility, unless the originator of the information is no longer
available to act on your request;
. is not part
of the personal health information maintained by or for the facility;
. is not part
of the information to which you have a right of access; or
. is already
accurate and complete, as determined by the facility.
If we deny your request
for amendment, we will give you a written denial including the reasons for the
denial and the right to submit a written statement disagreeing with the denial.
Right to an Accounting
of Disclosures.
You have the right to request an "accounting" of our disclosures of your personal
health information. This is a listing of certain disclosures of your personal
health information made by the facility or by others on our behalf, but does not
include disclosures for treatment, payment and health care operations or certain
other exceptions.
To
request an accounting of disclosures, you must submit a request in writing, stating
a time period beginning after April 14, 2003 that is within six years from the
date of your request. The first accounting provided within any 12-month period
will be free: for further requests within the same 12-month period, we may charge
you our costs.
Right
to a Paper Copy of This Notice.
You have the right to obtain a paper copy of this Notice, even if you have agreed
to receive this Notice electronically. You may 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 concerning personal health matters in a certain manner or at a certain
location. For example, you can request that we contact you only at a certain phone
number. We will accommodate your reasonable requests.
V.
COMPLAINTS
If you believe that your
privacy rights have been violated, you may file a complaint in writing with the
facility addressed to:
Sunni Herman
Privacy Officer
Gurwin Jewish Nursing & Rehabilitation
Centerr
68 Hauppauge Road
Commack, New York 11725
or with the Office of Civil
Rights in the U.S. Department of Health and Human Services.
We will not retaliate against
you if you file a complaint.
VI.
CHANGES TO THIS NOTICE
We
will promptly revise and distribute this Notice whenever there is a material change
to the uses or disclosures, your individual rights, our legal duties, or other
privacy practices stated in this Notice. We reserve the right to change this Notice.
Prior to implementing the revised Notice, we will provide you a copy. We will
post a copy of the current Notice in the facility. In addition, we will provide
a copy of the revised Notice to all patients.
VII. FOR
FURTHER INFORMATION
If
you have any questions about this Notice or would like further information concerning
your privacy rights, please contact the Social Work office at (631) 715-2578.
|
