You have several rights with regard to your health information, including the following:
The right to request that we not use or disclose your health information in certain ways.
The right to request to receive communications in an alternative manner or location.
The right to access and obtain a copy of your health information.
The right to request an amendment to your health information.
The right to an accounting of disclosures of your health information.
We reserve the right to change our privacy practices and to make the new provisions effective for
all health information we maintain. Should our privacy practices change, we will post the changes
on the bulletin board in our facility, as well as on our web site. A copy of the revised notice
will be available after the effective date of the changes upon request.
We will not use or disclose your health information without your authorization, except as
described in this notice.
If you have questions and would like additional information, you may contact our facility’s
Privacy Officer at 440-238-3361.
Who Will Follow This Notice:
This notice describes the practices of our nursing facility and of the following persons and
entities:
Any health care professional authorized to enter information into your medical chart.
All departments and units of this facility.
Any volunteer and contractor who provides services to you while you are in our facility.
All employees, staff and other facility personnel.
The following classes of providers and suppliers and their employees: laboratories;physical, occupational, speech and
respiratory therapy providers; transportation providers; radiology providers; pharmacies; audiology providers; dietary
providers; and medical supply companies.
The following classes of individual health care providers: attending physicians; optometrists; ophthalmologists;
dentists; podiatrists; psychologists; and psychiatrists.
All of the persons and entities noted above will follow the terms of this notice with regard to your health information
for services provided in our nursing facility or to you while you are a resident in our facility regardless of where the
services are actually provided. In addition, these persons and entities may share your health information with each other
for treatment, payment or other health care operations purposes as described in this notice.
How We Will Use or Disclose Your Health Information:
Treatment
We will use or disclose your health information for treatment purposes, including for the
treatment activities of other health care providers. For example, information obtained by a
nurse, physician, or other member of your healthcare team will be recorded in your record
and used to determine the course of treatment that should work best for you. Your physician
will document in your record his or her expectations of the members of your healthcare
team. Members of your healthcare team will then record the actions they took and their
observations. In that way, the physician will know how you are responding to treatment.
We will also provide your physician or a subsequent healthcare provider with copies of
various reports that should assist him or her in treating you once you’re discharged from
our nursing facility.
Payment
We will use or disclose your health information for payment, including for the payment
activities of other health care providers or payers. For example, a bill may be sent to you
or a third-party payer, including Medicare or Medicaid. The information on or accompanying
the bill may include information that identifies you, as well as your diagnosis, procedures,
and supplies used.
Health care operations
We will use or disclose your health information for our regular health operations. For
example, members of the medical staff, the risk or quality improvement manager, or members
of the quality improvement team may use information in your health record to assess the
care and outcomes in your case and others like it. This information will then be used in
an effort to continually improve the quality and effectiveness of the health care and
service we provide.
In addition, we will disclose your health information for certain health care operations
of other entities. However, we will only disclose your information under the following
conditions:
the other entity must have, or have had in the past, a relationship with you;
the health information used or disclosed must relate to that other entity’s relationship with you; and
the disclosure must only be for one of the following purposes:
quality assessment and improvement activities;
population-based activities relating to improving health or reducing health care costs;
case management and care coordination;
conducting training programs;
accreditation, licensing, or credentialing activities; or
health care fraud and abuse detection or compliance.
Business associates
There are some services provided in our organization through the use of 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 that they
can perform the job we’ve asked them to do. To protect your health information, however, we
require the business associates to appropriately safeguard your information.
Directory
Unless you notify us that you object, we may use your name, location in the facility, general
condition, and religious affiliation for directory purposes. This information may be provided
to members of the clergy and, except for religious affiliation, to other people who ask for
you by name.
Notification
We may use or disclose information to notify or assist in notifying a family member, personal
representative, or another person responsible for your care, of your location, and general
condition. If we are unable to reach your family member or personal representative, then
we may leave a message for them at the phone number that they have provided us, e.g., on an
answering machine.
Communication with family
We may disclose to a family member, other relative, close personal friend or any other person
involved in your health care, health information relevant to that person’s involvement in your
care or payment related to your care.
Marketing
We may contact you regarding your treatment, to coordinate your care, or to direct or recommend
alternative treatments, therapies, health care providers or settings. In addition, we may
contact you to describe a health-related product or service that may be of interest to you,
and the payment for such product or service.
Fund raising
We may contact you as part of a fund-raising effort.
Other uses & disclosures
We may use or disclose your protected health information in the following situations without
your authorization since these uses and disclosures are required or permitted by law without
such authorization:
As required by law
For public health activities, such as reporting to the Federal Drug Administration or the Occupational Safety and Health Administration
About victims of abuse, neglect or domestic violence
For health oversight activities
For judicial and administrative proceedings
For law enforcement purposes
About decedents, such as releases to coroners, medical examiners and funeral directors
For cadaveric organ, eye or tissue donation purposes
For research certain purposes where we have permission from an institutional review board or privacy board
To avert a serious threat to health or safety
For specialized government functions, such as national security
For workers’ compensation
Your Health Information Rights
Although your health record is the physical property of the nursing facility, the information
in your health record belongs to you. You have the following rights:
You may request that we not use or disclose your health information for a particular reason related to treatment, payment, the Facility’s general health care operations, and/or to a particular family member, other relative or close personal friend. We ask that such requests be made in writing on a form provided by our facility. Although we will consider your requests with regard to the use of your health information, please be aware that we are under no obligation to accept it or to abide by it. We will abide by your requests with regard to the disclosure of your clinical and personal records to anyone outside of the facility, except in an emergency, if you are being transferred to another health care institution, or the disclosure is required by law.
If you are dissatisfied with the manner in which or the location where you are receiving
communications from us that are related to your health information, you may request that we
provide you with such information by alternative means or at alternative locations. Such a
request must be made in writing, and submitted to our Privacy Officer. We will attempt to
accommodate all reasonable requests.
You may request to inspect and/or obtain copies of health information about you, which
will be provided to you in the time frames established by law. You may make such requests
orally or in writing; however, in order to better respond to your request we ask that you
make such requests in writing on our facility’s standard form. If you request to have copies
made, we will charge you a reasonable fee.
If you believe that any health information in your record is incorrect or if you believe
that important information is missing, you may request that we correct the existing
information or add the missing information. Such requests must be made in writing, and must
provide a reason to support the amendment. We ask that you use the form provided by our
facility to make such requests. For a request form, please contact the Privacy Officer.
You may request that we provide you with a written accounting of all disclosures made by
us during the time period for which you request (not to exceed 6 years). We ask that such
requests be made in writing on a form provided by our facility. Please note that an
accounting will not apply to any of the following types of disclosures: disclosures made
for reasons of treatment, payment or health care operations; disclosures made to you or
your legal representative, or any other individual involved with your care; disclosures
made pursuant to a valid authorization; disclosures to correctional institutions or law
enforcement officials; and disclosures for national security purposes. You will not be
charged for your first accounting request in any 12 month period. However, for any
requests that you make thereafter, you will be charged a reasonable, cost-based fee.
You have the right to obtain a paper copy of our Notice of Privacy Practices upon request.
You may revoke an authorization to use or disclose health information, except to the
extent that action has already been taken. Such a request must be made in writing.
For More Information or to Report a Problem
If you have questions and would like additional information, you may contact our facility’s
Privacy Officer at 440-238-9001.
If you believe that your privacy rights have been violated, you may file a complaint with us.
These complaints must be filed in writing on a form provided by our facility. The complaint
form may be obtained from the business office, and when completed should be returned to the
Privacy Officer. You may also file a complaint with the secretary of the Federal Department
of Health and Human Services. There will be no retaliation for filing a complaint.
