- Purpose of This Notice
We respect the privacy of your
protected health information and are committed to maintaining our
residents’ and patients’ confidentiality. This Notice applies to all
information and records related to your care that the organization has
received or created. 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. It also describes your rights and our obligations
regarding your protected health information.
We are required by law to:
- maintain the privacy of your protected health information;
- provide to you this detailed Notice of our legal duties and privacy
practices relating to your protected health information; and
- abide by the terms of the Notice that are currently in effect.
- Ways We May Use And Disclose Your Protected Health Information Without
Needing To Obtain Your Consent Or Authorization
For Treatment. We will use and disclose your protected health
information in providing you with treatment and services. We may
disclose your protected health information to facility and non-facility
personnel who may be involved in your care, such as physicians, nurses,
nurse aides, therapists, emergency personnel, and volunteers. For example,
a nurse caring for you may report any change in your condition to your
physician. We also may disclose protected health information to
individuals who will be involved in your care after you leave the
facility.
For Payment. We may use and disclose your protected health
information so that we can bill and receive payment for the treatment
and services you receive at the organization. For billing and payment
purposes, we may disclose your protected health information to your
representative, and 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 the proposed treatment or service.
For Health Care Operations. We may use and disclose your
protected 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 protected health
information statistics to evaluate our facility’s quality control
purposes services, including the performance of our staff.
- We May Use And Disclose Your Protected Health Information For Other Specific
Purposes
We may also combine our information with other health care providers’
information to compare how we are doing and learn ways to improve our
services to you. We will remove information from the data that would
identify you.
Business Associates. There are some services provided in our organization through contracts with business associates. An example
is laboratory tests. When these services are contracted, we may
disclose your health information to our business associates so that
they can perform the job we’ve asked them to do and bill you or your
third-party payer for services rendered. 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 will
include information about your name, address/location within the
organization, and telephone number in our telephone directory. The
directory information may be given to people who ask for you by name.
We may disclose certain limited protected health information about you
to a member of the clergy, such as your religious affiliation.
Family, Friends and Power of Attorney
We may disclose your protected health information to individuals, such
as family, friends, or any other person you tell us that are involved
in your care or who help pay for your care. Disclosures may be
face-to-face, by telephone or by electronic mail. Our health
professionals, using their best judgment, may disclose your protected
health information to a designated representative or Power of Attorney
(POA). This individual will be used by the organization as your primary
contact.
As Permitted or Required By Law. We may use and disclose your
protected health information to you, someone who has the legal right to
act for you (personal representative), or to the Secretary of the U.S.
Department of Health and Human Services, if necessary to make sure your
privacy is protected, and where required by law for:
? Public health activities and protected services agencies
such as reporting fraud or suspected abuse or neglect; disease
outbreaks, adverse reactions to medications, or problems with health
care products. We may disclose your protected health information to a
health oversight agency for oversight activities authorized by law.
They may include, for example, audits, investigations,
inspections and licensure actions or other legal proceedings necessary
for government oversight of the health care system, government payment
or regulatory programs, and compliance with civil rights laws.
? Judicial and administrative proceeding in response to a court or administrative order, subpoena, discovery request, or other lawful process.
? Law enforcement officials
request for the purpose to locate a missing person, a suspect, or
material witness, to report criminal conduct on our premises or in an
emergency to report the commission of a crime or imminent threat to
health or safety of staff, residents or patients. ? Research. We may allow protected health information of
residents from our organization or patients to be used or disclosed for
research purposes provided that the researcher adheres to certain
privacy protections. Your protected health information may be used for
research purposes only if the privacy aspect of the research has 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
authorized the use or disclosure.
? Coroners, medical examiners, funeral directors, organ procurement organizations
for the purpose of identifying a deceased individual, to determine the
cause of death, facilitate organ or tissue donations, or to provide
funeral directors with information in order to carry out their duties.
? National security, military and veterans for purposes of intelligence, counterintelligence and other national security activities.
? Disaster Relief. We may disclose your protected health information to an organization assisting in a disaster relief effort.
? Workers’ Compensation.
We may use or disclose your protected health information to comply with
laws relating to workers’ compensation or similar programs.
? Fundraising Activities.
You may be contacted for fundraising activities for the facility and
its operations. You will be given the opportunity to “opt out” (not
participate) if you do not want to receive any further fundraising
communications.
? Marketing. We may contact you to
provide appointment reminders or information about treatment
alternatives or other health-related benefits and services that may be
of interest to you.
- Your Written Authorization Is Required For All Other Uses Of Protected Health Information
We may use and disclose protected health information (other than
described in this Notice or if not permitted or required by law) ONLY
with your written Authorization on the form we will provide. You may
revoke your Authorization to use or disclose protected health
information at any time as long as it is in writing sent to the
attention of the social services department at Menno Haven, Inc. If you
revoke your Authorization, we will no longer use or disclose your
protected health information as you had specified, except where we have
already acted upon your Authorization.
Examples that may require your written authorization include
disclosure of psychotherapy notes or use of your protected health
information for marketing purposes.
- Your Rights Regarding Your Protected Health Information
You have the following rights regarding your protected health information at this organization:
Nursing Center Residents
Right to Request Restrictions. You have the right to request
restriction or limitation on our use or disclosure of your protected
health information for treatment, payment or health care operations.
You also have the right to restrict or limit the protected 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 required to agree to your requested restriction, unless
you are being transferred to another health care institution, the
release of records is required by law, if the release of information is
needed to provide emergency treatment, or for payment for services
rendered.
A written request for restrictions should be sent to the
director of social services. We prefer that you use our form. You must
tell us what information you want to limit, whether you want us to
limit our use, disclosure or both, and to whom you want the limits to
apply (for example, disclosures to a family member).
Right of Access to Protected Health Information. You have the
right to request, either orally or in writing, your medical or billing
records or other written information that may be used to make decisions
about your care. We prefer that you use our form for a written request.
The form may be obtained from and returned to the director of social
services. We must allow you to inspect your records within 24 hours of
your request. If you request copies of the record, we must provide you
with copies within 2 business days of that request. We will charge a
reasonable fee for copying and mailing your requested information,
however, this may be waived at the discretion of the medical director.
Other Residents and Patients
Right to Request Restrictions. You have the right to request
restriction or limitation on our use or disclosure of your protected
health information for treatment, payment or health care operations.
You also have the right to restrict or limit the protected 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.
Although we are not required to agree to your request,
we will give it serious consideration. If we do agree, we will comply
with your request unless the information is needed to provide you
emergency treatment.
You must make your request for restrictions in writing to the
assisted living office or health center. We prefer that you use our
form. You must tell us what information you want to limit, whether you
want us to limit our use, disclosure or both, and to whom you want the
limits to apply (for example, disclosures to a family member).
Right of Access to Protected 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 such as psychotherapy
notes.
We may deny your request to inspect or receive copies in
certain limited circumstances. If you are denied access to protected
health information, in some cases you will have a right to request
review of the denial. A licensed health care professional designated by
the facility who did not participate in the decision to deny would
perform this review.
If you want to inspect or obtain copies of your protected
health information or billing records, you must submit your request in
writing using the form we will provide to the assisted living office or
health center. We have 30 days to respond to your request. We will
charge a reasonable fee for our costs in copying and mailing your
requested information, however, this may be waived at the discretion of
the medical director.
All Residents and Patients
Right to Request Amendment. You have the right to request that
the organization amend your protected health information if you think
it is wrong or incomplete, as long as the information is kept by or for
the organization. You must make your request in writing on the form we
will provide, and you must state the reason for the requested
amendment. The request form should be obtained from and submitted to
the director of social services in the nursing center.
We may deny your request for amendment if the information:
- was not created by the organization or unless the originator of the
information is no longer available to act on your request;
- is not part of the protected health information maintained by or for the organization;
- is not part of the information to which you have a right of access; or
- is already accurate and complete, as determined by the organization.
If your request is denied a written reason for the denial will be given
to you and instructions on how you can give us a statement of
disagreement. Your statement of disagreement may be added to your
protected health information.
Right to an Accounting of Disclosure. You have the right to request a listing (accounting) of our disclosures of your protected health information, except for:
? those that we made to carry out treatment, payment and health care operations,
? those that were given to you or your personal representative,
? those that were given in accordance with an authorization signed by you or your representative, or
? those that were given out for law enforcement purposes.
To request an accounting of disclosures, you should obtain the request
form from and submit your request to the director of social services in
the nursing center. State a time period (it cannot be longer than six
(6) years prior to the date of your request). It cannot include dates
before April 14, 2003. You need to tell us in what form you want to
receive the listing; for example, on paper or via electronic means.
The first accounting provided within a twelve (12) month period will be
free. The organization will charge the prevailing cost for subsequent
requests.
Right to a Paper Copy of This Notice. You have the right to
obtain a paper copy of this Notice, even if you agreed to receive this
Notice electronically at our website, www.mennohaven.org. You may request a copy of this Notice at any time by contacting the social services department in the nursing center.
Right to Request Confidential Communications. You have the right
to request that we communicate with you concerning personal health
matters by a certain method or at a certain location. For example, you
can request that we contact you only at a certain phone number. We will
accommodate all reasonable requests.
To request confidential communications, you must make your request in
writing to the department responsible for your care - the nursing
center contact is the director of social services; the assisted living
contact is the assisted living director; and all other residents and
patients should contact the health center.
- Changes To This Notice
We reserve the right to change the Notice and to make the
revised or new Notice provisions effective for all protected health
information already received and maintained by the organization as well
as for all protected health information we receive in the future. 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 the Notice. We will
post a copy of the current Notice in our health facilities, and have
additional copies available at the social services office in each
nursing center health center for all residents and patients who want to
receive it.
- Corresponding With Complaints Or Requesting Further Information
If you believe that your privacy rights have been violated, you may file a complaint
by writing or telephoning the organization and/or the Secretary of the
U.S. Department of Health and Human Services at the following addresses
and phone numbers:
Menno Haven, Inc.
Corporate Compliance Officer
1427 Philadelphia Avenue
Chambersburg, PA 17201
1-717-261-4169 (hotline)
1-717-262-1012
Secretary of the Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, DC 20201
Toll free: 1-877-696-6775
You will not be penalized in any way for filing a complaint, and filing a complaint will not interfere with your health care.
If you have any questions about this Notice or would like
further information concerning your privacy rights or wish to receive
an updated copy of this Notice in the future, please contact:
Social Services Office:
Menno Village 717-263-8545
Penn Hall 717-261-2043
Effective Date: April 14, 2003
Revision Date:
