Protected Health Information - Auburn, New York

North Brook Heights Home For Adults
Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW THE INFORMATION CAREFULLY!

This Notice of Privacy describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for purposes that are permitted or required by law. It also describes your rights to access and control of your protected health information. "Protected Health Information" is information about you, including demographic information that may identify you and that relates to your past, present and future physical and mental health or condition and related health care services.

We are required by law to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice, at any time. The new notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices. You may also access our web site at www.NorthbrookHeights.com or by calling and/or requesting from the business office, and requesting that a revised copy be sent to you in the postal mail.

1. USES AND DISCLOSURE OF PROTECTED HEALTH INFORMATION

PERMITTED AND REQUIRED USES AND DISCLOSURES BASED UPON YOUR WRITTEN CONSENT:

Upon admission you will be asked to sign a consent form. Once you have consented to the use and disclosure of your protected health information for treatment, payment and health care operations by signing the consent form, North Brook Heights may then use and disclose this information as described in this section. Your protected health information may be used and disclosed by our staff and to others outside the facility that are directly involved in your care and treatment for the purpose of providing health care services to you. Your protected health information may also be used and disclosed to pay your health care bills and to support the health care operations of the facility.

Following are examples of the types of uses and disclosure of your protected health care information that the facility is permitted to make once you have signed the consent form. These examples are not meant to be exhaustive, but to describe the types of uses and disclosures that may be made by our office and staff once you have provided consent.

The facility may use or disclose your protected health information in the following situations only with your consent or authorization. They include:

TREATMENT: North Brook Heights will use and disclose your protected health information to provide, coordinate or manage your health care and any related services. This includes the coordination or management of your health care with a third party that has already obtained your permission to have access to your protected health information. For example, we would disclose your protected health information, as necessary, to your physician(s), hospitals or other health care agency that provides care to you. We will also disclose protected health information to other physicians who may be treating you or to whom you have been referred by your Primary Care Physician, when we have the necessary permission from you to disclose your protected health information. Your protected health information may also be provided to a physician or health care provider to whom you have been referred to or become involved with your health care to ensure that those involved have the necessary information to diagnose and treat you.

PUBLIC HEALTH: We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your protected health information, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority.

COMMUNICABLE DISEASES: We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.

HEALTH OVERSIGHT: We any disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.

ABUSE OR NEGLECT: We may disclose your protected health information to a public health authority that is authorized by law to receive reports of abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the government entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

FOOD AND DRUG ADMINISTRATION: We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, tract products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.

LEGAL PROCEDURES: We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process.

LAW ENFORCEMENT: We may also disclose protected health information, so long as applicable legal requirements are met, and for law enforcement purposes. The law enforcement purposes include (a) legal processes as otherwise required by law, (b) limited information requests for identification and location purposes, (c) pertaining to victims of a crime, (d) suspicion that death has occurred as a result of criminal conduct, (e) in the event that a crime occurs on the premises of the practice, and (f) medical emergency and it is likely that a crime has occurred.

CORONERS, FUNERAL DIRECTORS AND ORGAN DONATION: We may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. We may disclose such information in reasonable anticipation of death. protected health information may be used and disclosed for organ, eye or tissue donation purposes.

MILITARY ACTIVITIES AND NATIONAL SECURITY: When the appropriate conditions apply, we may use or disclose protected health information of individuals who were Armed Forces personnel for the purpose of determination by the Department of Veterans Affairs of your eligibility of benefits. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.

REQUIRED USES AND DISCLOSURES: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et. seq.

2. YOUR RIGHTS

Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.

YOU HAVE THE RIGHT TO INSPECT AND COPY YOUR PROTECTED HEALTH INFORMATION. This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information. A "designated record set" contains medical and billing records and other records that the facility and staff use for making decisions about you.

Under federal law, however, you may not inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in a civil, criminal or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. Depending upon the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Contact if you have any questions about access to your medical record.

YOU HAVE THE RIGHT TO REQUEST A RESTRICTION OF YOUR PROTECTED HEALTH INFORMATION. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care for the notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.

North Brook Heights and its staff is not required to agree to a restriction that you may request. If, after much careful deliberation, the facility, staff and/or your physician believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. If North Brook Heights agrees to the requested restriction(s), we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restrictions you wish to request with our Nursing staff, Privacy Coordinator, or Administration. Please make this request in writing to our Privacy Coordinator.

YOU HAVE THE RIGHT TO REQUEST AND RECEIVE CONFIDENTIAL COMMUNICATIONS FROM US BY ALTERNATIVE MEANS OR AT AN ALTERNATIVE LOCATION. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other methods of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Privacy Coordinator.

YOU HAVE THE RIGHT TO AMEND YOUR PROTECTED HEALTH INFORMATION. This means you may request an amendment of protected health information about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with used and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Privacy Coordinator to determine if you have questions about amending your medical record.

YOU HAVE THE RIGHT TO RECEIVE AN ACCOUNTING OF CERTAIN DISCLOSURES WE HAVE MADE, IF ANY, OF YOUR PROTECTED HEALTH INFORMATION. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, for a facility director, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. You may request a shorter time frame. The right to receive this information is subject to certain exceptions, restrictions and limitations.

YOU HAVE THE RIGHT TO OBTAIN A PAPER COPY OF THIS NOTICE FROM US, upon request, even if you have agreed to accept this notice electronically.

3. COMPLAINTS.

You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Privacy Coordinator of your complaint. We will not retaliate against for filing a complaint.

You may contact our Privacy Coordinator, Theresa Nyquest in writing at North Brook Heights Home for Adults, 170 Murray Street, Auburn, New York, 13021, by phone at (315) 253-2755 or via e-mail at tnyquist@northbrookheights.com for further information about the complaint process.