HIPAA

Notice of HIPAA 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.

Terrace Healthcare Center (the “Facility”) has summarized our responsibilities and your rights on this first page. For a complete description of our privacy practices, please review this entire notice.

Our Responsibilities:

The facility is required to:

* Maintain the privacy of your health information
* Provide you with this notice of our legal duties and privacy practices with respect to information we collect and maintain about you
* Abide by the terms of this notice

Your Rights:

As a resident of the Facility, 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 the 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 the Facility’s Contact Person at [718-796-5800 ext. 1700]

Understanding your Health/Record Information

Each time you visit the Facility, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as:

* A basis for planning your care and treatment
* A means of communication among the many health professionals who contribute to your care
* A legal document describing the care you received
* A means by which you or a third-party payer can verify that services billed were actually provided
* A tool in educating heath professionals
* A source of data for medical research
* A source of information for public health officials who oversee the delivery of health care in the United States
* A source of data for the Facility’s planning and marketing
* A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve

Understanding what is in your record and how your health information is used helps you to: ensure its accuracy, better understand who, what, when, where, and why others may access your health information, and make more informed decisions when authorizing disclosure to others.

How We Will Use or Disclose Your Health Information

We will use or disclose your health information for the following purposes without your specific authorization, unless otherwise noted. If you object to any of these uses or disclosures, please contact the Facility’s Contact Person

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. 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 the Facility.

1. 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
2. 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: (a) the other entity must have, or have had in the past, a relationship with you; (b) the health information used or disclosed must relate to that other entity’s relationship with you; and (c) the disclosure must only be for one of the following purposes: (i) quality assessment and improvement activities; (ii) population-based activities relating to improving health or reducing health care costs; (iii) case management and care coordination; (iv) conducting training programs; (v) accreditation, licensing, or credentialing activities; or (vi) health care fraud and abuse detection or compliance
3. 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
4. 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. We may also use your name on a nameplate next to or on your door in order to identify your room, unless you notify us that you object. If you object to any of these uses, please contact the Facility’s Contact Person
5. Notification. Unless you notify us that you object, we may use or disclose information to notify or assist in notifying a family member, personal representative, designated representative, or another person responsible for your care, of your location, and general condition or death. If we are unable to reach your family member, personal representative, or designated representative then we may leave a message for them at the phone number that they have provided us, e.g., on an answering machine
6. Communication with family. Under certain circumstances, we may disclose to a family member, designated representative, 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
7. Disaster relief purposes. We may use or disclose your health information in connection with disaster relief efforts
8. Research. We may disclose information to researchers when certain conditions have been met
9. Transfer of information at death. We may disclose health information to funeral directors, medical examiners, and coroners to carry out their duties consistent with applicable law
10. Organ procurement organizations. Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant
11. Food and Drug Administration (FDA). We may disclose to the FDA, or to a person or entity subject to the jurisdiction of the FDA, health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement
12. Workers compensation. We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
13. Public health. As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability
14. Correctional institution. Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals
15. Law enforcement. We may disclose your health information to the police or other law enforcement officials as required or permitted by law
16. OBRA. Under federal law, we are required to notify your legal representative or an interested family member of certain information. This information includes: (1) if you have been involved in an accident which results in injury and has the potential for requiring physician intervention; (2) if there has been a significant change in your physical, mental, or psychological status; (3) if there is a need to alter your treatment significantly; (4) if a decision has been made to transfer or discharge you from the Facility; (5) if there is a change in your room or your roommate assignment; and (6) if there is a change in your rights under federal or state law or regulations
17. Health Oversight Activities. We may disclose your PHI to a health oversight agency that oversees the health care system and is charged with responsibility for ensuring compliance with the rules of government health programs such as Medicare or Medicaid
18. Judicial and Administrative Proceedings. We may disclose your health information in the course of a judicial or administrative proceeding in response to a legal order or other lawful process
19. As required by law. We may use and disclose your PHI when required to do so by any other law not already referred to in the preceding categories

Uses and Disclosures Requiring Your Written Authorization

* Use or Disclosure with Your Authorization. For any purpose other than the ones described above, we only may use or disclose your health information when you grant us your written authorization on our authorization form. For instance, you will need to execute an authorization form before we can send your health information to the attorney representing the other party in litigation in which you are involved
* Marketing. We must also obtain your written authorization prior to using your health information to send you any marketing materials. (We can, however, provide you with marketing materials in a face-to-face encounter without obtaining your authorization. We are also permitted to give you a promotional gift of nominal value, if we so choose, without obtaining your authorization.) In addition, we may communicate with you about products or services relating to your treatment, case management or care coordination, or alternative treatments, therapies, providers or care settings without your authorization

Your Health Information Rights

Although your health record is the physical property of the 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 the 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. However, 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. For more information about this right, see 45 Code of Federal Regulations (C.F.R.) § 164.522(a)
* 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 the Facility’s Contact Person. We will attempt to accommodate all reasonable requests. For more information about this right, see 45 C.F.R. § 164.522(b)
* 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 the Facility’s Contact Person. We will attempt to accommodate all reasonable requests. For more information about this right, see 45 C.F.R. § 164.522(b)
* 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 the Facility to make such requests. For a request form, please contact the Contact Person. For more information about this right, see 45 C.F.R. § 164.526
* 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 the 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, designated representative or any other individual involved with your care; 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. For more information about this right, see 45 C.F.R. § 164.528
* You have the right to obtain a paper copy of our Notice of Privacy Practices upon request. You may also access and print a copy of our notice from our website http://www.terrace-healthcare.com/
* 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 have questions and would like additional information, you may contact the Facility’s Contact Person at [718-796-5800 ext. 1700]

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 the Facility. The complaint form may be obtained from the Privacy Officer, 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. You can contact the Facility’s Contact Person for the Secretary’s Address. There will be no retaliation for filing a complaint

Effective Date: April 14, 2003