Pinewood Manor Nursing and Rehabilitation Center
NOTICE OF PRIVACY PRACTICES
Effective April 13, 2003
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION
Pinewood Manor has an unwavering belief in integrity and fair dealing. We take pride in treating our residents and families with dignity and respect. Protecting your personal health information is very important to us. We want you to have a clear understanding of how we use and safeguard your protected health information.
This Notice of Privacy Practices describes how Pinewood Manor may use and disclose your protected health information (PHI) in order to carry out treatment, payment and health care operations and for other purposes permitted or required by law. It also describes your rights to access and control your PHI.
Pinewood Manor is required to abide by the terms of this Notice. However, we may modify the terms of this Notice at any time, and the new notice will be effective for all PHI in our possession at the time of the change, and any received thereafter. Upon request, we will provide you with any revised Notice.
Information we collect about you are from the following sources: Medical records, social security, Medicare, Medicaid, Veteran’s Administration, physicians, dentists, podiatrists, hospitals, clinics, laboratories, applications we have received from you, and information you have given us.
This information may include personal information regarding payment sources, income, health diagnosis, medications, treatments, and responsible parties.
Pinewood Manor uses PHI about you for treatment, payment and operational purposes. We do not require authorization to use your PHI for these purposes. We may also use or disclose your PHI without your authorization for several other reasons. Subject to certain requirements, we may give out health information without your authorization for public health reasons, for auditing purposes, for emergencies, and to other health care providers such as hospitals, physicians, Medicare, and Medicaid.
Pinewood Manor may use and disclose your PHI to assist your health care providers in your diagnosis and treatment. For example, we may disclose your PHI to providers to provide information about alternative treatments, allergies, or advance directives.
Pinewood Manor may use and disclose your PHI in order to pay for the services and items you may receive. For example, we may contact your health provider to certify that you received treatment, and we may request details regarding your treatment to determine if your benefits will cover, or pay for, your treatment. We also may use and disclose your PHI to obtain payment from third parties that may be responsible for such costs, such as family members.
Pinewood Manor may release your PHI to a friend or family member identified by you, that is assisting you in your care or is helping you pay for services.
Pinewood Manor may disclose your PHI to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.
inewood Manor may use and disclose your PHI in response to a court or administrative order. We may disclose your PHI in response to a medical records request, subpoena, or other lawful process.
Pinewood Manor may use and disclose your PHI when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.
You have the right to inspect and obtain a copy of your PHI that we maintain and have in our possession, including medical records and billing records. If you request copies, we will charge you a fee for the costs of copying, mailing, labor, and supplies associated with your request. To inspect and copy your PHI, you must submit your request in writing.
Under certain circumstances we may deny your request to inspect and copy your PHI. If you are denied access to this information, you have a right to appeal this decision based on certain legal guidelines.
You have the right to request an accounting of disclosures. This right applies to disclosures for purposes other than those made to carry out treatment, payment and health care operations as previously described in this notice. Your request must be made in writing and time period specific. Your request cannot be longer than six years and cannot include any dates before April 13, 2003. We may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
You have the right to request a restriction or limitation on the PHI we use or disclose about. Any request on the use and disclosure of your PHI must be in writing. Your request must describe in a clear and concise manner the information you wish restricted and to whom you want the limits to apply. Please be informed that restrictions involving medical care and or payments may jeopardize the facility’s ability to continue to provide services.