National Home: A Retirement Community
The
APARTMENT LIVING
ELKS NATIONAL HOME
Bedford, Virginia
Bedford, Virginia
NOTICE OF 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.
This notice is effective on April 14, 2003. This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted by law. It also describes your rights to access your protected health information. “Protected Health Information†is information about you, including demographic information, which may identify you and relates to your past, present or future physical or mental health or condition and related health care services.
We are required 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 at the time of your next appointment.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
Your protected health information may be used and disclosed by your physician, our office staff and others outside of the Elks National Home that are 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 operation of the physicians practice. The following are examples of the types of uses and disclosures of your protected health care information that the physicians office is permitted to make.
This notice is effective on April 14, 2003. This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted by law. It also describes your rights to access your protected health information. “Protected Health Information†is information about you, including demographic information, which may identify you and relates to your past, present or future physical or mental health or condition and related health care services.
We are required 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 at the time of your next appointment.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
Your protected health information may be used and disclosed by your physician, our office staff and others outside of the Elks National Home that are 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 operation of the physicians practice. The following are examples of the types of uses and disclosures of your protected health care information that the physicians office is permitted to make.
1. Treatment: We 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, such as a home health agency, that has already obtained your permission to have access to your protected health information. We will also disclose protected health information to other physicians, specialists or laboratories who may be treating you or to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.
2. Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may require before it approves or pays for the health care services we recommend for you such as making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and medical record review activities. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission.
3. Healthcare Operations: We may use or disclose, as needed, your protected health information in order to support the business activities of the Elks National Home. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, and conducting or arranging for other business activities. For example, we may disclose your protected health information to medical school students that see patients at the Elks National Home. In addition, we may use a sign-in sheet at the registration desk and we may call you by name when your physician is ready to see you. We may also use or disclose your protected health information, as necessary, to contact you to remind you of your appointment. For example, we may leave a message on your answering machine at home to confirm your appointment unless you specify otherwise.
We will share your PHI with third party “business associates†that perform various activities for the practice such as billing and transcription services. Whenever an arrangement between our office and a business associate involves the use or disclosure of your PHI, we will have a written contract that contains terms that will protect the privacy of your protected health information.
We may use or disclose your PHI as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. We may also use and disclose your PHI or other marketing activities. For example, your name and address may be used to send you information about products or services that we believe may be beneficial to you or to send you a newsletter about our practice and the services we offer. You may contact our privacy officer to request that these materials not be sent to you.
4. Others Involved in Your Healthcare: Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your PHI that directly relates to that persons involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose PHI to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your PHI to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.
5. Emergencies: We may use or disclose your PHI in an emergency treatment situation.
6. Required by Law: We may use or disclose your protected health information to the extent that is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified of any such uses or disclosures.
7. 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. We may also 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.
8. Health Oversight: We may disclose PHI 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.
9. Abuse or Neglect: We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child 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 governmental 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.
10. 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, and tracking of products to enable product recalls, make repairs or replacements, or to conduct post marketing surveillance as required.
11. Legal Proceedings: We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court, subpoena, discovery request or other lawful process.
12. Law Enforcement: We may also disclose protected health information, as long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include legal processes required by law, limited information requests for identification and location purposes, pertaining to victims of a crime, suspicion that a death has occurred as a result of criminal conduct, in the event that a crime occurs on the premises of the practice and medical emergency (not on the practices premises) and it is likely that a crime has occurred.
13. 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 cadaver organ, eye or tissue donation purposes.
14. Research: We may disclose your protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.
15. Criminal Activity: Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
16. Military Activity and National Security: When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel for activities deemed necessary by appropriate military command authorities, for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits or to foreign military authority if you are a member of that foreign military services. 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.
17. 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 Federal Law. Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke this authorization, at any time, in writing, except to the extent that your physician or the physicians practice has already taken an action relying on the use of your previously signed authorization.
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.
3. Healthcare Operations: We may use or disclose, as needed, your protected health information in order to support the business activities of the Elks National Home. These activities include, but are not limited to, quality assessment activities, employee review activities, training of medical students, licensing, and conducting or arranging for other business activities. For example, we may disclose your protected health information to medical school students that see patients at the Elks National Home. In addition, we may use a sign-
We may use or disclose your PHI as necessary, to provide you with information about treatment alternatives or other health-
5. Emergencies: We may use or disclose your PHI in an emergency treatment situation.
6. Required by Law: We may use or disclose your protected health information to the extent that is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified of any such uses or disclosures.
7. 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. We may also 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.
8. Health Oversight: We may disclose PHI 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.
9. Abuse or Neglect: We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child 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 governmental 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.
10. 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, and tracking of products to enable product recalls, make repairs or replacements, or to conduct post marketing surveillance as required.
11. Legal Proceedings: We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court, subpoena, discovery request or other lawful process.
12. Law Enforcement: We may also disclose protected health information, as long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include legal processes required by law, limited information requests for identification and location purposes, pertaining to victims of a crime, suspicion that a death has occurred as a result of criminal conduct, in the event that a crime occurs on the premises of the practice and medical emergency (not on the practices premises) and it is likely that a crime has occurred.
13. 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 cadaver organ, eye or tissue donation purposes.
14. Research: We may disclose your protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.
15. Criminal Activity: Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
16. Military Activity and National Security: When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel for activities deemed necessary by appropriate military command authorities, for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits or to foreign military authority if you are a member of that foreign military services. 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.
17. 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 Federal Law. Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke this authorization, at any time, in writing, except to the extent that your physician or the physicians practice has already taken an action relying on the use of your previously signed authorization.
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.
1. You have the right to obtain a copy of your protected health information: This means you may obtain a copy by providing our staff with a written request for your designated record set. A “designated record set†contains medical and billing records and any other records that your physician and the practice use for making decisions about you.
Under federal law, however, you may not inspect or copy the following records: psychotherapy notes, information being compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and any other records that are subject to Federal or State law. Depending on the circumstances, your request may be denied. You may have the right to have this decision reviewed. Please contact our Privacy Officer if you have questions about access to your medical record.
2. 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 or for 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.
Your physician is not required to agree to a restriction that you may request. If your physician believes it is in your best interest to permit use and disclosure of your protected health information, your information will not be restricted. If your physician does agree to the request, we may not violate that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you may wish to request with your physician. You may request a restriction by providing a written request to our Privacy Officer.
3. You may have the right to have your physician 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 amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you a copy of any such rebuttal. Please contact our Privacy Officer if you have questions about amending your medical record.
4. 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, 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. The right to receive this information is subject to certain exceptions, restrictions and limitations.
Under federal law, however, you may not inspect or copy the following records: psychotherapy notes, information being compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and any other records that are subject to Federal or State law. Depending on the circumstances, your request may be denied. You may have the right to have this decision reviewed. Please contact our Privacy Officer if you have questions about access to your medical record.
2. 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 or for 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.
Your physician is not required to agree to a restriction that you may request. If your physician believes it is in your best interest to permit use and disclosure of your protected health information, your information will not be restricted. If your physician does agree to the request, we may not violate that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you may wish to request with your physician. You may request a restriction by providing a written request to our Privacy Officer.
3. You may have the right to have your physician 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 amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you a copy of any such rebuttal. Please contact our Privacy Officer if you have questions about amending your medical record.
4. 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, 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. The right to receive this information is subject to certain exceptions, restrictions and limitations.
COMPLAINTS
You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated. You may file a complaint with us by notifying our Privacy Officer of your complaint. You may contact our Privacy Officer, Pam Mutter, RN at (540) 586-8232 for further information about the complaint process.
Address:
Pam Mutter, RN
Privacy Officer for Elks National Home
931 Ashland Avenue
Bedford, Virginia 24523
Privacy Officer for Elks National Home
931 Ashland Avenue
Bedford, Virginia 24523
