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Notice of Information 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.

Understanding Your Health Record/Information:

Each time you receive health care services at our residence, 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
  • means of communicating among the many health professionals who contribute to your care
  • legal document describing the care you received
  • means by which you or a third party payer can verify that services billed were actually provided
  • a tool in educating health professionals
  • a source of data for medical research
  • a source of information for public health officials who over see the delivery of health care in the United States
  • a source of data for facility 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 disclosures to others.

Our Responsibilities

Our Residence is required to:

  • maintain the privacy of your health information
  • provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
  • abide by the terms of this notice
  • notify you if we are unable to agree to a requested restriction
  • accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices materially change, we will mail you a revised notice.

We will not use or disclose your health information without your authorization, except as described in this notice.

Your Consent to Our Use of Your Health Information.

As a condition of your admission to our Residence and your receipt of services, we have asked you and you have consented to our use and disclosure of your health information for purposes of treatment, payment, health care operations and our business associates. Without the right to use and disclose information for these purposes we could not provide services to you. These purposes are described immediately below in paragraphs (1) through (4) in the next section.

How We Will Use or Disclose Your Health Information

Based on your consent as provided above, we will use and disclose your health information as follows:

  1. Treatment: We will use your health information for treatment. 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 that should work best for you. 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 our Residence.
  2. Payment: We will use your health information for payment. 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.
  3. Health care operations: We will use your health information for 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.
  4. Business associates: There are some services provided in our organization through contacts with business associates. Examples include our accountants, consultants and attorneys. 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. To protect your health information, however, we require the business associates to appropriately safeguard your information.


There are certain circumstances where federal or state law requires that we disclose your health information and in such cases we shall do so. They include:

  1. Food and Drug Administration (FDA): We may disclose to 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.
  2. 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.
  3. 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.
  4. 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.
  5. Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.
  6. Reports: Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more Residents, workers or the public.

There are certain other purposes, including those described in paragraphs (11) through (19), for which we may disclose your health information unless you withdraw your authorization for these purposes by giving us notice of such withdrawal.

  1. Directory: Unless you notify us that you object, we may use your name, and location in the facility for directory purposes 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.
  2. Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care that you have identified, of your location, and general condition. If we are unable to reach your family member or personal representative, then we may leave a message for them at the phone number that they have provided us, e.g., on an answering machine.
  3. Communication with family: Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care.
  4. Residence Communication: We may disclose information about you such as birthdays, anniversaries, stories, tributes, participation in events, or other activities that are unique to our residence. We may include information about you in our newsletter(s).
  5. Research: We may disclose 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 health information.
  6. Funeral Directors: We may disclose health information to funeral directors and coroners to carry out their duties consistent with applicable law.
  7. 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.
  8. 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.
  9. Fund Raising: We may contact you as part of a fund-raising effort.


Your Health Information Rights

Although your health record is the physical property of the Residence, 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 or the Residence’s general healthcare operations. We ask that such requests be made in writing on a form provided by our Residence. Although we will consider your request, please be aware that we are under no obligation to accept it or abide by it.
  • 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 alterative locations. Such a request must be made in writing, and submitted to the Administrator of this Residence. We will attempt to accommodate all reasonable requests.
  • You may request to inspect and/or obtain copies of health information about you. We will provide you access to inspect your health information within 24 hours of your request. If you request copies, we shall supply them within two business days. We reserve the right to charge you a reasonable fee for supplying copies.
  • 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 our Residence to make such requests. For a request form, please contact the Administrator.
  • 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 our Residence. Please note that an accounting will not apply to any of the following types of disclosures: disclosures made for reasons of treatment, payment or healthcare operations; disclosures made to you or your legal representative, or any other individual involved in 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.
  • You have the right to obtain a paper copy of our Notice of Information Practices upon request.
  • 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 you have questions and would like additional information, you may contact our Residence’s Administrator at (508) 896-7046.

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 our Residence. The complaint form may be obtained from the Administrator and when completed should be returned to the Administrator of this Residence. You may also file a complaint with our Corporate Privacy Officer at EPOCH Senior Living. You may also file a complaint with the Secretary of the Federal Department of Health and Human Services. There will be no retaliation for filing a complaint.

Effective Date: 4/1/03

 


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