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Health Insurance Portability and Accountability Act
(HIPAA)
GlenWood Park, Inc. dba/
GlenWood Park Retirement Village
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.
GlenWood Park
Retirement Village is providing this Notice of Privacy
Practices because the privacy of your health information is
very important to you and to us, and in compliance with
federal regulations.
By "your health
information" we mean the information that we maintain that
specifically identifies you and your health status.
Please contact the
senior vice president at (304) 425-8128 if you have any
questions regarding this notice.
General Description Summary
This notice describes how we use your health information
within GlenWood Park Retirement Village and disclose it
outside GlenWood Park Retirement Village, and why.
The Notice covers:
- Uses or disclosures which do
not require your written authorization.
- Treatment, payment,
and health care operations.
- Uses or disclosures of
your health information to which you may object.
- Uses or disclosures
required or permitted.
- Uses or disclosures
which require your written authorization.
- Your rights as a
resident regarding privacy of your health information.
- Our duties in
protecting your health information.
- Complaints, contact
person, effective date, and acknowledgement.
Uses or Disclosures That Do Not
Require Your Written Authorization
Treatment, Payment, and Health
Care Operations
We
use or disclose your health information to carry out your
treatment; to obtain payment for your treatment; and to
conduct health care operations. For example:
Treatment. We use your health
information to plan, coordinate, and provide your care. We
disclose your health information for treatment purposes to
physicians and other health care professionals outside our
facility who are involved in your care. For example, your
physician may order physical therapy services to improve
your strength and walking abilities. Our nursing staff will
need to talk with the physical therapist so that we can
coordinate services and develop a plan of care. We also may
disclose your health information to people outside our
facility who may be involved in your health care, such as
family members, social services, or home health agencies.
Payment. We use your information to
prepare documentation required by your insurance company,
HMO, or by Medicare or Medicaid. We disclose that part of
your health information that these organizations require to
pay us. For example, we may need to give information to your
health plan regarding the services you receive from our
facility so that your health plan will pay us or reimburse
you for the services. We also may tell your health plan
about a treatment you are going to receive in order to
obtain prior approval for the services or to determine
whether your health plan will cover the treatment.
Health Care Operations. We may use or
disclose your health information to perform certain
functions within our facility. These uses or disclosures are
necessary to operate GlenWood Park Retirement Village and to
make sure that our residents receive quality care. For
example, we may use your health information to review our
treatment and services and to evaluate the performance of
our staff in caring for you. We may combine health
information about many of our residents to determine whether
certain services are effective or whether additional
services should be provided. We may disclose your health
information to other health care professionals and other
personnel for review and learning purposes. We also may
combine health information with information from other
health care providers or facilities to compare how we are
doing and see where we can make improvements in the care and
services offered to our residents. We may remove information
that identifies you from this set of health information so
that others may use the information to study health care and
health care delivery without learning the specific
identities of our residents.
Uses or Disclosures of Your
Health Information to Which You May Object
We
may use or disclose your health information for the
following purposes, unless you ask us not to:
- Facility directories. We may use or
disclose certain limited health information about you in our
facility directory while you are a resident in our facility.
This information may include your name, your assigned unit
and room number, your religious affiliation, and a general
description of your condition. We will make known your
religious affiliation only to clergy. The directory
information, except for religious affiliation, may be given
to people who ask for you by name.
- Informing family and friends. We may
disclose your health information to family, friends, or
others identified by you who are involved in your care.
- Assistance
in disaster relief efforts.
- For fundraising activities. We may
contact you or your family for fundraising purposes. If you
do not wish to be contacted for this purpose, please contact
the senior vice president or the assistant to the president
and indicate that you do not wish to receive fundraising
communication from us.
- Confirming
appointments.
- Informing you about treatment alternatives
or other health-related benefits and services that may be of
interest to you.
If you object to our use of
your health information for any of these purposes, please
contact: senior vice president, vice president-services, or
the residential counselor.
Uses or Disclosures Required or
Permitted
Certain state and federal laws and regulations either
require or permit us to make certain uses or disclosures of
your health information without your permission. These uses
or disclosures are generally made to meet public health
reporting obligations or to ensure the health and safety of
the public at large. The uses or disclosures which we may
make pursuant to these laws and regulations and without your
written authorization include the following:
- Federal government investigation, when
required by the secretary of health and human services to
investigate or determine our compliance with federal
regulation.
- Federal,
state, or local law requirements.
- Public health activities, for example,
to report communicable diseases or death; to report
suspected or actual abuse or neglect; to report adverse
reactions to medications or problems with health care
products; to notify individuals of product recalls; or any
other matters involving the Food and Drug Administration.
- Health oversight activities by health oversight
agency. (A health oversight agency is an
organization authorized by the government to oversee
eligibility and compliance and to enforce civil rights
laws.)
- Judicial or administrative proceedings.
We may use or disclose your health information to courts or
administrative agencies charged with the authority to hear
and resolve lawsuits or disputes. We may disclose your
health information pursuant to a court order, a subpoena, a
discovery request, or other lawful process issued by a judge
or other person involved in the dispute.
- Law enforcement purposes, for example
to report certain types of wounds or other physical injuries
or to identify or locate a suspect, fugitive, material
witness, or missing person. We may use or disclose your
health information in response to a request received from a
law enforcement official in response to a court order,
subpoena, warrant, summons, or similar law process; to
report a death that we believe may be the result of criminal
conduct; to report criminal conduct in our facility; or in
emergency situations, to report a crime - the location of
the crime and possible victims; or the identity,
description, or location of the individual who committed the
crime.
- Coroners, medical examiners, or funeral directors.
We may use or disclose your health information to a
coroner or medical examiner for the purpose of identifying a
deceased individual or to determine the cause of death. We
also may use or disclose your health information to a
funeral director for the purpose of carrying out his or her
necessary activities.
- Organ procurement organizations or tissue
banks. If you are an organ donor, we may use or
disclose your health information to organizations that
handle organ procurement, transplantation, or tissue banking
for the purpose of facilitating organ or tissue donation or
transplantation.
- Research. We may use or disclose your
health information for research purposes under certain
limited circumstances. Because all research projects are
subject to a special approval process, we will not use or
disclose your health information for research purposes until
the particular research project for which your health
information may be used or disclosed has been approved
through this special approval process. However, we may use
or disclose your health information to individuals preparing
to conduct the research project in order to assist them in
identifying residents with specific health care needs who
may qualify to participate in the research project. Any use
or disclosure of your health information which may be done
for the purpose of identifying qualified participants will
be conducted on site at our facility. In most instances, we
will ask for your specific permission to use or disclose
your health information if the researcher will have access
to your name, address, or other identifying information.
- To avert a serious threat to health or safety.
We may use or disclose your health information when
necessary to prevent a serious threat to the health or
safety of you or other individuals. Any such use or
disclosure would be made solely to the individual/s or
organization/s that have the ability and/or authority to
assist in preventing the threat.
- Specialized government functions such as
military or veterans' affairs; national security, and
intelligence activities. If you are a member of the
armed forces we may use or disclose your health information
as required by military command authorities. We may use or
disclose your health information to authorize federal
officials for purposes of intelligence,
counter-intelligence, and other national security
activities, as authorized by law.
- Workers' Compensation. We may use or
disclose your health information to Workers' Compensation
programs when your health condition arises out of a
work-related illness or injury.
Uses or Disclosures That Require
Your Written Authorization
Your written authorization, which you may revoke (in
writing), is required if we use or disclose your health
information for any other purpose, in particular:
- Use of
psychotherapy notes beyond treatment, payment, and health
care operations.
- Marketing
of goods or services to you.
Your Rights As A Resident To
Privacy Of Your Health Information
- Right to request restrictions. You
have the right to request restrictions on our uses and
disclosures of your health information. However, we may
refuse to accept the restriction. If we do agree, we will
comply with your request unless the information is needed to
provide emergency treatment to you. Your request must be in
writing; forms are available for your use.
- Right to request confidential communications.
You have the right to request that we communicate with you
confidentially, for example, to speak with you only in
private; to send mail to an address you designate; or to
telephone you at a number you designate. We will make every
attempt to honor your request. Your request must be in
writing; forms are available for your use.
- Right to request access to your health
information. You have the right to request access
to your health information in order to inspect and/or
receive a copy of it. Your request must be in writing. We
may deny your request and, if so, you may request a review
of the denial. However, we will make every attempt to honor
your request. GlenWood Park Retirement Village will charge a
reasonable copying fee. Forms are available for your use.
- Right to request an amendment of your health
information. You have the right to request an
amendment to your health information. Your request must be
in writing and must provide a reason for the amendment. We
may deny your request and, if so, you may submit a statement
of disagreement. However, we will make every attempt to
honor your request. Forms are available for your use.
- Right to request an accounting of disclosures
of your health information. You have a right to
request an accounting of our disclosures of your health
information for purposes other than treatment, payment, and
health care operations. We will make every attempt to honor
your request. We are not required to provide an accounting
for disclosures before April 14, 2003 or for more than six
(6) years prior to the date of your request. Forms are
available for your use.
- Right to obtain a paper copy of this notice.
If you receive this Notice electronically, you have the
right to receive a paper copy.
To exercise any of these
rights or to receive forms, please write or telephone the
senior vice president, vice president-services, or
residential counselor.
Our Duties in Protecting Your
Health Information
- We are required
by law to maintain the privacy of your health information.
- Even
though the resident has the right to request his/her
protected health information not be disclosed, GlenWood Park
Retirement Village is under no obligation to grant the
request. Since GlenWood Park Retirement Village is a
Medicare and Medicaid organization, there are times when the
request cannot be honored - including emergencies, if the
resident is being transferred to another health care
facility, or the disclosure is required by law.
- We
must inform residents or their legal representatives of our
legal duties and privacy practices with respect to health
information. This Notice
discharges that duty.
- We must
abide by the terms of the Notice currently in effect.
- We
reserve the right to change the terms of this Notice and to
make the new Notice provisions effective for all health
information that we maintain. At any time, you may obtain a
copy of the current Notice from the senior vice president,
residential counselor, or admissions coordinator.
Complaints, Contact Person,
Effective Date, and Acknowledgement
- If you believe
your privacy rights have been violated, you may complain to
the following GlenWood Park associates: 1) Senior Vice
President; 2) Residential Counselor; 3) Vice
President-Services from 9:00 a.m.-5:00 p.m., Monday through
Friday; AND to the secretary of health and
human services. The charge nurse, Health Care Unit, is
available at all times to receive concerns and make contact
with the above-named individuals.
- You will
not be retaliated against for filing a complaint.
- You may
file your complaint with our facility by writing to the
senior vice president. Privacy complaint forms are available
for your use and may be obtained at the receptionist's desk
or bulletin board (wall pocket) in the main lobby hallway.
- You may
file a complaint with the secretary of health and human
services by writing to:
Secretary of Health and Human
Services, U.S. Department of Health and Human Services, 200
Independence Avenue, Southwest, Washington, DC 20201
- For further
information you may write or call the senior vice president.
This notice is effective April
14, 2003. |
