FILED: NEW YORK COUNTY CLERK 02/03/ :14 PM INDEX NO /2016 NYSCEF DOC. NO. 14 RECEIVED NYSCEF: 02/03/2017

Size: px
Start display at page:

Download "FILED: NEW YORK COUNTY CLERK 02/03/ :14 PM INDEX NO /2016 NYSCEF DOC. NO. 14 RECEIVED NYSCEF: 02/03/2017"

Transcription

1 SUPREME COURT OF THE STATE OF NEW YORK COUNTY OF NEW YORK X LISA HAMMER, as Executrix of the Estate of ROBERT GOODMAN, Deceased, and on behalf Index No.: /2016 of decedent s distributees, Plaintiff, PLAINTIFF S VERIFIED BILL OF PARTICULARS -against- AMSTERDAM NURSING HOME CORP., and SOUTH NASSAU COMMUNITIES HOSPITAL, Defendant(s) X Plaintiff, LISA HAMMER, as Executrix of the Estate of ROBERT GOODMAN, Deceased, and on behalf of decedent s distributees, by her attorney, MANGAN GINSBERG, LLP, pursuant to the Demands of Defendant, AMSTERDAM NURSING HOME CORP., for a Verified Bill of Particulars, alleges and responds as follows: 1. Dates of Negligent Acts or Omissions: During the course of plaintiff s decedent s admission to the defendant facility on or around April 2, 2015 June 16, Address: 1060 Amsterdam Ave, New York, NY Statement of every act of negligence, omission or commission: Defendant, AMSTERDAM NURSING HOME CORP., failed to heal or improve a decubitus sacral ulcer and lateral malleolus wounds over the course of a two-month admission because of lack of basic pressure relief; failure in preventing ROBERT s pressure ulcer from developing into a Stage IV sacral ulcer with bone exposure; failure to turn and position plaintiff s decedent, ROBERT, every two hours while in bed or chair to shift weight or encourage weight shifting every hour; failure to use proper devices; failure to provide adequate wound care and debridement; failure to transfer ROBERT out of his chair despite his and his daughter s frequent complaints to staff; 1 of 10

2 failure to perform adequate and appropriate skin assessments; failure to maintain an adequate diet and nutrition; negligence in allowing ROBERT to sit in soiled diapers for extended periods of time; failure in maintaining proper hygiene, specifically in failing to provide ROBERT with a clean and dry peri area; failure in properly treating the ulcer at all stages; failure to update and maintain proper care plan and medical records, specifically wound documentation; failure to use ordinary and reasonable care in the delivery of services to the plaintiff s decedent, and ensuring that services were delivered; failure to take reasonable precautions to prevent the development of ROBERT s injuries; failure to provide sufficient nursing staff knowing that insufficient staff would result in an inability to provide the necessary care and services; failure to institute a plan of care to prevent skin breakdown; and failure to use reasonable care in the employment, training and supervision of its employees to find out whether they were competent to do their work without danger of harm to others by failing to conduct reasonable background inquiries and required checks regarding lack of convictions and abuse. 4. Persons performing such acts, or failing to act: Said persons are in the exclusive knowledge of the defendants herein and include but are not limited to: all nurses, nurses aides, physicians, staff and agents employed by and/or charged with providing care to Robert Goodman while he resided at defendant facility. 5. Accepted medical practice/customs violated: Objection. Beyond the scope of Rule 3043(a) of the CPLR and/or calls for evidentiary material or information in the form of or to be gleaned from, expert testimony and, therefore, overly broad, and improper. See, Felock v. Albany Medical Center Hospital 1999 WL (3rd Dept. 1999); Liddell v. Cree, 233 AD 2d 593, 649 NYS 2d 101 (3rd Dept. 1996); Dellagio v. Paul, 250 AD 2d 806, 673 NYS 2d 212 (2nd Dept., 1998) Heyward v. Ellenville Community Hospital 215 AD 2nd 967; 627 NYS 2d 167 (3rd 2 of 10

3 Dept. 1995); McKenzie v. St. Elizabeth Hospital, 81 AD 2d 1003, 440 NYS 2d 109 (2nd Dept 1981); Rockefeller v. Hwang, 106 AD 2d 817, 484 NYS 2d. 206 (3rd Dept 1984); Wadler v. Stern, 124 AD 2d 725 (2nd Dept. 1986); Patterson v. Jewish Hospital and Medical Center of Brooklyn, 94 Misc. 2d 680, 405 NYS 2d 194, aff d 65 AD 2d 553, 409 NYS 2d 124 (2nd Dept. 1978). Defendant, its agents, servants and/or employees should be fully aware of the accepted medical practices and customs. Plaintiff reserves the right to supplement this response upon further discovery. 6. See responses to demand No Plaintiff is not alleging improper or defective equipment at this time. Plaintiff reserves the right to supplement this response upon further discovery. 8. Violations: 42 CFR (c) Pressure Sores, and 10 NYCRR (c) indicates "Based on the comprehensive Assessment of a resident, the facility must ensure that (l) A resident who enters the facility without pressure sores does not develop pressure sores unless the individual's clinical condition demonstrates that they were unavoidable; and (2) A resident having pressure sores receives necessary treatment and services to promote healing, prevent infection and prevent new sores from developing." The NYS rules and regulations-10 NYCRR (c) (1) adds to the first part of the regulation "demonstrates that they were unavoidable despite every reasonable effort to prevent them." The process of analyzing whether or not an ulcer is avoidable involves determining if the resident was properly assessed for the risk, the problem was appropriately care planned for and the interventions were implemented. 3 of 10

4 42 CFR and 10 NYCRR Quality of care "Each resident must receive and facility must provide the necessary care and services to attain or maintain the highest practicable physical, mental and psychosocial well-being, in accordance with the comprehensive assessment and plan of care. Intent-The facility must ensure that the resident obtains optimal improvement or does not deteriorate within the limits of a resident's right to refuse treatment, and within the limits of recognized pathology and the normal aging process. In any instance in which there has been a lack of improvement or a decline, the survey team must determine if the occurrence was unavoidable of avoidable. A determination of unavoidable decline or failure to reach highest practicable well-being may be made only if all of the following are present: An accurate and complete assessment (See ); A care plan which is implemented consistently and based on information from the assessment; Evaluation of the results of the interventions and revising the interventions as necessary. 42 CFR (b): A facility must make a comprehensive assessment of a resident's needs, using the RAI specified by the State. The assessment must include at least the following: identification and demographic information, customary routine, cognitive patterns, communication, vision, mood and behavior patterns, psychosocial well-being, physical functioning and structural problems, continence, disease diagnoses and health conditions, dental and nutritional status, skin conditions, activity pursuit, medications, special treatments and procedures, discharge potential, documentation of summary information regarding the additional assessment performed through the resident assessment protocols and documentation of participation in assessment. 4 of 10

5 42 CFR (1) Clinical Records "The facility must maintain clinical records on each resident in accordance with accepted professional standards and practices that are (i) Complete; (ii) Accurately documented; (iii) Readily accessible; and (iv) Systematically organized... " According to the Guidelines, "A complete clinical record contains an accurate and functional representation of the actual experience of the individual in the facility. It must contain enough information to show that the facility knows the status of the individual has adequate plans of care and provides sufficient evidence of the effects of the care provided. Documentation should include a picture of the resident's progress, including response to treatment, change in condition, and changes in treatment." 42CFR (b) (I) indicates that the facility must immediately inform the resident, consult with the resident's physician, and if known, notify the resident's legal representative or an interested family member when there is... (B) A significant change in the resident's physical, mental, psychosocial status (i.e., a deterioration in health, mental or psychosocial status in either life threatening conditions or clinical complications); (C) A need to alter treatment significantly (i.e., a need to discontinue an existing form of treatment due to adverse consequences or to commence a new form of treatment. Plaintiff reserves the right to supplement this response upon further discovery. 9. Plaintiff objects to this demand to the extent that it is overly broad. Notwithstanding and without waiving said objection, during the relevant period of negligence, April 2, 2015 June 16, 2015, plaintiff was not hospitalized at any facility other than that of defendants herein, therefore this information better known and available to defendants. 5 of 10

6 10. Injuries: Merging of decubitus sacral ulcer and lateral malleolus wounds to create a Stage IV pressure ulcer on plaintiff s decedent s sacrum with bone exposure, tunneling and necrosis, a large amount of foul serosanguinous (bloody) seepage; infection from exposure to fecal contamination; altered mental status; unmanaged pain and suffering; violation of dignity and death. 11. DOD: June 16, Medical cause of death: Objection. Beyond the scope of Rule 3043(a) of the CPLR and/or calls for evidentiary material or information in the form of or to be gleaned from, expert testimony and, therefore, overly broad, and improper. See, Felock v. Albany Medical Center Hospital 1999 WL (3rd Dept. 1999); Liddell v. Cree, 233 AD 2d 593, 649 NYS 2d 101 (3rd Dept. 1996); Dellagio v. Paul, 250 AD 2d 806, 673 NYS 2d 212 (2nd Dept., 1998) Heyward v. Ellenville Community Hospital 215 AD 2nd 967; 627 NYS 2d 167 (3rd Dept. 1995); McKenzie v. St. Elizabeth Hospital, 81 AD 2d 1003, 440 NYS 2d 109 (2nd Dept 1981); Rockefeller v. Hwang, 106 AD 2d 817, 484 NYS 2d. 206 (3rd Dept 1984); Wadler v. Stern, 124 AD 2d 725 (2nd Dept. 1986); Patterson v. Jewish Hospital and Medical Center of Brooklyn, 94 Misc. 2d 680, 405 NYS 2d 194, aff d 65 AD 2d 553, 409 NYS 2d 124 (2nd Dept. 1978). Plaintiff reserves the right to supplement this response upon further discovery. 13. DOB: xx/xx/1927; Address: 3861 Carrel Blvd. Oceanside NY Conditions for Treatment by Defendant: Activities of Daily living ( ADL ); ADL rehab; incontinent rehab; improving mood state; prevention of falls; nutritional monitoring; insuring skin integrity and wound care and prevention. 15. An autopsy was not performed. 6 of 10

7 16. Special damages: $100,000 further particulars to be supplied under separate cover. a. Hospitals: particulars to be provided under separate cover. b. Nurses: particulars to be provided under separate cover. c. Physicians: particulars to be provided under separate cover. d. Medical Supplies: N/A e. General expenses: N/A f. Funeral Expenses: particulars to be provided under separate cover. g. Other: Further particulars to be provided under separate cover. 17. Plaintiff responds to demand No. 17 (a-f) as follows: Objection. Plaintiff s decedent s employment information is not relevant because plaintiff is not claiming lost wages. Plaintiff reserves the right to supplement this response. 18. Next of Kin or distributees: a. Randi Goodman daughter b. Jaimie Goodman son c. Lisa Hammer - daughter 19. Place of birth, and name at that time: New York, New York; Robert Goodman 20. Not applicable. Spouse is deceased and not a next of kin or distributee. 21. Not applicable. See, response to demand No Plaintiff has not previously alleged any claims for the same or similar injuries as are claimed herein. 23. Collateral Source Reimbursement: Medicaid and/or Medicare are not Collateral Source s as a matter of law. See, CPLR of 10

8 24. SSN: Objection. NY General Business Law 399-ddd(2) prohibits the public disclosure of an individual s Social Security Number. See, Meyerson v. Prime Realty Servs., LLC, 7 Misc. 3d 911, 796 N.Y.S.2d 848 (New York Cnty., Feb. 28, 2005); see also, Daly v. Metro. Life Ins. Co., 4 Misc. 3d 887, 782 N.Y.S.2d 530 (New York Cnty., May 20, 2004). Objections notwithstanding, plaintiff s decedent s Social Security Number is as follows: xxx-xx Plaintiff does not allege lack of informed consent. 26. Res ipsa loquitur: Not applicable. 27. An autopsy was not performed. 28. Death certificate: Issued on June 25, 2015 and provided under separate cover. 29. There was a proceeding in Surrogates Court to obtain Letters of Administration, under File No Copy of letters of administration: Provided under separate cover. Dated: New York, New York January 27, 2017 TO: FUMUSO, KELLY, SWART, FARRELL, POLIN & CHRISTESEN, LLP Attorneys for Defendant: AMSTERDAM NURSING HOME CORP. 110 Marcus Boulevard Hauppauge, NY (631) MANGAN GINSBERG LLP /s/ By: Jonathan Ginsberg, Esq. Attorneys for Plaintiff 80 Maiden Lane, Suite 304 New York, New York (212) of 10

9 CC: BARTLETT, McDONOUGH, & MONAGHAN, LLP Attorneys for Defendant: SOUTH NASSAU COMMUNITIES HOSPITAL 170 Old Country Road Mineola, NY (516) of 10

10 VERIFICATION STATE OF NEW YORK ) ) COUNTY OF NEW YORK ) ss.: Lisa Hammer, being duly sworn, deposes and says: I am the Plaintiff in the within action; I have read the forgoing Verified Bill of Particulars pursuant to the demand of AMSTERDAM NURSING HOME CORP. and know the contents thereof; the same is true to my own knowledge, except as to the matters therein stated to be alleged on information and belief, and as to those matters, I believe them to be true. /s/ Lisa Hammer 10 of 10

SUPREME COURT OF THE STATE OF NEW YORK. Plaintiff. The following papers have been read on this motion: Notice of Motion dated 12/15/05

SUPREME COURT OF THE STATE OF NEW YORK. Plaintiff. The following papers have been read on this motion: Notice of Motion dated 12/15/05 SHORT FORM ORDER fcfirl SUPREME COURT OF THE STATE OF NEW YORK Present: HON. LAWRENCE J. BRENNAN Acting Justice Supreme Court ----------------------------------------------------------------- x DIANE SHERRRD

More information

Prepublication Requirements

Prepublication Requirements Prepublication Requirements Standards Revisions for Swing Bed Final Rule in Critical Access Hospitals The Joint Commission has approved the following revisions for prepublication. While revised requirements

More information

IN THE CIRCUIT COURT OF THE 15 th JUDICIAL CIRCUIT, IN AND FOR PALM BEACH COUNTY, FLORIDA

IN THE CIRCUIT COURT OF THE 15 th JUDICIAL CIRCUIT, IN AND FOR PALM BEACH COUNTY, FLORIDA IN THE CIRCUIT COURT OF THE 15 th JUDICIAL CIRCUIT, IN AND FOR PALM BEACH COUNTY, FLORIDA GREGORY ROLAND, as Plenary Guardian of PHYLLIS J. ROLAND, CIRCUIT CIVIL Case No.: Plaintiff, vs. AVANTÉ AT BOCA

More information

- vs - Index No.I Assigned Justice John M. Curran. Respondents. Upon the annexed petition of Mary Holl, verified October 12,

- vs - Index No.I Assigned Justice John M. Curran. Respondents. Upon the annexed petition of Mary Holl, verified October 12, STATE OF NEW YORK SUPREME COURT : COUNTY OF ERIE MARY HOLL, as President of Teamsters Local 264 35 Tyrol Drive Cheektowaga, NY 14227, RICHARD CARR 35 Tyrol Drive Cheektowaga, NY 14227, Petitioners, NOTICE

More information

COLORADO. Downloaded January 2011

COLORADO. Downloaded January 2011 COLORADO Downloaded January 2011 PART 1. GOVERNING BODY 1.1 GOVERNING BODY. The governing body is the individual, group of individuals, or corporate entity that has ultimate authority and legal responsibility

More information

Challenge Scenario. Featured TAG TOPIC SCENARIO NOTES F314

Challenge Scenario. Featured TAG TOPIC SCENARIO NOTES F314 TAG TOPIC Give residents proper treatment to prevent new bed (pressure) sores or heal existing bed sores. SCENARIO In this scenario, the facility failed to ensure that residents who were admitted without

More information

Behavioral Health Services. Division of Nursing Homes

Behavioral Health Services. Division of Nursing Homes Behavioral Health Services Division of Nursing Homes 483.40 Behavioral Health Services Overview F740 Introduction to Behavioral Health Services F741 Sufficient and Competent Staff F742 Treatment/Services

More information

Pain Specialists of Greater Chicago Notice of Privacy Practices

Pain Specialists of Greater Chicago Notice of Privacy Practices 1 Pain Specialists of Greater Chicago 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

More information

USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION WITHOUT AUTHORIZATION

USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION WITHOUT AUTHORIZATION USE AND DISCLOSURE OF PROTECTED HEALTH INFORMATION WITHOUT AUTHORIZATION Policy The Health Science Center may disclose protected health information without a patient authorization in the following circumstances:

More information

Reviewing regulatory requirements for top ten federal Nursing Home Tags issued in Minnesota. Eva Loch, MDH Nursing Evaluator

Reviewing regulatory requirements for top ten federal Nursing Home Tags issued in Minnesota. Eva Loch, MDH Nursing Evaluator Reviewing regulatory requirements for top ten federal Nursing Home Tags issued in Minnesota. Eva Loch, MDH Nursing Evaluator F282- Comprehensive Care Plans Regulatory language (SOM): 483.21(b)(3) Comprehensive

More information

A Closer Look at the Revised Nursing Facility Regulations. Quality of Care

A Closer Look at the Revised Nursing Facility Regulations. Quality of Care A Closer Look at the Revised Nursing Facility Regulations Quality of Care Executive Summary The substantive requirements for quality of care are retained in the revised regulations, and the Centers for

More information

Courtesy of RosenfeldInjuryLawyers.com (888)

Courtesy of RosenfeldInjuryLawyers.com (888) First Amended Complaint By the Szymanski Koroll Litigation Group, Cynthia Szymanski Koroll, Cynthia Szymanski Koroll, #6380, The Szymanski Koroll Litigation Group, One Court Place, Suite 102, Rockford,

More information

DISCIPLINARY PROCEDURE

DISCIPLINARY PROCEDURE KANSAS STATE BOARD OF HEALING ARTS 800 SW Jackson, Lower Level-Suite A Topeka, Kansas 66612 (785) 296-7413 or Toll Free (888) 886-7205 (785) 368-7103 (FAX) www.ksbha.org DISCIPLINARY PROCEDURE The Kansas

More information

WAR AGAINST PRESSURE ULCERS

WAR AGAINST PRESSURE ULCERS WAR AGAINST PRESSURE ULCERS KINGS HARBOR MULTICARE CENTER Liezel T. Vince Cruz, ANP-BC, WCC Louis A. Kaplan, PA-C, CWS, WCC Roy J. Goldberg, MD, FACP, AGSF, CMD Pressure Ulcers Pressure ulcers, also known

More information

IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT, LAW DIVISION

IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT, LAW DIVISION IN THE CIRCUIT COURT OF COOK COUNTY, ILLINOIS COUNTY DEPARTMENT, LAW DIVISION DECEASED NURSING HOME PATIENT, ) ) Plaintiff, ) ) v. ) No: ) NURSING HOME WHERE PATIENT ) DEVELOPED BED SORES ) ) Defendants.

More information

ADULT LONG-TERM CARE SERVICES

ADULT LONG-TERM CARE SERVICES ADULT LONG-TERM CARE SERVICES Long-term care is a broad range of supportive medical, personal, and social services needed by people who are unable to meet their basic living needs for an extended period

More information

Balance Fitness and Nutrition

Balance Fitness and Nutrition Balance Fitness and Nutrition HIPPA Notice of Privacy Practices Effective Date: January 29, 2012 THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN

More information

Return Completed Application To: ARISE & Ski, 635 James Street, Syracuse, NY 13203

Return Completed Application To: ARISE & Ski, 635 James Street, Syracuse, NY 13203 ARISE & Ski Volunteer Application We consider applicants for all positions without regard to race, religion, creed, gender, age, disability, marital or veteran status, sexual orientation or any other legally

More information

2:17-cv RMG Date Filed 04/04/17 Entry Number 1 Page 1 of 14

2:17-cv RMG Date Filed 04/04/17 Entry Number 1 Page 1 of 14 2:17-cv-00885-RMG Date Filed 04/04/17 Entry Number 1 Page 1 of 14 IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF SOUTH CAROLINA CHARLESTON DIVISION PATRICK JOHNSON ) As Administrator ) CASE NO.

More information

NEW BRIGHTON CARE CENTER

NEW BRIGHTON CARE CENTER NEW BRIGHTON CARE CENTER 805 6 th Ave NW, New Brighton, MN 55112 NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS

More information

As Introduced. Regular Session H. B. No

As Introduced. Regular Session H. B. No 131st General Assembly Regular Session H. B. No. 559 2015-2016 Representative Cupp Cosponsors: Representatives Antani, Becker, Henne, Huffman, McClain, Schaffer, Scherer, Smith, R., Sprague A B I L L To

More information

PATIENT INFORMATION Indiana Plastic Surgery Center, PC

PATIENT INFORMATION Indiana Plastic Surgery Center, PC PATIENT INFORMATION DATE: / / PHYSICIAN REFERAL: FAMILY/FRIEND REFERAL: PRIMARY CARE PHYSICIAN: LAST NAME FIRST M.I. HOME ( ) - CELL( ) - WORK( ) - EMAIL MAY WE CONTACT YOU: BY CELL PHONE / TEXTING?: YES

More information

1. Applicant Name: (Please check one) [ ]Insured/Patient [ ]Patient s Designee [ ]Provider. 2. Patient Name: 3. Patient Address:

1. Applicant Name: (Please check one) [ ]Insured/Patient [ ]Patient s Designee [ ]Provider. 2. Patient Name: 3. Patient Address: NEW YORK STATE EXTERNAL APPEAL APPLICATION New York State Insurance Department, PO Box 7209, Albany NY, 12224-0209 If an HMO or insurer (health plan) denies health care services as not medically necessary,

More information

A Review of Current EMTALA and Florida Law

A Review of Current EMTALA and Florida Law A Review of Current EMTALA and Florida Law South Carolina Hospital Fined $1.28 Million for EMTALA violations Doctor fined $40,000 for not showing up at Emergency Room Chicago Hospital and Docs settle EMTALA

More information

FAMILY PHARMACEUTICAL SERVICES NOTICE OF PRIVACY PRACTICES effective 9/23/2013

FAMILY PHARMACEUTICAL SERVICES NOTICE OF PRIVACY PRACTICES effective 9/23/2013 FAMILY PHARMACEUTICAL SERVICES NOTICE OF PRIVACY PRACTICES effective 9/23/2013 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

More information

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA

UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA UNITED STATES DISTRICT COURT FOR THE DISTRICT OF COLUMBIA AMERICAN NURSES ASSOCIATION, 8515 Georgia Avenue Suite 400 Silver Spring, MD 20910 and CIVIL ACTION NEW YORK STATE NURSES ASSOCIATION, 11 Cornell

More information

UNITED STATES DISTRICT COURT DISTRICT OF NEVADA

UNITED STATES DISTRICT COURT DISTRICT OF NEVADA Case :0-cv-0-LDG-PAL Document Filed /0/0 Page of JACOB L. HAFTER, ESQ. Nevada State Bar No. 0 MICHAEL NAETHE, ESQ. Nevada State Bar No. LAW OFFICE OF JACOB L. HAFTER, P.C. W. Lake Mead Boulevard, Suite

More information

Based on the comprehensive assessment of a resident, the facility must ensure that:

Based on the comprehensive assessment of a resident, the facility must ensure that: 7. QUALITY OF CARE Each resident must receive, and the facility must provide, the necessary care and services to attain or maintain the highest practicable physical, mental and psychosocial wellbeing,

More information

Preparing for the 2015 QIS Changes in abaqis

Preparing for the 2015 QIS Changes in abaqis Preparing for the 2015 QIS Changes in abaqis Resident Interview 2 Changed Question for QP210 Participation in Care Plan Before After RESIDENT INTERVIEW 3 CMS Removed Food Quality from Stage 1 Moved from

More information

To ensure proper disclosure and release of Protected Health Information (PHI) Division/Department: All HealthPoint Policy/Procedure #:

To ensure proper disclosure and release of Protected Health Information (PHI) Division/Department: All HealthPoint Policy/Procedure #: TITLE: Release of Medical Records Scope/Purpose: POLICY & PROCEDURE To ensure proper disclosure and release of Protected Health Information (PHI) Division/Department: All HealthPoint Policy/Procedure #:

More information

NOTICE OF PRIVACY PRACTICES

NOTICE OF PRIVACY PRACTICES Amended September 2013 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.

More information

(4) "Health care power of attorney" means a durable power of attorney executed in accordance with this section.

(4) Health care power of attorney means a durable power of attorney executed in accordance with this section. SOUTH CAROLINA STATUTES SECTION 62-5-504. Definitions. (A) As used in this section: (1) "Agent" or "health care agent" means an individual designated in a health care power of attorney to make health care

More information

THE FUNDAMENTALS of NURSING HOME ABUSE & NEGLECT LITIGATION IN ALABAMA

THE FUNDAMENTALS of NURSING HOME ABUSE & NEGLECT LITIGATION IN ALABAMA THE FUNDAMENTALS of NURSING HOME ABUSE & NEGLECT LITIGATION IN ALABAMA I. Introduction. Currently, there are approximately 27,000 persons who reside in one of 228 licensed nursing homes in the state of

More information

Our Terms of Use and other areas of our Sites provide guidelines ("Guidelines") and rules and regulations ("Rules") in connection with OUEBB.

Our Terms of Use and other areas of our Sites provide guidelines (Guidelines) and rules and regulations (Rules) in connection with OUEBB. OUE Beauty Bar - Terms of Use These are the terms of use ("Terms of Use") governing the purchase of products in the vending machine(s) installed by Alkas Realty Pte Ltd at OUE Downtown Gallery, known as

More information

Tube Feeding Status Critical Element Pathway

Tube Feeding Status Critical Element Pathway Use this pathway for a resident who has a feeding tube. Review the Following in Advance to Guide Observations and Interviews: Most current comprehensive and most recent quarterly (if the comprehensive

More information

Implications of Pressure Ulcers and Its Relation to Federal Tag 314

Implications of Pressure Ulcers and Its Relation to Federal Tag 314 SPECIAL ARTICLE Implications of Pressure Ulcers and Its Relation to Federal Tag 314 Courtney H. Lyder, ND The Centers for Medicare & Medicaid Services (CMS) released the revised Federal Regulation for

More information

Town of Billerica Police Department 6 Good Street Billerica, Ma (978) Fax (978)

Town of Billerica Police Department 6 Good Street Billerica, Ma (978) Fax (978) Town of Billerica Police Department 6 Good Street Billerica, Ma 01821 (978) 671-0900 Fax (978) 663-2392 www.billericapolice.org BILLERICA POLICE DEPARTMENT POLICE CANDIDATE APPLICATION FOR EMPLOYMENT In

More information

ADVANCED HEALTH CARE DIRECTIVE OF LAWRENCE HALL JR.

ADVANCED HEALTH CARE DIRECTIVE OF LAWRENCE HALL JR. ADVANCED HEALTH CARE DIRECTIVE OF LAWRENCE HALL JR. Identification. I, Lawrence Hall Jr., being a competent adult of sound mind, having the capacity to make health care decisions, willfully and voluntarily

More information

ALFRED ALINGU, MD INTERNAL MEDICINE

ALFRED ALINGU, MD INTERNAL MEDICINE Name Date of Birth Social Security Number Marital Status Address City State Zip Code Home Phone Cell Phone E-mail Address Pharmacy Name Pharmacy Phone Number Emergency Contact Phone Number Relationship

More information

OAK HAMMOCK AT THE UNIVERSITY OF FLORIDA, INC. NOTICE OF PRIVACY PRACTICES. Privacy Office: (352) Effective Date: September 23, 2013

OAK HAMMOCK AT THE UNIVERSITY OF FLORIDA, INC. NOTICE OF PRIVACY PRACTICES. Privacy Office: (352) Effective Date: September 23, 2013 OAK HAMMOCK AT THE UNIVERSITY OF FLORIDA, INC. NOTICE OF PRIVACY PRACTICES Privacy Office: (352) 548-1142 Effective Date: September 23, 2013 THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT

More information

Hospice and End of Life Care and Services Critical Element Pathway

Hospice and End of Life Care and Services Critical Element Pathway Use this pathway for a resident identified as receiving end of life care (e.g., palliative care, comfort care, or terminal care) or receiving hospice care from a Medicare-certified hospice. Review the

More information

PRESSURE-REDUCING SUPPORT SURFACES

PRESSURE-REDUCING SUPPORT SURFACES Status Active Medical and Behavioral Health Policy Section: Allied Health Policy Number: VII-54 Effective Date: 04/23/2014 Blue Cross and Blue Shield of Minnesota medical policies do not imply that members

More information

CAH SWING BED BILLING, CODING AND DOCUMENTATION. Lisa Pando, Sr. Consultant GPS Healthcare Consultants

CAH SWING BED BILLING, CODING AND DOCUMENTATION. Lisa Pando, Sr. Consultant GPS Healthcare Consultants CAH SWING BED BILLING, CODING AND Lisa Pando, Sr. Consultant GPS Healthcare Consultants Learning Objectives: 1. Review Medical Necessity documentation specific to swing bed patients 2. Reasons to use the

More information

Inspection Protocol Skin and Wound Care. Definition / Description. Use. Resident-related Triggered

Inspection Protocol Skin and Wound Care. Definition / Description. Use. Resident-related Triggered Resident-related Triggered Home Name: Inspection Number: (hard copy use only) Date: Inspector ID: Definition / Description Altered skin integrity: The potential or actual disruption of epidermal or dermal

More information

ALCOHOL DRUG ADDICTION AND MENTAL HEALTH SERVICES BOARD OF CUYAHOGA COUNTY POLICY STATEMENT. NOTIFICATION AND REVIEW OF REPORTABLE INCIDENTS & MUIs

ALCOHOL DRUG ADDICTION AND MENTAL HEALTH SERVICES BOARD OF CUYAHOGA COUNTY POLICY STATEMENT. NOTIFICATION AND REVIEW OF REPORTABLE INCIDENTS & MUIs ALCOHOL DRUG ADDICTION AND MENTAL HEALTH SERVICES BOARD OF CUYAHOGA COUNTY POLICY STATEMENT SUBJECT: NOTIFICATION AND REVIEW OF REPORTABLE INCIDENTS & MUIs EFFECTIVE DATE: November 21, 2013 PURPOSE To

More information

Minnesota Patients Bill of Rights

Minnesota Patients Bill of Rights Minnesota Patients Bill of Rights Legislative Intent It is the intent of the Legislature and the purpose of this statement to promote the interests and well-being of the patients of health care facilities.

More information

Case 3:13-cv Document 1 Filed 02/26/13 Page 1 of 18 IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF PUERTO RICO

Case 3:13-cv Document 1 Filed 02/26/13 Page 1 of 18 IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF PUERTO RICO Case 3:13-cv-01163 Document 1 Filed 02/26/13 Page 1 of 18 IN THE UNITED STATES DISTRICT COURT FOR THE DISTRICT OF PUERTO RICO ALMARIS ALONSO and ALBIN ALONSO, Plaintiffs, vs. LUZ DE ESPERANZA HOME CARE

More information

ATTORNEY COUNTY OF. Page 1 of 5

ATTORNEY COUNTY OF. Page 1 of 5 STATE OF NORTH CAROLINA HEALTH CARE POWER OF ATTORNEY COUNTY OF (Notice: This document gives the person you designate your health care agent broad powers to make health care decisions, including mental

More information

Initial Pool Process: Resident Interview

Initial Pool Process: Resident Interview Initial Pool Process: Resident Interview Care Area Probes Response Options Choices Are you able to make choices about your daily life that are important to you? I d like to talk to you about your choices.

More information

Provider Certification Standards Adult Day Care

Provider Certification Standards Adult Day Care Provider Certification Standards Adult Day Care December 2015 1 Definitions: Activities of Daily Living (ADL s)- Includes but is not limited to the following personal care activities: bathing, dressing,

More information

Federal Requirements of Participation for Nursing Homes Summary of Key Changes in the Final Rule Issued September 2016 Phase 2

Federal Requirements of Participation for Nursing Homes Summary of Key Changes in the Final Rule Issued September 2016 Phase 2 Federal Requirements of Participation for Nursing Homes Summary of Key Changes in the Final Rule Issued September 2016 Phase 2 On September 28, 2016, the Centers for Medicare & Medicaid Services (CMS)

More information

New Mexico DDSD General Events Report (GER) Guide

New Mexico DDSD General Events Report (GER) Guide New Mexico DDSD General Events Report (GER) Guide GER APPLICABILITY: All events that occur during delivery of Supported Living, Family Living, Intensive Medical Living, Customized In-Home Supports, Customized

More information

MDS 3.0/RUG IV OVERVIEW

MDS 3.0/RUG IV OVERVIEW MDS 3.0/RUG IV Distance Learning Series January - May 2016 OVERVIEW In keeping with the success of their previous highly-rated distance learning education offerings, LeadingAge state affiliates and Plante

More information

NO TALLAHASSEE, June 15, Mental Health/Substance Abuse STATE MENTAL HEALTH TREATMENT FACILITIES MORTALITY REPORTING AND REVIEW PROCEDURE

NO TALLAHASSEE, June 15, Mental Health/Substance Abuse STATE MENTAL HEALTH TREATMENT FACILITIES MORTALITY REPORTING AND REVIEW PROCEDURE CFOP 155-3 STATE OF FLORIDA DEPARTMENT OF CF OPERATING PROCEDURE CHILDREN AND FAMILIES NO. 155-3 TALLAHASSEE, June 15, 2015 Mental Health/Substance Abuse STATE MENTAL HEALTH TREATMENT FACILITIES MORTALITY

More information

Emergency Medical Treatment and Active Labor Act ( EMTALA )

Emergency Medical Treatment and Active Labor Act ( EMTALA ) Emergency Medical Treatment and Active Labor Act ( EMTALA ) Kim C. Stanger Compliance Bootcamp (2-18) This presentation is similar to any other legal education materials designed to provide general information

More information

Activities of Daily Living (ADL) Critical Element Pathway

Activities of Daily Living (ADL) Critical Element Pathway Use this pathway for a resident who requires assistance with or is unable to perform ADLs (Hygiene bathing, dressing, grooming, and oral care; Elimination toileting; Dining eating, including meals and

More information

DEFINITIONS (c)(1) Discharge Planning : Home Health Agency (HHA) : Inpatient Rehabilitation Facility (IRF) : Local Contact Agency :

DEFINITIONS (c)(1) Discharge Planning : Home Health Agency (HHA) : Inpatient Rehabilitation Facility (IRF) : Local Contact Agency : F660 483.21(c)(1) Discharge Planning Process The facility must develop and implement an effective discharge planning process that focuses on the resident s discharge goals, the preparation of residents

More information

Albuquerque Police Department Applicant Additional Documents. Name: Page 1 of 9

Albuquerque Police Department Applicant Additional Documents. Name: Page 1 of 9 Albuquerque Police Department Applicant Additional Documents Name: Page 1 of 9 Additional Documents Needed Instructions You will need to locate/gather all of the following documents and bring them with

More information

NURSING HOME LITIGATION: CASE SELECTION AND LITIGATION ISSUES-A WEBINAR

NURSING HOME LITIGATION: CASE SELECTION AND LITIGATION ISSUES-A WEBINAR NURSING HOME LITIGATION: CASE SELECTION AND LITIGATION ISSUES-A WEBINAR Alexis Aloi Graziano, Esq. Buchanan Ingersoll & Rooney PC (Princeton) Victoria A. Schall, Esq. Law Offices of Adam Kotlar (Cherry

More information

NOTICE OF PRIVACY PRACTICES

NOTICE OF PRIVACY PRACTICES 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. WHY ARE YOU GETTING

More information

TRUE AND EXACT COPY OF ORIGINAL

TRUE AND EXACT COPY OF ORIGINAL MAY-13-ZJll 14:04 FROM-WEBER LAW OFFICE 612-825-6304 BEFORE THE MINNESOTA T-960 P.003 F-462 TRUE AND EXACT COPY OF ORIGINAL BOARD OF MEDICAL PRACTICE In the Matter of the Medical License of Todd A. Leonard,

More information

Payne v Jewish Home & Hosp. Bronx Div NY Slip Op 32180(U) October 7, 2015 Supreme Court, Bronx County Docket Number: /2011 Judge: Stanley

Payne v Jewish Home & Hosp. Bronx Div NY Slip Op 32180(U) October 7, 2015 Supreme Court, Bronx County Docket Number: /2011 Judge: Stanley Payne v Jewish Home & Hosp. Bronx Div. 2015 NY Slip Op 32180(U) October 7, 2015 Supreme Court, Bronx County Docket Number: 311134/2011 Judge: Stanley B. Green Cases posted with a "30000" identifier, i.e.,

More information

Aneurin Bevan University Health Board Clinical Record Keeping Policy

Aneurin Bevan University Health Board Clinical Record Keeping Policy N.B. Staff should be discouraged from printing this document. This is to avoid the risk of out of date printed versions of the document. The Intranet should be referred to for the current version of the

More information

ADVANCE DIRECTIVE FOR A NATURAL DEATH ("LIVING WILL")

ADVANCE DIRECTIVE FOR A NATURAL DEATH (LIVING WILL) ADVANCE DIRECTIVE FOR A NATURAL DEATH ("LIVING WILL") NOTE: YOU SHOULD USE THIS DOCUMENT TO GIVE YOUR HEALTH CARE PROVIDERS INSTRUCTIONS TO WITHHOLD OR WITHDRAW LIFE-PROLONGING MEASURES IN CERTAIN SITUATIONS.

More information

Mandatory Reporting Requirements: The Elderly Rhode Island

Mandatory Reporting Requirements: The Elderly Rhode Island Mandatory Reporting Requirements: The Elderly Rhode Island Question Who is required to report? When is a report required and where does it go? Answer Any person. Any physician, medical intern, registered

More information

NOTICE OF PRIVACY PRACTICES

NOTICE OF PRIVACY PRACTICES 535 East 70th Street New York, NY 10021 (212) 606-1000 Specialists in Mobility NOTICE OF PRIVACY PRACTICES Effective Date: April 14, 2003 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE

More information

NOTICE OF PRIVACY PRACTICES MOUNT CARMEL HEALTH SYSTEM

NOTICE OF PRIVACY PRACTICES MOUNT CARMEL HEALTH SYSTEM NOTICE OF PRIVACY PRACTICES MOUNT CARMEL HEALTH SYSTEM Effective Date: 9/23/ 2013 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

More information

SOUTH CAROLINA HEALTH CARE POWER OF ATTORNEY

SOUTH CAROLINA HEALTH CARE POWER OF ATTORNEY SOUTH CAROLINA HEALTH CARE POWER OF ATTORNEY INFORMATION ABOUT THIS DOCUMENT THIS IS AN IMPORTANT LEGAL DOCUMENT. BEFORE SIGNING THIS DOCUMENT, YOU SHOULD KNOW THESE IMPORTANT FACTS: 1. THIS DOCUMENT GIVES

More information

Stark State College Policies and Procedures Manual

Stark State College Policies and Procedures Manual Stark State College Policies and Procedures Manual Title: BLOODBORNE INFECTIOUS DISEASES Effective: January 16, 2014 Policy No.: 3357:15-14-16 Revision 1 Page 1 of 2 POLICY: Start State College promotes

More information

General and Informed Consent to Treatment

General and Informed Consent to Treatment Section 3.11 General and Informed Consent to Treatment 3.11.1 Introduction 3.11.2 References 3.11.3 Scope 3.11.4 Did you know? 3.11.5 Definitions 3.11.6 Objectives 3.11.7 Procedures 3.11.7-A. General requirements

More information

DURABLE POWER OF ATTORNEY FOR HEALTH CARE OF [NAME]

DURABLE POWER OF ATTORNEY FOR HEALTH CARE OF [NAME] DURABLE POWER OF ATTORNEY FOR HEALTH CARE OF [NAME] 1. DESIGNATION OF HEALTH CARE AGENT. (a) Pursuant to the Missouri Durable Power of Attorney for Health Act, Mo.Rev.Stat. 404.700-404.735 and 404.800-404.872,

More information

SUGGESTIONS FOR PREPARING WILL TO LIVE DURABLE POWER OF ATTORNEY

SUGGESTIONS FOR PREPARING WILL TO LIVE DURABLE POWER OF ATTORNEY SUGGESTIONS FOR PREPARING WILL TO LIVE DURABLE POWER OF ATTORNEY (Please read the document itself before reading this. It will help you better understand the suggestions.) YOU ARE NOT REQUIRED TO FILL

More information

A Better You Counseling Services, LLC 1225 Johnson Ferry Road, Ste 170 Marietta GA

A Better You Counseling Services, LLC 1225 Johnson Ferry Road, Ste 170 Marietta GA A Better You Counseling Services, LLC 1225 Johnson Ferry Road, Ste 170 Marietta GA 30068 404-216-1135 Health Insurance Portability and Accountability Act (HIPAA) NOTICE OF PRIVACY PRACTICES I. COMMITMENT

More information

Section 7: Core clinical headings

Section 7: Core clinical headings Section 7: Core clinical headings Core clinical heading standards: the core clinical headings are those that are the priority for inclusion in EHRs, as they are generally items that are the priority for

More information

Patient Rights and Responsibilities

Patient Rights and Responsibilities Developed / Edited By: UNION HOSPITAL Reviewed By: Approved By: Policy Number: AG-245 Elkton, Maryland Effective Date: 11/2009 Hospital Policies and Procedures Patient Rights and Responsibilities Departments

More information

New Patient Intake Form

New Patient Intake Form New Patient Intake Form Facility Name: Patient Name: General Patient Information Weight: Height: B/P:! Hospice Past Medical History! DM (Last A1C)! Venous Stasis (Last Venous Doppler)! PAD (Last Arterial

More information

Your Medical Record Rights in i Maryland

Your Medical Record Rights in i Maryland Your Medical Record Rights in i Maryland (A Guide to Consumer Rights under HIPAA) JOY PRITTS, JD NINA L. KUDSZUS HEALTH POLICY INSTITUTE GEORGETOWN UNIVERSITY Your Medical Record Rights in Maryland (A

More information

Fall Liability in Long Term Care Facilities by Roger S. Weinberg, May

Fall Liability in Long Term Care Facilities by Roger S. Weinberg, May Fall Liability in Long Term Care Facilities by Roger S. Weinberg, May 2007 http://www.weinberglaw.com Falls are extremely common among older persons. It is estimated that 30% of non-institutionalized persons

More information

Subpart C Conditions of Participation PATIENT CARE Condition of participation: Patient's rights Condition of participation: Initial

Subpart C Conditions of Participation PATIENT CARE Condition of participation: Patient's rights Condition of participation: Initial Subpart C Conditions of Participation PATIENT CARE 418.52 Condition of participation: Patient's rights. 418.54 Condition of participation: Initial and comprehensive assessment of the patient. 418.56 Condition

More information

2201 Murphy Avenue, Suite 307 Nashville, TN Phone Fax Date. Patient s Full Name

2201 Murphy Avenue, Suite 307 Nashville, TN Phone Fax Date. Patient s Full Name Patient Information 2201 Murphy Avenue, Suite 307 Nashville, TN 37203 Phone 615-401- 9454 Fax 615-873- 1934 www.robbinsplasticsurgery.com Date Patient s Full Name Last First M.I. Preferred Name (if different

More information

HEALTH CARE DIRECTIVES POLICY

HEALTH CARE DIRECTIVES POLICY PURPOSE: HEALTH CARE DIRECTIVES POLICY To implement standards established by Congress in the Patient Self Determination Act of 1990. To comply with the MN Department of Health Statues regarding healthcare

More information

79th OREGON LEGISLATIVE ASSEMBLY Regular Session. Enrolled. Senate Bill 58

79th OREGON LEGISLATIVE ASSEMBLY Regular Session. Enrolled. Senate Bill 58 79th OREGON LEGISLATIVE ASSEMBLY--2017 Regular Session Enrolled Senate Bill 58 Printed pursuant to Senate Interim Rule 213.28 by order of the President of the Senate in conformance with presession filing

More information

Resident Rights in Nursing Facilities

Resident Rights in Nursing Facilities Your Guide to Resident Rights in Nursing Facilities 1-800-499-0229 1 Table of Contents The Ombudsman Advocate...3 You Take Your Rights with You...4 Federal Regulations Protect You...5 Medical Assessment

More information

NOTICE OF PRIVACY PRACTICES

NOTICE OF PRIVACY PRACTICES THIS NOTICE OF PRIVACY PRACTICES ( 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. Respect for

More information

State of Ohio Health Care Power of Attorney of

State of Ohio Health Care Power of Attorney of Page1 State of Ohio Health Care Power of Attorney of (Print Full Name) (Birth Date) I state that this is my Health Care Power of Attorney and I revoke any prior Health Care Power of Attorney signed by

More information

IN THE CIRCUIT COURT OF THE SEVENTEENTH JUDICIAL CIRCUIT, IN AND FOR BROWARD COUNTY, FLORIDA. Plaintiff, CASE NO.

IN THE CIRCUIT COURT OF THE SEVENTEENTH JUDICIAL CIRCUIT, IN AND FOR BROWARD COUNTY, FLORIDA. Plaintiff, CASE NO. IN THE CIRCUIT COURT OF THE SEVENTEENTH JUDICIAL CIRCUIT, IN AND FOR BROWARD COUNTY, FLORIDA OFFICE OF THE ATTORNEY GENERAL, DEPARTMENT OF LEGAL AFFAIRS, STATE OF FLORIDA, vs. Plaintiff, CASE NO. EVAL

More information

Survey Protocol for Long Term Care Facilities

Survey Protocol for Long Term Care Facilities Attachment B Survey Protocol for Long Term Care Facilities The provision of home dialysis treatments in a Long Term Care (LTC) facility place an increased burden on the LTC facility staff and may place

More information

Restorative Nursing: The NHA s Role and Organizational Outcomes

Restorative Nursing: The NHA s Role and Organizational Outcomes Restorative Nursing: The NHA s Role and Organizational Outcomes SUE LAGRANGE, RN, BSN, NHA, CDONA, CIMT DIRECTOR OF EDUCATION PATHWAY HEALTH 1 Objectives Upon completion of this program, attendees should

More information

ADMISSION CARE PLAN. Orient PRN to person, place, & time

ADMISSION CARE PLAN. Orient PRN to person, place, & time ADMISSION DATE: CODE STATUS: ADMISSION CARE PLAN ADMISSION DIAGNOSIS: 1. DELIRIUM 2. COGNITIVE LOSS Resident will be as alert and oriented as possible Resident will be as alert and oriented as comfortable

More information

sample Pressure Sores Prevention & Awareness Copyright Notice This booklet remains the intellectual property of Redcrier Publications L td

sample Pressure Sores Prevention & Awareness Copyright Notice This booklet remains the intellectual property of Redcrier Publications L td First name: Surname: Company: Date: Pressure Sores Prevention & Awareness Please complete the above, in the blocks provided, as clearly as possible. Completing the details in full will ensure that your

More information

Emergency Contact: Name Relationship Address

Emergency Contact: Name Relationship Address Participant Information Name Treatment Start Date Address City State Zip Home/Cell Phone Work Phone Birth date Age SSN Marital Status Primary Insurance Provider Insurance ID # Primary Insured Name: Primary

More information

Notice of Privacy Practices for Protected Health Information

Notice of Privacy Practices for Protected Health Information Notice of Privacy Practices for Protected Health Information This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review

More information

HCCA South Central Regional Annual Conference November 21, 2014 Nashville, TN. Post Acute Provider Specific Sections from OIG Work Plans

HCCA South Central Regional Annual Conference November 21, 2014 Nashville, TN. Post Acute Provider Specific Sections from OIG Work Plans HCCA South Central Regional Annual Conference November 21, 2014 Nashville, TN Kelly Priegnitz # Chris Puri # Kim Looney Post Acute Provider Specific Sections from 2012-2015 OIG Work Plans I. NURSING HOMES

More information

HIPAA PRIVACY TRAINING

HIPAA PRIVACY TRAINING HIPAA PRIVACY TRAINING HIPAA Privacy Training Objective Present a general overview of HIPAA and define important terms Understand the purpose of HIPAA and the Privacy Rule Understand the term Protected

More information

Center for Medicaid and State Operations/Survey and Certification Group. Promising Practices to Support the Intake of Nursing Home Complaints

Center for Medicaid and State Operations/Survey and Certification Group. Promising Practices to Support the Intake of Nursing Home Complaints DEPARTMENT OF HEALTH & HUMAN SERVICES Centers for Medicare & Medicaid Services 7500 Security Boulevard, Mail Stop S2-12-25 Baltimore, Maryland 21244-1850 Center for Medicaid and State Operations/Survey

More information

SANTA RITA CARE CENTER Notice of Information Practices

SANTA RITA CARE CENTER Notice of Information Practices SANTA RITA CARE CENTER 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

More information

(PLEASE PRINT) Sex M F Age Birthdate Single Married Widowed Separated Divorced. Business Address Business Phone Cell Phone

(PLEASE PRINT) Sex M F Age Birthdate Single Married Widowed Separated Divorced. Business Address Business Phone Cell Phone (PLEASE PRINT) Emma Warner, MSW, LCSW, ACSW Tulsa, OK 74105 (918) 749-6935 Personal Information Name Address Last Name First Name Initial Home Phone Soc. Sec. # City State Zip Sex M F Age Birthdate Single

More information

ALABAMA MEDICAID AGENCY ADMINISTRATIVE CODE CHAPTER 560-X-45 MATERNITY CARE PROGRAM TABLE OF CONTENTS

ALABAMA MEDICAID AGENCY ADMINISTRATIVE CODE CHAPTER 560-X-45 MATERNITY CARE PROGRAM TABLE OF CONTENTS ALABAMA MEDICAID AGENCY ADMINISTRATIVE CODE CHAPTER 560-X-45 MATERNITY CARE PROGRAM TABLE OF CONTENTS 560-X-45-.01 560-X-45-.02 560-X-45-.03 560-X-45-.04 560-X-45-.05 560-X-45-.06 560-X-45-.07 560-X-45-.08

More information

always legally required to follow the privacy practices described in this Notice.

always legally required to follow the privacy practices described in this Notice. The ANXIETY & STRESS MANAGEMENT INSTITUTE 1640 Powers Ferry Rd, Building 9, Suite 10 0, Marietta, Georgia 30067, 770-953-0080 Health Insurance Portability and Accountability Act (HIPAA) NOTICE OF PRIVACY

More information

HIPAA Privacy Policies & Procedures Table of Contents

HIPAA Privacy Policies & Procedures Table of Contents HIPAA POCKET GUIDE HIPAA Privacy Policies & Procedures Table of Contents I. Clinical Policies A. Accounting of Disclosures..Pg 6 B. De-Identification of Information..Pg 7 C. Facility Directory...Pg 7

More information