HCR MANORCARE NOTICE OF INFORMATION PRACTICES THIS NOTICE ( 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. We have summarized our resposibilities ad your rights i this first sectio. For a complete descriptio of our privacy practices, please review this etire Notice. Our Resposibilities We are required to: Maitai the privacy of your health iformatio; Provide you with this Notice of our legal duties ad iformatio practices with respect to iformatio we collect ad maitai about you; Abide by the terms of this Notice curretly i effect; ad Notify you followig a breach of usecured protected health iformatio. Your Rights You have several rights with regard to your health iformatio. Those iclude the right to: Request that we ot use or disclose your health iformatio i certai ways; Request to receive commuicatios i a alterative maer or locatio; Request access ad obtai a copy of your health iformatio; Request a amedmet to your health iformatio; ad Request a accoutig of disclosures of your health iformatio. We reserve the right to chage our privacy practices ad to make the ew provisios effective for all health iformatio we maitai. Should our privacy practices chage, we will post the chages i a physical place withi our buildig (if applicable) ad o our website ( Website ) www.hcr-maorcare.com. A copy of the revised Notice will be available after the effective date of the chages upo request. You may request a copy from the Admiistrator/Executive Director ( Admiistrator ) or obtai a copy o our Website. We will ot use or disclose your health iformatio without your authorizatio, except as described i this Notice. If you have questios ad would like additioal iformatio, you may cotact the local Admiistrator or the Chief Compliace Officer at 1-800-366-1232.
Uderstadig Your Health Record Each time you visit a medical provider, a record of your visit is made. Typically, this record cotais your symptoms, examiatio ad test results, diagoses, treatmet, ad a pla for future care or treatmet. This iformatio, ofte referred to as your health or medical record, serves the followig purposes: Basis for plaig your care ad treatmet Commuicatio amog health professioals ivolved i your care Legal documet describig the care you received Proof that services billed were actually provided A tool to educate health professioals A source of data for medical research A source of iformatio for public health officials who oversee the delivery of health care A tool to measure ad improve the care we give Uderstadig what is i your record ad how your health iformatio is used helps you to: Esure its accuracy Uderstad who, what, whe, where, ad why others may access your health iformatio Make iformed decisios whe authorizig disclosure to others How We Will Use or Disclose Your Health Iformatio Uses ad Disclosures That May Be Made Without Your Authorizatio or Opportuity to Object For Treatmet. We may use ad disclose your health iformatio to provide you with treatmet ad services. We may disclose your health iformatio to those persos who may be ivolved i your care, such as physicias, urses, urse aides, physical therapists, dietary ad admissios persoel. For example, a urse carig for you will report ay chage i your coditio to your physicia. While ot required uder federal law, we geerally obtai your coset to disclose your health iformatio for treatmet purposes through our admissio or erollmet process. For Paymet. We may use ad disclose your health iformatio so that we ca bill ad receive paymet for the treatmet ad services you receive. For example, we may disclose your health iformatio to your resposible party, a isurace or maaged care compay, Medicare, Medicaid or aother third party payer. We may cotact Medicare or your health pla to cofirm your coverage or to request prior approval for a proposed treatmet or service. While ot required uder federal law, we geerally obtai your coset to disclose your health iformatio for paymet purposes through our admissio or erollmet process. For Health Care Operatios. We may use ad disclose your health iformatio for our regular health operatios. These uses ad disclosures are ecessary to maage our operatios ad to moitor our quality of care. For example, we may use your health iformatio to evaluate our services, icludig the performace of our staff. While ot required uder federal law, we geerally obtai your coset to disclose your health iformatio for health care operatios
purposes through our admissio or erollmet process. Orgaized Health Care Arragemet. HCR MaorCare is a participat i a Orgaized Health Care Arragemet ( OHCA ). A OHCA is a arragemet or relatioship that allows two or more Covered Etities who participate i joit activities to share health iformatio about their patiets i order to maage ad beefit their joit operatios. The Covered Etities participatig i the OHCA will share health iformatio with each other as ecessary to carry out treatmet, paymet, or health care operatios relatig to the OHCA. Busiess Associates. Outside people ad etities provide some services for us. Examples of these "busiess associates" iclude our accoutats, cosultats ad attoreys. We may disclose your health iformatio to our busiess associates so that they ca perform the job we've asked them to do. We require our busiess associates to safeguard your iformatio so that it is protected. Busiess Associates are also required by law to safeguard your iformatio. Newsletters / Bulleti Boards. Some of our busiess uits have bulleti boards ad ewsletters that are distributed to staff ad residets. If applicable, we may post your ame ad birth date o a bulleti board ad i a ewsletter, uless you otify us. Research. We may disclose iformatio to researchers whe certai coditios have bee met. Trasfer of Iformatio at Death. We may disclose health iformatio to fueral directors, medical examiers, ad coroers to carry out these duties cosistet with applicable law. Orga Procuremet Orgaizatios. Cosistet with applicable law, we may disclose health iformatio to orga procuremet orgaizatios or other etities egaged i the procuremet, bakig, or trasplatatio of orgas for the purpose of tissue doatio ad trasplat. Food ad Drug Admiistratio (FDA). We may disclose to the FDA, or to a perso or etity subject to the jurisdictio of the FDA, health iformatio relative to adverse evets with respect to food, supplemets, product ad product defects, or post marketig surveillace iformatio to eable product recalls, repairs, or replacemet. Workers compesatio. We may disclose health iformatio to the extet authorized by ad to the extet ecessary to comply with laws relatig to workers' compesatio or other similar programs established by law. Public health. As required by law, we may disclose your health iformatio to public health or legal authorities charged with prevetig or cotrollig disease, ijury, or disability. Correctioal istitutio. Should you be a imate of a correctioal istitutio, we may disclose to the istitutio or agets health iformatio ecessary for your health ad the health ad safety of other idividuals. Law eforcemet. We may disclose health iformatio for law eforcemet purposes as required by law or i respose to a valid subpoea. Reports. Federal law allows a member of our work force or a busiess associate to release
your health iformatio to a appropriate health oversight agecy, public health authority or attorey, if the work force member or busiess associate believes i good faith that we have egaged i ulawful coduct or have otherwise violated professioal or cliical stadards ad are potetially edagerig oe or more patiets, workers or the public. Required by Law. We may use or disclose your health iformatio to the extet that use or disclosure is otherwise required by federal, state, or local law. Uses ad Disclosures That May Be Made Either With Your Agreemet or the Opportuity to Object Directory / List of Patiets. Uless you otify us that you object, we may use your ame, locatio i the facility (if applicable), geeral coditio, ad religious affiliatio for directory purposes. We may release iformatio i our directory, except for your religious affiliatio, to people who ask for you by ame. We may provide the directory iformatio, icludig your religious affiliatio, to ay member of the clergy. Notificatio. Uless you otify us that you object, we may use or disclose iformatio to otify or assist i otifyig a family member, resposible party, or aother perso resposible for your care, of your locatio ad geeral coditio. If we are uable to reach your family member or resposible party, the we may leave a message for them at the phoe umber that they have provided us, e.g. o a aswerig machie. Commuicatio with Family. Uless you otify us that you object, we may disclose to a family member, other relative, close persoal fried or ay other perso ivolved i your health care, health iformatio relevat to that perso's ivolvemet i your care or paymet related to your care. If appropriate, these commuicatios may also be made after your death, uless you istructed us ot to make such commuicatios. Uses ad Disclosures of Your Health Iformatio Based o Your Writte Authorizatio Psychotherapy Notes. We must obtai your writte authorizatio for most uses ad disclosures of psychotherapy otes. Marketig. We must obtai your writte authorizatio to disclose your health iformatio for most marketig purposes. We may cotact you regardig your treatmet, to coordiate your care, or to direct or recommed alterative treatmets, therapies, health care providers or settigs. I additio, we may cotact you to describe a health-related product or services that may be of iterest to you, ad the paymet for such product or service. Sale of Health Iformatio. We must obtai your writte authorizatio for ay disclosure of your health iformatio which costitutes a sale of health iformatio. Other Uses. Other uses ad disclosures of your health iformatio, ot described above, will be made oly with your writte authorizatio (uless otherwise permitted or required by law). You may revoke your authorizatio, at ay time, i writig, except to the extet we have take actio i reliace o the authorizatio. Additioal Restrictios o Uses ad Disclosures of Your Health Iformatio
Certai state laws may impose additioal restrictios o the use ad disclosure of your health iformatio. If a use or disclosure of health iformatio described i this Notice is prohibited or materially limited by other laws that apply to us, it is our itet to meet the requiremets of the more striget law. A summary of these more striget state laws are available i the State Law Addedum. For a copy of the State Law Addedum to this Notice, please cotact your local Admiistrator or visit our Website. Your Health Iformatio Rights You have the followig rights regardig your health iformatio. You may exercise these rights by submittig a request i writig to our Admiistrator: Right to Request Restrictios. You have the right to request restrictios o our use or disclosure of your health iformatio for treatmet, paymet or health care operatios. You also have the right to restrict the health iformatio we disclose about you to a family member, fried or other perso who is ivolved i your care or the paymet for your care. Such requests should be made i writig o a form provided by us. Although we will cosider your requests with regard to the use of your health iformatio, please be aware that we are uder o obligatio to accept it, except we must agree ot to disclose your health iformatio to your health pla if the disclosure: (1) is for paymet or health care operatios ad is ot otherwise required by law; ad (2) relates to a health care item or service which you paid for i full out of pocket. If we do agree to accept your requested restrictio, we will comply with your request except as eeded to provide you emergecy treatmet. Right of Access to Health Iformatio. You have the right to ispect ad obtai a copy of your medical or billig records or other writte iformatio that may be used to make decisios about your care, subject to some limited exceptios. Such records will be provided to you i the time frames established by law. We may charge a reasoable fee for our costs i copyig ad mailig your requested iformatio. We may dey your request to ispect or receive copies i certai limited circumstaces. If you are deied access to health iformatio, i some cases you will have a right to request review of the deial. Right to Request Amedmet. If you believe that ay health iformatio i your record is icorrect or if you believe that importat iformatio is missig, you may request that we correct the existig iformatio or add the missig iformatio. Such requests must be made i writig, ad must provide a reaso to support the amedmet. We may dey your request for amedmet i certai circumstaces. If we dey your request for amedmet, we will give you a writte deial icludig the reasos for the deial. You have the right to submit a writte statemet disagreeig with the deial. Right to a Accoutig of Disclosures. You have the right to request a "accoutig" of our disclosures of your health iformatio. This is a listig of certai disclosures of your health iformatio made by us or by others o our behalf, but does ot iclude disclosures for
treatmet, paymet ad health care operatios or certai other exceptios. To request a accoutig of disclosures, you must submit a request i writig, statig a time period that is withi six years from the date of your request. A accoutig will iclude, if requested: the disclosure date; the ame of the perso or etity that received the iformatio ad address, if kow; a brief descriptio of the iformatio disclosed; a brief statemet of the purpose of the disclosure or a copy of the authorizatio request; or certai summary iformatio cocerig multiple similar disclosures. The first accoutig provided withi a 12-moth period will be free; for further requests, we may charge you our costs. Right to a Paper Copy of This Notice. You have the right to obtai a paper copy of this Notice, eve if you have agreed to receive this Notice electroically. You may request of copy of this Notice at ay time. Right to Request Cofidetial Commuicatios. You have the right to request that we commuicate with you cocerig persoal health matters i a certai maer or at a certai locatio. For example, you ca request that we cotact you oly at a certai phoe umber. We will accommodate your reasoable requests. Right to Revoke Authorizatio. You may revoke a authorizatio to use or disclose health iformatio, except to the extet that actio has already bee take. This request must be made i writig. Right to Breach Notificatio. You have the right to be otified if you are affected by a breach of usecured protected health iformatio. Right to Opt Out of Fudraisig Commuicatios. We may cotact you for fudraisig purposes. You have the right to opt out of receivig these commuicatios. For More Iformatio or to Report a Problem If you believe that your privacy rights have bee violated, you may file a complait i writig with us or with the Office for Civil Rights i the U.S. Departmet of Health ad Huma Services. To file a complait with us, you may cotact the local Admiistrator or the Chief Compliace Officer at 1-800-366-1232. We will ot retaliate agaist you if you file a complait. If you have ay questios about this Notice or would like further iformatio cocerig your privacy rights, please cotact the local Admiistrator or the Chief Compliace Officer at 1-800-366-1232. Effective Date: October 15, 2016
HCR MANORCARE NOTICE OF INFORMATION PRACTICES STATE LAW ADDENDUM This state law addedum supplemets our Notice of Iformatio Practices. The chart below icludes several categories of health iformatio that are subject to more restrictive state laws. For each category, we have provided a geeral summary of how we are permitted to use ad disclose your health iformatio, ad the states that follow those more restrictive rules. HIV/AIDS State law permits disclosure of HIV-related iformatio i fewer circumstaces tha HIPAA. We will oly disclose HIV-related iformatio with your coset or as otherwise permitted or required by state ad federal law. Commuicable Diseases/STDs State law permits disclosure of commuicable disease iformatio i fewer circumstaces tha HIPAA. We will oly disclose commuicable disease iformatio with your coset or as otherwise permitted or required by state ad federal law. State law permits disclosure of a miors commuicable disease of iformatio i fewer circumstaces tha HIPAA. We will oly disclose a miors commuicable disease iformatio with coset or as otherwise permitted or required by state ad federal law. Metal Health State law permits disclosure of metal health iformatio i fewer circumstaces tha HIPAA. We will oly disclose metal health iformatio with your coset or as otherwise permitted or required by state ad federal law. Your isurer may oly request from us certai types of metal health iformatio. Substace Abuse State law permits disclosure of substace abuse iformatio i fewer circumstaces tha HIPAA. We will oly disclose substace abuse iformatio with your coset or as otherwise permitted or required by state ad federal law. Your isurer may oly request from us certai types of substace abuse iformatio. Geetic Iformatio State law permits disclosure of geetic iformatio i fewer circumstaces tha HIPAA. We will oly disclose geetic iformatio with your coset or as otherwise permitted or required by state ad federal law. Other State law permits disclosure of your health records i fewer circumstaces tha HIPAA. We will oly disclose AZ, CA, CO, CT, DE, FL, GA, IA, IL, IN, KS, KY, MI, NC, NJ, OH, OK, PA, TX, WA, WI AZ, IN, NC, OK, TX, WA, WI DE, FL CA, IL, IN, MN, NM KY CA, FL, IA, IN, MD, PA KY AZ, CO, DE, FL, GA, MO, NJ, NM, NV, TX, WA, WI CA, MN, WA
your health iformatio with your coset or as otherwise permitted or required by state ad federal law. Iformatio regardig your Medicaid eligibility is cofidetial. State law permits disclosure of o-commuicable disease iformatio i fewer circumstaces tha HIPAA. We will oly disclose o-commuicable disease iformatio with your coset or as otherwise permitted or required by state ad federal law. We will ot use or disclose your health iformatio for marketig purposes without your coset, except i limited circumstaces permitted by state law which are fewer tha those permitted by HIPAA. Health Iformatio Exchages We have chose to participate i the Chesapeake Regioal Iformatio System for our Patiets, Ic. (CRISP), a regioal health iformatio exchage servig Marylad ad D.C. As permitted by law, your health iformatio will be shared with this exchage i order to provide faster access, better coordiatio of care ad assist providers ad public health officials i makig more iformed decisios. You may opt-out ad disable all access to your health iformatio available through CRISP by callig 1-877-952-7477 or completig ad submittig a Opt-Out form to CRISP by mail, fax or through their website at www.crisphealth.org. Public Health reportig ad Cotrolled Dagerous Substaces iformatio, as part of the Marylad Prescriptio Drug Moitorig Program (PDMP), will still be available to providers. We may participate i the North Dakota Health Iformatio Network ( Network ). You agree to be a part of the Network uless you specifically opt out. If you do ot opt out, ad we participate i the Network, your health iformatio will be available through the Network for the purposes of treatmet, obtaiig paymet for treatmet, health care operatios, to comply with public health reportig requiremets, ad as required by law. Disclosure will ot be made without your coset for the followig purposes: disclosures prohibited by law; comparative studies or by third parties; or the sale or commercial use of health iformatio. If you opt out of participatio i the Network, your health iformatio caot be used or disclosed through the Network except as required by law, as authorized by you i a medical emergecy, or by the provider who origially created or ordered the creatio of the health iformatio. IN OK TX MD ND