ST. MARGARET HALL
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.
If you have any questions regarding this notice, please contact
St. Margaret Hall's Privacy Officer, Debbie Groh, RN at 513-487-3557
Privacy is a Sacred Treasure-upheld by our Mission and Philosophy and the Law.
We respect the Privacy of your Personal Health Information and are committed to maintaining our Residents’ Confidentiality. This notice applies to all information and medical records related to your care that our Facility has received or created. It extends to information received or created by our Employees, Staff, Volunteers, Consultants, Therapists, and Physicians. This Notice informs you about the possible uses and disclosures and your rights and our obligations regarding your Personal Health Information. (Henceforth identified by the abbreviation: PHI)
We are required by law to:
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Maintain the Privacy of your PHI;
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Provide you with a copy of this detailed Notice of our Legal Duties and Privacy Practices relating to your PHI and are required to obtain a Written Acknowledgment or document a “good faith effort” to obtain an Acknowledgment that individuals have received a Notice of St. Margaret Hall Privacy Practices;
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Abide by the terms of this Notice that are currently in effect;
We reserve the right to change this Notice and make the revised or changed Notice effective for Health Information we already have about you as well as any information we receive in the future.
1. OUR POLICY FOR USE OR DISCLOSURE OF YOUR PHI-
You will be asked to sign an Acknowledgment that you have received a copy of our Notice of Privacy Practices.
Your PHI can be used and disclosed for purposes of Treatment, Payment and Health Care Operations.
The following are brief descriptions for the uses and disclosures we may make in each of these categories:
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For Treatment-
We will use and disclose your PHI in providing you with Treatment and Services. We may disclose your PHI to Facility and non-Facility Personnel who may be involved in your care, such as Physicians (including Medical, Dental, Podiatry, Audiology, Optometry), Nurses, Therapists, etc., including individuals who would be involved in your care if/after you leave the Facility;
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For Payment-
We may use and disclose your PHI so that we can bill and receive payment for any Treatments and Services you receive at the Facility. For billing and payment purposes, we may disclose your PHI to your Representative, Insurance or Managed Care Company, Evercare, Medicare, Medicaid or other Third Party Payor. For example, we may contact Medicare or your Health Plan to confirm your coverage or request prior approval for a proposed Treatment or Service.
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For Health Care Operations-
We may use and disclose your PHI for Facility Operations. These uses and disclosures are necessary to manage the Facility and to monitor our Quality of Care. For example, we may use PHI to evaluate our Facility’s Services, including the performance of our Staff.
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Fundraising Activities-
We may use a limited amount of your Health Information for purposes of contacting you to raise money for our Facility and its Operations. We may disclose this Health Information to a Foundation related to the Facility so that the Foundation may contact you during their Fundraising Efforts for the Facility. The information, which we may use or disclose, will be limited to your name, address, phone number, and dates for which you received Treatment or Services at our Facility. If you do not want our Facility or Foundation to contact you for these Fundraising Purposes, you must notify us in writing.
2. WE MAY USE OR
DISCLOSE PHI ABOUT YOU FOR OTHER SPECIFIC PURPOSES-
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Facility Roster-
Unless you give us a Written Notice of Objection, we will include certain Limited Information about you in our Facility Roster.
This information may include your Name, your Assigned Unit and Room Number, and your Religious Affiliation. Our Roster contains no specific medical information about you. We may release information in our Roster, except for your Religious Affiliation, to people who ask for you by name. We may provide Roster Information, including your Religious Affiliation to any member of the Clergy.
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Individuals involved in your care or payment for your care-
Unless you give us a Written Notice of Objection, we may disclose certain aspects of your PHI to a family member or close personal friend, including clergy, who is directly involved in your care.
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Disaster Relief-
We may disclose your PHI to organizations assisting our Facility in a Disaster Relief Effort.
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As required by law-
We will disclose your PHI when required by law to do so.
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Public Health Activities-
We may disclose your PHI for Public Health Activities, including but not limited to:
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Disclosure to a Public Health or other Government Authority for preventing or controlling disease, injury or disability, or reporting any suspected or actual abuse, neglect or mistreatment;
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Disclosure to the Food and Drug Administration (FDA) regarding adverse events or problems with products for tracking products in certain circumstances, to enable Product Recalls or to comply with other FDA Requirements;
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To notify a person whom may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition;
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For specific purposes involving workplace illness or injuries;
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Reporting Victims of Abuse, Neglect, or Mistreatment-
If it is our belief that you have been a victim of abuse, neglect or mistreatment while under the auspices of the Facility, we may use and disclose your PHI to notify a Government Authority if required by law, or if you agree to the report.
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Government Oversight Activities-
We may disclose your PHI to Governmental Agencies overseeing Health Activities authorized by law. These may include, but are not limited to, Audits, Investigations, Inspections, Licensure Actions, other legal proceedings, or other activities necessary for governmental oversight of the Health Care System, Payment or Regulatory Programs, and in compliance with Civil Rights Laws.
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Judicial and Administrative Proceedings-
We may disclose PHI responding to a Court or Administrative Order, including but not limited to, Subpoena, Discovery Request, or other lawful process; every effort will be made to contact you, or your representative, regarding the request.
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Law Enforcement-
We may disclose your PHI for Law Enforcement Purposes including, but not limited to: -
In compliance with Regulatory Reporting Requirements;
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In compliance with a Court Order, Warrant, Subpoena, Summons, Investigative Demand or similar legal process;
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When requested for information about a victim of a crime, if the individual agrees or under other limited circumstances;
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Reporting information about a questionable death;
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Providing information about criminal conduct occurring at the Facility;
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Reporting information in emergency circumstances about a crime;
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When it is necessary to identify or apprehend an individual relative to a violent crime or escape from justice.
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Research Project-
We may permit PHI to be used or disclosed for Research Projects/Programs or Proposals, Private, Public or Grant Funded, provided the Researcher adheres to Privacy Protections, referred to as the “Limited Data Set” which permits disclosure of Dates of Admission, Discharge, Birth, Death, and Geographical Information, other than Street Address, without Authorization or Waiver of Authorization by the Facility’s Ad Hoc Privacy Committee (as part of Quality Assurance). Any information, which could directly identify you, will not be used unless you or your Representative authorizes such disclosure or a Waiver by the Privacy Committee has been obtained.
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Medical Examiners, Coroners, Funeral Directors, Organ Donor Organizations-
We may release your PHI to a Medical Examiner, Coroner, Funeral Director or, if you are an Organ Donor, to the Organization involved in the procurement of tissue, organs, or body.
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To avert a serious threat to health or safety-
We may use or disclose PHI if and when it is necessary to prevent a serious threat to your health or safety, or to the health and safety of others or the public. Any disclosure that would be sanctioned would be to Government, Medical, or other Officials with the ability to help prevent the threat.
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Workers’ Compensation-
We may use or disclose PHI in compliance with laws relative to Worker’s Compensation or similar Governmental Programs.
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National Security-
We may use or disclose PHI in matters dealing with National Security.
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Reminders of Medical Appointments-
We may use or disclose PHI for outside appointments relating to your health.
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Treatment Alternatives-
We may use or disclose PHI to inform you of alternative treatments which may be of benefit to you.
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Health-Related Benefits and Services-
We may use or disclose PHI to inform you of Health Related Benefits and/or Services that may be of interest to you.
3. FOR OTHER USES OF PHI-YOUR AUTHORIZATION IS REQUIRED-
If directed by you, and only with your Written Authorization, will we use and disclose PHI (other then as described in this Notice or as required by law)? You may revoke your authorization, in writing, to use or disclose PHI at any time.
4. YOUR RIGHTS REGARDING PHI-
The following are your rights regarding PHI while you are a Resident at St. Margaret Hall:
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Right to Request Restrictions- Must be in writing
You have the right to request restrictions on the use and disclosure of PHI by the Facility, for Treatment, Payment, or Health Care Operations. Additionally, you have the right to restrict the PHI we disclose about you to a Family Member, Friend, or other person who is involved in your care or in the payment of your care.
We will adhere to your Requested Restriction unless you are being transferred to another Health Care Facility, if it is required by law or if the release of PHI is needed to provide you with Emergency Treatment.
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Right of Access to PHI-
You have the right to request access to your Medical, Billing or other Written Information that may be used to make decisions about your care, either verbally or in writing. We must allow you to inspect your records within 24-hours of your request (excluding weekends and holidays). If you wish copies of the records, we must provide them to you within 48-hours of your request. However, we may charge reasonable fees for our cost of copying and, if requested, mailing your requested information.
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Right to Request Amendment of PHI-
You have the right to amend any PHI maintained by the Facility for as long as it is kept by the Facility. The Request for Amendment must be made in writing with reason given for the requested amendment. -
Was not created by our Facility;
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Is not part of the PHI maintained by or for the Facility;
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Is not part of the information to which you have a Right of Access;
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Is already determined by the Facility to be accurate and complete;
If your request for amendment is denied, the denial will be given to you in writing with the reason/s for the denial. You have the right to submit a written statement as to why you disagree with the denial.
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Right to an Accounting of Disclosures-
You have the right to request an Accounting of all Disclosures of PHI. This accounting will list certain disclosures of your PHI made by the Facility, or others on our behalf, but does not include disclosures for Treatment, Payment, Health Care Operations, or certain other exceptions. -
The Disclosure Date;
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The name of the person or entity (and address if known) that received the information;
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A brief description of information disclosed;
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A short statement addressing the Purpose of the Disclosure or a copy of the Authorization or Request;
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Summary Information regarding multiple similar requests.
The first accounting provided within a 12-month period will be free; for further requests you will be charged our costs.
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Right to a Paper Copy of this Notice-
You have the right to obtain a paper copy of this Notice, even if you have agreed to receive it electronically. You can request a copy of this Notice at any time.
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Right to Request Confidential Communications-
You have the right to request that we communicate with you in a particular manner or at a certain location regarding PHI. For example, you can request that we contact you only at a particular phone number or in person. Any reasonable request will be accommodated.
5. COMPLAINTS-
If you believe that your Privacy Rights have been violated, you may file a Written Complaint with the Facility or with the Office of Civil Rights, in the U.S. Department of Health and Human Services. To file a Written Complaint with the Facility, please contact our Privacy Officer, Debbie Groh, RN, at 513-487-3557.
All complaints will be investigated. No personal issue will be raised for filing a complaint with the Facility.
6. CHANGES-
Whenever there is a material change to
the Uses or Disclosures, your Individual Rights, our Legal Duties, or other
Privacy Practices as stated in this Notice, it would be promptly revised and
distributed. St. Margaret Hall reserves the right to amend, change or revise
this Notice effective for all PHI already received or maintained, or to be
received or maintained in the future in the Facility. A current copy of
this Notice will be posted in the Facility, and revised copies will be
distributed to all Residents.
7. FOR ADDITIONAL INFORMATION
Any additional information, clarifications, or questions can be addressed to our Privacy Officer, Debbie Groh, RN at 513-487-3557.
8. This Notice is effective as of January 1, 2003.