Privacy Statement

 

NOTICE OF PRIVACY PRACTICES

 

THIS NOTICE DESCRIBES HOW MEDICAL/ HEALTH

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 about this notice, please contact the

      administrator of West Hartford Health & Rehabilitation Center.  The effective date of this

                                                                          privacy notice is April 14, 2004.

 

                        At West Hartford Health & Rehabilitation Center, we respect the privacy and confidentiality of your health

                        information.  This Notice of Privacy Practices (“Notice”) describes how

                        we may use and disclose your medical/health information and how you

                        can get access to this information.  This Notice applies to uses and

                        disclosures we may make of all your health information whether

                        created or received by us.

                           

I.	Our responsibilities to you
II.	How we will use and how disclosure affects your health Information for treatment, payment, and health care operations
III.	Other uses and disclosures we many make without your written authorization.
IV.	Your written authorization is required for all other uses or disclosures of your health information.
V.	Your rights regarding your health information
VI.	Special regulations regarding disclosure of psychiatric and HIV- related information
VII.	Compl   Complaints

 

 

                        I.  OUR RESPONSIBILITIES TO YOU 

 

                        We are required by law to:

 

                    1.  Maintain the privacy of your health information and to provide

                         you with notice of our legal duties and privacy practices.

    2.  Comply with the terms of our Notice currently in effect.

 

We reserve the right to change our practices and to make the new

              provisions effective for all health information we maintain, including

both health information we already have and health information we

create or receive in the future.  Should we make changes, we will make

the revised notice available to you by posting it in a clear and

prominent location.

 

 

II.  HOW WE WILL USE AND HOW DISCLOSURE AFFECTS YOUR

HEALTH INFORMATION FOR TREATMENT, PAYMENT AND

HEALTH CARE OPERATIONS 

     

We may use and disclose your health information for the purpose of

treatment, payment and health care operations as described below.

 

  1.  For Treatment

       We may use and disclose your health information to provide you

       with treatment and services and to coordinate your continuing

       care.  Your health information may be used by doctors and

       nurses, as well as by lab technicians, dieticians, physical

       therapists, certified nursing assistants or other personnel

       involved in your care, both within our facility and by other health

      care providers involved in your care.  For example, a pharmacist

      will need certain information to fill a prescription ordered by your

      doctor.  We may also disclose your health information to persons

      or facilities that will be involved in your care after you leave our

      facility.  For example, should you need home care services after

      you leave the facility, we may disclose information to the Home

      Care Agency that will provide those services.

 

2.   For Payment

                    We may use and disclose your health information so that we can

                     bill and receive payment for the treatment and services you

                     receive.  For billing and payment purposes, we may disclose your

                     health information to an insurance or managed care company,

                     Medicare, Medicaid or another third party payor.  For example,

                     we may contact Medicare or your health plan to confirm your

                     coverage or to request approval for a proposed treatment or

                     service.

 

              3.    FOR HEALTH CARE OPERATIONS

                     We may use and disclose your health information as necessary

                      for our internal operations, such as for general administration

                      activities and to monitor the quality of care you receive with us.

                      For example, we may use your health information to evaluate

                      and improve the quality of care you received, for education and

                      training purposes, and for planning for services.

 

                         III. OTHER USES AND DISCOLOSURES WE MAY MAKE WITHOUT  YOUR WRTTEN AUTHORIZATION

 

 

                    Under the Privacy Regulations, we may make the following uses and disclosures without obtaining a written authorization from you:

 

 

                       1.   As Required by law

                             We may disclose your health information when required by law to do so.

        

                       2.   Facility Directory

                             Unless you object, we may use and disclose certain limited information about you in our directory while you are a patient. This information may include your name, your location in the facility, your general condition and your religious affiliation. Our directory does not include specific medical information about you. We may disclose directory information, except for your religious affiliation to people who ask for you by name. We may provide the directory information, including your religious affiliation, to a member of the clergy.

 

                       3.    Persons Involved in your Care or Payment for your Care

                              Unless you object, we may disclose health information about you to a family member, close personal friend or other persons you identify, including clergy who are involved in your care. These disclosures are limited to information relevant to the person’s involvement in your car or in arranging payment for your care.

 

                       4.   Public Health Activities

                             We may disclose your health information for public health activities.

 

                       5.    Reporting Victims of Abuse, Neglect or Domestic Violence

                              If we believe that you have been a victim of abuse, neglect or domestic violence, we may disclose your health information to notify a government authority, if authorized by law or if you agree to the report.

 

                       6.     Health Oversight Activities

                              We may disclose your health information to a health oversight agency for actives authorized by law. A health oversight agency is a state or federal agency that oversees the health care system. Some of the actives may include, for example, audits, investigations, inspections and licensure actions.

 

                       7.    Judicial and Administrative Proceedings

                              We may disclose your health information in response to a court or administrative order. We may also disclose information in response to a subpoena, discovery request or other lawful process.

 

             8.  Law Enforcement

                        We may disclose your health information for certain law enforcement purposes, including for   examples, to file reports required by law or to report emergencies or suspicious deaths; identify or locate a suspect or missing person; or to answer certain requests for information concerning crimes.

 

 9.  Coroners, Medical Examiners, Funeral Directors, Organ Procurement Organizations

                        We may release your health information to a coroner, medical examiner, funeral director and if you are an organs and tissues donor, an organ and tissue procurement organization.

 

                10.   Research

  Your health information may be used for research purposes, but only if :(1) the      privacy aspects of the research purpose, but reviewed and approved by a special privacy Board or Institutional Review Board, and the Board can legally waive patient authorizations otherwise required by the Privacy Regulations: (2) the researcher is collecting information for research proposal; (3) the research occurs after your death; or (4) if you give written authorization for the use or disclosure.

 

                11.  To Avert a Serious Threat to Health or Safety

                       When necessary to prevent a serious threat to your health or safety, or the health or

                        safety, or the health or safety of the public or another person, we may use or

                        disclose your health information to someone able to help lessen or prevent the

                        threatened harm.

 

12.  Military and Veterans

        If you are a member of the armed forces, we may use and disclose your health information as required by military command authorities.  We may also use and disclose health information about you if you are a member of a foreign military as required by the appropriate foreign military authority.

 

13. National Security and Intelligence Activities; Protective Services for the Patient and Others

        We may disclose health information to authorized federal officials conducting national security and intelligence activities or as needed to provide protection to the President of the United States, certain other persons or foreign heads of states, or to conduct certain special investigations.

 

14.  Inmates/Law Enforcement Custody

       If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose your health information to the institution or official for certain purposes, including your own health and safety as well as that of others.

 

15.   Worker’s  Compensation

        We may use or disclose your health information to comply with laws  relating to workers’ compensation or similar programs.

 

16.   Disaster Relief

        We may disclose health information about you to an organization assisting in a disaster relief effort.

 

17.   Treatment Alternatives and Health-Related Benefits and Services

        We may use or disclose your health information to inform you about treatment alternatives and health-related benefits and services that may be on interest to you.

 

18.   Business Associates

        We may disclose your health information to our Business Associates under a Business Associate Agreement

 

 

IV.  YOUR WRITTEN AUTHORIZATION IS REQUIRED FOR ALL OTHER USES OR DISCLOSURES OF YOUR HEALTH INFORMATION

 

    1.  We will obtain your written authorization (an “authorization”} prior to making any use or disclosure other than those described above.

 

    2.   A written authorization is designed to inform you of a specific use or disclosure other than those set forth above that we plan to make of your health information.  The authorization describes the particular health information to be used or disclosed and the purpose of the use or disclosure.  Where applicable, the written authorization will also specify the name of the person to whom we are disclosing the health information.  The authorization will also contain an expiration date or event.

 

   3.   You may revoke a written authorization previously given by you at any time, but you must do so in writing.  If you revoke your authorization, we will no longer use or disclose your health information for the purposes specified in thaw authorization except where we have already taken actions in reliance on your authorization.

 

V.  YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

 

 

1.  Right to Request Restrictions

     You have the right to request that we restrict the way we use or disclose your health information for treatment, payment or health care operations.  However, we are not required to agree to the restriction.  If we do agree to a restriction , we will honor that restriction except in the event of an emergency, and will only disclose the restricted information to the extent necessary for your payment.

 

2.   Right to Request Confidential Communications

      You have the right to request that we communicate with you concerning your health matters in a certain manner or at a certain location.  For example, you can request that we only speak with you in your room.  We will accommodate your reasonable requests.

 

3.   Right of Access to Personal Health Information

      You have the right to inspect and upon written request, obtain a copy of your health information.  Under Connecticut law, if the facility makes a copy of your medical record, we will not charge more than $.65 per page, plus postage if appropriate.

 

4.   Right to Request Amendment

      You have the right to request that we amend your health information.  Your request must be made in writing and must state the reason for the requested amendment.  We may deny your request for amendment if the information: (a) was not created by us, unless you provide reasonable information that the originator of the information is no longer available to act on your request; (b) is not part of the health information maintained by us; or (c) is already accurate and complete, as determined by us.

 

      If we deny your request for amendment, we will give you a written denial notice, including the reasons for the denial.  In that event, you have the right to submit a written statement disagreeing with the denial.  Your letter of disagreement will be attached to your medical record.

 

5.   Right to an Accounting of Disclosures

      You have the right to request an “accounting” of certain disclosures of your health information.  This is a listing of disclosures made by us or by others on our behalf, but does not include disclosures for treatment, payment and health care operations, or certain other exceptions.

 

      You must submit your request in writing and you must state the time period for which you would like the accounting.  The accounting will include the disclosure date; the name of the person or entity that received the information and address, if known; a brief description of the information disclosed; and a brief statement of the purpose of the disclosure.  The first accounting provided within a 12-month period will be free; for further requests, we may charge you our costs for completing the accounting.

 

VI.   SPECIAL REGULATIONS REGARDING DISCLOSURE OF PSYCHIATRIC AND HIV-RELATED INFORMATION

 

For disclosure concerning certain health information such as HIV-related information or records regarding psychiatric care that have been sent to us by another provider, special restrictions apply.  Generally, we will disclose such information only with an authorization, or as otherwise required by law.

 

 

 

VII.  COMPLAINTS

 

     1.  If you believe that your privacy rights have been violated, you may file a complaint in writing with us or with the Office of Civil Rights in the U.S. Department of Health and Human Services at 200 Independence Avenue, S.W., Room 509 F, HHH Building, Washington, D.C. 20201.

 

     2.  To file a complaint with us, you should contact the administrator of the facility in question.

 

     3.  We will not retaliate against you in any way for filing a complaint against the facility.