NOTICE OF PRIVACY PRACTICES
This notice describes how health information about you can be used and disclosed, and how you can gain access to this information. Please review it carefully.
General description and purpose of notice
This notice describes our information privacy practices and that of:
Any health care professional authorized to enter information into your medical record created and/or maintained at our facility;
Any member of a volunteer group which we allow to help you while receiving services at our facility;
All facility employees, staff, and other personnel; and
Other entities under contract to assist in providing healthcare in a clinically integrated manner.
The above individuals or entities may share your protected health information with each other for purposes of treatment, payment, health care operations, or business associate operations, as further described in this notice.
Our facility’s policy regarding your protected health information
Certain state and federal laws and regulations require us to implement policies and procedures to safeguard the privacy of your protected health information. This notice will provide you with information regarding our privacy practices and applies to all of your protected health information created and/or maintained at our facility, including any information that we receive from other health care providers or facilities. The notice describes the ways in which we may use or disclose your protected health information and describes your rights and our obligations regarding any such uses or disclosures. We reserve the right to change the terms of this notice of privacy practices and to make new notice provisions effective for all protected health information we maintain. In the event of revision, new copies will be posted in the facility, on our website and available upon request.
Uses or disclosures of your protected health information
We may use or disclose your protected health information in one of the following ways:
For purposes of treatment, payment, health care operations, or business associate operations;
Pursuant to your written authorization;
Pursuant to your verbal agreement; or
As permitted or required by law.
The following describes each of the different ways that we may use or disclose your protected health information.
Uses or disclosures made without your verbal or written authorization
We may use or disclose your protected health information for purposes of treatment, payment, or health care operations.
Treatment. We may use your protected health information to provide you with health care treatment and services. We may disclose your protected health information to personnel who are involved in your health care.
Payment. We may use or disclose your protected health information so that we may bill and collect payment from you, an insurance company, or another third party for the health care services you receive at our facility.
Health care operations. We may use or disclose your protected health information to perform certain functions within our facility. These uses or disclosures are necessary to operate our facility and to make sure that our residents receive quality care.
Business Associates. There are services provided in our facilities through contracts with third parties who are our business associates. We may share your protected health information with our business associates so that they can perform the job we’ve asked them to do. We require our business associates to sign a contract that states they will appropriately protect your information. Examples of business associates include medical records storage companies, computer software companies and accreditation agencies.
Uses or disclosures made pursuant to your written authorization
We may use or disclose your protected health information pursuant to your written authorization for purposes other than treatment, payment or health care operations. You have the right to revoke a written authorization at any time as long as your revocation is provided to us in writing. If you revoke your written authorization, we will no longer use or disclose your protected health information for the purposes identified in the authorization, except to the extent that we have already relied on your authorization, that disclosure is required for us to obtain payment for services already provided or that the law prohibits revocation.
Restrictions on disclosure of Protected Health Information (PHI) to health plan. We will abide by your written request to restrict disclosure of protected health information for services you will pay out-of-pocket in full. To request this restriction, please do so in writing and submit to the Privacy Officer. You will be required to make arrangements for direct payment for your services and pay out-of-pocket in full for the services provided.
Restrictions on Marketing. We may ask you to sign an authorization to use or disclose your protected health information as part of a marketing effort. The authorization will state if the facility will receive any direct or indirect compensation for the marketing. Your authorization is needed except for face-to-face communications made by the facility to you or for promotional gifts of nominal value. Marketing is defined as a communication about a product or service that encourages the purchase or use of the product or service.
Uses or disclosures made pursuant to your verbal agreement.
We may use or disclose your protected health information, pursuant to your verbal agreement, for purposes of including you in our facility directory or for purposes of releasing information to persons involved in your care as described below.
Facility directory. We may use or disclose certain limited protected health information about you in our facility directory while you are a resident at our facility. This information may include your name, your assigned unit and room number and your religious affiliation. Your religious affiliation may only be given to a member of the clergy. The directory information, except for religious affiliation, may be given to people who ask for you by name. If you would like to opt out of our facility directory please inform the admissions’ staff.
Individuals directly involved in your care. We may disclose your protected health information to individuals, such as family and friends, who are directly involved in your care or who help pay for your care. We also may disclose your protected health information to a person or organization assisting in disaster relief efforts for the purpose of notifying your family or friends involved in your care about your condition, status and location.
Uses or disclosures permitted or required by law.
Certain state and federal laws and regulations either require or permit us to make certain uses or disclosures of your protected health information without your permission. These uses or disclosures are generally made to meet public health reporting obligations or to ensure the health and safety of the public at large. The uses or disclosures which we may make pursuant to these laws and regulations include the following:
Public health activities. We may use or disclose your protected health information to public health authorities that are authorized by law to receive and collect protected health information for the purpose of preventing or controlling disease, injury or disability.
Health oversight activities. We may use or disclose your protected health information to a health oversight agency that is authorized by law to conduct health oversight activities. These oversight activities may include audits, investigations, inspections, or licensure and certification surveys.
Judicial or administrative proceedings. We may use or disclose your protected health information to courts or administrative agencies charged with the authority to hear and resolve lawsuits or disputes.
Worker’s compensation. We may use or disclose your protected health information to worker’s compensation programs when your health condition arises out of a work-related illness or injury.
Law Enforcement official. We may use or disclose your protected health information in response to a request received from a law enforcement official.
Coroners, medical examiners, or funeral directors. We may use or disclose your protected health information to a coroner or medical examiner for the purpose of identifying a deceased individual or to determine the cause of death. We also may use or disclose your protected health information to a funeral director for the purpose of carrying out his/her necessary activities.
Organ procurement organizations or tissue banks. If you are an organ donor, we may use or disclose your protected health information to organizations that handle organ procurement, transplantation, or tissue banking for the purpose of facilitating organ or tissue donation or transplantation.
Research. We may use or disclose your protected health information for research purposes under certain limited circumstances.
To avert a serious threat to health or safety. We may use or disclose your protected health information when necessary to prevent a serious threat to the health or safety of you or other individuals.
Military and veterans. If you are a member of the armed forces, we may use or disclose your protected health information as required by military command authorities.
National security and intelligence activities. We may use or disclose your protected health information to authorized federal officials for purposes of intelligence, counterintelligence, and other national security activities, as authorized by law.
Required by Law. We may use or disclose your information where such uses or disclosures are required by federal, state or local law.
Your rights regarding your protected health information.
You have the following rights regarding your protected health information which we create and/or maintain:
Right to inspect and copy. You have the right to inspect and copy protected health information that may be used to make decisions about your care. Generally, this includes medical and billing records, but does not include psychotherapy notes. If this facility maintains an electronic health record you may request a copy in writing of your record in either electronic or paper format. This facility may charge for a copy of your records.
Right to request an amendment. If you feel that the protected health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for our facility.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
was not created by us, unless the person or entity that created the information is no longer available to make the amendment
is not part of the protected health information kept by or for our facility
is not part of the information which you would be permitted to inspect and copy
is accurate and complete
Right to an accounting of disclosures. You have the right to request an accounting of the disclosures which we have made of your protected health information. This accounting will not include disclosures of protected health information that we made for purposes of treatment, payment, or health care operations.
Right to request restrictions. You have the right to request a restriction or limitation on the protected health information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the protected health information we disclose about you to someone, such as a family member or friend, who is involved in your care or in the payment of your care. In addition, you may restrict disclosures to a health plan if you are paying for your care entirely out-of-pocket.
We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide emergency treatment to you.
Right to request confidential communications. You have the right to request that we communicate with you about your health care in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
Right to receive notice of a breach. You have the right to be notified upon a breach of any of your unsecured protected health information. The Privacy Officer will work with appropriate facility personnel to determine whether a breach has occurred and what notification requirements may be required for the particular breach. In addition, the covered component that maintains the data will report to the HIPAA Privacy Officer to ensure that appropriate measures are initiated for both privacy and security breaches.
Please submit any requests regarding your rights, as described above to the Privacy Officer. Contact information for the Privacy Officer is located at the end of this Notice. For purposes of requesting a copy of your legal health record, please request a form from your facility.
If you believe your privacy rights have been violated, or you need more information regarding your rights, please contact our privacy officer or the secretary of the Department of Health and Human Services. You will NOT be penalized for filing a complaint.
Country Meadows Village
c/o Privacy Officer
155 S. Evergreen Road
Woodburn, OR 97071
Office of Civil Rights