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Notice of Privacy Practices |
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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.
DEFINITIONS
"Protected health information" means any individually identifiable
health information, whether oral or recorded in any form, that is
created, received, used, or disclosed by Western Home Communities and
relates to your past, present, or future physical or mental health or
condition; the provision of health care to you; or the past, present,
or future payment of health care provided to you. Protected health
information includes demographic information, such as your name and address,
which can be used to identify you.
"We" or "us" or "our" means Western Home Communities.
"You" or "your" means a resident who receives or has received health care
services from Western Home Communities. If a person has legal authority
to act on your behalf in making decisions related to your health care, "you"
or "your" will pertain to your personal representative to the extent relevant
and appropriate to such representation.
PURPOSE
The purpose of this Notice of Privacy Practices is to explain your rights
and our legal duties concerning the use and disclosure of your protected
health information by Western Home Communities.
OUR LEGAL DUTIES
Western Home Communities is required by law to maintain the privacy of
your protected health information and to provide you with a notice of its
legal duties and privacy practices. An explanation of our legal duties and
privacy practices regarding your protected health information is provided
below. We may not use or disclose your protected health information in a
manner that is inconsistent with our current Notice of Privacy Practices.
Permitted Uses and Disclosures of Your Protected Health Information for
Treatment, Payment and Health Care Operations
The following sections describe different ways that we can use and disclose
your protected health information for treatment, payment, and health
care operations. For each of these categories, we have included an example
to explain what we mean.
Treatment Purposes
We may use your protected health information, without your
authorization, necessary to provide you treatment and services. We may
also disclose your protected health information to other health care
providers involved in your medical treatment. An example of a permitted use
of your protected health information for treatment purposes is our use of
the information to provide you appropriate care and treatment. An example
of a permitted disclosure of your protected health information for
treatment purposes is our disclosure of the information to your physician
to ensure that the physician has the necessary information to diagnose or
treat you.
Payment Purposes
We may use and disclose your protected health information, without your written authorization, to bill for the treatment and services provided to you, and to obtain payment for those services from you, a health plan, or another third party payer. An example of a permitted use of your protected health information for payment purposes is our use of the information to bill you or your personal representative for the health care services you receive from Western Home Communities. An example of a permitted disclosure of your protected health information for payment purposes is our disclosure of the information to a health plan as a part of a claim for payment for the services provided to you.
Health Care Operations
We may use or disclose your protected health information, without your written authorization, in order to conduct certain activities that are necessary to operate our business. These activities include, but are not limited to, quality assessment activities, case management and care coordination activities, regulatory compliance evaluations, employee review activities, student training activities, and contacting you about possible treatment alternatives that may be of interest to you. An example of a permitted use of your protected health information for health care operations is our use of the information to review our treatment and services and to evaluate and improve the performance of our staff in caring for you. An example of a permitted disclosure of your protected health information for health care operations is our disclosure of the information to a health plan involved in payment for the services provided to you as a part of its health care compliance activities.
We may share your protected health information with third party "business associates" that perform various activities (e.g., billing, consulting, or administrative services) on our behalf. Whenever an arrangement between Western Home Communities and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.
Incidental Uses or Disclosures
There may be other incidental uses or disclosures of your protected health information that may be permitted, but are not specifically listed as examples in our Notice of Privacy Practices. One example of a permitted incidental disclosure of your protected health information is posting your name at the door of your room at the facility. We will make reasonable efforts within our means to limit our use and disclosure of your protected health information to the minimum necessary, and to employ reasonable safeguards to protect the privacy of your protected health information.
Other Permitted and Required Uses and Disclosures of Your Protected Health Information
Facility Directory
Unless you express an objection, we may use certain limited information about you to maintain a facility directory. This information may include your name, your location in the facility, a general description of your condition (e.g., recently released from the hospital), and your religious affiliation. Our directory does not include specific medical information about you. We may release information in our directory, except for your religious affiliation, to people who ask for you by name. We may provide the directory information, including your religious affiliation, to any member of the clergy.
You have the right to prohibit or restrict the use or disclosure of some or all of your protected health information for the facility directory. If you are not able to agree or object to our use or disclosure of your protected health information for the facility directory because you are incapacitated or because of a medical emergency situation, we may use or disclose the information contained in the facility directory provided that our use or disclosure of the information is consistent with your prior expressed preference or, in our professional judgment, we believe it is in your best interest to use or disclose the information.
Disclosures to Individuals Involved in Your Health Care or in the Payment of Your Health Care
Unless you express an objection, we may disclose to a member of your family, another relative, a close personal friend of yours, or any other person you identify, your protected health information that relates directly to the person's involvement with your health care or payment of your health care. If you are unable to agree or object to such a disclosure, we may disclose your protected health information, as necessary, to these individuals, if we determine in our professional judgment that it is in your best interest to disclose the information.
Uses or Disclosures for Notification Purposes
Unless you express an objection, we may use or disclose your protected health information to notify or assist in notifying a member of your family, your personal representative, or any other person that is responsible for your care, of your location, general condition, or death. If you are unable to agree or object to such a disclosure, we may disclose such information for notification purposes if we determine in our professional judgment that it is in your best interest to disclose the information.
Uses or Disclosures to Disaster Relief Organizations
We may use or disclose your protected health information to an organization authorized to assist in disaster relief efforts for the purpose of coordinating the efforts of the organization in notifying a member of your family, your personal representative, or another person responsible for your care, of your location, general condition, or death. If you are unable to agree or object to such a disclosure, we may disclose such information for notification purposes if we determine in our professional judgment that it is in your best interest to disclose the information.
If you have the capacity to agree or object to a disclosure of your protected health information to a disaster relief organization, we will first obtain your agreement or provide you with an opportunity to object to the disclosure; provided, however, that we determine, in our professional judgment, that obtaining your agreement or objection does not interfere with the ability of disaster relief organizations to respond to emergency circumstances.
Uses and Disclosures Required by Law
We may use or disclose your protected health information to the extent required by law. Such use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. When required by law, we may use or disclose your protected health information without your authorization or without providing you with an opportunity to agree or object to such use or disclosure. We will notify you, as required by law, of any such uses or disclosures.
Disclosures to You
We are required by law to disclose your protected health information to you, when you request it, subject to our right to deny you access to the information when permitted or required by law.
Disclosures to the U.S. Department of Health and Human Services
We are required by law to disclose your protected health information to the U.S. Department of Health and Human Services during an investigation of our compliance with federal laws protecting the privacy of your personal health information. Such disclosure may be made without your authorization or without providing you with an opportunity to agree or object.
Reporting Dependent Adult Abuse
We are required by law to disclose your protected health information to the Iowa Department of Inspections and Appeals or the Iowa Department of Human Services if we believe you are a victim of dependent adult abuse. If we believe that immediate protection is advisable, we are also required by law to make an oral report to the appropriate law enforcement agency. Such disclosure may be made without your authorization or without providing you with an opportunity to agree or object.
Disclosures in a Judicial or Administrative Proceeding
We may disclose your protected health information in response to, and to the extent required by, a court or administrative order. We may also disclose your protected health information in response to a subpoena, discovery request, or other lawful process, provided that we receive satisfactory assurance from the party seeking the information that reasonable efforts have been made to notify you of the request or to obtain an order or agreement protecting the information. Such disclosures may be made without your authorization or without providing you with an opportunity to agree or object.
Disclosures for Law Enforcement Purposes
We may disclose your protected health information for a law enforcement purpose to a law enforcement official in any of the following circumstances:
(1) As required by law, including laws that require the reporting of certain wounds or other injuries which appear to have been received in connection with the commission of a criminal offense;
(2) In compliance with a court order, subpoena, or administrative request seeking information that is relevant and material to a law enforcement inquiry;
(3) To identify or locate a suspect, fugitive, material witness, or missing person, provided such disclosure is limited to the information permitted by law;
(4) In response to a law enforcement official's request about a known or suspected victim of a crime, if you agree to the disclosure or, if you cannot agree because of an emergency or personal incapacity, we believe, in our professional judgment, that disclosure would be in your best interest;
(5) To report information about a suspicious death resulting from criminal conduct;
(6) To provide information about criminal conduct occurring on our premises; or
(7) When we provide emergency health care in a medical emergency (except a medical emergency resulting from nondependent abuse, neglect, or domestic violence), other than an emergency occurring on our premises, to alert law enforcement officials of a violent crime and of the identity of the perpetrator of the crime; or
(8) When necessary to identify or apprehend an individual who participated in a violent crime or escaped from lawful custody, provided such disclosure is limited to the information permitted by law.
Such disclosures may be made without your authorization or without providing you with an opportunity to agree or object.
Disclosures for Public Health Activities
We may disclose your protected health information for the following public health activities and purposes:
(1) To a public health authority authorized by law to receive information for the purpose of preventing or controlling disease, injury, or disability;
(2) To a representative of the federal Food and Drug Administration (FDA) for authorized activities related to the quality, safety, or effectiveness of FDA-regulated products or activities; or
(3) To an employer, about a member of the employer's workforce, if Western Home Communities has provided health care to the member at the employer's request, concerning a work-related illness or injury or a workplace-related medical surveillance, in order for the employer to comply with its legal obligations.
Such disclosures may be made without your authorization or without providing you with an opportunity to agree or object.
Disclosures for Health Oversight Activities
We may disclose your protected health information to a health oversight agency for oversight activities authorized by law, such as audits, inspections, or investigations, conducted for the purpose of overseeing the health care system, government health benefit programs, other government regulatory programs for which health information is necessary to determine compliance with program standards, or entities subject to civil rights laws for which health information is necessary for determining compliance with the laws. Such disclosures may be made without your authorization or without providing you with an opportunity to agree or object.
Disclosures to Coroners and Funeral Directors and Organ Procurement Organizations
We may disclose your protected health information to a coroner or medical examiner for identification purposes, to determine cause of death, or to carry out other duties authorized by law. We may also disclose your protected health information to funeral directors or persons responsible for transporting deceased individuals, in accordance with law, as necessary to carry out their duties. A disclosure to a funeral director may be made prior to, and in reasonable anticipation of, death. If you are a donor, your protected health information may be used or disclosed for cadaveric organ, eye, or tissue donation purposes. Such disclosures may be made without your authorization or without providing you with an opportunity to agree or object.
Disclosures for Research Purposes
We may use or disclose your protected health information for authorized research purposes, provided that the researcher adheres to certain privacy practices, including obtaining approvals from an authorized Privacy Board or an Institutional Review Board. Your protected health information may be used for research purposes only if the researcher is collecting information in preparing a research protocol, if the research occurs after your death, or you have authorized the use and disclosure of the information. Such disclosures may be made without your authorization or without providing you with an opportunity to agree or object.
Participation in experimental research requires your written informed consent, which consent may be combined in a written authorization to use or disclose your protected health information for the experimental research study.
Uses and Disclosures to Avert a Serious Threat to Health or Safety
We may use or disclose your protected health information if we believe the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public, and the disclosure is made to persons reasonably able to prevent or lessen the threat. Such uses and disclosures may be made without your authorization or without providing you with an opportunity to agree or object.
Uses and Disclosures for Specialized Government Functions
(1) Military Activities. If you are a member of the armed forces, we may use and disclose your protected health information as required by military command authorities. We may also use and disclose protected health information about foreign military personnel as required by the appropriate foreign military authority. Such uses and disclosures may be made without your authorization or without providing you with an opportunity to agree or object.
(2) National Security and Intelligence Activities. We may disclose your protected health information to authorized federal officials conducting lawful intelligence, counter-intelligence, and other national security activities authorized by law.
(3) Protective Services for the President and Others. We may disclose your protected health information to authorized federal officials providing protective services to authorized persons, including the President or foreign heads of state, or in connection with conducting authorized investigations.
(4) Correctional Institutions and Other Law Enforcement Custodial Situations. We may disclose to a correctional institution or a law enforcement official with lawful custody of an inmate necessary protected health information about the individual, provided that the individual has not been released on parole, probation, supervised release, or otherwise is no longer in lawful custody.
Such uses and disclosures may be made without your authorization or without providing you with an opportunity to agree or object.
Disclosures for Workers' Compensation
We may disclose your protected health information as authorized to comply with laws relating to workers' compensation or other similar legally established programs that provide benefits for work-related injuries or illness. Such uses and disclosures may be made without your authorization or without providing you with an opportunity to agree or object.
Uses and Disclosures for Appointment Reminders
We may use or disclose your protected health information to remind you about appointments.
Uses and Disclosures to Provide Information about Treatment Alternatives or Other Health-Related Benefits and Services
We may use or disclose your protected health information to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Uses and Disclosures for Fundraising Activities
We may use certain protected health information, limited to your contact information, such as your name, address, and telephone number and the dates you received treatment or services from us, for the purpose of contacting you to raise money for the facility. We may also disclose the same limited information to a business associate or a foundation related to Western Home Communities for the purpose of contacting you to raise money on our behalf.
Uses and Disclosures of Protected Health Information Requiring Your Written Authorization
Uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described in this Notice of Privacy Practices. You may revoke an authorization, at any time, in writing, except to the extent we have already taken an action in reliance on the use or disclosure indicated in the authorization.
More Stringent Laws
In some circumstances, your protected health information may be subject to other laws and regulations that afford greater protections than what is outlined in this Notice of Privacy Practices. For example, disclosure of information pertaining to HIV/AIDS related testing, substance abuse, and mental health information may be subject to more stringent standards than described here. In the event your protected health information is afforded greater protection under federal or state law, we will comply with the requirements of those laws.
YOUR RIGHTS
You have certain legal rights regarding your protected health information maintained by or for Western Home Communities.
Right of Access
You have the right to inspect and obtain a copy of your protected health information contained in a designated record set for as long as we maintain the information. A "designated record set" contains your clinical records, personal records, and financial records and other records used by us to make decisions about your health care. You do not have a right of access to information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, or to other protected health information prohibited by law from access. Any requests to inspect and obtain a copy of your protected health information may be made orally or in writing to our Privacy Official.
We may, in some instances, have the right to deny you access to your protected health information. If we deny you access, you have the right, under some circumstances, to have the denial reviewed by a licensed health care professional who did not participate in the original decision to deny. We will provide or deny access in accordance with the determination of the reviewing official, and promptly provide you with written notice of the reviewing official's determination.
Right to Amend Your Protected Health Information
You have the right to request that we amend your protected health information contained in a designated record set for as long as we maintain this information. Your request for an amendment to your protected health information must be submitted in writing to our Privacy Official and must provide a reason for the request. If we grant your request for an amendment, we will make the appropriate amendment to your protected health information in the designated record set and will notify appropriate parties of the amendment.
We may deny your request for amendment under certain circumstances permitted by law. If we deny your request for an amendment, we will provide you with a timely, written denial explaining the basis for our denial. If we deny your request for an amendment, you have the right to file a statement of disagreement with us. We may prepare a rebuttal to your statement of disagreement and, if we do so, will provide you with a copy of our rebuttal.
Right to Request a Restriction of Your Protected Health Information
You have the right to request restrictions on our use or disclosure of your protected health information for treatment, payment, or health care operations. You also have the right to restrict the protected health information that we disclose to a member of your family, another relative, a close personal friend, or any other person identified by you, who is involved in your health care or payment of your health care, or for notification purposes, as described in this Notice of Privacy Practices.
We are not required to agree to a restriction requested by you, except that while you are capable of making health care decisions, you may restrict disclosures to family members, relatives, or friends. If we agree to a requested restriction, we will comply with your request, except when the use or disclosure of your protected health information is needed to provide you with emergency treatment. We may terminate our agreement to a restriction when you agree or request the termination and the termination is properly documented, or when we inform you that we are terminating the restriction. We may not agree to a restriction that prevents uses or disclosures required by law.
Right to Receive Confidential Communications
You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests made to us in writing to our Privacy Official. We may condition our accommodation of your request upon receiving information from you, when appropriate, about how payment for treatment and services will be handled and specifying an alternative address or other method of contact. We will not require an explanation from you of the reasons for your request as a condition of providing communications to you on a confidential basis.
Right to Receive an Accounting of Disclosures
You have the right to receive an accounting of disclosures of your protected health information made by us to others in the six years prior to your request (or such shorter time period as requested by you). This right applies to disclosures for purposes other than treatment, payment, or health care operations and excludes, among others, disclosures made to you, disclosures made to your family members or friends involved in your care, disclosures of information contained in the facility directory, disclosures made for notification purposes, disclosures made pursuant to an authorization, and disclosures made prior to April 14, 2003. Your right to receive an accounting of disclosures is subject to certain exceptions, restrictions, and limitations.
To request an accounting of disclosures, you must submit a request in writing to our Privacy Official, stating a time period beginning after April 13, 2003, that is within six years from the date of your request. An accounting will generally include the following information: (1) the date of the disclosure; (2) the name and, if known, the address of the entity or person who received your protected health information; (3) a brief description of the protected health information disclosed; and (4) a brief statement of the purpose of the disclosure or a copy of the written request. In lieu of the information listed above, we may provide you with a summary instead, if the disclosures involved multiple similar disclosures. The first accounting provided to you within a 12-month period will be provided for free. We reserve the right to charge a reasonable, cost-based fee for each subsequent request made within the same 12-month period.
Right to Receive a Paper Copy of this Notice
You have a right to receive a paper copy of our Notice of Privacy Practices, even if you have agreed to receive the notice electronically. You may request a copy of our Notice of Privacy Practices at any time. You may also obtain a copy of our Notice of Privacy Practices at our web site at www.westernhomecommunities.org.
CHANGES TO THIS NOTICE
We will promptly revise and distribute our Notice of Privacy Practices whenever there is a material change to uses or disclosures, your rights, our legal duties, or other privacy practices stated in this notice. We reserve the right to change the terms of this notice and to make the new notice provisions effective for all protected health information maintained by us, including the protected health information created or received by us prior to the effective date of the new notice. We will post a copy of the current notice in a clear and prominent location in the facility, and will provide a copy of the revised notice to all of our residents upon request.
COMPLAINTS
If you believe that we have violated your privacy rights, you may file a complaint in writing with us or with the U.S. Department of Health and Human Services Office for Civil Rights. You may file a complaint with us by notifying our Privacy Official of your complaint. We will not retaliate against you for filing a complaint.
CONTACT INFORMATION
The responsibilities of the Privacy Official are carried out by the Administrator of the Elizabeth E. Martin Health Center. You may contact the Privacy Official if you have questions about your privacy rights, or to file a complaint about a violation of your privacy rights, by contacting the Privacy Official at 319-277-2141.
EFFECTIVE DATE
The effective date of this Notice of Privacy Practices is January 28, 2005.
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