HEARTHSTONE ALZHEIMER CARE PRIVACY POLICY
At Hearthstone Alzheimer Care, we respect the confidentiality of your health information and will protect your information in a responsible and professional manner. The Health Information Portability and Accountability Act (HIPAA) requires us to maintain the privacy of your health information and to present you with this notice. This law went into effect on April 14, 2003. As further interpretation of this law is forthcoming, we may revise this notice. In the event that we revise this notice, we will post the revised version at all Hearthstone facilities and on our website. This notice explains how we use information about you and when we can share that information with others. It also informs you about your rights with respect to your health information and how you can exercise these rights.
When we talk about "information" or "health information" in this notice we mean the following:
Protected health information, as defined in the privacy rule at 45 CFR §
164.501
means individually identifiable health information:
(1) Except as provided in paragraph (2) of this definition, that is:
(i) Transmitted by electronic media;
(ii) Maintained in any medium described in the definition of electronic media
at § 162.103 of this subchapter; or
(iii) Transmitted or maintained in any other form or medium.
(2) Protected health information excludes individually identifiable health information
in:
(i) Education records covered by the Family Educational Right and Privacy Act,
as amended, 20 U.S.C. 1232g; and
(ii) Records described at 20 U.S.C. 1232g(a)(4)(B)(iv).
HOW WE USE OR SHARE INFORMATION
The following are ways we may use or share information about you:
We may share your information with your doctors or hospitals to help them provide
medical care to you. For example, if you are in the hospital, we may give them
access to any medical records.
We may use or share your information with others to help manage your health
care. For example, we might talk to your doctor to suggest a disease management
or wellness program that could help improve your health.
We may share your information with others who help us conduct our business operations.
We will not share your information with these outside groups unless they agree
to keep it protected. For example, for residents who participate in the Group
Adult Foster Care (GAFC) program, we will share this information with our billing
agency. We also may share information with our host, should you require a therapeutic
diet.
We may use or share your information for certain types of public health or disaster
relief efforts. For example, if the building had to be evacuated, we would share
this information with emergency personnel (police or fire department) who may
aid us in transporting residents to another location.
There are also state and federal laws that may require us to release your health information to others. We may be required to provide information for the following reasons:?
* We may report information to state and federal agencies that regulate us
such as the Executive Office of Elder Affairs and, if you are a participant
in the Group Adult Foster Care (GAFC) program, the Executive Office of Health
and Human Services Division of Medical Assistance.
* We may share information for public health activities.
* We may report information to public health agencies if we believe there is
a serious health or safety threat.
* We may share information with an oversight agency for certain oversight activities
(for example, audits, inspections, licensure, and disciplinary actions.)
* We may provide information to a court or administrative agency (for example,
pursuant to a court order, search warrant or subpoena).
* We may report information for law enforcement purposes. For example, we may
give information to a law enforcement official for purposes of identifying or
locating a suspect, fugitive, material witness or missing person.
* We may report information to a government authority regarding child abuse,
neglect or domestic violence.
* We may share information with a coroner or medical examiner to identify a
deceased person, determine a cause of death, or as authorized by law. We may
also share information to funeral director as necessary to carry out their duties.
* We may use or share information for procurement, banking or transplantation
of organs, eyes or tissue.
* We may share information relative to specialized government functions, such
as military and veteran activities, national security and intelligence activities,
and the protective services for the President and others.
If one of the above reasons does not apply, we must get your written permission to use or disclose your health information. If you give us written permission and change your mind you may revoke your written permission at any time. The request for revocation must be made in writing. Once you give us authorization to release your health information, we cannot guarantee that the person to whom the information is provided will not disclose the information.
WHAT ARE YOUR RIGHTS
The following are your rights with respect to your health information. If you
would like to exercise the following rights, please contact us in writing at
Hearthstone Alzheimer Care, Attn. Privacy Officer, 271 Lincoln Street, Suite
1, Lexington, MA 02421.
* You have the right to ask us to restrict how we use or disclose your information
for treatment, payment, or health care operations.
You also have the right to ask us to restrict information that we have been
asked to give to family members or to others who are involved in your health
care or payment for your health care. Please note that while we will try to
honor your request, we are not required to agree to these restrictions.
* You have the right to ask to receive confidential communications of information.
* You have the right to inspect and obtain a copy of information that we maintain
about you in your designated record set.
45 CFR 164.501 defines a "designated record set" as:
(1) A group of records maintained by or for a covered entity that is:
(i) The medical records and billing records about individuals maintained by
or for a covered health care provider;
(ii) The enrollment, payment, claims adjudication, and case or medical management
record systems maintained by or for a health plan; or
(iii) Used, in whole or in part, by or for the covered entity to make decisions
about individuals.
(2) For purposes of this paragraph, the term record means any item, collection,
or grouping of information that includes protected health information and is
maintained, collected, used, or disseminated by or for a covered entity.
However, you do not have the right to access certain types of information and
we may decide not to provide you with copies of the following information:
· contained in psychotherapy notes;
· compiled in reasonable anticipation of, or for use in a civil criminal
or administrative action
or proceeding; and
· subject to certain federal laws governing biological products and clinical
laboratories.
Additionally, in certain other situations, we may deny your request to inspect or obtain a copy of your information. If we deny your request, we will notify you in writing and may provide you with a right to have the denial reviewed.
You have the right to ask us to amend information we maintain about you in your designated record set. We may require that your request be in writing and that you provide a reason for your request. We will respond to your request no later than 60 days after we receive it. If we are unable to act within 60 days, we may extend that time by no more than an additional 30 days. If we need to extend this time, we will notify you of the delay and the date by which we will complete action on your request.
If we make the amendment, we will notify you that it was made. In addition, we will provide the amendment to any person that we know has received your health information. We will also provide the amendment to other persons identified by you.
If we deny your request to amend, we will notify you in writing of the reason for the denial. The denial will explain your right to file a written statement of disagreement. We have a right to rebut your statement. However, you have the right to request that your written request, our written denial and your statement of disagreement be included with your information for any future disclosures.
You have the right to receive an accounting of certain disclosures of your information made by us during the six years prior to your request.
Please note that we are not required to provide you with an accounting of the
following information:
· Any information collected prior to April 14, 2003.
· Information disclosed or used for treatment, payment, and health care
operations purposes.
· Information disclosed to you or pursuant to your authorization;
· Information that is incident to a use or disclosure otherwise permitted.
· Information disclosed for a facility's directory or to persons involved
in your care or other notification purposes;
· Information disclosed for national security or intelligence purposes;
· Information disclosed to correctional institutions, law enforcement
officials or health oversight agencies;
· Information that was disclosed or used as part of a limited data set
for research, public health, or health care operations purposes.
We may require that your request be in writing. We will act on your request for an accounting within 60 days. We may need additional time to act on your request, and therefore may take up an additional 30 days. Your first accounting will be free, and we will continue to provide to you one free accounting upon request every 12 months. However, if you request an additional accounting within 12 months of receiving your free accounting, we may charge you a fee. We will inform you in advance of the fee and provide you with an opportunity to withdraw or modify your request.
EXERCISING YOUR RIGHTS
You have a right to receive a copy of this notice upon request at any time.
You can also view a copy of the notice on our web site at www.thehearth.org.
Should any of our privacy practices change, we reserve the right to change the
terms of this notice and to make the new notice effective for all protected
health information we maintain. Once revised, we will provide the new notice
to you by direct mail and post it on our website.
If you have any questions about this notice or about how we use or share information,
please contact the Privacy Officer at Hearthstone's Home Office, Hearthstone
Alzheimer Care, 1-888-422-2273. That office is open Monday through Friday from
9:00 a.m. to 5:00 p.m. You can also send us questions by e-mail at privacy_officer@thehearth.org
.
If you believe your privacy rights have been violated, you may file a complaint with us by contacting the Privacy Officer at Hearthstone Alzheimer Care, 271 Lincoln Street, Suite 1, Lexington, MA 02421. All complaints must be submitted in writing. You may also notify the Secretary of the U.S. Department of Health and Human Services of your compliant.
We will not take any action against you for filing a compliant.
I, ____________________, resident/representative, have been issued a copy of Hearthstone's Privacy Policy and Disclosure Statement by Hearthstone Alzheimer Care. This notice describes how medical information about the resident may be used and disclosed and how the resident or their representative can get access to this information.
The privacy policy was prepared to help me to understand the resident's rights concerning his or her protected healthcare information (PHI).
I understand that I have the right to file a complaint regarding any privacy concerns or breach of privacy, with Hearthstone or with the Department of Health and Human Services. To file a complaint with Hearthstone, contact the privacy officer at Hearthstone Alzheimer Care, 271 Lincoln Street, Suite 1, Lexington, MA 02421. All complaints must be submitted in writing. I will NOT be penalized for filing a complaint.
_______________________________ ________________
Signature of Resident's Representative Date
Issued by: _________________________________ ________________
Signature of Hearthstone Representative Date