PENACOOK PLACE NURSING AND REHABILITATION SERVICES

Notice of Privacy Practices

Effective April 14, 2003

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.

 

We respect the privacy of your personal health information and are committed to maintaining our residents’ confidentiality.  This notice  applies to all information and records related to your care that Penacook Place has received or created.  It extends to information received or created by our employees, staff, volunteers and physicians.  This Notice informs you about the possible uses and disclosures of your personal health information.  It also describes your rights and our obligations regarding your personal health information.

 

We are required by law to:

  • Maintain the privacy of your protected health information;
  • Provide to you this detailed Notice of our legal duties and privacy practices relating to your personal health information; and
  • Abide by the terms of the Notice that are currently in effect.

 

1.  WITH YOUR Acknowledgment of receipt of the Notice of Privacy Practices, WE MAY USE AND DISCLOSE YOUR PERSONAL HEALTH INFORMATION FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS

 

You will be asked to sign an acknowledgment allowing us to disclose your personal health information for purposes of treatment, payment and health care operations.  We have described these uses and disclosures below and provide examples of the types of uses and disclosures we may take in each of these categories.

 

For Treatment:  We will use and disclose your personal health information in providing you with treatment and services.  We may disclose your personal health information to Penacook Place and non-Penacook Place personnel who may be involved in your care, such as physicians, nurses, nurse’s aides, physical therapists and medical consultants.  For example, a nurse caring for you will report any change in your condition to your physician.  We also may disclose personal health information to individuals who will be involved in your care after you leave Penacook Place.

 

For Payment:  We may use and disclose your personal health information so that we can bill and receive payment for the treatment and service you receive at Penacook Place.  For billing and payment purposes, we may disclose your personal health information to your representative, 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 prior approval for a proposed treatment or service. 

 

For Health Care Operations:  We may use and disclose your personal health information for Penacook Place operations.  These uses and disclosures are necessary to manage Penacook Place and to monitor our quality of care.  For example, we may use personal health information to evaluate our Penacook Place’s services, including the performance of our staff. 


We may require that you sign a consent as described above as a condition of our providing treatment to you because the uses and disclosures of your personal health information are essential to our ability to care for you.

 

2.  WE MAY USE AND DISCLOSE PERSONAL HEALTH INFORMATION ABOUT YOU FOR OTHER SPECIFIC PURPOSES

 

Penacook Place Directory:  Unless you object, we will include certain limited information about you in the Penacook Place directory.  This information may include your name, your location in the Penacook Place, your general condition 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.

 

Individuals Involved in Your Care or Payment for Your Care:  Unless you object, we may disclose your personal health information to a family member or close personal friend, including clergy, who is involved in your care.

 

Disaster Relief:  We may disclose your personal health information to an organization assisting in  disaster relief effort.

 

As Required by Law:  We will disclose your personal health information when required by law to do so.

 

Public Health Activities:  We may disclose your personal health information for public health activities.  These activities may include, for example:

  • Reporting to a public health or other government authority for preventing or controlling disease, injury or disability or reporting abuse or neglect.
  • To notify a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition.

 

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 use and disclose your personal health information to notify a government authority if required or authorized by law or if you agree to the report.

 

Health Oversight Activities:  We may disclose your personal health information to a health oversight agency for oversight activities authorized by law.  These may include, for example, audits, investigations, inspections, and licensure actions or other legal proceedings.  These activities are necessary for government oversight of the health care system, government payment or regulatory programs and compliance with civil rights laws.

 

Judicial and Administrative Proceedings:  We may disclose your personal health information in response to a court or administrative order.  We also may disclose information in response to a subpoena, discovery request, or other lawful process; efforts must be made to contact you about the request or to obtain an order or agreement protecting the information.

 

Law Enforcement:  We may disclose your personal health information for certain law enforcement purposes, including:

  • As required by law to comply with reporting requirements;
  • To comply with a court order, subpoena, summons, investigative demand or similar legal process;
  • To identify or locate a suspect, fugitive, material witness, or missing person;
  • When information is requested about the victim of a crime if the individual agrees or under other limited circumstances;
  • To report information about a suspicious death;
  • To provide information about criminal conduct occurring at the Penacook Place;
  • To report information in emergency circumstances about a crime; or
  • Where necessary to identify or apprehend an individual in relation to a violent crime or an escape from lawful custody.

 

Research:  We may allow personal health information of patient form Penacook Place to be used or disclosed for research purposes provided that the researcher adheres to certain privacy protections.  Your personal health information may be used for research purposes only if the privacy aspects of the research have been reviewed and approved by a special Privacy Board or Institutional Review Board, if the researcher is collecting information in preparing a research proposal, if the research occurs after your death, or if you authorize the use or disclosure.

 

Coroners, Medical Examiners, Funeral Directors, Organ Procurement Organizations:  We may release your personal health information to a coroner, medical examiner, funeral director or, if you are an organ donor, to an organization involved in the donation of organs and tissues.

 

To Avert a Serious Threat to Health or Safety:  We may use and disclose your personal health information when necessary to prevent a serious threat to your health or safety  or the health or safety of the public or another person.  However, any disclosure would be made only to someone able to help prevent the threat.

 

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

 

Worker’s Compensation:  We may use or disclose your personal health information to comply with laws relating to workers’ compensation or similar programs.

 

National Security and Intelligence Activities:  Protective Service for the President and Others:  We may disclose personal 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. 

 

3.  USES AND DISCOSURES WITH YOUR AUTHORIZATION

 

Except as described in this notice, we will use and disclose your health information only with your written Authorization.  You may revoke an Authorization in writing at any time.  If you revoke an Authorization, we will no longer use or disclose your health information for the purposes covered by that Authorization, except where we have already relied on that Authorization.

 

4.  YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

 

Listed below are your rights regarding your health information.  These rights may be exercised by submitting a request to Penacook Place.  Each of these rights is subject to certain requirements, limitations, and exceptions.  At your request, Penacook Place will supply you with the appropriate form to complete.   You have the right to:

  • Request Restrictions.  You have the right to request restrictions on our use or disclosure of your personal health information for treatment, payment or health care operations.  You also have the right to restrict the personal health information we disclose about you to a family member, friend or other person who is involved in your care or the payment of your care.

 

We are required to agree to your requested restriction with respect to the release of your health information to any individual outside Penacook Place unless you are being transferred to another health care institution, the release of records is required by law, third party payment or to provide you with emergency care.

 

  • Access Personal Health Information:  You have the right to request, either orally or in writing, your medical billing records or other written information that may be used to make decisions about your care.  We must allow you to inspect your records within 24 hours of your request (except holidays and weekends).  If you request copies of the records, we must provide you with copies within two working days of that request.  We may charge you a reasonable fee consistent with state law in copying and mailing your requested information.

 

  • Request Amendment:  You have the right to request an amendment of your health information maintained by Penacook Place for as long as the information is kept by or for us.  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 Penacook Place, unless the originator of the information is no longer available to act on your request; (b) is not part of the health information maintained by Penacook Place; (c) is not part of the information to which you have the right of access; or (d) is already accurate and complete, as determined by Penacook Place.

 

If we deny your request for amendment, we will give you a written denial including the reasons for the denial and the right to submit a written statement disagreeing with the denial.

 

  • Request 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 Penacook Place or by others on your behalf, but this does not include disclosures for treatment, payment and health care operations or certain other exceptions.

 

To request the accounting of disclosures, you must submit a request in writing, stating the time period beginning after April 13, 2003 that is within six years from the date of your request.  The first accounting provided with a 12-month period will be free; for further requests, we may charge you our costs.

 

  • Request 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 this notice electronically. You may request a copy of this Notice at any time by speaking with our Business Office, the Director of Administrative Services or your Neighborhood Social Worker.
     

5.  CHANGES TO THIS NOTICE

 

We reserve the right to change this Notice and make the revised or new Notice provisions effective for all health information already received and maintained by Penacook Place as well as for all health information we receive in the future.   We will post a copy of the current Notice in the Recreation Room on the first floor of Penacook Place.  We will provide a copy of the revised notice upon request.
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