Notice of Privacy Information Practices

ST. JOSEPH MANOR HEALTH CARE, INC.

Effective date:  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. 

Please contact the Director of Human Resources at 508-583-5834 if you have any questions regarding this notice. 

A.                 General description and purpose of notice. 

This notice describes our information privacy practices and that of:

1.                  Any health care professional authorized to enter information into your medical record created and/or maintained at St. Joseph Manor; 

2.                  Any member of a volunteer group which we allow to help you while receiving services at St. Joseph Manor; and 

3.                  All St. Joseph Manor employees, staff, and other authorized facility personnel. 

All of the individuals or entities identified above will follow the terms of this notice.  These individuals or entities may share your PHI with each other for purposes of treatment, payment, or health care operations, as further described in this notice. 

B.            St. Joseph Manor's policy regarding your health information.

We are legally required and committed to preserving and protecting the privacy and confidentiality of your PHI created and/or maintained at St. Joseph Manor.  This health information, is information that could be used to identify you and is called “Protected Health Information” or PHI.  Certain state and federal laws and regulations require us to implement policies and procedures to safeguard the privacy of your health information.

This notice will provide you with information regarding our privacy practices and applies to all of your PHI created and/or maintained at St. Joseph Manor, 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 PHI and also describes your rights and our obligations regarding any such uses or disclosures.  We will abide by the terms of this notice, including any future revisions that we may make to the notice as required or authorized by law.  

We reserve the right to change this notice and to make the revised or changed notice effective for PHI we already have about you as well as any information we receive in the future.  The first page of the notice contains the effective date and any dates of revisions to this document.  We will post a copy of the current notice in St. Joseph Manor.   

C.                 Uses or disclosures of your health information. 

We may use or disclose your PHI in one of following ways: 

(1)               Pursuant to your written authorization (for purposes other than treatment, payment or health care operations)

(2)               Pursuant to your verbal agreement (for use in St. Joseph Manor directory or to discuss your health condition with family or friends who are involved in your care);

(3)               As permitted by law

(4)               As required by law 

The following describes each of the different ways that we may use or disclose your health information.  Where appropriate, we have included examples of the different types of uses or disclosures.  While not every use or disclosure is listed, we have included all of the ways in which we may make such uses or disclosures.  

1.                  How we may use or disclose your Protected Health Information. 

We may use or disclose your PHI for purposes of treatment, payment, or health care operations.  

a.                  Treatment.  We may use your PHI to provide you with health care treatment and services.  We may disclose your PHI to doctors, nurses, nursing assistants, medication aides, technicians, medical and nursing students, rehabilitation therapy specialists, or other personnel who are involved in your health care.  For example, your physician may order physical therapy services to improve your strength and walking abilities.  Our nursing staff will need to talk with the physical therapist so that we can coordinate services and develop a plan of care.  We also may disclose your PHI to people outside of St. Joseph Manor who may be involved in your health care, such as family members, social services, or home health agencies. 

i.                    Treatment alternatives, Health-related benefits and services. We may use or disclose your PHI for purposes of contacting you to inform you of treatment alternatives or health-related benefits and services that may be of interest to you. 

b.                  Payment.  We may use or disclose your PHI 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 St. Joseph Manor.  For example, we may need to give information to your health plan regarding the services you received from St. Joseph Manor so that your health plan will pay us or reimburse you for the services.  We also may tell your health plan about a treatment you are going to receive in order to obtain prior approval for the services or to determine whether your health plan will cover the treatment. 

c.                   Health care operations.  We may use or disclose your PHI to perform certain functions within St. Joseph Manor.  These uses or disclosures are necessary to operate our facility and to make sure that our residents receive quality care.  For example, we may use your PHI to review our treatment and services and to evaluate the performance of our staff in caring for you.  We may combine PHI about many of our residents to determine whether certain services are effective or whether additional services should be provided.  We may disclose your PHI to physicians, nurses, nursing assistants, medication aides, rehabilitation therapy specialists, technicians, medical and nursing students, and other personnel for review and learning purposes.  We also may combine PHI with information from other health care providers or facilities to compare how we are doing and see where we can make improvements in the care and services offered to our residents.  We may remove information that identifies you from this set of PHI so that others may use the information to study health care and health care delivery without learning the specific identities of our residents. 

i.                    Fundraising activities. We may use a limited amount of your PHI for purposes of contacting you to raise money for St. Joseph Manor and its operations.  We may disclose this PHI to a foundation related to the facility so that the foundation may contact you to raise money for St. Joseph Manor.  The information, which we may use or disclose, will be limited to your name, address, phone number, and dates for which you received treatment or services at St. Joseph Manor.   

ii.                  If you do not want St. Joseph Manor or affiliated foundation to contact you for these fundraising purposes, you must notify our Privacy Officer in writing at St. Joseph Manor, 215 Thatcher Street, Brockton, MA 02302-3999. 

2.                  Uses or disclosures made pursuant to your verbal agreement. 

We may use or disclose your health information, pursuant to your verbal agreement, for purposes of including you in the St. Joseph Manor directory or for purposes of releasing information to persons involved in your care as described below. 

a.                  Facility directory.  We may use or disclose certain limited PHI about you in the St. Joseph Manor directory while you are a resident at St. Joseph Manor.  This information may include your name, your assigned unit and room number, your religious affiliation, and a general description of your condition.  Your religious affiliation may 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.   

b.                  Individuals involved in your care.  We may disclose your PHI to individuals, such as family and friends, who are involved in your care or who help pay for your care.  We also may disclose your PHI 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.  

3.                  Uses or disclosures permitted by law. 

Certain state and federal laws and regulations either require or permit us to make certain uses or disclosures of your PHI 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: 

a.                  Public health activities.  We may use or disclose your PHI to public health authorities that are authorized by law to receive and collect PHI for the purpose of preventing or controlling disease, injury or disability.  We may use or disclose your PHI for the following purposes: 

i.                     To report births and deaths

ii.                   To report suspected or actual abuse, neglect, or domestic violence involving a child or an adult

iii.                  To report adverse reactions to medications or problems with health care products

iv.                 To notify individuals of product recalls

v.                   To notify an individual who may have been exposed to a disease or may be at risk for spreading or contracting a disease or condition 

b.                  Health oversight activities.  We may use or disclose your PHI 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.  These activities are necessary for the government to monitor the persons or organizations that provide health care to individuals and to ensure compliance with applicable state and federal laws and regulations. 

c.                   Judicial or administrative proceedings.  We may use or disclose your PHI to courts or administrative agencies charged with the authority to hear and resolve lawsuits or disputes.  We may disclose your PHI pursuant to a court order, a subpoena, a discovery request, or other lawful process issued by a judge or other person involved in the dispute, but only if efforts have been made to (i) notify you of the request for disclosure or (ii) obtain an order protecting your health information. 

d.                  Worker’s compensation.  We may use or disclose your PHI to worker’s compensation programs when your health condition arises out of a work-related illness or injury.   

e.                  Law Enforcement official.  We may use or disclose your PHI in response to a request received from a law enforcement official for the following purposes: 

i.                     In response to a court order, subpoena, warrant, summons or similar lawful process

ii.                   To identify or locate a suspect, fugitive, material witness, or missing person

iii.                  Regarding a victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement

iv.                 To report a death that we believe may be the result of criminal conduct

v.                   To report criminal conduct at St. Joseph Manor

vi.                 In emergency situations, to report a crime - the location of the crime and possible victims; or the identity, description, or location of the individual who committed the crime 

f.                    Coroners, medical examiners, or funeral directors.  We may use or disclose your PHI 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 PHI to a funeral director for the purpose of carrying out his/her necessary activities. 

g.                  Organ procurement organizations or tissue banks.  If you are an organ donor, we may use or disclose your PHI to organizations that handle organ procurement, transplantation, or tissue banking for the purpose of facilitating organ or tissue donation or transplantation.

h.                  Research.  We may use or disclose your PHI for research purposes under certain limited circumstances.  Because all research projects are subject to a special approval process, we will not use or disclose your PHI for research purposes until the particular research project for which your PHI may be used or disclosed has been approved through this special approval process.  However, we may use or disclose your PHI to individuals preparing to conduct the research project in order to assist them in identifying residents with specific health care needs who may qualify to participate in the research project.  Any use or disclosure of your PHI, which may be done for the purpose of identifying qualified participants will be, conducted onsite at St. Joseph Manor.  In most instances, we will ask for your specific permission to use or disclose your PHI if the researcher will have access to your name, address or other identifying information. 

i.                    To avert a serious threat to health or safety.  We may use or disclose your PHI when necessary to prevent a serious threat to the health or safety of you or other individuals.  Any such use or disclosure would be made solely to the individual(s) or organization(s) that have the ability and/or authority to assist in preventing the threat. 

j.                    Military and veterans.  If you are a member of the armed forces, we may use or disclose your PHI as required by military command authorities. 

k.                  National security and intelligence activities.  We may use or disclose your PHI to authorized federal officials for purposes of intelligence, counterintelligence, and other national security activities, as authorized by law.

l.                    Inmates.  If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may use or disclose your PHI to the correctional institution or to the law enforcement official as may be necessary (i) for the institution to provide you with health care; (ii) to protect the health or safety of you or another person; or (iii) for the safety and security of the correctional institution. 

4.                  Uses or disclosures required by law.   

We may use or disclose your information where such uses or disclosures are required by federal, state or local law. 

5.                  Uses or disclosures, which require your written authorization. 

We may use or disclose your PHI for purposes other than treatment, payment or health care operations or as described in this document and for purposes which are not required by law only after receiving your written authorization.  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 PHI for the purposes identified in the authorization.  You understand that we are unable to retrieve any disclosures that we may have made pursuant to your authorization prior to its revocation.  Some examples of uses or disclosures that may require your written authorization include the following:  

a.                   A request to provide your PHI to an attorney for use in a civil litigation claim. 

b.                  A request to provide your PHI for purposes of including you on a mailing list. 

D.        Your rights regarding your health information.

You have the following rights regarding your PHI, which we create and/or maintain: 

1.                  Right to inspect and copy.  You have the right to inspect and copy PHI that may be used to make decisions about your care.  Generally, this includes medical and billing records but does not include psychotherapy notes. 

To inspect and copy your health information, you must submit your request in writing to St. Joseph Manor’s HIPAA Privacy Officer.  If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request. 

We may deny your request to inspect and copy your PHI in certain limited circumstances.  If you are denied access to your health information, you may request that the denial be reviewed.  Another licensed health care professional selected by St. Joseph Manor will review your request and the denial.  The person conducting the review will not be the person who initially denied your request.  We will comply with the outcome of this review.

2.                  Right to request an amendment.  If you feel that the PHI 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 St. Joseph Manor. 

To request an amendment, your request must be made in writing and submitted to St. Joseph Manor’s Privacy Officer.  In addition, you must provide us with a reason that supports your request. 

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 

a.                   was not created by us, unless the person or entity that created the information is no longer available to make the amendment

b.                  is not part of the PHI kept by or for St. Joseph Manor 

c.                   is not part of the information which you would be permitted to inspect and copy 

d.                  is accurate and complete 

3.                  Right to an accounting of disclosures.  You have the right to request an accounting of the disclosures that we have made of your health information.  This accounting will not include disclosures of PHI that we made for purposes of treatment, payment, or health care operations or for disclosures we made that you authorized us to make. 

To request an accounting of disclosures, you must submit your request in writing to St. Joseph Manor’s Privacy Officer.  Your request must state a time period that may not be longer than six (6) years prior to the date of your request and may not include dates before April 14, 2003.  Your request should indicate in what form you want to receive the accounting (for example, on paper or via electronic means).  The first accounting that you request within a twelve (12)-month period will be free.  For additional accountings, we may charge you for the costs of providing the accounting.  We will notify you of the cost involved, and you may choose to withdraw or modify your request at that time before any costs are incurred. 

4.                  Right to request restrictions.  You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment, or health care operations.  You also have the right to request a limit on the PHI 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.  For example, you could ask that we not use or disclose information regarding a particular treatment that you received. 

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. 

To request restrictions, you must make your request in writing to St. Joseph Manor’s Privacy Officer.  In your request, you must tell us (a) what information you want to limit; (b) whether you want to limit our use, disclosure or both; and, (c) to whom you want the limits to apply (for example, disclosures to a family member). 

5.                  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. 

To request confidential communications, you must make your request in writing to St. Joseph Manor’s Privacy Officer.  We will not ask you the reason for your request.  We will accommodate all reasonable requests. 

Your request must specify how and or where you wish to be contacted.

 6.                  Right to a paper copy of this notice.  You have the right to receive a paper copy of this notice.  You may ask us to give you a copy of this Notice at any time.  Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

To obtain a paper copy of this notice, contact St. Joseph Manor’s Privacy Officer at:

St. Joseph Manor
215 Thatcher Street
Brockton, MA 02302

E.         Complaints. 

If you believe your privacy rights have been violated, you may file a complaint in writing, with St. Joseph Manor or with the Secretary of the Department of Health and Human Services (“HHS”) at 200 Independence Avenue, S.W., Washington, D.C 20201 or by sending HHS an e-mail at HHS.Mail@hhs.gov. 

To file a complaint with St. Joseph Manor, contact St. Joseph Manor’s Privacy Officer. 

NOTE:   All complaints must be submitted in writing. 

You will NOT be penalized for filing a complaint.