NOTICE OF PRIVACY PRACTICES

THE FOLLOWING NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY.

Provident Group is providing this Notice of Privacy Practices because the privacy of your health information is important to you and to us and in compliance with federal regulations related to the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

                This Notice will describe how we use your health information within Provident Group facilities, and why.  This Notice will cover the uses and disclosures that require authorization and those that do not require an authorization from the resident or the resident representative.   Within this Notice, your rights regarding privacy will be detailed as well as the facility’s duties in protecting your health information.

For the purposes of this notice, “Health Information” refers to the information that we maintain that specifically identifies you and your health status.

Uses and Disclosures that Do Not Require Your Written Authorization

The facility uses or discloses your health information to carry out your treatment; to obtain payment for your treatment; and, to conduct healthcare operations.

•       For Treatment, your health information is used to plan, coordinate, and provide your care.  We disclose your health information for treatment purposes to physicians and other healthcare professionals who are involved in providing your care.
   

•       For Payment, your health information is used to prepare documentation required by your insurance company (i.e. Medicare, Medicaid, HMO, etc.)  We disclose that which is required for reimbursement for services provided in the delivery of your care.
   

•       For Healthcare Operations, your health information is used or disclosed for the purpose of evaluation and quality improvement.

Uses and Disclosures of Your Health Information to Which You May Object

The facility may use or disclose your health information for the following purposes, unless you make a request that the information not be disclosed.

•       Informing family and friends:  We may disclose your health information to family, friends, or others identified by you who are involved in your care.
   

•       Assistance in disaster relief efforts:  We may disclose your health information to disaster relief agencies to notify family members, friends, or others identified as caregivers of your location or condition.

Uses or Disclosures that Do Not Require Consent, Authorization, or an Opportunity for the Resident to Agree or Object

The facility may use of disclose your health information in the following circumstances without your written authorization where required or permitted as applicable.

•       Public Health Purposes:  control of disease, reports of abuse or neglect, reports of adverse events or defects concerning food or dietary supplements, tracking products for recalls or repairs, report of death
   

•       Abuse, Neglect, or Domestic Violence:  information regarding such situations that will protect the resident or others from serious harm will be reported to the appropriate government authority as required by law
   

•       Health Oversight Activities:  State and Federal licensure requirements or disciplinary actions; civil, administrative, or criminal investigations
   

•       Judicial and Administrative Proceedings:  information as required for court proceedings
   

•       Law Enforcement: information as required by law for special reporting requirements, court-ordered information, crime investigations

Uses or Disclosures that Require Your Written Authorization

Your written authorization, which may be revoked in writing, is required if the facility discloses your health information for any other purpose, in particular the disclosure of psychotherapy notes beyond treatment, payment, and healthcare operations. 

Your Rights as a Resident to the Privacy of Your Health Information

·         Right to Request Restrictions: You have the right to request restrictions on the facility’s uses and disclosures of your health information.  However, the facility may refuse to accept the restriction.

·         Right to Request Confidential Information: You have the right to request that we communicate with you confidentially with regard to your health information.

·         Right to Request Access to Your Health Information: You have the right to request access to your health information for inspection or to copy the information.

·         Right to Request an Amendment of Your Health Information: You have the right to request, in writing, that your health information be amended.  The facility may deny your request and, if so, you may request a review of the denial.

·         Right to Request an Accounting of Disclosures of Your Health Information: You have the right to request an accounting of the facility’s disclosures of your health information for purposes other than treatment, payment, and healthcare operations.  The facility is not required to account for information disclosed prior to April 14, 2003 or for more than six (6) years prior to the date of the request.

·         Right to Obtain a Copy of this Notice: If you received this Notice electronically, you have the right to receive a paper copy.

The Facility’s Duties in Protecting Your Health Information

·         The facility is required by law to maintain the privacy of every resident’s protected health information and to describe its duties and practices with respect to protected health information.

·         The facility is required to abide by the terms of this Notice.

·         The facility reserves the right to change the terms of this Notice and the make notice for new provisions for all protected health information maintained.  Any revisions made will be provided to residents as applicable.

Complaints Regarding Violation of Your Rights for Privacy of Health Information

You have the right to lodge a complaint regarding the misuse or improper disclosure of your health information.  You will not be retaliated against for filing a complaint. 

•       To file a complaint with the facility representative, contact the designated Privacy Liaison. 

 Contact Name:________________________________________

 Contact Phone Number:________________________________

      You may also file a complaint with the facility Privacy Officer, Mary DePietro, at 615-305-1182.

•       To file a complaint with the Secretary of Health and Human Services, submit a complaint in writing to:

Secretary of Health and Human Services
U. S. Department of Health and Human Services
200 Independence Avenue, S. W.
Washington, D.C. 20201
(www.hhs.gov)

For additional information, contact Mary DePietro, Vice President and Managing Director of Senior Living Services at 615-315-1182.