NOTICE OF PRIVACY PRACTICES

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.

WHO WILL FOLLOW THIS NOTICE.
This notice describes our center’s practices and that of:

1. All departments and units of the center.
2. Members of the center’s medical staff and any other healthcare professionals authorized to enter information into your center chart.
3. Any member of a volunteer group we allow to help you while you are in the center.
4. All employees, staff, and other center personnel.

OUR DUTIES REGARDING MEDICAL INFORMATION:
We understand that protected health information (“medical information”) about you is personal. We are committed to protecting medical information about you. This notice applies to all of the records of your care generated by the center, whether made by center personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your medical information created in the doctor’s office or clinic. This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of your medical information.

We are required by law to:

1. Maintain the privacy of your medical information.
2. Give you this notice of our legal duties and privacy practices regarding your medical information.
3. Follow the terms of this notice that is currently in effect.

WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU TO CARRY OUT TREATMENT, PAYMENT OR HEALTH CARE OPERATIONS.

The following categories describe different ways that we may use and disclose medical information about you to carry out treatment, payment or health care operations.

Treatment – We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students or other center personnel who are involved in taking care of you at the center. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments or consultative contracted services of the center also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work and x-rays. We also may disclose medical information about you to another health care provider so that the other provider can treat you. For example, we may disclose medical information about you to your doctor so that he can provide medical care to you.

Payment – We may use and disclose medical information about you so that the treatment and services you receive at the center may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan or insurance company information about skilled nursing and rehabilitation services received at the center so your health plan or insurance company will pay us or reimburse you for the care and services delivered. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. We also may disclose medical information about you to another health care provider, health plan or health care clearinghouse for the payment activities
of that other provider or entity. For example, we may disclose medical information about you to your doctor so that he may obtain reimbursement for the services which he has provided to you.

Health Care Operations – We may use and disclose medical information about you for center operations. These uses and disclosures are necessary to run the center and make sure that all of our residents receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical information about many center residents to decide what additional services the center should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, medical students and other center personnel for review and learning purposes. We may also combine the medical information we have with medical information from other centers to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific residents are. We also may disclose medical information about you to another health care provider, health plan or health care clearinghouse for the health care operations of that other provider or entity, if that other provider or entity either has or had a relationship with you. For example, we may disclose medical information about you to another center where you were treated for the quality assessment and improvement activities of the other center.

Organized Health Care Arrangement – An organized health care arrangement includes a clinically integrated care setting in which residents receive health care from more than one health care provider. A center is perhaps the most common example of a clinically integrated care setting, when a center and physicians with medical staff privileges at the center together provide treatment to residents. We may disclose medical information about you to another entity that participates with the center in
providing for your care. For example, we may disclose medical test results about you to your doctor so that he is able to treat you.

Appointment Reminders – We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at the center. We may contact you as a follow up after discharge to ensure resident safety and commitment to quality service.

Treatment Alternatives – We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you. For example, we may provide alternative treatment options or comfort care in lieu of aggressive or evasive treatment plans.

Health – Related Benefits and Services – We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.

WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU FOR A CENTER DIRECTORY AND TO GIVE INFORMATION TO INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE.

The following categories describe different ways that we may use and disclose medical information about you for a center directory and to give information to individuals involved in your care or payment for your care.

However, generally speaking, we must orally inform you of this and give you the opportunity to orally agree to or prohibit or restrict use and disclosure of medical information about you for these purposes. In certain situations, such as emergencies, your incapacity or disaster relief purposes, we do not have to inform you or give you an opportunity to agree or object to our use and disclosure of medical information about you for these purposes.

Center Directory – We may include certain limited information about you in the center directory while you are a resident at the center. This information may include your name, location in the center, your assigned physician, birthdate, and your religious affiliation. The directory information, except for your religious affiliation, may be released to people who ask for you by name. This is so your family, friends and clergy can visit you in the center and generally know how you are doing.

Individuals Involved in Your Care or Payment for Your Care – We may release medical information about you to a person who has been determined to be involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family or friends your condition and that you are in the center. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.

WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU WITHOUT YOUR WRITTEN AUTHORIZATION OR THE OPPORTUNITY FOR YOU TO ORALLY AGREE OR OBJECT IN CERTAIN SITUATIONS.

The following categories describe different ways that we may use and disclose medical information about you in certain situations without your written authorization or the opportunity for you to orally agree or object to the use and disclosure.

As Required By Law – We will disclose medical information about you when required to do so by federal, state or local law.

Public Health Activities – We may disclose medical information about you for public health activities. These activities include but are not limited to the following: reports to public health authorities for the purpose of preventing or controlling disease, injury or disability, including reporting such items and reporting deaths, and reports to the Food and Drug Administration.

Victims of Abuse, Neglect or Domestic Violence – We may disclose to a government authority medical information about a person whom we believe to be a victim of abuse, neglect or domestic violence.

Health Oversight Activities – We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Judicial and Administrative Proceedings – If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made by the person seeking the information to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement Purposes – We may release medical information about you to a law enforcement official under certain circumstances. These include, but are not limited to: a response to a court order, subpoena, warrant, summons or similar process; to identify or locate a suspect, fugitive, material witness, or missing person; to give information about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement; about a death we believe may be the result of criminal conduct; about criminal conduct at the center; and in emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.

Coroners, Medical Examiners and Funeral Directors – We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about residents of the center to funeral directors as necessary to carry out their duties.

To Avert a Serious Threat to Health or Safety – We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.

Workers’ Compensation – We may release medical information about you for workers’ compensation or similar programs that provide benefits for work-related injuries or illness.

All Other Purposes – Other uses and disclosures that are not mentioned above will be made only with your written authorization, and you may revoke this authorization in writing at any time, except for what we have already disclosed pursuant to your authorization.

YOU HAVE RIGHTS REGARDING YOUR MEDICAL INFORMATION.

You have the following rights regarding your medical information:

Right to Request Restrictions – You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. We are not required to agree to your request, except as provided in the next sentence in parentheses. (We must comply with your written request to restrict the use and disclosure of your record to a health plan for the purpose of carrying out payment or health care operations when you pay the out-of-pocket treatment fees in full at the time that the service is rendered.) If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions regarding your medical information from the center you must make your request in writing to the Facility Administrator. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse. We have the right to terminate restrictions that we have agreed to.

Right to Request Confidential Communications – You have the right to request that we communicate with you about medical matters 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 from the center you must make your request in writing to the Facility Administrator. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Right to Inspect and Copy – You have the right to inspect and copy your medical information. Usually, this includes medical and billing records. To inspect and copy medical information from the center you must submit your request in writing to the Health Information Coordinator. Forms are available at the Reception desk for purpose and detail of the record request. 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 in certain circumstances. If you are denied access to medical information, in most situations you may request that the denial be reviewed. If we deny your request and if you have the right of review, another licensed health care professional chosen by the center or other entity which denied your request will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review. If the Center uses or maintains an electronic health record, you have the right to obtain your records. We will provide the record to you as a PDF file emailed to you through encrypted email.  You also may choose to direct us to submit the record directly to a third party that you specifically designate in writing. We may charge a fee for the copying the record and supplies if you request that the copy be provided to a third party.

Right to Amend – If you feel that medical information 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 the center or other entity. To request an amendment from the center you must provide 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:

1. Was not created by us, unless the person or entity that created the information is no longer available to make the amendment.
2. Is not part of the medical information kept by or for us.
3. Is not part of the information which you would be permitted to inspect and copy.
4. Or, is accurate and complete.

Right to a Paper Copy of This Notice – You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. You may contact the Facility Administrator. If you are currently a resident at the center, you may ask your nurse to assist you in obtaining this copy. You may obtain a copy of this notice at our website, www.colonialhr.com/Privacy-Practices.

CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the center. The notice will contain the effective date on the first page.

COMPLAINTS: CONTACT INFORMATION
If you have a complaint, you may file it with the center if it is applicable to the center. If you want to file a complaint with us or need further information from us about the matters covered by this notice, you may contact the Social Service Director by calling (860) 564-4081, or by mail (at 16 Windsor Avenue, Plainfield, CT 06374). All complaints must be submitted in writing. You will not be retaliated against for filing a complaint.