Each time you are admitted to our Facility, a record of your stay is made containing health and financial information. Typically, this record contains information about your condition, the treatment we provide, and payment for the treatment. We may use and/or disclose this information to:

  • Plan your care and treatment.
  • Means of communication among the many health professionals who contribute to your care.
  • Legal document describing the care that you received.
  • Means by which you or a third-party payer can verify that you actually received the services billed for.
  • Tool in medical education.
  • Source of information for public health officials charged with improving the health of the regions they serve.
  • Tool to assess the appropriateness and quality of care that you received.
  • Tool to improve the quality of health care and achieve better patient outcomes.

Understanding what is in your health records and how your health information is used helps you to–

  • Ensure its accuracy and completeness.
  • Understand who may access your health information.
  • Make informed decisions about authorizing disclosure to others.


For Treatment. We may use and disclose your health information to provide treatment to you. Our facility personnel (e.g., nurses, therapists, and others) will share your health information with each other in order to provide you with the appropriate treatment. For example, your nurses may need to tell the dietitian that you have diabetes so that she can plan your meals. We may also disclose your health information to health care providers outside our facility who are involved in your care. These include a variety of providers such as physicians (e.g. M.D., D.O., podiatrist, dentist, optometrist), therapists (e.g., physical therapists, occupational therapist, speech therapist), portable radiology units, clinical labs, hospice caregivers, pharmacies, psychologists, social workers, and medical equipment suppliers. For example, a doctor treating you for a broken leg needs to know if you have diabetes because diabetes may slow the healing process. We may disclose health information to those who may be involved in your care after you leave our facility. This may include home health nurses who will be providing care in your home.

For Payment. We may use and disclose health information about you so that the treatment and services you receive at this facility may be billed to you, a government program, an insurance company, or other third party payers. For example, in order to be paid, we may need to share information with your payer about services we provided to you. We may also discuss with payers a treatment that you are going to receive in order to obtain prior approval or to determine whether payers will cover the treatment. We may disclose health information to health plans or other health care providers for their payment activities.

For Health Care Operations. We may use and disclose health information about you for our day-to-day health care operations. This is necessary to ensure that all residents receive quality care. For example, we may use health information for quality assessment and improvement activities and for developing and evaluating clinical protocols. We may also combine health information about many residents to help determine what additional services we should offer, what services should be discontinued, and whether certain new treatments are effective. Health information about you may be used by our business office for business development and planning, cost management analyses, insurance claims management, risk management activities, and in developing and testing information systems and programs. We may also use and disclose information for professional review, performance evaluation, and for training programs. Other aspects of health care operations that may require use and disclosure of your health information include accreditation, certification, licensing and credentialing activities, review and auditing, including compliance reviews, medical reviews, legal services, and compliance programs. Your health information may be used and disclosed for the business management and general activities of the facility including resolution of internal grievances, customer service, and due diligence in connection with a sale or transfer of the facility. In limited circumstances, we may disclose your health information to another entity subject to HIPAA for its own health care operations. We may remove information that identifies you so that the health information may be used to study health care and health care delivery without learning the identities of residents. We may disclose your age, birth date, and general information about you in the facility newsletter, on activities calendars, and to entities in the community that wish to acknowledge your birthday or commemorate your achievements on special occasions or “Life Events”.

Your name will be posted beside your room door, on the outside cover of your medical record and affixed to assistive devices, wheelchairs and other personal items. Your name, diet, and seating requirements will be placed on dining room place cards and meal tray tickets. Your photograph will be placed in your medical charts and medication records. Additionally video stills and images may be used for promotion to the general public.


Business associates: We provide some services through contracts with business associates.
Examples include medical record consultants, pharmacy consultants and attorneys. When we use these services, we may disclose your health information to the business associates so that they can perform the function(s) that we have contracted with them to do and bill you or your third-party payer for services provided. To protect your health information, however, we require the business associates to appropriately safeguard your information.

Treatment Alternatives. We may use and disclose health information to tell you about possible treatment options or alternatives that may be of interest to you.

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

Facility Directory: Unless you notify us that you object, we will use your name, location in the facility, general condition, and religious affiliation for directory purposes. This information may be provided to members of the clergy and, such as a priest or rabbi, even if they don’t ask for you by name. This is so your family, friends, and clergy can visit you in the facility and generally know how you are doing.

Individuals Involved with Your Care or Payment for your care.
We may disclose health information about you to a close friend, family member or other relative, or any person you designate who is involved in your care or payment for your care. We may disclose health 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.


Although your health records are the physical property of the facility, you have the following rights with regard to the information contained therein:

Right to Inspect and Copy. You have the right to review and copy your health information, such as prescription and billing records. You must submit your request to the Facility Privacy Officer who may require that it be reduced to writing. We may charge a fee for the costs of copying, mailing or other supplies associated with your request.

Right to Amend. If you feel that health information in your record is incorrect or incomplete, you may ask us to amend the information. You have this right as long as the information is kept by or for the facility. (An amendment is not necessary to correct clerical errors.)

You must submit your request in writing on the form provided by the Facility Privacy Officer. In addition, you must provide a reason for 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:

  • Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
  • Is not part of the health information kept by or for the facility; or
  • Is accurate and complete

Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you. You may request that we limit the health information on the Facility Directory or that we limit disclosure to someone who is involved in your care or the payment for your care.

We are not required to agree to your request. If you agree, we will comply with your request unless the information is needed to provide emergency treatment.
You must submit your request in writing to the Facility Privacy Officer. 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.

Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is a list of certain disclosures we made of your health information other than those made for purposes such as treatment, payment, or health care operations, or pursuant to your authorization.

You must submit your request in writing to the Facility Privacy Officer. Your request must state a time period, which may not be longer than six (6) years from the date the request is submitted and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). Your first request within a 12-month period will be free. For additional lists, we may charge you the costs of providing the list. 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.

Right to Request Alternate Communications. You have the right to request that alternative methods be used to communicate with you regarding your Protected Health Information. For example, while you are a resident at our facility, you may request that we mail your billing statements to your son’s home address rather than providing them directly to you.

You must submit your request in writing to the Facility Privacy Officer. We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests.

Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice even if you have agreed to receive the Notice electronically. You may ask us to give you a copy of the Notice at any time.


Organ and Tissue Donation. If you are an organ donor, we may disclose health information to organizations that handle organ procurement to facilitate donation and transportation.

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

Research. We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.

Funeral Directors, Coroner, Medical Examiner. We may disclose health information to funeral directors consistent with applicable law to enable them to carry out their duties. And to a coroner or medical examiner as necessary to identify a deceased person or determine the cause of death.

Marketing/continuity of care: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Fundraising: We may contact you as a part of a fundraising effort. You have the right to request not to receive subsequent fundraising materials.

Food and Drug Administration (“FDA”): We may disclose to the FDA health information relative to adverse effects/events with respect to food, drugs, supplements, product or product defects, or postmarketing surveillance information to enable product recalls, repairs, or replacement.

Workers compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs that provide benefits for work-related injuries or illness.
Public Health Risks: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability, reporting births or deaths, reporting abuse or neglect or domestic violence if we believe a resident has been a victim, reporting reactions to medications or problems with a product and notifying people of product recalls.

Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena, about you, the victim of a crime, about a death we believe may be the result of criminal conduct, and about criminal conduct at the facility.

National Security and Intelligence Activities. We may disclose health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

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 heath 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 Facility. The Notices will specify the effective date. In addition, if material changes are made to this Notice, the Notice will contain an effective date for the revisions. Copies may be obtained by contacting the Facility Privacy Officer.

If you believe your privacy rights have been violated, you may file a complaint with the Facility or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with the Facility contact the Facility Privacy Officer. All complaints must be submitted in writing. You will not be penalized for filing a complaint.

Other uses and disclosures of health information not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission.

Effective date of this Notice is January 23, 2018, unless otherwise provided for in this Notice.