Asbury
Communities, Inc.
Notice of Privacy Practices
Effective: April 14, 2003
PREFACE
Asbury Communities, Inc. and its affiliated organizations (“we,” “us” or “Asbury”)
are committed to maintaining the privacy and security of resident and associate
health information. Below is a detailed Notice of Privacy Practices which
identifies our obligation with respect to our obligations to protecting health
information. Each affiliate also maintains a similar, but separate, Notice of
Privacy Practices (see affiliate Home Page for a copy of its 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.
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 our facility 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.
I. 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 have described these uses and disclosures below and provide examples of the
types of uses and disclosures we may make 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 facility and non-facility personnel who may be involved in your
care, such as physicians, nurses, nurse aides, and physical therapists. 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 the facility.
For Payment. We may use and disclose your personal health information so that we
can bill and receive payment for the treatment and services you receive at the
facility. For billing and payment purposes, we may disclose your personal health
information to your representative, an insurance or managed care company, to
confirm your coverage or to request prior approval for a proposed treatment of
service.
For Health Care Operations. We may use and disclose your personal health
information for facility operations. These uses and disclosures are necessary to
manage the facility and to monitor our quality of care. For example, we may use
personal health information to evaluate our facility’s services, including the
performance of our staff.
II. WE MAY USE AND DISCLOSE PERSONAL HEALTH INFORMATION ABOUT YOU FOR OTHER
SPECIFIC PURPOSES
Facility Directory. Unless you object, we will include certain limited
information about you in our facility directory. This information may include
your name, your location in the facility, and 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 a 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;
• Reporting to the federal Food and Drug Administration (FDA) concerning adverse
events or problems with products for tracking products in certain circumstances,
to enable product recalls or to comply with other FDA requirements;
• To notify a person to who may have been exposed to a communicable disease or
may otherwise be at risk of contracting or spreading a disease or condition; or
• For certain purposes involving workplace illness or injuries.
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 my disclose
information in response to a subpoena, discovery request, or other lawful
process; efforts must be made to contact you abut 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, warrant, 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 facility;
• 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 residents from our
facility 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 tissue.
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.
Workers’ 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 Services 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.
Fundraising Activities. We may use certain personal health information to
contact you in an effort to raise money for the facility and its operations. We
may disclose personal health information to a foundation related to the facility
so that the foundation may contact you in raising money for the facility. In
doing so, we would only release contact information, such as your name, address
and phone number and the dates you received treatment or services at the
facility.
Appointment Reminders. We may use or disclose personal health to remind you
about appointments.
Treatment Alternatives. We may use or disclose personal health information to
inform you about treatment alternatives that may be of interest to you.
Health-Related Benefits and Services. We may use or disclose personal health
information to inform you about health-related benefits and services that may be
of interest to you.
III. YOUR AUTHORIZATION IS REQUIRED FOR OTHER USES OF PERSONAL HEALTH
INFORMATION
We will use and disclose personal health information (other than as described in
this Notice or required by law) only with your written Authorization. You may
revoke your Authorization to use or disclose personal health information in
writing, at any time. If you revoke your Authorization, we will no longer use or
disclose your personal health information for the purposes covered by the
Authorization, except where we have already relied on the Authorization.
IV. YOUR RIGHTS REGARDING YOUR PERSONAL HEALTH INFORMATION
You have the following rights regarding your personal health information at the
facility:
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 for your care.
We are not required to agree to your requested restriction (except that while
you are competent you may restrict disclosures to family members or friends). If
we do agree to accept your requested restriction, we will comply with your
request except as needed to provide you emergency treatment.
Right of Access to Personal Health Information. You have the right to request,
either orally or in writing, your medical or 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. If you request
copies of the records, we must provide you with copies within 2 days of that
request. We may charge a reasonable fee for our costs in copying and mailing
your requested information.
We may deny your request to inspect or receive copies in certain limited
circumstances. If you are denied access to personal health information, in some
cases you will have a right to request review of the denial. This review would
be performed by a licensed health care professional designated by the facility
who did not participate in the decision to deny.
Right to Request Amendment. You have the right to request the facility to amend
any personal health information maintained by the facility for as along as the
information is kept by or for the facility. You must make your request in
writing and must state the reason for the requested amendment.
We may deny your request for amendment if the information
• was not created by the facility, unless the originator of the information is
no longer available to act on our request;
• is not part of the personal health information maintained by or for the
facility;
• is not part of the information to which you have a right of access; or
• is already accurate and complete, as determined by the facility.
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.
Right to an Accounting of Disclosures. You have the right to request an
“accounting” of our disclosures of your personal health information. This is a
listing of certain disclosures of your personal health information made by the
facility or by others on our behalf, but does not include disclosures for
treatment, payment and health care operations or certain other exceptions.
To request an accounting of disclosures, you must submit a request in writing,
stating a time period beginning after April 13, 2003 that is within six years
from the date of your request. An accounting will include, if requested: the
disclosure date; the name of the person or entity that received the information
and address, if known; a brief description of the information disclosed; a brief
statement of the purpose of the disclosure or a copy of the authorization or
request; or certain summary information concerning multiple similar disclosures.
The first accounting provided within a 12-month period will be free; for the
further requests, we may charge you our costs.
Right to 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.
Right to Request Confidential Communications. You have the right to request that
we communicate with you concerning personal health matters in a certain manner
or at a certain location. For example, you can request that we contact you only
at a certain phone number. We will accommodate your reasonable requests.
V. COMPLAINTS
If you believe that your privacy rights have been violated, you may file a
complaint in writing with the facility or with the Office of Civil Rights in the
U.S. Department of Health and Human Services. To file a complaint with the
facility, contact the Hotline at 1-877-455-7827. This Hotline, which may be used
anonymously, operates 24 hours a day, 7 days per week (excluding holidays).
VI. CHANGES TO THIS NOTICE
We will promptly revise and distribute this Notice whenever there is a material
change to the uses or disclosures, your individual rights, our legal duties, or
other privacy practices stated in this Notice. We reserve the right to change
this Notice and to make the revised or new Notice provisions effective for all
personal health information already received and maintained by the facility as
well as for all personal health information we receive in the future. We will
post a copy of the current Notice in the facility. In addition, we will provide
a copy of the revised Notice to all residents. This copy will either be mailed
or hand delivered to you or your representative.
VII. JOINT NOTICE
This notice also covers and applies to our affiliated health care providers,
such as the medical staff, for services they provide in our facilities.
VIII. FOR FURTHER INFORMATION
If you have any questions about this Notice or would like further information
concerning your privacy rights, please contact the facility Administrator or
Executive Director or the Compliance Officer at 301-250-2032.