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Privacy

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.

Centre Crest has a legal and ethical obligation to preserve the confidentiality of its residents, staff, business partners, and business data. Privacy and confidentiality practices are strictly followed to ensure Protected Health Information is carefully managed and disseminated appropriately. This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment, or health care operations and for other purposes permitted or required by law. It also describes your rights to access and control your protected health information. "Protected Health Information" is information about your past, present, or future physical or mental health, related health care services, and demographic information. We are required, by law, to provide you with this information.

We are required to follow the terms of this Notice of Privacy Practices. We may change our notice at any time. The new notice will be effective for all protected health information we maintain at that time. We will post the Notice of Privacy Practices or any revised version near the Administrative offices. We will send any revised notice with the monthly account statements.

Uses and Disclosures of Protected Health Information

We will gather and create information about your past, present, or future physical or mental health, related health care services, and demographic information. The information will be used for the purposes of treatment, payment of services, and the operation of Centre Crest. Your information will be shared with our staff on a need to know basis. Staff are limited to resident information based on the work they perform and the area they are assigned to work. Staff will be given the minimum necessary information to successfully complete their job. Your information may be disclosed to other care providers, not on Centre Crest staff, involved in your care. This could include Physical Therapists, Dieticians, Pharmacists, other medical providers etc. for the purpose of providing health care services to you. Your health care information may be disclosed to pay your health care bills and to support the operation of Centre Crest.

Following are examples of the types of uses and disclosures of your protected health care information Centre Crest is permitted to disclose. These are not meant to be exhaustive, but to describe the types and uses and disclosures that may be made.

Treatment: We will gather and record your health information in your chart to be used by your doctors, nurses, therapists, and other care givers. We will use and disclose your protected health information to provide and coordinate your health care and related services. For example, doctors, specialists, therapists, or other healthcare professionals who may be treating you will have access to the information in your chart for treatment purposes. Information in your chart will be given to other medical facilities such as a hospital, laboratory, or pharmacy if they are involved in your care.

Payment: Your protected health information will be used, as needed, to obtain payment for healthcare services. This may include preauthorization of service, making determinations of eligibility or coverage for insurance benefits, reviewing services provided to you, and utilization review. For example, protected health information may be shared with your health plan so they can pre-approve procedures and/or make payments.

Healthcare Operations: We may use or disclose, as needed, your protected health information to support the business activities of Centre Crest. These activities include, but are not limited to, quality assessment activities, regulatory review activities, and training of students studying to enter the healthcare field.. For example, we may share your health information with RN students as part of their training, your name and room number will be on our facility directory unless you tell us otherwise, and you medical record may be reviewed so our staff can assure you received quality care.

Business Associates: We may share your protected health information with third party " business associates" that perform various services for Centre Crest such as medical equipment suppliers, and financial and legal services.

Communication with your Designated Representative: We may use or disclose information to notify or assist in notifying your personal representative(s) of your location, care, and condition. If we are unable to contact your personal representative(s), we may leave a message on their answering machine asking them to contact us.

Other Uses: Business Associates are bound to maintain the confidentiality of your health information. We may use or disclose your protected health information, as necessary, to arrange appointments with specialists or other healthcare providers. We may also use and disclose your protected health information for sending you a Centre Crest newsletter. You may contact our Privacy Officer to request that these materials not be sent to you. We will obtain your written permission before using your photograph, name, and protected health information in brochures, advertisements, or other forms of marketing.

Protected Health Information is maintained in a locked cabinet or room with the exception of the current medical chart. The current medical chart is kept in the nurses station. Only nursing staff and medical professionals and housekeeping staff are permitted in this area. Staff access to protected health information is based upon their position at Centre Crest. Protected health information is maintained by Centre Crest for seven years. A dedicated fax line is used to fax Protected health Information that is urgently needed. Staff are trained to follow appropriate fax procedures to insure the information is faxed to the correct person.

Uses and Disclosures of Protected Health Information Based upon Your Written Authorization Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization, at any time, in writing. Centre Crest will not release any information after receiving your revocation. Centre Crest may have released information prior to receiving your revocation.

Other Permitted and Required Uses and Disclosures That May Be Made With Your Consent, Authorization, or Opportunity to Object We may use and disclose your protected health information in the following instances. You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information.

Facility Directories: Unless you object, we will use and disclose in our facility directory your name and room number. Members of the clergy will be told your religious affiliation if they represent your denomination and you agree to be listed in the clergy directory.

Persons who ask about you by name, may be given you condition, in general terms, by the Registered Nurse. Your name and picture will be placed outside of you door, unless you ask us not to.

Others Involved in Your Healthcare: Unless you object, we may disclose to your personal representative(s), generally a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person's involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your health care.

Emergencies: We may use or disclose your protected health information in an emergency treatment situation. If this happens, we will try to obtain consent from you, or your designated representative as soon as reasonably practicable after the delivery of treatment.

Communication Barriers: We may use and disclose your protected health information if we attempt to obtain consent from you but are unable to do so due to substantial communication barriers, your responsible person can not be located, and it is determined, using professional judgement, that you intend to consent to use or disclosure under the circumstances.

Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object

We may use or disclose your protected health information in the following situations without your consent or authorization. These situations include:

Required By Law: We may use or disclose your protected health information to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. Disclosures of this type include but are not limited to information given to Funeral Directors, to report certain diseases to the appropriate agency,or in response to a subpoena.

Public Health: We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your protected health information, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority.

Health Oversight: We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies such as the Department of Health and the Office on Aging that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.

Abuse or Neglect: We may disclose your protected health information to a public health authority that is authorized by law to receive reports of resident abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws. Disclosures would typically be made to the Department of Health and Office on Aging.

Legal Proceedings and Law Enforcement: We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request, or other lawful process.

We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes. These law enforcement purposes include (1) legal processes and otherwise required by law, (2) limited information requests for identification and location purposes, (3) pertaining to victims of a crime or in the event that a crime occurs on the premises.

Coroners, Funeral Directors, and Organ Donation: We may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. We may disclose such information in reasonable anticipation of death. Protected health information may be used and disclosed for cadaveric organ, eye, or tissue donation purposes.

Criminal Activity: Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.

Military Activity and National Security: We may use or disclose protected health information of individuals who are Armed Forces personnel for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.

Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et. seq.

Your Rights

Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.

You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information. A "designated record set" contains medical and billing records and any other records that Centre Crest uses for making decisions about you.

Under federal law, however, you may not inspect or copy the following records; psychotherapy notes and protected health information that is subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Officer if you have questions about access to your medical record.

You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.

Centre Crest is not required to agree to a restriction that you may request. A team consisting of the Medical Director, the Director of Medical Records, the Director of Nursing, and the Administrator will determine if your request will be granted. If the group believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. If they agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. You may request a restriction by completing a Request for Restriction of Protected Health Information Form and submitting it to the Director of Medical Records. S/he will forward the request to the Administrator.

Centre Crest will terminate the restriction if: a) You agree with the termination or request it in writing b) you orally agree to the termination and its is documented in writing c) Centre Crest informs you that we are terminating the agreement to a restriction.

You have the right to receive confidential communication from us by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or request another address or method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Privacy Officer.

You have the right to request amendment to your protected health information. This means you may request an amendment of protected health information about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. This process is to be used when the requestor believes that information in the designated record set is in error, not because there is a disagreement with a diagnosis, assessment, or objective description based upon a qualified healthcare providers professional judgement. Please contact our Privacy Officer to determine if you have questions about amending your medical record.

You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, for a facility directory, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures for six years prior to the date of the request or from the time the Disclosure Log of Protected Health Information was initiated. The right to receive this information is subject to certain exceptions, restrictions and limitations.

You have the right to obtain a paper copy of this notice from us. You can request a copy of this notice from the Privacy Officer, even if you have agreed to accept this notice electronically.

Complaints

You may complain to us or to the Office of Civil Rights if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Privacy Officer of your complaint. This complaint must be in writing on a form we will provide you.You may contact our Privacy Officer, Lynn Hall, HIM at (814) 355-6758 for further information or a form. We will not retaliate against you for filing a complaint.

If you have any questions about this Notice please contact our Privacy Officer at (814) 355-6758. Lynn Hall, HIM is the Privacy Officer.

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Resident's Signature Date

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Responsible Person's Signature Date Resident Name
This notice was published and becomes effective on April 1, 2003