NOTICE OF PRIVACY PRACTICES
EFFECTIVE DATE: APRIL 14, 2003
 
THIS NOTICE DESCRIBES HOW MEDICAL/HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY.

UNDERSTANDING YOUR HEALTH RECORD/INFORMATION:
We respect the privacy of your protected health information and are committed to maintaining our residents’ confidentiality.  This notice applies to all information and records related to your care that Carol Woods has received or created.  It extends to information received or created by: any independent health care professional who treats or cares for residents at Carol Woods and is authorized to enter information into your medical record; all departments and units of Carol Woods; all employees of Carol Woods; any volunteers we allow to help you while you are at Carol Woods; any vendors or independent contractors who have access to protected health information of residents at Carol Woods and all students or trainees.
Each time you visit a hospital, physician, or other healthcare provider, a record of your visit is made.  Typically, this record contains your symptoms, examination and test results, diagnoses, treatment and a plan for future care or treatment.  This information, often referred to as your health or medical record, serves as a:

• Basis for planning your care, services, and treatment;
  
• Means of communicating among the many health professionals who contribute to your care;
  
• Legal document describing the care you received;
  
• Means by which you or a third-party payer can verify that services billed were actually provided;
  
• Tool in educating health professionals;
  
• Source of data for medical research;
  
• Source of information for public health officials charged with improving the health of the nation;
  
• Source of data for facility planning and marketing;
  
• Tool with which the provider can assess and continually work to improve the care rendered and the outcomes achieved.
  

Understanding what is in your health record and how your health information is used helps you to:

• Ensure its accuracy;
  
• Better understand who, what, when, where, and why others may access your health information;
  
• Make more informed decisions when authorizing disclosure to others.
  
  

YOUR HEALTH INFORMATION RIGHTS:
Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you.  You have the right to:

• Request a restriction on certain uses and disclosures of your health information as provided by 45 CFR 164.522.  This means you may ask us not to use or disclose any part of your health information for the purposes of treatment, payment, or healthcare operations.  You may also request that any part of your 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.  Your request may be made orally or in writing to the Carol Woods’ Privacy Officer, and must state the restriction requested and to whom you want the restriction to apply.  Carol Woods will carefully consider every request for restriction, but is not required to agree to a restriction that you may request.  The aforementioned regulatory requirement applies unless superceded by other more stringent regulatory requirements..
  
• Obtain a paper copy of this Notice of Privacy Practices upon request.  This means you may request a paper copy, even if you have received this notice electronically.
  
• Inspect and obtain a copy of your health record as provided for in 45 CFR 164.524.  Except as otherwise provided in 164.524, you may inspect and obtain a copy of your health information that is contained in a designated record set for as long as Carol Woods maintains the health information.  To inspect and obtain a copy of your health record, contact the Carol Woods’ Privacy Officer.  The aforementioned regulatory requirement applies unless superceded by other more stringent regulatory requirements.
  
• Amend your health record as provided in 45 CFR 164.526.  This means you may request an amendment of clinical/health information about you in a designated record set for as long as Carol Woods maintains this information.  This request must be in writing to the attention of the author of the clinical/health information.  The Request For Amendment Of Health Information form must be used for all requests for an amendment.  In certain cases, Carol Woods may deny your request for an amendment.  If your request for amendment is denied, you have the right to file a statement of disagreement with Carol Woods.  Carol Woods may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.  Please contact the Carol Woods’ Privacy Officer if you have questions about amending your medical record.
  
• Obtain an accounting of disclosures of your health information as provided in 45 CFR 164.528.  This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this notice.  It excludes disclosures: a) Carol Woods may have made to you, b) for a facility directory/resident roster, and c) to family members or others involved in your care for notification purposes.  You have the right to receive specific information regarding these disclosures that occur after April 14, 2003.  The right to receive this information is subject to certain exceptions, restrictions and limitations.  Address your request to obtain an accounting of disclosures to the attention of the Carol Woods’ Privacy Officer.
  
• Request confidential communications of your health information by alternative means or at alternative locations.  This means a health care provider must permit individuals to request and must accommodate reasonable requests by individuals to receive communications of protected health information from the provider by alternative means or at alternative locations.  Please make this request in writing to the Carol Woods’ Privacy Officer.
  
• Revoke your authorization to use or disclose health information except to the extent that action has already been taken as provided in 45 CFR 164.508.  This means an individual may revoke an authorization at any time, provided that the revocation is in writing, except to the extent that action has already been taken.
  

CAROL WOODS’ RESPONSIBILITIES:
Carol Woods is required to:

• Maintain the privacy of your protected health information (PHI);
  
• Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you;
  
• Abide by the terms of this notice;
  
• Notify you if we are unable to agree to a requested restriction; and
  
• Accommodate reasonable requests you make to communicate confidential health information by alternative means or at alternative locations.
  

Notice of Privacy Practices Availability:  This notice will be prominently posted in the following designated areas within the campus:  Carol Woods Clinic B4, Carol Woods Health Center B4, Assisted Living B5, B6 and B7.  Residents will be provided a paper copy of this initial notice.  This notice will also be available on the Carol Woods Web site www.carolwoods.org for downloading.

Revision of Notice of Privacy Practices:  Carol Woods reserves the right to change privacy practices and to make the new provisions effective for all protected health information (PHI) we maintain.  Should our privacy practices change, the Carol Woods’ Privacy Officer will place an article in the Friday Memo, and provide you with a paper copy of the revised notice upon request.  Carol Woods will post the revised notice in the designated areas within the campus as listed above, and will post the revised notice on the Carol Woods Web site for downloading.
Carol Woods will not use nor disclose your health information without your authorization, except as described in this notice.

FOR MORE INFORMATION OR TO REPORT A PROBLEM:
If you have questions and would like additional information, you may contact the Carol Woods’ Privacy Officer.
If you believe your privacy rights have been violated, you can file a complaint with the Carol Woods’ Privacy Officer or with the Secretary of Health and Human Services.  There will be no retaliation for filing a complaint.

CAROL WOODS WILL USE AND DISCLOSE YOUR MEDICAL/HEALTH INFORMATION FOR TREATMENT, PAYMENT AND HEALTHCARE OPERATIONS.

Some instances of this use and disclosure are:
For Treatment:   As an example, information obtained by a nurse, physician, nurse practitioner, or other member of your healthcare team will be recorded in your record and used to determine the course of treatment/services that should work best for you.  Your physician will document in your record his or her expectations of the members of your healthcare team.  Members of your healthcare team will then record the actions they took and their observations.  In that way, the physician will know how you are responding to treatment.  We will also provide your physician or a subsequent healthcare provider with copies of various reports that should assist him or her in treating you.

For Payment:  As an example, a bill may be sent to you or a third-party payer.  The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and medical supplies used.

For Regular Healthcare Operations:  As an example, information in your health record may be used to assess the care and outcomes in your case and others like it.  This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and services Carol Woods provides.  Quality improvement monitoring and audit functions, include but are not limited to the following positions:  Medical Director, members of the Quality Assurance Committee, members of the interdisciplinary care plan team, Medical Records Coordinator, Pharmacy Consultant, members of the Orange County Nursing Home Advisory Committee.

To Business Associates:  There are some services provided at Carol Woods through contracts with Business Associates.  Examples include hospital, physician, laboratory, and pharmacy services.  When the services are contracted, Carol Woods may disclose your health information to Business Associates so that they can perform the needed service(s) and bill you or your third-party payer for services rendered.  In other cases, Business Associates may have access to your health information due to the proximity of health information to their work.  To protect your health information, however, Carol Woods requires each Business Associate to safeguard your information appropriately through a Business Associate Agreement.

For Facility Directory and Resident Rosters:  Unless you notify the Carol Woods’ Privacy Officer that you object; we will use your name, apartment number, and telephone extension for the purpose of maintaining Carol Woods’ Directory and for Carol Woods Resident Rosters for our licensed buildings B4, B5, B6, and B7.  This information may be provided to people who ask for you by name.

For Notification Purposes:  Unless you notify the Carol Woods’ Privacy Officer that you object, we may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition.

For Communication with Family:  Unless you notify the Carol Woods’ Privacy Officer that you object, healthcare professionals, using their best judgment, may disclose to a family member, close personal friend, or any other person whom you identify; health information relevant to that person’s involvement in your care or payment related to your care.
For Clinic and Health Center Operations:  Unless you notify the Carol Woods Privacy Officer that you object, we may disclose your health information to students or trainees from schools of medicine, nursing or other allied health professions, who are seeing you in conjunction with your primary physician, nurse practitioner, or other licensed healthcare professional.  We may use a sign-in sheet in the Carol Woods Clinic in Building 4, and ask you to sign your name.  We may also call you by name in the waiting room.  We may use or disclose your health information as necessary to contact you for appointments or information about treatment alternatives or other health-related services.

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

To a Funeral Director:  We may disclose health information to funeral directors consistent with applicable law to carry out their duties.
To an Organ Procurement Organization:  Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

For Marketing or Fund Raising:  We may disclose to the Carol Woods Residents Association demographic information for the purposes of marketing or fund raising.

To the Food and Drug Administration (FDA):  We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacement.

To Workers Compensation Programs:  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 established by law.

To Public Health Authorities:  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.

To Agencies Investigating Abuse or Neglect:  We may disclose 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.

To Agencies Responsible for Health Oversight:  We may disclose your health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections.

For Specialized Government Functions:  We may disclose PHI about you if it relates to military and veterans’ activities, national security and intelligence activities, protective services for the President, and medical suitability or determinations of the Department of State.

To Law Enforcement:  We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.  Federal law makes provisions for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.