BARNWELL NURSING & REHABILITATION CENTER
Notice of Information 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.
Understanding Your Health Record Information
Barnwell maintains a health or medical record for each resident. This record
contains your symptoms, examination and test results, diagnosis, treatment, a
plan of care and other information relevant to your stay at the facility. This
information serves as a:
■ basis for planning your care and treatment
■ means of communication 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
■ a tool in educating health professionals
■ a source of data for medical research
■ a source of information for public health officials who oversee the delivery
of health care in the United States
■ a source of data for facility planning and marketing
■ a tool with which we can assess and continually work to improve the care we
render and the outcomes we achieve
Understanding what is in your 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, and make more informed decisions
when authorizing disclosure to others.
Our Responsibilities
Our nursing facility is required to:
■ maintain the privacy of your health information
■ 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
■ accommodate reasonable requests you may have to communicate health information
by alternative means or at alternative locations
We reserve the right to change our practices and to make the new provisions
effective for all protected health information we maintain. Should our
information practices change, we will mail you a revised notice.
We will not use or disclose your health information without your authorization,
except as described in this notice.
How We Will Use or Disclose Your Health Information
(1) Treatment. We will use your health information for treatment. For example,
information obtained by a nurse, physician or other member of your health care
team will be recorded in your record and used to determine the course of
treatment 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 once you’re discharged form our nursing facility.
(2) Payment. We will use your health information for payment. For example, a
bill may be sent to you or a third-party payer, including Medicare or Medicaid.
The information on or accompanying the bill may include information that
identifies you, as well as your diagnosis, procedures and supplies used.
(3) Health Care Operations. We will use your health information for regular
health operations. For example, members of the medical staff, the risk or
quality improvement manager or members of the quality improvement team may use
information in your health record 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 health care and service
we provide.
(4) Business Associates. There are some services provided in our organization
through contacts with business associates. Examples include our accountants,
consultants and attorneys. When these services are contracted, we may disclose
your health information to our business associates so that they can perform the
job we’ve asked them to do. To protect your health information, however, we
require the business associates to appropriately safeguard your information.
(5) Directory. Unless you notify us that you object, we may 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, except for religious affiliation, to other people who ask for you by name.
We may also use your name on a name plate next to or on your door in order to
identify your room, unless you notify us that you object.
(6) Notification. We may use or disclose information to notify or assist in
notifying a family member, personal representative or another person responsible
for your care, of your location and general condition. If we are unable to reach
your family member or personal representative, then we may leave a message for
them at the phone number that they have provided us, e.g., on an answering
machine.
(7) Communication with Family. Health professionals, using their best judgment,
may disclose to a family member, other relative, close personal friend or any
other person you identify, health information relevant to that person’s
involvement in your care or payment related to your care.
(8) 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.
(9) Funeral Directors. We may disclose health information to funeral directors
and coroners to carry out their duties consistent with applicable law.
(10) Organ Procurement Organizations. 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.
(11) Marketing. 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.
(12) Fund Raising. We may contact you as part of a fund-raising effort.
(13) 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.
(14) 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 established by law.
(15) Public Health. 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.
(16) Correctional Institution. Should you be an inmate of a correctional
institution, we may disclose to the institution or agents thereof health
information necessary for your health and the health and safety of other
individuals.
(17) Law Enforcement. We may disclose health information for law enforcement
purposes as required by law or in response to a valid subpoena.
(18) Reports. Federal law makes provision 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.
Your Health Information Rights
Although your health record is the physical property of the nursing facility,
the information in your health record belongs to you. Your have the following
rights:
■ You may request that we not use or disclose your health information for a
particular reason related to treatment, payment, the Facility’s general health
care operations and/or to a particular family member, other relative or close
personal friend. We ask that such requests be made in writing on a form provided
by our facility.
Although we consider your requests with regard to the use of your health
information, please be aware that we are under no obligation to accept it or to
abide by it. We will abide by your requests with regard to the disclosure of
your clinical and personal records to anyone outside of the facility, except in
an emergency, if you are being transferred to another health care institution,
or the disclosure is required by law.
■ If you are dissatisfied with the manner in which or the location where you are
receiving communications from us that are related to your health information,
you may request that we provide you with such information by alternative means
or at alternative locations. Such a request must be made in writing and
submitted to Medical Records. We will attempt to accommodate all reasonable
requests.
■ You may request to inspect and/or obtain copies of health information about
you, which will be provided to you in the time frames established by law. You
may make such requests orally or in writing; however, in order to better respond
to your request we ask that you make such requests in writing on our facility’s
standard form. If you request to have copies made, we will charge you a
reasonable fee.
■ If you believe that any health information in your record is incorrect or if
you believe that important information is missing, you may request that we
correct the existing information or add the missing information. Such requests
must be made in writing, and must provide a reason to support the amendment. We
ask that you use the form provided by our facility to make such requests. For a
request form, please contact Medical Records.
■ You may request that we provide you with a written accounting of all
disclosures made by us during the time period for which you request (not to
exceed 6 years). We ask that such requests be made in writing on a form provided
by our facility. Please note that an accounting will not apply to any of the
following types of disclosures: disclosures made for reasons of treatment,
payment or health care operations; disclosures for national security purposes.
You will not be charged for your first accounting request in any 12 month
period. However, for any requests that you make thereafter, you will be charged
a reasonable, cost-based fee.
■ You have the right to obtain a paper copy of our Notice of Information
Practices upon request.
■ You may revoke an authorization to use or disclose health information, except
to the extent that action has already been taken. Such a request must be made in
writing.
For More Information or to Report a Problem
If you have questions and would like additional information, you may contact
Medical Records at (518)758-6222 extension 3038.
If you believe that your privacy rights have been violated, you may file a
complaint with us. These complaints must be filed in writing on a form provided
by our facility. The complaint form may be obtained from Medical Records, and
when completed should be returned to Medical Records. You may also file a
complaint with the secretary of the federal Department of Health and Human
Services. There will be no retaliation for filing a complaint.
4/14/2003
11/03
