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Notice of PRIVACY
PRACTICES
Effective Date: April 14, 2003
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This notice describes how
medical information about you may be used and disclosed and how
you can get access to this information.
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INTRODUCTION
As a patient, you have certain privacy protections regarding your
medical information: how it may be used, how it may be disclosed,
and how you may obtain access to this information. This notice is
a public document and will be provided to anyone who asked for a
copy. PLEASE READ THIS INFORMATION CAREFULLY.
Understanding your medical record
Each time you visit a Dillon Living Center, 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. It also includes billing documents
for those services. This information is referred to as your medical
record or as your "protected health information."
Dillon Living Center is required to:
- maintain the privacy of your health information;
- provide you with a notice of our legal duties and our privacy
practices regarding information we collect and maintain about
you;
- abide by the terms of the notice currently in effect;
- 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.
Our responsibilities to our patients
We will not use or disclose your health information without
your authorization, except as described in this notice.
Dillon Living Center reserves the right to change its practices
and to make the new provisions effective for all protected health
information we maintain. Should our information practices change,
we will make the new notice available at various places throughout
the Dillon Living Center and on this web site, www.dillonlivingcenter.com.
To request information or file a complaint
If you have questions, would like additional information, or want
to report a problem regarding the handling of your information,
you may contact:
Dillon Living Center
Privacy Officer
(620) 665-2170
Also, if you believe your privacy rights have been violated, you
may file a written complaint at our office by delivering the written
complaint to:
Dillon Living Center
Privacy Officer
(620) 665-2170
You may also file a privacy complaint by contacting the U.S. Department
of Health and Human Services whose street address and phone number
are as follows:
200 Independence Ave., SW
Washington, D. C. 20201
(202)
619-0257
We cannot, and will not, require you to waive the right to file
a privacy complaint with the Secretary of Health and Human Services
as a condition of receiving treatment from Dillon Living Center.
We cannot and will not retaliate against you for filing a privacy
complaint with the Secretary.
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SECTION 1: How your medical information
may be used or disclosed
Treatment Purposes
We may use medical information about you to provide you with medical
treatment or services. We may disclose medical information about
you to doctors, nurses, technicians, medical students or other Dillon
Living Center personnel who are involved in taking care of you at
the Dillon Living Center.
For example: A doctor treating you for a broken leg may need to
know if you have diabetes because diabetes may slow the healing
process. In addition, the doctor may need to tell the dietitian
you have diabetes so that we can arrange for appropriate meals.
We will also provide a copy of your records to a consultant, a physician,
or healthcare provider who will be caring for you after your discharge
from the Dillon Living Center.
Payment Purposes
We may use and disclose health information about you so that the
treatment and services you receive at the Dillon Living Center may
be billed to and payment may be collected from you, an insurance
company or a third party payor. For example, we may need to give
your insurance company information about the surgery you received
so your carrier will make payment.
Healthcare Operations
We may use and disclose health information about you for Dillon
Living Center operations. These uses and disclosures are necessary
to run the Dillon Living Center and make sure that all of our patients
receive quality care. For example, we may use health information
to review our treatment and services and to evaluate the performance
of our staff in caring for you.
Communication
We may use your address and/or telephone number to contact you about
appointments, to report test results, to check on your welfare following
treatment, to complete satisfaction surveys, or to provide information
about treatment alternatives or other health-related services that
may interest you. We may leave a message on your answering machine.
Business Associates
There are some services provided at Dillon Living Center through
contacts with business associates. Our business associates include
collection agencies, auditors, and records storage firms. When we
use these services, we may disclose your health information to our
business associates so they may perform the job we have asked them
to do. We require the business associate to protect your information.
Research
We may disclose information to researchers who have proper approval
and
will ensure the privacy of your health information.
Funeral Directors/Coroners
We may disclose health information to funeral directors/coroners
so they may carry out their duties as permitted by law.
Organ Procurement Organizations
We may disclose health information to organ banks and other agencies
involved in organ or tissue donation and transplant.
Fund-Raising
We may contact you as part of a fund-raising effort.
Food and Drug Administration (FDA)
We may disclose health information to the FDA relative to adverse
events with respect to food, supplements, product and product defects,
or relative
to post marketing surveillance information to enable product recalls,
repairs, or replacement.
Workers Compensation
We may disclose health information to your employer, or to public
health or legal authorities charged with preventing or controlling
disease, injury, or disability in the workplace.
Public Health
We may disclose your health information, as required by law, to
public health or legal authorities charged with preventing or controlling
disease, injury, or disability.
Abuse & Neglect
We may disclose your protected health information to public authorities
as allowed by law to report abuse or neglect.
Correctional Institutions
If you are an inmate of a correctional institution, we may disclose
to the institution or its agents the health information necessary
for your health and the health and safety of other individuals.
Law Enforcement
We may disclose health information for law enforcement purposes
as required by law, such as when required by a court order, or in
cases involving felony prosecutions, or to the extent an individual
is in the custody of law enforcement.
Health Oversight
Federal law allows us to release your health information to appropriate
health oversight agencies or for health oversight activities.
Judicial/Administrative Proceedings
We may disclose your health information in the course of any judicial
or administrative proceeding: 1) if you give your consent; 2) if
allowed or required by law; or 3) if directed by a proper court
order.
Threat to Health & Safety
We may disclose your health information to prevent or lessen a serious,
imminent threat to the health or safety of the public as required
by law.
Special Government Functions
We may disclose your health information for special government functions
as authorized by law such as to Armed Forces personnel, for national
security purposes, or to public assistance program personnel.
Other Uses
Other uses and disclosures besides those identified in this notice
will be made only if allowed by law or with your written authorization.
You may revoke the authorization as described in Section 3.
If a member of our staff or a business associate believes in good
faith that we have engaged in unlawful conduct or have violated
professional or clinical standards, he or she may release health
information to an appropriate health oversight agency, public health
authority, or attorney. |
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SECTION 2: Unless you tell us you object
Directory
We may use your name, location, room telephone number, general condition,
and religious affiliation for directory purposes. This information
may be provided to a member of the clergy or a church representative,
and except for religious affiliation, to other people who ask for
you by name.
Notification
Using our best judgment, we may disclose to a relative or any other
person you identify, health information relevant to that person's
involvement in your care or in payment for your care. We may also
tell your family or another person responsible for your care, your
location at the Dillon Living Center and general condition. |
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SECTION 3: Your rights regarding health information
The health record we maintain and billing records are the physical
property of Dillon Living Center. The information in it, however,
belongs to you.
Requests
should be made
in writing
using forms we
will provide.
Please ask a
staff person. |
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You have the right to request a restriction on certain uses and
disclosures of your medical record. We are not required to grant
the request.
You have the right to obtain a paper copy of the Notice of Privacy
Practices for Protected Health Information.
You may request to view and receive a copy of your health record
and billing record.
You have the right to appeal if you are denied access to your medical
record, providing your request is not prohibited by law.
You have the right to request that your record be amended if you
believe the record is incorrect or incomplete.
You have the right to file a statement of disagreement if your amendment
is denied. You may also require that the request for amendment and
any denial be attached in all future disclosures of your medical
record.
You have the right to an accounting of your medical record disclosures.
This applies only to disclosures that are required by law. It does
not include disclosures of information for treatment, payment, or
operations, disclosures made to you or made at your request, or
disclosures made to family members or friends in the course of providing
care.
You have the right to request that communication of your health
information be made by alternative means or at an alternative location.
Unless information or action has already been taken, you have the
right to revoke any authorizations you have made regarding the disclosure
of your information. |
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