Notice of Privacy Practices Dissemination
It is the policy of Concord Care Centers to disseminate a
written notice to all residents that addresses its policies and
procedures with respect to the treatment, use and disclosure of
individually identifiable health information and with respect to
the facility’s legal duties with respect to such information (a
“Notice of Privacy Practices”).
The Notice of Privacy Practices shall include all elements and
statements that are required by law. In summary, the Notice
shall inform the residents about the potential uses and
disclosures of their health information, as well as their rights
with respect to that information, including: (1) a description
of each of the purposes for which the Facility is permitted to
disclose their health information, including, for example,
treatment, payment, and health care operations; and (2) a
description of when written authorization is required before the
Facility may disclose the individual’s health information in
Notice of Privacy Practices
- Facility will provide the Notice of Privacy Practices at the
time of admission or when service is first provided to the
individual, whichever is first, and obtain written
acknowledgment of receipt of the notice.
- A copy of the Notice of Privacy Practices will be kept in
the resident’s medical record and the effective date will be
- Facility will provide a copy of the written notice to
residents and to any other person upon request.
- Facility will post a copy of the Notice of Privacy Practices
on its bulletin board in the entrance lobby, and on its
- If there is a material change in the Facility’s use and
disclosure policy that affects the rights of residents, legal
duties imposed, or the practices of the Facility, then a new
notice will be posted on the Facility’s bulletin board and on
its web site. Material changes will not be implemented until a
revised notice has been posted by the Facility. Updated
notices will not be provided to residents, but will be made
available upon request.
- The Facility’s Privacy Officer, its Administrator, shall be
responsible for ensuring that written notices are received and
posted in accordance with this policy, and for keeping copies
of the notices posted and any revisions thereto.
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 summarized our responsibilities and your rights on this
first page. For a complete description of our privacy practices,
please review this entire notice.
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
- Abide by the terms of this notice.
- Notify you following a breach of unsecured protected health
As a resident of our facility, you have several rights with
regard to your health information, including the following:
The right to request that we not use or disclose your health
information in certain ways.
The right to request to receive communications in an
alternative manner or location.
The right to access and obtain a copy of your health
The right to request an amendment to your health information.
The right to an accounting of disclosures of your health
We will not use or disclose your health information without
your authorization, except as described in this notice. Thus,
for example, we will require your authorization before we would
use or disclose your protected health information for marketing
purposes, and, if applicable, for most uses of psychotherapy
notes. In addition, we will not sell your health information
without a specific authorization from you.
If you have questions and would like additional information,
you may contract our Corporate Privacy Officer, the facility
Administrator, at (800) 293-7196, extension 104.
Understanding Your Health Record/Information
Each time you visit a nursing facility, 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 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.
How We Will Use or Disclose Your Health Information
- Treatment. We will use your health information for
treatment. For example, information obtained by a nurse,
physician, or other member of your healthcare 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 are discharged from
our nursing facility.
- 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.
- 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
In addition, we will disclose your health information for
certain health care operations of other entities. However, we
will only disclose your information under the following
conditions: (a) the other entity must have, or have had in the
past, a relationship with you; (b) the health information used
or disclosed must relate to that other entity's relationship
with you; and (c) the disclosure must only be for one of the
following purposes: (i) quality assessment and improvement
activities; (ii) population-based activities relating to
improving health or reducing health care costs; (iii) case
management and care coordination; (iv) conducting training
programs; (v) accreditation, licensing, or credentialing
activities; or (vi) health care fraud and abuse detection or
- 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.
- 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 nameplate next to
or on your door in order to identify your room, unless you
notify us that you object.
- 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.
- 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.
- Research. We may disclose information to researchers
when certain conditions have been met.
- Transfer of information at death. We may disclose
health information to funeral directors and coroners to carry
out their duties consistent with applicable law.
- Organization 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.
- 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
- 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.
- 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.
- 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
- 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.
- Law enforcement. We may disclose health information
for law enforcement purposes as required by law or in response
to a valid subpoena.
- Reports. Federal law makes provision for your health
information to be released to any 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
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. You 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 will consider
your request with regard to the use of your health
information, please be aware that we are under no obligation
to accept it or 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. For more
information about this right, see 45 Code of Federal
Regulations (C.F.R.) §164.522(a).
- 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 the nursing home or the Corporate
office. We will attempt to accommodate all reasonable
requests. For more information about this right, see 45 Code
of Federal Regulations (C.F.R.) §164.522(b)
- 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. For more
information about this right, see 45 Code of Federal
Regulations (C.F.R.) §164.524.
- 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 request. For a request form, please
contact the facility Administrator. For more information about
this right, see 45 Code of Federal Regulations (C.F.R.)
- 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 made to you or your legal representative, or any
other individual involved with your care; disclosures to
correctional institutions or law enforcement officials; and
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. For more
information about this right, see 45 Code of Federal
Regulations (C.F.R.) §164.528.
- You have the right to obtain paper copy of our Notice of
Privacy Practices upon request. You may also access and print
a copy of our notice from our website: www.ConcordCareCenters.com.
- 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, we
are available by e-mail at "firstname.lastname@example.org."
We will respond to your electronic inquiry the next business day.
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 the Social Service Department at the
facility, and when completed should be returned to CEO, Concord
Health Care, Inc., 202 Churchill Hubbard Road, Youngstown, Ohio,
44505. 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.
Effective Date: September 23, 2013
© Concord Care Centers