The Notice of Privacy Practices covers:

1. Uses or disclosures which do not require your written authorization.
2. Treatment, payment, and health care operations (TPO).
3. Uses or disclosures of your health information to which you may object.
4. Uses or disclosures required or permitted.
5. Uses or disclosures which require your written authorization.
6. Your rights as a resident regarding privacy of your health information.
7. Our duties in protecting your health information.
8. Complaints, contact person, effective date, and acknowledgement.

• Treatment, payment and health care operations (TPO)
• Uses or disclosures of your health information to which you may object.
• Uses or disclosures required or permitted.

We use or disclose your health information to carry out your treatment; to obtain payment for your treatment; and to conduct health care operations (TPO). for example:

• For treatment, we use your health information to plan, coordinate, and provide your care.  We disclose your health information for treatment purposes to physicians and other health care professional outside our facility who are involved in your care.

• For payment, we use your health information to prepare documentation required by your insurance company or HMO or by Medicare or Medicaid.  We disclose that part of your health information that these organizations require to pay us.

• For health care operations, we use or disclose your health information, for example, to improve the quality of our services, to plan better ways of treating residents, and to evaluate staff performance.

We may use/disclose your health information for the following purposes unless you say not to:

• Facility directories.  We maintain a resident directory including, for each resident, name, location in our facility, health condition in general terms, and religious affiliation.  We may disclose this information to people who ask for you by name.  We will make known your religious affiliation only to clergy.
• Informing family and friends.  We may disclose you health information to family, friends, or others identified by you who are involved in your care.
• Assistance in disaster relief efforts.
• For fundraising activities.  We may contact you or your family for fundraising purposes.  If you do not wish to be contacted for this purpose, please contact Joseph Cuozzo or Michelle Knobloch, NHA and Privacy Officer and indicate that you do not wish to receive fundraising communication from us.
• Informing you about treatment alternatives or other health-related benefits and services that may be of interest to you.

4. Uses or disclosures required or permitted

Where we are required or permitted to do so, we may use or disclose your health information in the following circumstances without your written authorization.

• Federal government investigation, when required by the Secretary of Health and Human Services to investigate or determine our compliance with federal regulation.
• Federal, state or local law requirements.
• Public health activities, for example to report communicable diseases or death; or for matters involving the Food and Drug Administration.
• Reporting or abuse, neglect or domestic violence.
• Health oversight activities by a health oversight agency.  A health oversight agency is an organization authorized by the government to oversee eligibility and compliance and to enforce civil rights laws.
• Judicial or administrative proceedings, for example responding to a court order or subpoena.
• Law enforcement purposes, for example to report certain types of wounds or other physical injuries or to identify or locate a suspect, fugitive, material witness, or missing person.
• Use by coroners, medical examiners, or funeral directors.
• Facilitating organ, eye or tissue donation.
• Research, provided that very strict controls are enforced.
• Averting a serious threat to your health or safety or that of the public.
• Specialized government functions such as military or veterans' affairs; national security, and intelligence activities.
• Workers' compensation.

5. Uses or disclosures which require your written authorization

Your written authorization, which you may revoke (in writing), is required if we use or disclose your health information for any other purpose, in particular:

Our use of psychotherapy notes beyond treatment, payment, and health care operations.  Marketing of goods or services to you.

6. Your rights as a resident to Privacy of Your Health Information

• Right to Request Restrictions:

• Right to Request Confidential Communications:

• Right to Request Access to Your Health Information:

• Right to Request an Amendment of Your Health Information:

• Right to Request an Accounting of Disclosures of Your Health Information:

• Right to Obtain a Paper Copy of this Notice

7. Our Duties in Protecting Your Health Information

• We are required by law to maintain the privacy of your health information.
• We must inform residents of their legal representatives of our legal duties and privacy practices with respect to health information.  This Notice discharges that duty.
• We must abide by the terms of the Notice currently in effect.  We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all health information that we maintain.  At any time, you may obtain a copy of the current notice from Michelle Knobloch, NHA and Privacy Official.

8. Complaints, Contact Person, Effective Date and Acknowledgement

• You may complain to us and to the Secretary of Health and Human Services if you believe your privacy rights have been violated.
• You will not be retaliated against for filing a complaint.
• You may file your complaint with your facility by writing Michelle Knobloch, NHA and Privacy Official.
• You may file a complaint with the Secretary of Health and Human Services by writing to:

• For further information you may write or call Michelle Knobloch, NHA and Privacy Official
• This notice is effective April 14, 2003.