Notice of Privacy Practices
BETH SHOLOM HOME OF EASTERN VIRGINIA
NOTICE OF PRIVACY 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.
THIS PRIVACY
NOTICE IS PROVIDED BY BETH SHOLOM HOME OF EASTERN VIRGINIA (“We” or “BSHEV”).
This notice covers functions of BSHEV in connection with providing medical
care for our residents. The phrase “medical information” in this notice means
your personal medical information that BSHEV creates or receives as part of
providing treatment services for you. This notice describes our privacy practices,
legal duties, and your rights concerning your medical information. We are
required by law to maintain the privacy of your medical information and to
issue this notice. This notice takes effect April 14, 2003. It will remain
in effect until we issue a new notice. This notice applies to BSHEV, our employees,
staff, and volunteers who provide services to our residents. Our privacy policy
applies to all of the records of your medical care maintained by us, whether
created by us or by your personal doctor. Your personal doctor or other provider
may have different policies or notices regarding the doctor’s or provider’s
use and disclosure of your medical information created in the doctor’s or
provider’s office or clinic or outside of our facility. We reserve the right
to change the terms of this notice at any time and to make the provisions
of the new notice effective for all medical information that we maintain.
Any revised notice will be provided to you: (1) by mail or (2) at this office.
Anyone may request a copy of this notice at any time. For more information
about our privacy practices, or for additional copies of this notice, please
contact our Privacy Officer. Contact information is provided at the end of
this notice. ________________________________________________________________________________
HOW WE MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION ________________________________________________________________________________
BSHEV must use and give out your medical information to provide information:
* To you or someone who has the legal right to act for you (your personal
representative); * To the Secretary of the Department of Health and Human
Services, if necessary, to make sure your privacy is protected; and * Where
required by law. BSHEV may use and disclose your medical information without
your specific authorization for the purposes of treatment, payment, and health
care operations. Treatment activities. We will use your medical information
to provide you with medical treatment and services. Your medical information
may be used by doctors, nurses and other health care providers who are involved
in taking care of you. We may disclose your medical information for the treatment
activities of any other health care providers. We may send a copy of your
medical record to another health care provider who needs to provide follow-up
or additional care to you. Payment activities. We may use and disclose medical
information to obtain payment for health care services that you received.
This means that we may use medical information to arrange for payment (such
as preparing bills and managing accounts). We also may disclose medical information
to others (such as insurers, collection agencies, and consumer reporting agencies).
In some instances, we may disclose medical information to an insurance plan
before you receive certain health care services because, for example, we may
want to know whether the insurance plan will pay for a particular service.
Health care operation activities. We may use and disclose medical information
in performing a variety of business activities that we call “health care operations.”
These health care operations activities allow us to perform our normal business
activities, improve the quality of care we provide and reduce health care
costs. For example, we may use or disclose medical information in performing
the following activities: * Reviewing and evaluating the skills, qualifications,
and performance of health care providers taking care of you. * Providing training
programs for students, trainees, health care providers or non-health care
professionals to help them practice or improve their skills. * Cooperating
with outside organizations that evaluate, certify or license health care providers,
staff or facilities in a particular field or specialty. * Reviewing and improving
the quality, efficiency and cost of care that we provide to you and our other
residents. * Improving health care and lowering costs for groups of people
who have similar health problems and helping manage and coordinate the care
for these groups of people. * Cooperating with outside organizations that
assess the quality of the care others and we provide, including government
agencies and private organizations. * Planning for our organization’s future
operations. * Reviewing our activities and using or disclosing medical information
in the event that control of our organization significantly changes. * Working
with others (such as lawyers, accountants and other providers) who assist
us to comply with this notice and other applicable laws. * Reminding you of
appointments or telling you about recommended treatment options or alternatives.
Business Associates. We may disclose your medical information to other entities
that provide a service to us or on our behalf that requires the release of
patient medical information. However, we only will make these disclosures
if we have received satisfactory assurance that the other entity will properly
safeguard your medical information. Health-Related Benefits and Services.
We may use and disclose medical information to tell you about health-related
benefits or services that may be of interest to you. To you and others as
you authorize. BSHEV must disclose your medical information to you. This is
described in the “Your Rights” section of this notice, below. You may also
give BSHEV written authorization on a form provided by our Privacy Officer
to use or disclose your medical information to anyone for any lawful purpose.
If you give BSHEV an authorization, you may revoke it in writing at any time.
Your revocation will not affect any use or disclosures permitted by your authorization
while it is in effect. Without your written authorization, BSHEV may not use
or disclose your medical information for any reason except as described in
this notice. To persons involved in your care. We may disclose medical information
to a relative, close personal friend or any other person you identify if that
person is involved in your care and the information is relevant to your care.
If the resident is a minor, we may disclose medical information about the
minor to a parent, guardian or other person responsible for the minor except
in limited circumstances. We may also use or disclose medical information
to a relative, other person involved in your care or possibly a disaster relief
organization (such as the Red Cross) if we need to notify someone about your
location or condition. You may ask us at any time not to disclose medical
information to persons involved in your care. We will agree to your request
and not disclose the information except in certain limited circumstances (such
as emergencies). Other uses and disclosures. BSHEV may also use or give out
your medical information without your specific authorization for the following
purposes: * As required by law: We will disclose medical information about
you when required to do so by federal, state or local law. * Threat to health
or safety: We may use or disclose medical information if we believe it is
necessary to prevent or lessen a serious threat to health or safety. * Public
health activities: We may use or disclose medical information for public health
activities. Public health activities require the use of medical information
for various activities including, but not limited to, activities related to
investigating diseases, reporting abuse and neglect, monitoring drugs or devices
regulated by the Food and Drug Administration, and monitoring work-related
illnesses or injuries. For example, if you have been exposed to a communicable
disease, we may report it to the State and take other actions to prevent the
spread of the disease. * Abuse, neglect or domestic violence: We may disclose
medical information to a government authority (such as the Department of Social
Services) and we reasonably believe that you may be a victim of abuse, neglect
or domestic violence. * Health oversight activities: We may disclose medical
information to a health oversight agency for activities authorized by law.
These oversight activities include audits, investigations, examinations, inspections,
and licensure. * Legal proceedings: If you are involved in a lawsuit or dispute,
we may disclose medical information about you in response to a court or administrative
order. We may also disclose medical information about you in response to a
subpoena, discovery request, or other lawful process by someone else involved
in the dispute, but only if efforts have been made to tell you about the request.
We may also disclose your information to attorneys working on your behalf.
We would disclose medical information to a court if a judge orders us to do
so. * Law enforcement: We may release medical information if asked to do so
by a law enforcement official under certain circumstances including: in response
to a court order, subpoena, warrant, summons or similar process; to identify
or locate a suspect, fugitive, material witness, or missing person; about
the victim of a crime if, under certain limited circumstances, we are unable
to obtain the person’s agreement; about a death we believe may be the result
of criminal conduct; about criminal conduct at our facility; and in emergency
circumstances to report a crime. * Coroners and others: We may disclose medical
information to a coroner, medical examiner, or funeral director as necessary
for them to carry our their duties. * Organ and tissue donation: If you are
an organ donor, we may release medical information to organizations that handle
organ procurement or organ, eye or tissue transplantation or to an organ donation
bank, as necessary, to facilitate organ or tissue donation or transplantation.
* Workers’ compensation: We may disclose medical information in order to comply
with workers’ compensation laws. * Certain government functions: We may use
or disclose medical information for certain government functions including,
but not limited to, military and veterans’ activities and national security
and intelligence activities. We may also use or disclose medical information
to a correctional institution in some circumstances. * Research: We may use
and disclose medical information about you to researchers. In most circumstances,
you must sign a separate release form specifically authorizing us to use and/or
disclose your medical information for research. However, there are certain
exceptions. Your medical information may be disclosed without your authorization
for research if the authorization requirement has been waived or altered by
a special committee that is charged with ensuring that the disclosure will
not pose a great risk to your privacy or that measures are being taken to
protect your medical information. Your medical information also may be disclosed
to researchers to prepare for research as long as certain conditions are met.
Medical information regarding people who have died can be released without
authorization under certain circumstances. Limited medical information may
be released to a researcher who has signed an agreement promising to protect
the information released. * Food and Drug Administration (FDA): We may disclose
medical information to a person subject to the jurisdiction of the FDA for
public health purposes related to the quality, safety or effectiveness of
FDA-regulated products or activities, such as collecting or reporting adverse
events, dangerous products, and defects or problems with FDA-regulated products.
* Summary information: We may use medical information to create summary information
that can be used and disclosed without being identified back to you. * Fundraising
activities: We may use and disclose medical information about you so that
we or a foundation related to BSHEV may contact you in an effort to raise
money for BSHEV. We only release information such as your name, address and
telephone number and the dates you received treatment or services. If you
do not want BSHEV to contact you for fundraising efforts, please notify the
Privacy Officer. * Marketing: We must obtain your prior written authorization
to use your protected health information for marketing purposes except for
a face-to-face encounter or a communication involving a promotional gift of
nominal value. We are prohibited from selling lists of residents to third
parties or from disclosing protected health information to a third party for
the marketing activities of the third party without your authorization. *
BSHEV directory: We may include your name, location and your general condition
(e.g., fair, stable, etc.) in the directory while you are a resident at BSHEV.
The directory information may be released to people who ask for you by name
so your family, friends and clergy can visit you. You may ask to restrict
some or all of the information contained in the directory. * Organized health
care arrangement: An organized health care arrangement (“OHCA”) is a clinically
integrated health care setting in which individuals typically receive health
care from more than one provider. BSHEV may elect to participate in an OHCA
with physicians, pharmacies, labs, and other providers in connection with
services provided to you in the facility. Medical information may be shared
among the providers participating in the OHCA for health care operations,
and participants will agree to be governed by this notice of privacy practices.
________________________________________________________________________________
YOUR RIGHTS ________________________________________________________________________________
Access. You have the right to inspect and obtain copies of your medical information
for as long as your information is maintained in BSHEV’s “designated record
set.” BSHEV’s designated record set includes records that we receive, generate,
and maintain in connection with your treatment provided by BSHEV. Your right
of access to medical information does not extend to certain information, such
as information compiled in reasonable anticipation of, or for use in, a civil,
criminal or administrative proceeding. If you request a copy, we may charge
a reasonable fee for copying, mailing, or other supplies associated with your
request. We may be able to provide you with a summary or explanation of the
information. Contact our Privacy Officer for more information on these services
and any possible additional fees. Any request to exercise your individual
right of access to your medical information must be in writing on a form provided
by our Privacy Officer. We will respond to your request for access within
thirty (30) days of receiving the request. If all or any part of your request
is denied, our response will detail any appeal rights you may have with respect
to that decision. Amendment. You have the right to have us amend (which means
correct or supplement) medical information about you that we maintain in certain
groups of records. If you believe that we have information that is either
inaccurate or incomplete, we may amend the information to indicate the problem
and notify others who have copies of the inaccurate or incomplete information.
If you would like us to amend information, you must provide us with a request
in writing on a form provided by our Privacy Officer and explain why you would
like us to amend the information. We will respond to your request for amendment
within sixty (60) days of receiving the request. We may deny your request
in certain circumstances. If we deny your request, we will explain our reason
for doing so in writing. You will have the opportunity to send us a statement
explaining why you disagree with our decision to deny your amendment request,
and we will share your statement whenever we disclose the information in the
future. Accounting for Disclosures. You have the right to request and receive
an accounting of disclosures of your medical information made by BSHEV, but
BSHEV is not required to account for many types of disclosures, including:
* Any disclosures made prior to April 14, 2003. * Disclosures for treatment,
payment or health care operations activities. * Disclosures to you or pursuant
to your authorization. * Disclosures to persons involved in your care. * Disclosures
for disaster relief, national security or intelligence purposes. * Disclosures
that are incidental to a permitted use or disclosure. To request an accounting
of disclosures, you must send a written request to us on a form provided by
the Privacy Officer. You may request one (1) such accounting at no charge
every twelve (12) months. You may request that the accounting cover up to
a six-year period of reportable disclosures from the date of your request.
BSHEV will respond within sixty (60) days of your request. We reserve the
right to impose a reasonable charge for requests made more than once a year.
Alternate Means of Contacting You. You have the right to request to be contacted
at a different location or by a different method. For example, you may prefer
to have all written information mailed to your work address rather than to
your home address. We will agree to any reasonable request for alternative
methods of contact. If you would like to request an alternative method of
contact, you must submit your request to us in writing on a form provided
by our Privacy Officer. Restriction Request. You have the right to request
that we limit the use and disclosure of medical information about you for
treatment, payment and health care operations. We are not required to agree
to your request. If we do agree to your request, we must follow your restrictions
(except if the information is necessary for emergency treatment). You may
cancel the restrictions at any time. In addition, we may cancel a restriction
at any time as long as we notify you of the cancellation and continue to apply
the restriction to information collected before the cancellation. You must
submit your request for a restriction to us in writing on a form provided
by our Privacy Officer. ________________________________________________________________________________
CONTACT INFORMATION ________________________________________________________________________________
Please contact our Privacy Officer if: * You want a printed copy of our current
notice. * You want to access your medical information. * You want to request
an amendment to your medical information. * You want to request an accounting
of our disclosures of your medical information. * You want to request a restriction
on our use and disclosure of your medical information. * You want us to communicate
with you at an alternative address or by alternate means. * You have questions,
concerns or complaints about this notice or our privacy practices. BSHEV Contact:
Privacy Officer 6401 Auburn Drive Virginia Beach, Virginia 23464 (757) 420-2512
________________________________________________________________________________
COMPLAINTS ________________________________________________________________________________
If you believe your privacy rights have been violated, you may file a complaint
with BSHEV directed to the attention of our Privacy Officer. You may also
submit a written complaint to the Secretary of the Department of Health and
Human Services. The filing of a complaint will not affect your rights under
BSHEV, and BSHEV will not retaliate against anyone who files a complaint.
[04-14-03]
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