PLEASE REVIEW IT CAREFULLY.

Uses and disclosures that require your consent:

Treatment: Your health information may be used by staff members or disclosed to other health care professionals for the purposes of evaluation of your health, diagnosing medical conditions, and providing treatment. For example, results of laboratory tests and procedures will be available to all health professionals who may provide treatment or who may be consultants needed to contribute to your care.

Payment: Your health information will be used to seek payment for your stay from any agency designated a payer for your stay. The bill for your stay may include information that identifies you, as well as your diagnosis, procedures and supplies used.

Health care operations: Your health information may be used as necessary to support the day-to-day activities and management of Wheatcrest Hills. For example, information on the services you received may be used to support budgeting and financial reporting, and activities to evaluate and promote quality.

Law enforcement: Your health information may be disclosed to law enforcement agencies, without your permission, to support government audits and inspections, to facilitate law-enforcement investigation, and to comply with government mandated reporting.

Public health reporting: Your health information may be disclosed to public health agencies as required by law. For example, we are required to report certain communicable diseases or incidents to the state’s public health department.

Other uses and disclosures require your authorization: Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If your change your mind after authorizing a use or disclosure of your information, you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision.

Additional Uses of Information that require your authorization:

Directory: Unless you notify us that you object, we will use your name and location in the facility for directory purposes. This information may be provided to people who ask for you by name.

Notification: We may use or disclose information to notify or assist in notifying a family member, legal representative, or other person responsible for your care, your location and your general condition. On admission you will be asked to designate family members who the facility may disclose your health information.

Communication with family: Health professionals using their best judgment may disclose to a family member, other relative, or close personal friends or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care.

Funeral directors: We may disclose health information to funeral directors, consistent with applicable law to carry out their duties.

Marketing: We may use your name, location in the facility, or your participation in daily activities of the facility for marketing purposes.

Food and Drug Administration: As required by law, we may disclose to the FDA, health information relative to adverse events with the respect to food, supplements, product and product defects to enable recalls, repairs, or replacement.

Workers Compensation: We may disclose health information to the extent authorized and by the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

Wheatcrest Hills is required by law to maintain the privacy of your protected health information and to provide you with this notice of privacy practices. We also are required to abide by the privacy policies and practices that are outlined in the notice.

Right to Revise Privacy Practices

As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in the federal and state laws and regulations. Whatever the reason for the revisions, we will provide you with a revised notice. The revised policies and practices will be applied to all protected health information that we maintain.

Right to Inspect Protected Health Information

As permitted by federal regulation, we require that request to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting the Social Services Director, the Director of Nursing, or the Privacy Officer.

Complaints

If you would like to submit a comment or complaint about our privacy practices, you can do so by written concerns to the Administrator or the Privacy Officer. If you believe that your privacy rights have been violated, you should call the matter to our attention. You will not be penalized or otherwise retaliated against for filing a complaint.

Contact Person

For any further information concerning our privacy practices, contact the Privacy Officer of Wheatcrest Hills

This Notice is effective on or after 04/14/03.