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
If you have any questions about this Notice, please contact
our Privacy Officer:
Charmaine Preiss
14311 Brandermill Woods Trail
Midlothian, VA 23112
804-744-1173
cpreiss@brandermillwoods.com
We understand that medical information about you and your health
is personal and we are committed to protecting that information.
We create a record of the care and services you receive at Brandermill
Woods in order to provide you with quality care and to comply
with certain legal requirements.
This Notice of Privacy Practices describes how we may use and
disclose medical information about you, including demographic
information, that may identify you and your related health care
services to carry out your treatment, obtain payment for our services,
to perform the daily health care operations of this practice and
for other purposes that are permitted or required by law. This
notice also describes your rights to access and control your medical
information.
We are required to abide by the terms of this Notice of Privacy
Practices.
Written Acknowledgment
You will be asked to sign a written statement acknowledging
that you have received a copy of this notice. The acknowledgment
only serves to create a record that you have received a copy of
the notice.
Changes to this Notice
We may change the terms of our Notice, at any time. The new
Notice will be effective for all medical information that we maintain
at that time. Upon your request, we will provide you with any
revised Notice of Privacy Practices. To request a revised copy,
you may call our office and request that a revised copy be sent
to you in the mail or you may ask for one at the time of your
next visit. The current Notice of Privacy Practices will be also
posted on our Web site: www.brandermillwoods.com
How We May Use and Disclose Medical Information about You
The following categories describe the different ways that Brandermill
Woods may use and disclose your medical information and a few
examples of what we mean. These examples are not meant to describe
every circumstance, but to give you an idea of the types of uses
and disclosures that may be made by our office. Other uses and
disclosures of your medical information that are not listed or
described below will be made only with your written authorization.
You may revoke your prior written authorizations(s), at any time,
in writing, but it will not apply to any actions we have already
taken.
For your treatment: Your medical information
may be used and disclosed by us for the purpose of providing medical
treatment to you or for another health care provider providing
medical treatment to you. For example, a staff member obtains
treatment information about you and documents it in your medical
record and the physician has access to that information. If you
require an x-ray to be taken, the x-ray technician also has access
to your medical information. In addition, your medical information
may be provided to a physician to whom you have been referred
or are otherwise seeing to ensure that the physician has the necessary
information to diagnose or treat you.
To obtain payment for our services: Your medical
information may be used and disclosed by us to obtain payment
for your health care bills or to assist another health care provider
in obtaining payment for their health care bills. For example,
we may submit requests for payment to your health insurance company
for the medical services that you received. We may also disclose
your medical information as required by your health insurance
plan before it approves or pays for the health care services we
recommend for you.
For our health care operations: Your medical
information may be used and disclosed by us to support our daily
operations. These health care operation activities include, but
are not limited to, quality assessment activities, employee review
activities, training of medical students, licensing, fundraising
activities, and conducting or arranging for other business activities.
For example, we may disclose your medical information to medical
school students that see residents at our facility. We may also
use the medical information we have to determine where we can
make improvements in the services and care we offer.
For the health care operations of other health care providers:
We may also use your medical information to assist another health
care provider treating you with its quality improvement activities,
evaluation of the health care professionals or for fraud and abuse
detection or compliance. For example, we may disclose your medical
information to another physician to assist in its efforts to make
sure it is complying with all rules related to operating a medical
practice.
To provide you with treatment alternatives:
We may use or disclose your medical information to provide you
with information about treatment alternatives or other health-related
benefits and services that may be of interest to you. For example,
we may contact physical therapy providers to discuss the services
they provide when we have a resident who needs these services.
To our business associates: We will share your
medical information with third party "business associates"
that perform various activities (e.g., billing, laboratories,
pharmacies) for the practice. Whenever an arrangement between
our office and a business associate involves the use or disclosure
of your medical information, we will have a written agreement
that contains terms that will protect the privacy of your medical
information. For example, Brandermill Woods may request an x-ray.
Your medical information will be disclosed to this company, but
a written agreement between our office and the company that performs
the x-ray will prohibit the x-ray company from using your medical
information in any way other than what we allow.
For fund-raising activities: We may use or disclose
your demographic information and the dates that you received treatment
from us in order to contact you for fundraising activities supported
by our office. If you do not want to receive these materials,
please contact the Privacy Officer and request that these fundraising
materials not be sent to you.
Others involved in your health care: Unless
you object, we may disclose to a member of your family, a relative,
a close friend or any other person you identify, your medical
information that directly relates to that person’s involvement
in your health care. If you are unable to agree or object to such
a disclosure, we may disclose such information as necessary if
we determine that it is in your best interest based on our professional
judgment. We may use or disclose your medical information to notify
a family member or any other person that is responsible for your
care of your location and general health condition. Finally, we
may use or disclose your medical information to an authorized
public or private entity to assist in (1) disaster relief efforts
and (2) to coordinate uses and disclosures to family or other
individuals involved in your health care.
As required by law: We may use or disclose your
medical information to the extent that the use or disclosure is
required by law. The use or disclosure will be made in compliance
with the law and will be limited to the relevant requirements
of the law. You will be notified, as required by law, of any such
uses or disclosures.
For public health activities: We may disclose
your medical information for public health activities and purposes
to a public health authority that is permitted by law to collect
or receive the information. The disclosure will be made for the
purpose of controlling disease, injury or disability. We may also
disclose your medical information, if directed by the public health
authority, to any other government agency that is collaborating
with the public health authority.
As required by the Food and Drug Administration:
We may disclose your medical information to a person or company
required by the Food and Drug Administration to report adverse
events, product defects or problems, biologic product deviations,
or to track products; to enable product recalls; or to conduct
post marketing surveillance, as required.
For communicable disease exposure: We may disclose
your medical information, if authorized by law, to a person who
may have been exposed to a communicable disease or may otherwise
be at risk of contracting or spreading the disease or condition.
To your employer: We may disclose your medical
information concerning a work related injury or illness to your
employer if you are covered under your employer’s policy
in order to conduct an evaluation relating to medical surveillance
of the work place or to evaluate whether you have a work-related
injury, in accordance with the law.
For abuse or neglect: We may disclose your medical
information to a public health authority that is authorized by
law to receive reports of adult abuse or neglect. In addition,
we may disclose your medical information if we believe that you
have been a victim of abuse, neglect or domestic violence as may
be required or permitted by Virginia and/or federal law.
For health oversight: We may disclose your medical
information to a health oversight agency for activities authorized
by law. Oversight agencies seeking this information include government
agencies that oversee the health care system, government benefit
programs (such as Medicare or Medicaid), other government regulatory
programs and civil rights laws.
In legal proceedings: We may disclose your medical
information in the course of any judicial or administrative proceeding,
in response to an order of a court or administrative tribunal
(to the extent such disclosure is expressly authorized), and in
certain conditions in response to a subpoena or other lawful request.
For law enforcement: We may also disclose your
medical information, so long as all legal requirements are met,
for law enforcement purposes. Examples of these law enforcement
purposes include (1) information requests for identification and
location purposes, (2) pertaining to victims of a crime, (3) suspicion
that death has occurred as a result of criminal conduct, (4) in
the event that a crime occurs on the premises of the retirement
community, and (5) in an medical emergency where it is likely
that a crime has occurred.
To coroners, to funeral directors, and for organ donation:
We may disclose your medical information to a coroner or medical
examiner for identification purposes, determining cause of death
or for the coroner or medical examiner to perform other duties
authorized by law. We may also disclose medical information to
a funeral director in order to permit the funeral director to
carry out its duties. We may disclose such information in reasonable
anticipation of death. Your medical information may be used and
disclosed for cadaver organ, eye or tissue donation purposes.
For research: We may disclose your medical information
to researchers when their research has been established as required
by federal and state law.
Due to criminal activity: Consistent with applicable
federal and state laws, we may disclose your medical information
if we believe that the use or disclosure is necessary to prevent
or lessen a serious and imminent threat to the health or safety
of a person or the public. We may also disclose your medical information
if it is necessary for law enforcement authorities to identify
or apprehend an individual.
For military activity and national security:
When the appropriate conditions apply, we may use or disclose
medical information of individuals who are Armed Forces personnel
(1) for activities deemed necessary by appropriate military command
authorities; (2) for the purpose of a determination by the Department
of Veterans Affairs of your eligibility for benefits; or (3) to
foreign military authority if you are a member of that foreign
military services. We may also disclose your medical information
to authorized federal officials for conducting national security
and intelligence activities, including for the provision of protective
services to the President or others legally authorized.
For workers’ compensation: Your medical
information may be disclosed by us as authorized to comply with
worker’s compensation laws and other similar legally established
programs.
For required uses and disclosures: Under the
law, we must make disclosures to you and, when required by the
Secretary of the Department of Health and Human Services, to investigate
or determine our compliance with the requirements of the Health
Insurance Portability and Accountability Act and its regulation.
Your Rights
Following is a statement of your rights with respect to your
medical information and a brief description of how you may exercise
these rights. A resident may make a request for access to their
records either orally or in writing. However, in order to better
respond to residents’ requests, Brandermill Woods will ask
that all requests be put into writing and use the facility’s
approved "Authorization for the Release of Health Information".
Residents may make requests for health information orally,
but Brandermill Woods prefers to receive such requests in writing.
You have the right to inspect and copy your medical
information. You may inspect and obtain a copy of the
medical information that we maintain about you. The information
may contain medical and billing records and any other records
that we use for making decisions about you. Please contact our
Privacy Officer if you have questions about access to your medical
record.
You have the right to request a restriction of your
medical information. This means you may ask us not to
use or disclose any part of your medical information for the purposes
of treatment, payment or health care operations. You may also
request that any part of your medical information not be disclosed
to family members or friends who may be involved in your care.
Your request must state the specific restriction requested and
to whom you want the restriction to apply.
We are not required to agree to your request. If we agree to
the requested restriction, we may not use or disclose your medical
information in violation of that restriction unless it is needed
to provide emergency treatment or unless we otherwise notify you
that we can no longer honor your request. With this in mind, please
discuss any restriction you wish to request with your physician.
Please request all restrictions in writing to our Privacy Officer.
You have the right to request that we accommodate you
in communicating confidential medical information. We
will accommodate reasonable requests, but we may condition this
accommodation by asking you for information as to how payment
will be handled or other information necessary to honor your request.
Please make this request in writing to our Privacy Officer.
You have the right to ask us to amend your medical information.
You may request an amendment of your medical information as long
as we maintain this information. In certain cases, we may deny
your request for an amendment. If we deny your request for amendment,
you have the right to file a disagreement with us and we may respond
in writing to you. Please contact our Privacy Officer if you have
questions about amending your medical record.
You have the right to receive an accounting of certain
disclosures we have made, if any, of your medical information.
This right applies to disclosures for purposes other than treatment,
payment or health care operations as described in this Notice
of Privacy Practices. It excludes disclosures we may have made
pursuant to your authorization (permission), made directly to
you, to family members or friends involved in your care, or for
appointment notification purposes. You have the right to receive
specific information regarding these disclosures that occurred
after April 14, 2003. You may request a shorter timeframe. The
right to receive this information is subject to certain exceptions,
restrictions and limitations.
You have the right to obtain a paper copy of this notice
from us. If you would like a paper copy of this notice,
please request one from our Privacy Officer or request one when
you are in our offices.
Complaints
You may complain to us if you believe your privacy rights have
been violated by us. To file a complaint, please contact our Privacy
Officer who will be happy to assist you. You may file a complaint
with us by notifying our Privacy Officer of your complaint. We
will not retaliate against you for filing a complaint. If you
do not wish to file a complaint with us, you may contact the Secretary
of Health and Human Services.
Privacy Contact
If you have any questions about this Notice or required additional
information, please contact our Privacy Officer as indicated on
page 1 of this document. Our Privacy Officer is available during
normal business hours to discuss your privacy questions, concerns
or complaints.
Effective Date. This notice was published and
becomes effective on April 14, 2003.
Revised 10/13/2003
|
