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844.264.3258

Effective Date (updated policy) August 2013

Wellington Management

Jerseyville Nursing & Rehabilitation Center, Montgomery Nursing & Rehabilitation Center, The Pillars of North County Health & Rehabilitation Center, Westwood Hills Health & Rehabilitation Center, Mid-South Health Clinic, NW Rehab

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.

 

1. Summary of Rights and Obligations Concerning Health Information

 

We are committed to preserving the privacy and confidentiality of your health information, which is required by both Federal and state law, as well as by ethics of the medical profession. We are required by law to provide you with this notice of our legal duties, your rights, and our privacy practices, with respect to using and disclosing your health information.

Each time you visit us, we make a record of your visit. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. We have an ethical and legal obligation to protect the privacy of your health information, and we will only use or disclose this information in limited circumstances. In general, we may use and disclose your health information to:

  • plan your care and treatment;
  • provide treatment by us or others;
  • communicate with other providers such as referring physicians;
  • receive payment from you, your health plan, or your health insurer;
  • make quality assessments and work to improve the care we render and the outcomes we achieve, known as health care operations;
  • make you aware of services and treatments that may be of interest to you; and comply with state and federal laws that require us to disclose your health information.
  • We may also use or disclose your health information where you have authorized us to do so.
  • You have certain rights to your health information. You have the right to: ensure the accuracy of your health records request confidential communications between you and your physician and request limits on the use and disclosure of your health information; and request an accounting of certain uses and disclosures of health information we have made about you.

We are required to:

  •     maintain the privacy of your health information;
  •     provide you with notice, such as this Notice of Privacy Practices, as to our legal duties and privacy practices with respect to information we collect and maintain about you;
  •     abide by the terms of our most current Notice of Privacy Practices;
  •     notify you if we are unable to agree to a requested restriction; and
  •     accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

 

We reserve the right to change our practices and to make the new provisions effective for all of your health information that we maintain.

Should our information practices change, a revised Notice Privacy Practices will be available upon request. If there is a material change, a revised Notice of Privacy Practices will be distributed to the extent required by law.

We will not use or disclose your health information without your authorization, except as described in our most current Notice of Privacy Practices.

In the following pages, we explain our privacy practices and your rights to your health information in more detail.

If you have limited proficiency in English, you may request a Notice of Privacy Practices in [name of language(s)].

2. We May Use or Disclose Your Medical Information In the Following Ways

A.     Treatment.   We may use and disclose your medical information to provide you with medical treatment or services. For example we may use your health information to write a prescription or to prescribe a course of treatment. We will record your current healthcare information in a record so, in the future, we can see your medical history to help in diagnosing and treatment, or to determine how well you are responding to treatment. We may provide your health information to other health providers, such as referring or specialist physicians, to assist in your treatment. Should you ever be hospitalized, we may provide the hospital or its staff with the health information it requires to provide you with effective treatment.

B.   Payment.   We may use and disclose your health information so that we may bill and collect payment for the services that we provided to you. For example, we may contact your health insurer to verify your eligibility for benefits, and may need to disclose to it some details of your medical condition or expected course of treatment. We may use or disclose your information so that a bill may be sent to you, your health insurer, or a family member. The information on or accompanying the bill may include information that identifies you and your diagnosis, as well as services rendered, any procedures performed, and supplies used. Also, we may provide health information to another health care provider, such as an ambulance company, to assist in their billing and collection efforts.

C.   Health Care Operations.    We may use and disclose your health information to assist in the operation of facility. For example, members of our staff may use information in your health record to assess the care and outcomes in your and others like it as part of a continuous effort to improve the quality and effectiveness of the healthcare and services we provide. We may use and disclose your health information to conduct cost-management and business planning activities for our practice. We may also provide such information to other health care entities for their health care operations. For example, we may provide information to your health insurer for its quality review purposes.

D.   Business Associates. Sometimes contracts with third-party business associates for services. Examples include answering services, transcriptionists, billing services, consultants, and legal counsel. We may disclose your health information to our business associates so that they can perform the job we have asked them to do. To protect your health information, however, we require our business associates to appropriately safeguard your information.  Download our Business Associate Agreement

E.   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 provide 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 name plate next to or on your door in order to identify your room, unless you notify us that you object.

F.   Treatment Options.   We may use and disclose your health information in order to inform you of alternative treatments.

G.   Release to Family/Friends.   Our health professionals, using their professional judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, your health information to the extent it is relevant to that person’s involvement in your care or payment related to your care. We will provide you with an opportunity to object to such a disclosure whenever we practicably can do so. We may disclose the health information of minor children to their parents or guardians unless such disclosure is otherwise prohibited by law. If we are unable to reach your family member or personal representative, then we may leave a message for them at the phone number they have provided us, e/g. on answering machine.

H.   Health-Related Benefits and Services.   We may use and disclose health information to tell you about health-related benefits or services that may be of interest to you. In face-to-face communications, such as appointments with your physician, we may tell you about other products and services that may be of interest to you.

I.   Newsletters and Other Communications.   We may use your personal information in order to communicate to you via newsletters, mailings, or other means regarding treatment options, health related information, disease management programs, wellness programs, or other community based initiatives or activities in which our practice is participating.

J.   Disaster Relief.   We may disclose your health information in disaster relief situations where disaster relief organizations seek your health information to coordinate your care, or notify family and friends of your location and condition. We will provide you with an opportunity to agree or object to such a disclosure whenever we practicably can do so.

K.   Marketing.   In most circumstances, we are required by law to receive your written authorization before we use or disclose your health information for marketing purposes. However, 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 to you. Under no circumstances will we sell our patient lists or your health information to a third party without your written authorization.

L.   Fundraising.   We may contact you as part of a fundraising effort relating to the facility.

M.   Public Health Activities.    We may disclose medical information about you for public health activities. These activities generally include the following:

  • licensing and certification carried out by public health authorities;
  • prevention or control of disease, injury, or disability;
  • reports of births and deaths;
  • reports of child abuse or neglect;
  • notifications to people who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; organ or tissues donation; and notifications to appropriate government authorities if we believe a patient has been the victim of abuse, neglect, or domestic violence. We will make this disclosure when required by law, or if you agree to the disclosure, or when authorized by law and in our professional judgment disclosure is required to prevent serious harm.

N.   Funeral Directors and Coroners.   We may disclose health information to funeral directors and coroners so that they may carry out their duties consistent with applicable law.

O.   Organ 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.

P.   Food and Drug Administration (FDA).   We may disclose to the FDA and other regulatory agencies of the federal and state government health information relating to adverse events with respect to food, supplements, products and product defects, or post-marketing monitoring information to enable product recalls, repairs, or replacement.

Q.   Psychotherapy Notes.   Under most circumstances, without your written authorization we may not disclose the notes a mental health professional took during a counseling session. However, we may disclose such notes for treatment and payment purposes, for state and federal oversight of the mental health professional, for the purposes of medical examiners and coroners, to avert a serious threat to health or safety, or as otherwise authorized by law.

R.   Research.    We may disclose your health information to researchers when the information does not directly identify you as the source of the information or when a waiver has been issued by an institutional review board or a privacy board that has reviewed the research proposal and protocols for compliance with standards to ensure the privacy of your health information.

S.   Workers Compensation.    We may disclose your 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.

T.   Law Enforcement.   We may release your health information:

  • in response to a court order, subpoena, warrant information, summons or similar process if authorized under state or federal law;
  • to identify or locate a suspect, fugitive, material witness, or similar 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 [name of facility]; to coroners or medical examiners;
  • in emergency circumstances to report a crime, the location of the crime or victims, or the identity, description, or location of the person who committed the crime;

    to authorized federal officials for intelligence, counterintelligence, and other national security authorized by law; and
    to authorized federal officials so they may conduct special investigations or provide protection to the President, other authorized persons, or foreign heads of state.

U.   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.

V.   De-identified Information.   We may use your health information to create “de-identified” information or we may disclose your information to a business associate so that the business associate can create de-identified information on our behalf. When we “de-identify” health information, we remove information that identifies you as the source of the information. Health information is considered “de-identified” only if there is no reasonable basis to believe that the health information could be used to identify you.

W.   Personal Representative.   If you have a personal representative, such as a legal guardian, we will treat that person as if that person is you with respect to disclosures of your health information. If you become deceased, we may disclose health information to an executor or administrator of your estate to the extent that person is acting as your personal representative.

X.   Limited Data Set.   We may use and disclose a limited data set that does not contain specific readily identifiable information about you for research, public health, and health care operations. We may not disseminate the limited data set unless we enter into a data use agreement with the recipient in which the recipient agrees to limit the use of that data set to the purposes for which it was provided, ensure the security of the data, and not identify the information or use it to contact any individual.

Y.   Volunteers.    We may disclose to volunteers in our facility health information only to the extent of that person’s involvement in your care.

3. Authorization for Other Uses of Medical Information

Uses of medical information not covered by our most current Notice of Privacy Practices or the laws that apply to us will be made only with your written authorization. If you provide us with authorization to use or disclose medical information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose medical information about you for the reasons covered by your written authorization, except to the extent that we have already taken action in reliance on your authorization or, if the authorization was obtained as a condition of obtaining insurance coverage and the insurer has the right to contest a claim or the insurance coverage itself. We are unable to take back any disclosures we have already made with your authorization, and we are required to retain our records of the care that we provided to you.

4. Your Health Information Rights

Although your health record is the physical property of the nursing facility, the information in your health records belongs to you. You have the following rights regarding medical information we gather about you.

A.   Right to Obtain a Paper Copy of This Notice.   You have the right to a paper copy of this Notice of Privacy Practices at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy.

B.   Right to Inspect and Copy.   You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does no include psychotherapy notes. To inspect and copy medical information, you must submit a written request to our Privacy Officer. We will supply you with a form for such a request. If you request a copy of your medical information, we may charge a reasonable fee for the costs of labor, postage, and supplies associated with your request. We may not charge you a fee if you require your medical information for a claim for benefits under the Social Security Act (such as claims for Social Security, Supplemental Security Income, and Medicaid benefits) or any other state or federal needs-based benefit program.

We may deny your request to inspect and copy in certain limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. A licensed healthcare professional who was not directly involved in the denial of your request will conduct the review. We will comply with the outcome of the review.

If your medical information is maintained in an electronic health record, you also have the right to request that an electronic copy of your record be sent to you or to another individual or entity. We may charge you a reasonable cost based fee limited to the labor costs associated with transmitting the electronic health record.

C.   Right to Amend.   If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as we retain the information. To request an amendment, your request must be made in writing and submitted to our Privacy Officer. We ask that you use the form provided by our facility to make such requests. In addition, you much provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

If we deny your request for amendment, you may submit a statement of disagreement. We may reasonably limit the length of this statement. Your letter of disagreement will be included in your medical record, but we may also include a rebuttal statement.

D.   Right to an Accounting of Disclosures.   You have the right to request an accounting of disclosures of your health information made by us. In your accounting, we are not required to list certain disclosures, including:

  • was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
  • is not part of the medical information kept by or for the facility;
  • is not part of the information which you would be permitted to inspect and copy; or
  • is accurate and complete.
  • disclosures made for treatment, payment and health care operations purposes or disclosures made incidental to treatment, payment and health care operations, however, if the disclosures were made through an electronic health record, you have the right to request an accounting for such disclosures that were made during the previous 3 years;
  • disclosures made pursuant to your authorization;
  • disclosures to correctional institutions or law enforcement officials;
  • disclosures for national security purposes;
  • disclosures for made to create a limited data set; or
  • disclosures made directly to you.

To request an accounting of disclosures, you must submit your request in writing to our Privacy Officer. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you would like the accounting of disclosures (for example, on paper or electronically by e-mail). The first accounting of disclosures you request within any 12 month period will be free. For additional requests within the same period, we may charge you for the reasonable costs of providing the accounting of disclosures. We will notify you of the costs involved and you may choose to withdraw or modify your request at that time, before any costs are incurred. Under limited circumstances mandated by federal and state law, we may temporarily deny your request for an accounting of disclosures.

E.   Right to Request Restrictions.    You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or health care operations. If you paid out-of-pocket for a specific item or service, you have the right to request that medical information with respect to that item or service not be disclosed to a health plan for purposes of payment or health care operations, and we are required to honor that request. You also have the right to request a limit on the medical information we communicate about you to someone who is involved in your care or the payment of your care. Except as noted above, we are not required to agree to your request. If we do agree, we will comply with your request unless the restricted information is needed to provide you with emergency treatment. To request restrictions, you must make your request in writing to our Privacy Officer. In your request, you must tell us:

  • what information you want to limit;whether you want to limit or use, disclosure, or both; and to whom you want the limits to apply.

 

F.   Right to Request Confidential Communications.   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. To request confidential communications. you must make your request in writing to our Privacy Officer. We will not ask you the reason for your request. We will attempt to accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

G.   Right to Revoke Authorization.    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.

H.   Right to Receive Notice of a Breach.   We are required to notify you by first class mail or by e-mail (if you have indicated a preference to receive information by e-mail), of any breaches of Unsecured Protected Health Information as soon as possible, but in any event, no later than 60 days following the discovery of the breach. “Unsecured Protected Health Information” is information that is not secured through the use of technology or methodology identified by the Secretary of the U.S. Department of Health and Human Services to render the Protected Health Information unusable, unreadable, and undecipherable to unauthorized users. The notice is required to include the following information:

  • a brief description of the breach, including the date of the breach and the date of its discovery, if known;
  • a description of the type of Unsecured Protected Health Information involved in the breach; steps you should take to protect yourself from potential harm resulting from the breach; a brief description of actions we are taking to investigate the breach, mitigate losses, and protect against further breaches; contact information, including a toll-free telephone number, e-mail address, Web site or postal address to permit you to ask questions or obtain additional information.
  • In the event the breach involved 10 or more patients whose contact information is out of date we will post a notice of the breach on the home page of our Web site or in a major print or broadcast media. If the breach involves more than 500 patients in the state or jurisdiction, we will send notices to prominent media outlets. If the breach involves more than 500 patients, we are required to immediately notify the Secretary. We also are required to submit an annual report to the Secretary of a breach that involved less than 500 patients during the year and will maintain a written log of breaches involving less than 500 patients.

5. For More Information or to Report a Problem

If you have questions and would like additional information, you may contact the facility’s Privacy Officer by sending a message on the front page of this website by clicking the DropDown Menu titled - COMPLIANCE / HIPAA

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 Privacy Officer, and when completed should be returned to the Privacy Officer. All complaints must be submitted in writing and should be submitted within 180 days of when you knew or should have known that the alleged violation occurred. You may also file a complaint with the secretary of the federal Department of Health and Human services, contacting the Secretary of the U.S. Department of Health and Human Services, 200 Independence Ave., S.W., Washington, D.C. 20201. See the Office for Civil Rights website, www.hhs.gov/ocr/hipaa for more information.

 

There will be no retaliation for filing a complaint.

Acknowledgement of Receipt of Notice of Privacy Practices:  Download Your Copy


 

Effective Date: August 2008 

Wellington Management

HIPAA Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

 

This Notice applies to facilities owned or managed by Wellington Management Corporation (“Wellington Management”), including Jerseyville Nursing & Rehabilitation Center, Montgomery Nursing & Rehabilitation Center, The Pillars Nursing & Rehabilitation Center of North County, Westwood Hills Healthcare & Rehabilitation Center, NW Rehab, L.L.C., as well as the Mid-South Health Clinic.

 

Our Legal Duty

State and federal law requires Wellington Management to:

Maintain the privacy of your health information · provide you with this notice about our legal duties and privacy practices and your legal rights pertaining to health information we collect and maintain about you · follow the privacy practices described in this notice while it is in effect · notify you if we are unable to agree to a requested restriction pertaining to your health information · accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

We reserve the right to change our information practices and to make the changes effective for all protected health information we maintain. Should our information practices change, we will change our Notice of Privacy Practices and make the new Notice available to you.

How We Will Use or Disclose Your Health Information

We use and disclose health information about you for treatment, to obtain payment for healthcare operations and for other purposes. For example:

(1) Treatment. We may disclose health information about you to physicians, hospitals, medical technicians or other healthcare providers who are or who may be providing treatment to you.

(2) Payment. We may use and disclose your health information to obtain payment for services we provide to you.

(3) Healthcare operations. We may use and disclose your health information in connection with our healthcare operations including quality assessment and improvement activities, reviewing the competence or qualifications of healthcare professionals, evaluating practitioner and provider performance, investigating claims, conducting training programs, accreditation, certification, licensing or credentialing activities.

(4) Business associates. We may disclose your health information to our business associates so that they can perform services for us. To protect your health information, we require our business associates to keep your information confidential.

(5) Directory and Newsletters. Unless you notify us that you object, we may use your name, location in the facility and general condition for directory purposes. This information may be provided to people who ask for you by name. We may also use your name on a facility directory, name plate next to or on your door in order to identify your room, unless you notify us that you object.· Furthermore, unless you notify us that you object, we may use your name, likeness and information for publication in our newsletters.· These newsletters may include birthdays, pictures of you, background information about you, dates of discharge or transfer, and other newsworthy information about your stay at our homes.· We believe our newsletters are a necessary part of our health care operations, fostering a collegial, family-type atmosphere for the benefit and welfare of our residents and the individuals we serve.

(6) Notification of Persons Involved in Care. 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 or on an answering machine.

(7) Communication with family. We may disclose to a family member, relative, 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.

(8) Research. We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.

(9) Funeral directors. We may disclose health information to funeral directors and coroners to carry out their duties.

(10) Organ 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.

(11) Marketing. We may use your health information to inform you about treatment alternatives or other health related benefits and services that may be of interest to you. We will not disclose your health information to others for the purpose of marketing.

(12) 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.

(13) 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.

(14) 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 disability.

(15) Law enforcement. We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.

(16) Reports. Federal law makes provision for your health information to be released to an 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 public.

(17) Required by Law. We may use or disclose your health information as may be required by law.

(18) National Security. We may disclose your health information to federal and state officials as may be required for national security activities.

Your Health Information Rights

Although your health record is the property of Wellington Management, Inc., you have the following rights:

o Inspection and Copying. You may look at and obtain copies of health information about you (with limited exceptions). Requests to view or to obtain copies of your health information must be in writing, signed by you or your authorized representative. If you request copies, we will charge you a reasonable copying and administrative fee according to law.

o Restriction. You may request additional restrictions on the use and disclosure of health information about you. Although we will consider and attempt to accommodate all reasonable requests, we are under no obligation to accept or abide by such requests.

o Amendments. You may request that we amend or make additions to your health information. Such requests must be made in writing, and must explain the reason for requesting the amendment or addition. We may deny your request under certain circumstances.

o Disclosure Accounting. You may request that we provide you with a written statement of all disclosures of your health information made by us during a time period not exceeding 6 years immediately prior to your request and not for disclosures before April 14, 2003. Such an accounting does not apply to 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 may obtain this accounting at no charge once in a twelve month period but you will be charged a reasonable fee for our efforts to comply with additional requests by you in any twelve month period.

o Copy of Notice of Privacy Practices. This Notice of Privacy Practices is posted at Wellington Management and its Nursing Facilities and it is on our website: "thehomeswithheart.com" and you have the right to obtain a paper copy of our Notice of Privacy Practices.

o Revocation of Authorization. You may revoke an authorization to use or disclose health information, except to the extent that action has already been taken in reliance on your authorization. Such a revocation must be in writing signed by you or your authorized representative.

For More Information or to Report a Problem

If have questions and would like additional information, you may contact our Organization's Privacy Officer at 855-656-6544

or you may contact the corporation directly, Wellington Management, by using the Contact Us page on this website.

 

If you believe that your privacy rights have been violated, you may file a complaint with us. These complaints must be filed in writing should be sent to the Privacy Officer at the above address. You may also file a complaint with the Secretary of the United States Department of Health and Human Services. There will be no retaliation for filing a complaint.

 

Acknowledgement of Receipt of Notice of Privacy Practices:  Download Your Copy