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Gracedale Nursing Home
County of Northampton

Notice of Privacy Practices
Effective April 2003

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 at (610) 746-1944.

This notice describes Gracedale’s practices and that of any health care professional authorized to enter information in your chart. This includes all departments and units, all employees, staff, physicians, volunteers and other personnel.

Our Responsibilities
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at Gracedale. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of care generated by Gracedale, whether made by Gracedale personnel or your physician.

This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information. We are required by law to: make sure that medical information that identifies you is kept private; give you this notice of our legal duties and privacy practices with respect to medical information about you; and follow the terms of the notice that is currently in effect.

How We May Use and Disclose Medical Information About You
The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures, we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall into one of the categories.

  • For Treatment   We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, students or other personnel who are involved in taking care of you. For example, a doctor treating you for an ingrown toenail needs to know if you have diabetes because the diabetes may slow the healing process. In addition, the dietician would need to know you have diabetes so that we can arrange for appropriate meals. Different departments also may share medical information about you in order to coordinate the different things you need like physical therapy, occupational therapy, and lab work. We also may disclose medical information about you to people outside Gracedale who may be involved in your medical care after you leave here, such as family members or others we use to provide services that are part of your care.
  • For Payment   We may use or disclose medical information about you so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company, or a third party. For example, we will need to give your health plan information so the plan will pay us for the services you receive. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or determine whether your plan will cover the treatment.
  • For Health Care Operations   We may use or disclose medical information about you for nursing home operations. These uses and disclosures are necessary to operate Gracedale and make sure that all of our residents receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical information about many residents to decide what additional services to offer, what may not be needed, and whether new things are effective. We may also disclose information to doctors, nurses, and other professional personnel for review and learning purposes. We may also combine the medical information we have with that medical information from other nursing homes to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific individuals are.
  • Treatment Alternatives   We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
  • Health-Related Benefits or Services   We may use or disclose medical information to tell you about health-related benefits or services that may be of interest to you. For example, if you are eligible for Veteran’s benefits, we may provide information to the Veteran’s Administration so you may receive these benefits.
  • Directory   We may include certain limited information about you in the directory. This information includes your name, location in the facility, and your religious affiliation. The directory information, except for your religious affiliation, may be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest, minister, rabbi, or lay clergy, even if they don’t ask for you by name. This is so your family, friends, and clergy can visit you here at Gracedale.
  • Individuals Involved in Your Care or Payment for Your Care   We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care.
  • As Required by Law   We will disclose medical information about you when required to do so by federal, state, or local law.
  • To Avert a Serious Threat to Health or Safety   We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
  • Organ and Tissue Donation   If you are an organ donor, we may release medical information about you to organizations that handle organ procurement or organ, eye, or tissue transplantation, or to an organ donor bank, as necessary to facilitate organ or tissue donation and transplantation.
  • Public Health Risks   We may disclose medical information about you for public health activities. These activities generally include the following: to prevent or control disease, injury or disability; to report deaths; to report reactions to medications or problems with products; to notify people of recalls of products they may be using; to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
  • Victims of Abuse/ Neglect   We may disclose medical information about you to notify the appropriate government authority if we know or suspect that you have been the victim of abuse or neglect.
  • Health Oversight Activities   We may disclose medical information to a health oversight agency for activities covered by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
  • Lawsuits and Disputes   If you are involved in a lawsuit or a 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 or to obtain an order protecting the information requested.
  • Law Enforcement   We may release medical information if asked to do so by a law enforcement official in response to a court order, subpoena, warrant, summons or similar process. We may also share information to identify or locate a suspect, fugitive, material witness, or missing person or about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement. Information may be released about a death we believe may be the result of criminal conduct; about criminal conduct at Gracedale and 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.
  • Coroners, Medical Examiners, and Funeral Directors   We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about residents to funeral directors as necessary to carry out their duties.
  • National Security and Intelligence Activities   We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
  • Worker’s Compensation   If an employee is injured while providing care to you, we may release medical information about you if it is pertinent to the case.

Your Rights Regarding Medical Information About You
You have the following rights regarding medical information we maintain about you:

  • Right to a paper copy of this notice   You may ask us to give you a copy of this notice at any time.
  • Right to request restrictions   You have the right to request restrictions or limitation on the medical information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or payment of care, such as a family member or friend. We are not required to agree with your request. If we do agree, we will comply with the request unless information is needed to provide emergency treatment. To request restrictions, you must make your request in writing to the Privacy Officer at (610) 746-1944. In your request you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure, or both; and (3) to whom you want the limits to apply.
  • Right to inspect and obtain a copy   You have the right to inspect and receive a copy of medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. To inspect your record, you must ask the charge nurse on your unit. To receive a copy, you must submit your request in writing to the Director of Nursing. A fee is charged for the costs of copying, mailing, or other supplies associated with your request.
    We may deny your request to inspect and copy in certain very limited circumstances. If you are denied, you may request that the denial be reviewed. Gracedale’s Administrator will review your request and the denial. The person conducting the review will not be the person who denied your request. Gracedale will comply with the decision by the Administrator.
  • Right to amend   If you feel that medical information about you is incorrect or incomplete, you may ask us to amend the information. To request an amendment, your request must be made in writing and submitted to the Privacy Officer. You must provide a reason that supports your request. We may deny your request if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if the information to be amended (1) was not created by us, unless the creator is no longer available to make the amendment; (2) is not part of the medical record kept by Gracedale; (3) is not part of the information which you would be permitted to inspect and copy; and (4) is accurate and complete.
  • Right to an accounting of disclosures   You have the right to request an “accounting of disclosures”. This is a list of the disclosures we made of medical information about you. To request this list, you must submit your request in writing to the 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. The first list you request in a 12 month period will be free. Additional lists will be charged at the rate determined annually by the Commonwealth of Pennsylvania. We will notify you of the cost and you may choose to withdraw or modify your request at that time before any costs are incurred.
  • Right to request confidential communication   You have the right to request that we communicate with you about your medical matters in a certain way or at a certain location. For example, you may ask that we only contact you here at Gracedale. To request confidential communications, you must make your request in writing to the Privacy Officer. We will not ask you the reason for your request. Gracedale will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Other Uses of Medical Information
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

Changes to this Notice
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you, as well as any information we receive in the future. We will post a copy of the current notice in the Arcade and in the Social Services Department. You may request a current copy of this notice by contacting the Privacy Officer or your Social Worker.

The notice will contain the effective date on the cover and on the first page.

Complaints
If you believe your privacy rights have been violated, you may file a complaint with Gracedale or with the Secretary of the Department of Health and Human Services. To file a complaint with Gracedale, contact the Privacy Officer at (610) 746-1944. All complaints must be filed in writing. You will not be penalized for filing a complaint.

 

 
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