NOTICE OF PRIVACY PRACTICES
EFFECTIVE DATE OF REVISED PRIVACY NOTICE: 7/22/2021
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW CAREFULLY.
If you have any questions about this Notice or wish to file a complaint, please contact:
C/O Elegance Living, LLC
1416 Clarkview Road Baltimore, Maryland 21209
I. OUR GENERAL DUTIES REGARDING YOUR MEDICAL INFORMATION
We receive, use and create medical information and records related to the care and services you receive at Symphony at Mentor, hereafter referred to as “the Community.” We need such information to provide you with quality care, to comply with certain legal requirements, and to carry out business functions of the Community. We are required by law to maintain the privacy of your medical information (also known as “protected health information” or PHI). In other words, we must make sure that medical information that identifies you is kept private. We are committed to protecting your privacy rights, and will only use or disclose your medical information as permitted by law.
This Notice applies to all records of your care used or generated by the Community and describes the different ways that we use and disclose your medical information. It also describes certain rights you have with respect to your medical information. We are required by law to give you this Notice of our legal duties and privacy practices with respect to medical information about you. You have the right to receive a paper copy of this Notice. In addition, a copy of our current Notice is available on our internet website. We will not share your information other than as described here unless you tell us we can in writing. If you give us permission for specific disclosures, you may change your mind at any time. Let us know in writing if you change your mind.
We are required by law to abide by the terms of the Notice that is currently in effect. Please be aware that we may change the terms of this Notice at any time. We will post a copy of the current notice in the reception area of the Community. In addition, we will make a copy of the current notice in effect available to you upon your request at any time.
II. USES AND DISCLOSURES OF YOUR MEDICAL INFORMATION
A. Frequent and Routine Uses and Disclosures for Treatment, Payment, Health Care Operations, and Administrative Purposes.
Upon your move-in to the Community, we will use good faith efforts to obtain from you a written acknowledgment that you have received a copy of this Notice of Privacy Practices. After that, with very few exceptions, State and Federal privacy laws including HIPAA permit us to use and disclose your medical information for treatment, payment and/or health care operations purposes and other routine uses, as described below.
(i) No Consent Needed: We are not required to obtain your consent to use/disclose your resident information for the following purpose(s):
(a) Treatment – We may use or disclose medical information about you to provide you with medical treatment or services. This means that we may share medical information about you with doctors, nurses and other staff at the Community who are involved in taking care of you. It also means that we may disclose medical information about you to providers outside the Community who are or may be involved in your medical care. For example, we may disclose medical information to a physician, a hospital, surgical center or other facility which we may send you to for procedures or required care.
(b) For Payment – We may use or disclose medical information about you to your insurance company, a governmental payer or other responsible third party for the purpose of receiving payment for the medical treatment you received. For example, we may tell your health plan about a medical treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. We may also use your medical information for billing and collections purposes.
(c) For Health Care Operations – We also may use and disclose medical information about you for our day-to-day health care operations. These uses and disclosures are for the necessary business of the Community, and to ensure that all 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 help determine what additional services we should offer, what services should be discontinued, and whether certain new treatments are effective. For some of these health care operations purposes, we will share your medical information with third party “business associates” that perform various activities (such as billing or transcription services) for the Community. Whenever an arrangement between the Community and a business associate involves the use or disclosure of your medical information, we will have a written contract that contains terms that will protect the privacy of your protected health information.
(ii) Exceptions – State laws and some federal laws may be more protective of certain information than HIPAA. For instance, many states restrict the use or disclosure of “highly confidential information” such as information relating to treatment for mental health, development disabilities, alcoholism, drug dependence or information concerning HIV status and genetic tests. Some states also have specific procedures for responding to discovery requests and subpoenas or for disclosing information to coroners or funeral directors or other third parties. The Community will not use your information in any way that is not permitted by state law or other more restrictive federal laws.
B. Other Uses and Disclosures of Medical Information for which Resident Permission or Authorization is Not Necessary.
We may use and disclose medical information without your express permission in the following situations:
(i) Uses and Disclosures to Family and Friends – We may disclose to your family member, or close, personal friend involved with your medical care, medical information about you that is directly relevant to your family member or friend’s involvement with your care or with the payment related to your care. In most instances, before we disclose any medical information about you to your family members or friends, we will inform you of the disclosure and give you an opportunity to agree or object to the disclosure.
(ii) Uses and Disclosures for Disaster Relief Purposes – For the limited circumstances of disaster relief efforts, we may disclose medical information about you to your close family or friends, or to a public or private disaster relief entity for purposes of notifying your family and friends of your condition and location. If you are available and competent prior to the disclosure, we will give you an opportunity to agree or object to the disclosure to the extent that providing you with the prior notice and an opportunity to restrict or object to the disclosure will not interfere with our ability to respond to the situation.
(iii) Uses and Disclosures Required by Law – We may use or disclose medical information to the extent that such use or disclosure is required by federal, state or local law and the use or disclosure complies with and is limited to the relevant requirements of such law.
(iv) Uses and Disclosures for Treatment Alternatives – We may use or disclose medical information to tell you about possible treatment options or alternatives that may be of interest to you.
(v) Health Related Benefits, Services and Reminders – We may contact you to provide an appointment, reminders or information about treatment alternatives or other health related benefits and services that may be of interest to you.
(vi) Community Directory – We may include information about you in the Community directory while you are a resident. This information may include your name, location in the Community, your general condition (example: fair, stable, etc.). The directory information may be disclosed to people who ask for you by name. This is so your family and friends can visit you in the Community and know how you are generally doing.
(vii) Uses and Disclosures for Public Health Activities – We may use or disclose medical information about you for public health activities, such as to:
(a) a public health authority that is authorized by law to collect or receive information for the purposes of preventing or controlling disease, injury or disability;
(b) a public health authority or other appropriate government entity authorized by law to receive reports of child abuse or neglect;
(c) an FDA agent or official to report reactions to medication or problems with products;
(d) a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition; or
(e) an employer, to evaluate whether the individual has a work-related illness.
(viii) Disclosures about Victims of Abuse, Neglect or Domestic Violence – We may disclose medical information about you to a government authority, including a social service or protective agency if we reasonably believe you to be a victim of abuse, neglect, or domestic violence.
(ix) Uses and Disclosures for Health Oversight Activities – We may use or disclose medical information to inform a health oversight agency for oversight activities authorized by law, including audits; civil, administrative, or criminal investigations; inspections; or licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
(x) Disclosures for Judicial and Administrative Proceedings – We may disclose medical information about you in the course of a judicial or administrative proceeding with a valid court order or appropriate subpoena or discovery request.
(xi) Disclosures for Law Enforcement Purposes – We may disclose medical information if asked to do so by a law enforcement official for a legitimate law enforcement purpose, so long as the disclosure complies with state and federal law.
(xii) Uses and Disclosures to Coroners, Medical Examiners and Funeral Directors – We may disclose medical information to a coroner or medical examiner for the purpose of identifying a deceased person, determining the cause of death, or other duties as authorized by law. We may also disclose medical information to funeral directors as necessary to carry out their duties.
(xiii) Uses and Disclosures for Organ, Eye or Tissue Donation Purposes – We may use or disclose medical information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of cadaveric organs, eyes, or tissue for the purpose of facilitating organ, eye, or tissue donation and transplantation.
(xiv) Uses and Disclosures for Research Purposes – We may use or disclose medical information about you for research purposes, if we follow a special approval process. This process evaluates the proposed research project and its use of medical information, specifically trying to balance the research needs with residents’ needs for privacy of their medical information. If we do not complete this approval process, we will not use or disclose medical information for research without your Authorization.
(xv) Uses and Disclosures to Avert a Serious Threat to Health or Safety – We may use or disclose medical information about you if we reasonably believe, in good faith, that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of your or any other person.
(xvi) Uses and Disclosures for Specialized Government Functions – We may use or disclose medical information of individuals who are Armed Forces personnel, to authorized federal officials for national security and intelligence purposes and for protection of the President of the United States or other heads of state. In some circumstances, we may use or disclose medical information about an inmate or individual that a correctional institute has lawful custody of.
(xvii) Uses and Disclosures for Workers’ Compensation – We may disclose medical information as authorized by and to the extent necessary to comply with state laws relating to workers’ compensation.
C. Uses and Disclosures with Your Authorization Only – A use and disclosure of medical information for purposes not listed above in Sections A and B, including most marketing purposes, will only be made with your written Authorization. The Authorization form that we use complies with applicable laws. You may revoke this Authorization at any time by providing us with written notice of such revocation. Your revocation shall become effective immediately upon our receipt of such notice, except to the extent that we have already relied upon your previous Authorization.
III. YOUR RIGHTS REGARDING PRIVATE MEDICAL INFORMATION
You have the following rights with respect to your own medical information.
A. Right to Choose Someone to Act for You – You have the right to appoint someone to act on your behalf and make choices about your health information. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
We will make sure the person has this authority and can act for you before we take any action.
B. Right to Request Restrictions – You have the right to request that we restrict or limit the uses or disclosures of your medical information. For example, you could ask that we not disclose or use information about a certain medical treatment you received. We are not required to agree to your request, however. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will agree to this request unless a law requires us to share the information.
To request restrictions, you must make your request in writing to the Privacy Officer at the top of this Notice. In your request, you must tell us:
- what information you want to limit;
- whether you want to limit our use, disclosure, or both; and
- to whom you want the limits to apply, for example, disclosures to your spouse.
C. Right to Receive Confidential Communications – You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work.
To request confidential communications, you must make your request in writing to the Community’s Administrator or the Privacy Officer (address/phone above). We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
D. Right to Inspect and Copy Your Medical Information – You have the right to inspect and copy medical information that may be used to make decisions about your care. If you agree in advance, we may provide you with a summary or explanation of your medical information.
You must submit your request in writing to the Community’s Administrator or the Privacy Officer. If you request a copy of the information, we may, as permitted by state law, charge a reasonable fee for the costs of preparing a summary or explanation of your medical information or for the costs of copying, mailing, or other supplies associated with your request. The person listed above can also advise you about any fees we will charge for copying the information you have requested.
If your medical information is maintained in an electronic format (known as an electronic medical record or an electronic health record), you have the right to request that an electronic copy of your record be given to your or transmitted to another individual or entity. If the medical information is not readily producible in the form or format you request we will provide you with a paper copy.
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to certain medical information you may request that the denial be reviewed.
E. Right to Request that we Amend Medical Information – You have the right to request an amendment of your medical information if you feel the information is incomplete or incorrect for as long as the information is maintained by the Community. To request an amendment, your request must be made in writing and submitted to the Community’s Administrator or the Privacy Officer (address/phone above); you must provide a reason for your request. If the Community, in compliance with state and federal law, rejects your amendment request, we shall permit you to submit to us a written statement of disagreement to be kept with your medical information. The Community may reasonably limit the length of such statement of disagreement.
F. Right to be Notified in the Event of a Breach of Your Protected Health Information – In the event that we become aware of an impermissible use or disclosure of your medical information which constitutes a threat to the security and privacy of your information, we will notify you of the breach in a timely manner and advise you of steps that we are taking to resolve the problem, as well as steps that you may wish to take.
G. Right to Receive an Accounting of Certain Disclosures of Medical Information – You have the right to receive an accounting of the disclosures of your medical information made by the Community in the six years prior to the date on which the accounting is requested and may not include dated before April 14, 2003.
We DO NOT have to account for disclosures made;
- to carry out treatment, payment and health care operations unless disclosure was made through an electronic health record;
- to you (or legal representative);
- for the Community’s directory or to persons involved in the individual’s care;
- for national security or intelligence purposes;
- to correctional institutions or law enforcement officials;
- pursuant to your authorization;
- for certain research purposes; or
- that occurred prior to the compliance date for the Community.To request this list or accounting of disclosures, you must submit your request in writing to the Privacy Officer (address/phone above). Your request should indicate in what form you want the list (for example, on paper or electronically). You have the right to one accounting of disclosures of your medical information in a twelve-month period free of charge.
We may charge a reasonable fee for the costs associated with your request for any additional accountings within the same twelve-month period. You may modify or withdraw your additional accounting requests in order to reduce or avoid the fee.
If you believe your privacy rights have been violated, you may file a complaint with the Community or with the Secretary of the Department of Health and Human Services. To file a complaint with the Secretary of the Department of Health and Human Service, contact: Medical Privacy, Complaint Division, Office of Civil Rights, United States Department of Health and Human Services, 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington, D.C. 20201; Voice Hotline Number (800) 368-1019; or by visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
To file a complaint with the Community, contact the Community’s Executive Director or the Privacy Officer identified at the top of this Notice. All complaints must be submitted in writing.
You will not be penalized in any way for filing a complaint.