The Maria-Joseph Living Care Center

Care is our mission.  Faith is our guide.

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.

The terms of this Notice of Privacy Practices apply to the Maria-Joseph Center and its business associates.  The Center will share personal health information of residents as necessary to carry out treatment, payment, and health care operations as permitted by law.  This notice describes the practices of our nursing facility and of the following persons and entities:

·        Any health care professional authorized to enter information into your medical chart.

·        All departments and units of this facility.

·        Any volunteer and contractor who provides services to you while you are in our facility.

·        All employees, staff and other facility personnel.

·        The following classes of providers and suppliers and their employees:  laboratories, transportation providers, radiology providers, pharmacies, and medical supply companies.

·        The following classes of individual health care providers:  attending physicians, optometrists, ophthalmologists, dentists, podiatrists, psychologists and psychiatrists.

We are required by law to maintain the privacy of our residents’ personal health information and to provide residents with notice of our legal duties and privacy practices with respect to your personal health information.  We are required to abide by the terms of this Notice so long as it remains in effect.  We reserve the right to change the terms of this Notice of Privacy Practices as necessary and to make the new Notice effective for all personal health information maintained by us.  Copies of revised notices will be mailed to all residents and their responsible parties and copies may be obtained in the Center’s Admissions Office, by mailing your request to the Center, or can be found on our website at www.mariajoseph.org.

Uses and Disclosures of Your Personal Health Information

Treatment We will use or disclose your health information for treatment purposes, including for the treatment activities of other health care providers.  For example, information obtained by a nurse, physician, or other member of your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you.  Your physician will document in your record his or her expectations of the members of your healthcare team.  Members of your healthcare team will then record the actions they took and their observations.  In that way, the physician will know how you are responding to treatment.  We will also provide your physician or a subsequent healthcare provider with copies of various reports that should assist him or her in treating you once you are discharged from our nursing facility.

Payment  We will use or disclose your health information for payment, including for the payment activities of other health care providers or payers.  For example, a bill may be sent to you or a third-party payer, including Medicare or Medicaid.  The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.

Health care operations  We will use or disclose your health information for our regular health operations.  For example, members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it.  This information will then be used in an effort to continually improve the quality  and effectiveness of the health care and services we provide.

In addition, we will disclose your health information for certain health care operations of other entities.  However, we will only disclose your information under the following conditions: (a) the other entity must have, or have had in the past, a relationship with you; (b) the health information used or disclosed must relate to that other entity’s relationship with you; and (c) the disclosure must only be for one of the following purposes: (i) quality assessment and improvement activities; (ii) population-based activities relating to improving health or reducing health care costs; (iii) case management and care coordination; (iv) conducting training programs; (v) accreditation, licensing, or credentialing activities; or (vi) health care fraud and abuse detection or compliance.

Business associates  There are some services provided in our organization through the use of outside people and entities.  Examples of these “business associates” include our accountants, consultants and attorneys.  We may disclose our 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 the business associates to appropriately safeguard your information.

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 provided 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 nameplate next to or on your door in order to identify your room, unless you notify us that you object.

Notification  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, e.g., on an answering machine.

Communication with family  We may disclose to a family member, other relative, close personal friend or any other person involved in your health care, health information relevant to that person’s involvement in your care or payment related to your care.

Marketing  We may contact you regarding your treatment, to coordinate your care, or to direct or recommend alternative treatments, therapies, health care providers or settings.  In addition, we may contact you to describe a health-related product or services that may be of interest to you, and the payment for such product or service.

Fund-raising  We may contact you as part of a fund-raising effort.

Other uses & disclosures  We may use or disclose your protected health information in the following situations without your authorization since these uses and disclosures are required or permitted by law without such authorization:

• As required by law            
• For public health activities, such as reporting to the Federal Drug Administration or the Occupational Safety and Health Administration
• About victims of abuse, neglect or domestic violence
• For health oversight activities
• For judicial and administrative proceedings
• For law enforcement purposes
• About decedents, such as releases to coroners, medical examiners and funeral directors
• For cadaveric organ, eye or tissue donation purposes.
• To avert a serious threat to health or safety
• For specialized government functions, such as national security
• For workers’ compensation

Rights That You Have

Although your health record is the physical property of the nursing facility, the information in your health record belongs to you.  You have the following rights:

·        You may request that we not use or disclose your health information for a particular reason related to treatment, payment, the Facility’s general health care operations, and/or to a particular family member, other relative or close personal friend.  We ask that such request be made in writing on a form provided by our facility.  Although we will consider your request with regard to the use of your health information, please be aware that we are under no obligation to accept it or to abide by it.  We will abide by your request with regard to the disclosure of your clinical and personal records to anyone outside of the facility, except in an emergency, if you are being transferred to another health care institution, or the disclosure is required by law.  For more information about this right, see 45 Code of Federal Regulations (C.F.R.) 164.522(a).

·        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.  Such a request must be made in writing, and submitted to Karrie Toms, Compliance Liaison.  We will attempt to accommodate all reasonable requests.  For more information about this right, see 45 C.F.R. 164.522(b).

·        You may request to inspect and/or obtain copies of health information about you, which will be provided to you in the time frames established by law.  You may make such request orally or in writing; however, in order to better respond to your requests we ask that you make such requests in writing on our facility’s standard form.  If you request to have copies made, we will charge you a reasonable fee.  For more·        information about this right, see 45 C.F.R. 164.524.

·        If you believe that any health information in your record is incorrect or if you believe that important information is missing, you may request that we correct the existing information or add the missing information.  Such requests must be made in writing, and must provide a reason to support the amendment.  We ask that you use the form provided by our facility to make such requests.  For a request form, please contact the Compliance Liaison.  For more information about this right, see 45 C.F.R. 164.526.

·        You may request that we provide you with a written accounting of all disclosure made by us during the time period for which you request (not to exceed 6 years).  We ask that such requests be made in writing on a form provided by our facility.  Please note that an accounting will not apply to disclosures made:

o       for reasons of treatment, payment or health care operations;

o       to you or your legal representative, or any other individual involved with your care;

o       to a facility directory;

o       to correctional institutions or law enforcement officials;

o       for national security purposes;

o       pursuant to an authorization; and

o       prior to April 14, 2003

You will not be charged for your first accounting request in any twelve (12) month period.  However, for any requests that you make thereafter, you will be charged a reasonable, cost-based fee.  For more information about this right, see 45 C.F.R. 164.528.

For More Information or to Report a Problem

If you have questions and would like additional information, you may contact our facility’s Compliance Liaison at (937) 278-2692 ext. 211 or our Privacy Officer, Cynthia Howley, at (937) 208-9789.

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 Karrie Toms, Compliance Liaison, and when completed should be returned to the Compliance Liaison or Cynthia Howley, Privacy Officer at the address on the form.  You may also file a complaint with the secretary of the federal Department of Health and Human Services.  There will be no retaliation for filing a complaint.

Effective Date

This Notice of Privacy Practices is effective April 14, 2003.

A member of Premier Health Partners

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4830 Salem Ave.

Dayton, Ohio 45416-1798

(937)-278-2692