“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.”
GENERAL INFORMATION:
When you are admitted, receive treatment or diagnostic services
at this Facility a record of visits/services is made. This record
generally will include a history, physical, consultations, assessment
by nursing, social services, dietary, diagnostic reports, such
as x-ray and laboratory results, the Minimum Data Set, medications,
treatments, care plan/plan of care, authorizations, consents,
progress notes by the physician, nursing, social services and
others involved in treatment services. This information is included
in your health record either manual and/or computerized and is
used as a:
- Source for documenting assessment, planning care
and treatment, recording informed consent, recording progress,
ongoing assessment of health status/progress/needs
- Means of communicating among health professionals
who evaluate you and/or provide care and treatment; copies are
provided for continuity of care to consultants, hospitals, emergency
room or another Health Facility where you might be transferred
- Source to support billing for services and to
meet the requirements of third party payers
Legal document supporting the care, services and treatment provided
- A resource during surveys by the state, federal
and other review agencies
- A tool with which we can assess and continually
work to improve care
- A source to be used by students and a tool in
educating health professionals
Understanding what is in your record and how your
health information is used will assist you to: Ensure
accuracy, better understand,
who, what, when, where and why others may need access
to your health information, make
informed decisions when authorizing
disclosure to others.
YOUR
RIGHTS: The health record is the physical property
of the Windsor_ that compiled it. The information belongs to you.
You have the
right to:
- Inspect and copy your health record
- Amend your health record
- Request alternate means of communication to obtain
your health information
- Request an accounting of disclosures of Protected
Health Information
- Request receipt of the notice electronically
and/or to obtain a paper copy of the notice
- Revoke authorization to use or disclose health
information except to the extent that action has already been
taken
Report
a problem - or if you have a question, or desire
additional information, you may contact Facility Privacy Contact:
Administrator at each facility or if you are not satisfied, contact:
Senior Corporate Privacy Official at:
1 (888) 234-4442.
File a complaint if you think your privacy rights
have been violated. If you are not satisfied with the response
to your concern, you may file a written or oral complaint with
the Administrator. If your response is still a concern you may
file a complaint with the Corporate compliant hotline at
You are also notified that you may file a complaint with:
Secretary
of Health and Human Services
Office for Civil Rights
US Department of HHS
50 United Nations Plaza, Room 322
San Francisco, CA 94102
Phone: (415) 437-8310
The Facility is responsible
to:
- Maintain the privacy of your health information,
to use and disclose information only with your authorization,
unless there are exceptions described in this notice or otherwise
allowed by related laws, rules and regulations
- Provide you with a notice as to our legal duties
and privacy practices with respect to information we collect,
maintain, use, and disclose about you
- Abide by this notice
- Provide any amendment record along with other
documents when information is disclosed
- Notify you if we are unable to agree to requested
restriction/s
- Accommodate reasonable requests you may have
to communicate health information by alternate means or at alternative
locations
- Use or disclose your health information as required
for statistical and funding purposes by the Offices of Statewide
Health Planning and Development, the Centers for Medicare and
Medicaid Services (CMS) and to the State Medicaid (Medi-Cal)
system
The Facility reserves the right to change our privacy
practices and to make new practices known to you through our routine
methods of communications to the latest address/contact provided.
Your health information
will be used for the following:
We
will use your information for treatment. Information
obtained by the physician/s, nursing, social, administrative staff
or other providers of service will be recorded in your manual
and/or computerized record. This information is used to plan your
treatment and services as well as to document progress, events,
plans of care, observations and evaluation of care and treatment,
information for consultants, diagnostic services or for other
providers on transfer to another Facility or other Health Facility.
We
will use your health information for payment. A
bill may be sent to a third party such as Medicare, MediCal (Medicaid),
Health Maintenance Organizations (HMO), and Insurance Companies
or to you.
At least some health information may be provided to the payee
that identifies your demographic information, the diagnosis and
additional health information to support the billing.
We will use your health
information for health care operations.
The Facility and Corporation (as applicable) and staff will use
the health/medical record information as needed to carry out the
regular operations of the Facility and the respective clinical
needs of the treatment staff including the
- Collecting and reporting to the Office of Statewide
Health Planning and Development
- Use for specific quality assurance processes,
committee meetings, on-site reviews for management, internal
surveys quality assurance processes and reviews
- Health
record information
needed for administrative reporting usually for internal Facility
use and/or the Corporation. Uses of this information may or
may not be specific to a patient’s name, i.e., collecting
information regarding incidents, trending information for management
purposes both at the Facility and Corporate level.
Business
Associates: The Facility
may use outside providers for some of the services that we provide
through contracts/agreements. Some examples of these services
are the use of specialty consultants; i.e., cardiology, radiology,
etc., certain diagnostic tests that are not carried out by the
Facility, or consultant educators who may use the specific information
to carry out training for the Facility staff.
Patient
Location: Patient location will be provided (unless
there is an opposing designation in writing) to those individuals
who are determined to be legally authorized representative to
obtain the information, responsible party; emergency contact,
and in case of conservatorship application, the attorney representing
the client.
Notification
and Communication: The Facility may use or disclose
health information to notify or assist in notifying representatives
as identified as a responsible party/emergency contact. The latest
available address will be utilized. It is understood the information
may be provided to you for appointments, results of tests, general
information that would not be confidential via telephone, including
voice mail message, email, fax, and written. The Facility may
notify the responsible representatives of the appointments, special
meetings to discuss care and treatment, at other times related
to the condition/status of the patient. The Facility or the Corporation
is not responsible for assuring the information is retained private
once it is provided through agreed upon communication methods
or when submitted to the name/s of the responsible party/emergency
contact.
Research:
Disclosure of health information for the purposes of research
shall only be made after documented approval for the research.
Names of the individual will not be included unless there is a
specific authorization.
Funeral
Directors and Coroner’s Office:
In the event it is necessary we may disclose the health
information to funeral directors and coroner’s office consistent
with applicable laws as required for them to carry out their duties.
Food
and Drug Administration, Public Health and other required reporting:
We may disclose health information to the extent that is
required by law and in the best interest of the client and the
requirements of the requesting agency.
Workers
Compensation and Employee Actions:
Information may be disclosed to the extent only as required
to carry out the required activities. The privacy of the resident/patient
will be protected within the legal parameters of State.
Law
Enforcement: Disclosure
of health information will be provided to the extent necessary
to carry out the health and safety of the individual, i.e., general
description of the person applicable health condition, special
marks, clothing type, other identification data, and information
as required by law based on the situation.
- Resident Identifiers:
- Resident’s name and room number may
be used in the following ways, outside of room, pictures,
diet cards, diet list, arm bands, wheelchairs, activity
boards, resident records, resident roster.
- Names of resident’s are included on
a resident roster that is distributed throughout facility.
The roster title page will be added in order to improve
security.
- Use of whiteboards, bulletin boards or other
methods placed in various locations in the facility, used
for established systems are to be removed and/or room number
and names will be covered and visible only when in use.
- Monthly Facility newsletters
Effective
date:
April 14, 2003