NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU
MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS
TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY
At St. Anne Home, we respect the privacy of your
personal health information and are committed to
maintaining our residents' confidentiality. This
Notice applies to all information and records related
to your care that our facility has received or created.
It extends to information received or created by
our employees, staff, volunteers and the Medical
Director or employed physicians. This Notice informs
you about the possible uses and disclosures of your
personal health information. It also describes your
rights and our obligations regarding your personal
We are required by law to:
maintain the privacy of your protected health
- provide to you this detailed Notice of our
legal duties and privacy practices relating to your
personal health information; and
- abide by the terms of the Notice that are
currently in effect.
1. WE MAY USE AND DISCLOSE YOUR PERSONAL HEALTH
INFORMATION FOR TREATMENT, PAYMENT, AND HEALTH CARE
OPERATIONS WITHOUT NEEDING TO OBTAIN YOUR CONSENT
may use and disclose your personal health information
for purposes of treatment, payment and health care
operations. We have described these uses and disclosures
below and provide examples of the types of uses and
disclosures we may make in each of these categories.
For Treatment. We will use and disclose your personal
health information in providing you with treatment
and services. We may disclose your personal health
information to facility and non-facility personnel
who may be involved in your care, including but not
limited to physicians, nurses, nurse aides, nursing
students, and rehabilitation therapists. For example,
a nurse caring for you will report any change in
your condition to your physician. We also may
disclose personal health information to individuals
who will be involved in your care after you leave
For Payment. We may use and disclose your personal
health information so that we can bill and receive
payment for the treatment and services you receive
at the facility. For billing and payment purposes,
we may disclose your personal health information
to your representative, an insurance or managed care
company, Medicare, Medicaid or another third party
payor. For example, we may contact Medicare or your
health plan to confirm your coverage or to request
prior approval for a proposed treatment or service.
For Health Care Operations. We may use and disclose
your personal health information for facility operations.
These uses and disclosures are necessary to manage
the facility and to monitor our quality of care.
For example, we may use personal health information
to evaluate our facility's services, including the
performance of our staff.
2. WE MAY USE AND DISCLOSE PERSONAL HEALTH INFORMATION
ABOUT YOU FOR OTHER SPECIAL SITUATIONS
We may use
or disclose your health information in certain special
situations as described below. For these situations,
you have the right to limit these uses and disclosures
as provided for in Section 5 of this Notice.
Facility Directory. Unless you object, we will include
certain limited information about you in our facility
directory. This information may include your name,
your location in the facility, your general condition
and your religious affiliation. Our directory does
not include specific medical information about you.
We may release information in our directory, except
for your religious affiliation, to people who ask
for you by name. We may provide the directory information,
including your religious affiliation, to any member
of the clergy.
Individuals Involved in Your Care or Payment for
Your Care. Unless you object, we may disclose your
personal health information to a family member or
close personal friend, including clergy, who is involved
in your care. We may make such disclosures when:
(a) we have your verbal agreement to do so; (b) we
make such disclosures and you do not object; or (c)
we can infer from the circumstances that you would
not object to such disclosures.
We also may disclose your health information to
family members or friends in instances when you are
unable to agree or object to such disclosures, provided
that we feel it is in your best interests to make
such disclosures and the disclosures relate to that
family member or friend’s involvement in your
care. For example, if your medical condition prevents
you from either agreeing or objecting to disclosures
made to your family or friends, we may share information
with the family member or friend that comes to visit
you at our facility, but we will share only that
information which relates to their involvement in
Disaster Relief. We may disclose your personal health
information to an organization assisting in a disaster
Fundraising Activities. We may use certain personal
health information to contact you in an effort to
raise money for the facility and its operations.
We may disclose personal health information to a
foundation related to the facility and/or fund raising
consultant so that the foundation and/or fund raising
consultant may contact you in raising money for the
facility. In doing so, we would only release contact
information, such as your name, address and phone
number and the dates you received treatment or services
at the facility.
3. OTHER PERMITTED OR REQUIRED USES AND DISCLOSURES
OF PERSONAL HEALTH INFORMATION
As Required By Law.
We will disclose your personal health information
when required by law to do so. Public Health Activities.
We may disclose your personal health information
for public health activities. These activities may
include, for example
- reporting to a public health or other government
authority for preventing or controlling disease,
injury or disability, or reporting child abuse or
- reporting to the federal Food and Drug Administration
(FDA) concerning adverse events or problems with
products for tracking products in certain circumstances,
to enable product recalls or to comply with other
- to notify 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
- for certain purposes involving workplace
illness or injuries.
Reporting Victims of Abuse.
Neglect or Domestic Violence. If we believe that you have been a victim
of abuse, neglect or domestic violence, we may use
and disclose your personal health information to
notify a government authority if required or authorized
by law, or if you agree to the report.
Health Oversight Activities. We may disclose your
personal health information to a health oversight
agency for oversight activities authorized by law.
These may include, for example, audits, investigations,
inspections and licensure actions or other legal
proceedings. These activities are necessary for government
oversight of the health care system, government payment
or regulatory programs, and compliance with civil
Judicial and Administrative
Proceedings. We may
disclose your personal health information in response
to a court or administrative order. We also may disclose
information in response to a subpoena, discovery
request, or other lawful process; efforts will be
made to contact you about the request or to give
you an opportunity to obtain an order or agreement
protecting the information.
Law Enforcement. We may disclose your personal health
information for certain law enforcement purposes,
including as required by law to comply with reporting
requirements; to comply with a court order, warrant,
subpoena, summons, investigative demand or similar
legal process; to identify or locate a suspect, fugitive,
material witness, or missing person; when information
is requested about the victim of a crime if the individual
agrees or under other limited circumstances; to report
information about a suspicious death; to provide
information about criminal conduct occurring at the
facility; to report information in emergency circumstances
about a crime; or where necessary to identify or
apprehend an individual in relation to a violent
crime or an escape from lawful custody.
Coroners, Medical Examiners,
Funeral Directors, Organ Procurement Organizations. We may release your
personal health information to a coroner, medical
examiner, funeral director or, if you are an organ
donor, to an organization involved in the donation
of organs and tissue.
To Avert a Serious Threat to
Health or Safety. We
may use and disclose your personal health information
when necessary to prevent a serious threat to your
health or safety or the health or safety of the public
or another person. However, any disclosure would
be made only to someone able to help prevent the
Military and Veterans. If you are a member of the
armed forces, we may use and disclose your personal
health information as required by military command
authorities. We may also use and disclose personal
health information about foreign military personnel
as required by the appropriate foreign military authority.
Workers' Compensation. We may use or disclose your
personal health information to comply with laws relating
to workers' compensation or similar programs.
National Security and Intelligence
Activities Protective Services for the President
and Others. We may disclose
personal health information to authorized federal
officials conducting national security and intelligence
activities or as needed to provide protection to
the President of the United States, certain other
persons or foreign heads of states or to conduct
certain special investigations.
Appointment Reminders. We may use or disclose personal
health information to remind you about appointments.
Treatment Alternatives. We may use or disclose personal
health information to inform you about treatment
alternatives that may be of interest to you.
Health Related Benefits and
Services. We may use
or disclose personal health information to inform
you about health‑related benefits and services
that may be of interest to you.
4. YOUR AUTHORIZATION IS REQUIRED FOR ALL OTHER
USES OF PERSONAL HEALTH INFORMATION
Except as described
in this Notice or required by law, we will use and
disclose personal health information only with your
written Authorization. You may revoke your Authorization
to use or disclose personal health information in
writing, at any time. If you revoke your Authorization,
we will no longer use or disclose your personal health
information for the purposes covered by the Authorization,
except where we have already relied on the Authorization.
5. YOUR RIGHTS REGARDING YOUR PERSONAL HEALTH INFORMATION
have the following rights regarding your personal
health information at the facility:
Right to Request Restrictions. You have the right
to request restrictions on our use or disclosure
of your personal health information for treatment,
payment or health care operations. We are not required
to agree to your requested restriction. However,
if we do agree to the restriction, then we must adhere
to the restriction.
You also have the right to restrict the personal
health information we disclose about you to a family
member, friend or other person who is involved in
your care or the payment for your care. You can object
to the use of the following information in our facility
directory: your name, your location in St. Anne Home,
your health condition described in general terms
and your religious affiliation. You can object to
the disclosure of the following information to your
family and friends who make specific inquiries about
you: your name, your location in St. Anne Home and
your health condition described in general terms.
You can object to the disclosure of the following
information to members of the clergy who make specific
inquiries about you: your name, your location in
St. Anne Home, your health condition described in
general terms and your religious affiliation. You
can object to the disclosure of the protected health
information for purposes of assisting in disaster
relief. If you wish to exercise your right to make
any of these use and disclosure objections related
to our facility directory, your family or friends,
members of the clergy or for disaster relief purposes
and are a nursing facility resident, please contact
Christy Kremer, Director of Social Services at (724)
837-6070. Please contact Margaret Cramer at (724)
837-6070 if you are calling on behave of, or are
a, personal care facility resident.
Any agreement we make to a request for additional
restrictions must be in writing signed by a person
authorized to make such an agreement. We will not
be bound unless our agreement is so memorialized
Right of Access to Personal
Health Information. You have the right to request, either orally or in
writing, your medical or billing records or other
written information that may be used to make decisions
about your care. We must allow you to inspect your
records within 24 hours of your request. If you request
copies of the records, we must provide you with copies
within 48 hours, exclusive of weekends or holidays,
of that request. We charge a reasonable fee for our
costs in copying and mailing your requested information,
please refer to the Schedule of Charges updated each
Right to Request Amendment. You have the right to
request the facility to amend any personal health
information maintained by the facility for as long
as the information is kept by or for the facility.
You must make your request must be made in writing
and must state the reason for the requested amendment.
We may deny your request for amendment if the information:
- was not created by the facility, unless the
originator of the information is no longer available
to act on our request;
- is not part of the personal
health information maintained by or for the facility;
- is not part of the information to which you
have a right of access; or
- is already accurate and
complete, as determined by the facility.
If we deny your request for amendment, we will give
you a written denial including the reasons for the
denial and the right to submit a written statement
disagreeing with the denial.
Right to an Accounting of Disclosures. You have
the right to request an "accounting" of
our disclosures of your personal health information.
This is a listing of certain disclosures of your
personal health information made by the facility
or by others on our behalf, but does not include
disclosures for treatment, payment and health care
operations, disclosures made pursuant to a signed
and dated Authorization, or certain other exceptions.
To request an accounting of disclosures, you must
submit a request in writing, stating a time period
beginning on or after April 14, 2003 that is within
six years from the date of your request. An accounting
will include, if requested: the disclosure date;
the name of the person or entity that received the
information and address, if known; a brief description
of the information disclosed; a brief statement of
the purpose of the disclosure or a copy of the authorization
or request; or certain summary information concerning
multiple similar disclosures. The first accounting
provided within a 12 month period will be free; for
further requests, we may charge you our costs.
Right to a Paper Copy of This
Notice. You have the
right to obtain a paper copy of this Notice, even
if you have agreed to receive this Notice electronically.
You may request a copy of this Notice at any time.
Right to Request Confidential
have the right to request that we communicate with
you concerning personal health matters in a certain
manner or at a certain location. For example, you
can request that we contact you only at a certain
phone number. We will accommodate your reasonable
If you believe that your privacy rights
have been violated, you may file a complaint in writing
with the facility or with the Office of Civil Rights
in the U.S. Department of Health and Human Services.
To file a complaint with the facility, contact Jeff
S. Long, Associate Administrator / CCO at (724) 837-6070.
We will not retaliate against you if you file a
7. CHANGES TO THIS NOTICE
We will promptly revise
and distribute this Notice whenever there is a material
change to the uses or disclosures, your individual
rights, our legal duties, or other privacy practices
stated in this Notice. We reserve the right to change
this Notice and to make the revised or new Notice
provisions effective for all personal health information
already received and maintained by the facility as
well as for all personal health information we receive
in the future. We will post a copy of the current
Notice in the facility. In addition, we will provide
a copy of the revised Notice to all residents.
8. FOR FURTHER INFORMATION
If you have any questions
about this Notice or would like further information
concerning your privacy rights, please contact Christy
Kremer, Director of Social Services at (724) 837-6070
if you are calling on behave of, or are a, nursing
facility resident. Please contact Jennie Long,
Director of Villa Angela at St. Anne Home at (724)
837-6070 if you are calling on behave of, or are
a, personal care facility resident.