Notice of Privacy Practices
This notice describes how medical information about residents may be used and disclosed and how residents can get access to this information.
Please review it carefully.
I. Our Duty to Safeguard Your Protected Health Information
We are committed to preserving the privacy and confidentiality of your health information whether created by us or maintained on our premises. We are required by certain state and federal regulations to implement policies and procedures to safeguard the privacy of your health information. Copies of our privacy policies and procedures are maintained in the business office. We are required by state and federal regulations to abide by the privacy practices described in this notice including any future revisions that we may make to the notice as may become necessary or as authorized by law.
Individually identifiable information about your past, present, or future health or condition, the provisions of health care to you, or payment for the health care treatment or services you receive is considered protected health information (PHI). As such, we are required to provide you with this Privacy Notice that contains information regarding our privacy practices that explains how, when and why we may use or disclose your protected health information and your rights and our obligations regarding any such uses or disclosures. Except in specified circumstances, we must use or disclose only the minimum necessary protected health information to accomplish the intended purpose of the use or disclosure of such information.
We reserve the right to change this notice at any time and to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future about you. Should we revise/change this Privacy Notice, we will post a copy of the new/revised Privacy Notice in the main lobby. You also may request and obtain a copy of any new/revised Privacy Notice from the business office.
II. How We May Use and Disclose Your Protected Health Information
We use and disclose protected health information for a variety of reasons. We have a limited right to use and/or disclose your health information for purposes of treatment, payment, or for the operations of our facility. For other uses, you must give us your written authorization to release your protected health information unless the law permits or requires us to make the use or disclosure without your authorization.
Should it become necessary to release your protected health information to an outside party, we will require the party to have a signed agreement with us that the party will extend the same degree of privacy protection to your information as we do.
The privacy law permits us to make some uses or disclosures of your protected health information without your consent or authorization. The following describes each of the different ways that we may use or disclose your protected health information. Where appropriate, we have included examples of the different types of uses or disclosures. These include:
- Use and Disclosures Related to Treatment:
We may disclose your protected health information to those who are involved in providing medical and nursing care services and treatments to you. We may also disclose your protected health information to outside entities performing other services relating to your treatment.
- Use and Disclosures Related to Payment:
We may use or disclose your protected health information to bill and collect payment for services or treatments we provided to you.
- Use and Disclosures Related to Health Care Operations:
We may use or disclose your protected health information to perform certain functions within our facility should these uses or disclosures become necessary to operate our facility and to ensure that you and others we provide care and services to continue to receive quality care and services. We may also combine your health information with information from other health care providers to study how our facility is performing in comparison to like facilities or what we can do to improve the care and services we provide to you. When information is combined, we remove all information that would identify you so that others may use the information in developing research on the delivery of health care services without learning your identity.
- Use and Disclosures Related to Treatment Alternatives, Health-Related Benefits and Services:
We may use or disclose your protected health information for purposes of contacting you to inform you of treatment alternatives or health-related benefits and services that may be of interest to you.
III. Uses and Disclosures Requiring Your Written Authorization
For uses and disclosures of your protected health information beyond treatment, payment and operations purposes, we are required to have your written authorization, except as permitted by law. You have the right to revoke an authorization at any time to stop future uses or disclosures of your information except to the extent that we have already undertaken an action in reliance upon your authorization. Your revocation request must be provided to us in writing.
IV. Uses and Disclosures of Information That Do Not Require Your Consent or Authorization
State and federal laws and regulations either require or permit us to use or disclose your protected health information without your consent or authorization. The uses or disclosures that we may make without your consent or authorization include the following:
- When Required by Law:
We may disclose your protected health information when a federal, state or local law requires that we report information about suspected abuse, neglect, or domestic violence, reporting adverse reactions to medications or injury from a health care product, or in response to a court order or subpoena.
- For Public Health Activities for the Purpose of Preventing or Controlling Disease, Injury or Disability:
We may disclose your protected health information when we are required to collect information about diseases or injuries (e.g., your exposure to a disease or your risk for spreading or contracting a communicable disease or condition, product recalls, or to report vital statistics (e.g., births/deaths) to the public health authority).
- For Health Oversight Activities:
We may disclose your protected health information to a health oversight agency such as a protection and advocacy agency, the state agency responsible for inspecting our facility or to other agencies responsible for monitoring the health care system for such purposes as reporting or investigation of unusual incidents or to ensure that we are in compliance with applicable state and federal laws and regulations and civil rights issues.
- To Coroners, Medical Examiners, Funeral Directors, Organ Procurement Organizations or Tissue Banks:
We may disclose your protected health information to a coroner or medical examiner for the purpose of identifying a deceased individual or to determine the cause of death. We may also disclose your health information to a funeral director for the purposes of carrying out your wishes and/or for the funeral director to perform his/her necessary duties.
If you are an organ donor, we may disclose your protected health information to the organization that will handle your organ, eye or tissue donation for the purposes of facilitating your organ or tissue donation or transplantation.
- For Research Purposes:
We may disclose your protected health information for research purposes only when a privacy board has approved the research project. However, we may use or disclose your protected health information to individuals preparing to conduct an approved research project in order to assist such individuals in identifying persons to be included in the research project.
- To Avert a Serious Threat to Health or Safety:
We may disclose your protected health information to avoid a serious threat to your health or safety or to the health or safety of others. When such disclosure is necessary, information will only be released to those law enforcement agencies or individuals who have the ability or authority to prevent or lessen the threat of harm.
- For Specific Government Functions:
We may disclose protected health information of military personnel and veterans, when requested by military command authorities, to authorized federal authorities for the purposes of intelligence, counterintelligence, and other national security activities (such as protection of the President), or to correctional institutions.
V. Your Right Regarding Your Protected Health Information
You have the following rights concerning the use or disclosure of your protected health information that we create or that we may maintain on our premises:
- To Request Restrictions on Uses and Disclosures of Your Protected Health Information:
You have the right to request that we limit how we use or disclose your protected health information for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care or services. For example, you could request that we not disclose information to family members or friends about a medical treatment you received.
Should you wish a restriction placed on the use and disclosure of your protected health information, you must submit such request in writing.
- The Right to Inspect and Copy Your Medical and Billing Records:
You have the right to inspect and copy your health information, such as your medical and billing records that we use to make decisions about your care and services. In order to inspect and/or copy your health information, you must submit a written request to us. If you request a copy of your medical information, we may charge you a reasonable fee for the paper, labor, mailing, and/or retrieval costs involved in filing your requests. We will provide you with information concerning the cost of copying your health information prior to performing such service.
- The Right to Amend or Correct Your Health Information:
You have the right to request that your health information be amended or corrected if you have reason to believe that certain information is incomplete or incorrect. You have the right to make such requests of us for as long as we maintain/retain your health information. Your requests must be submitted to us in writing. We will respond within sixty (60) days of receiving the written request. If we approve your request, we will make such amendments/corrections and notify those with a need to know of such amendments/corrections.
We may deny your request if:
- Your request is not submitted in writing;
- Your written request does not contain a reason to support your request;
- The information was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
- It is not a part of the health information kept by or for our facility;
- It is not part of the information which you would be permitted to inspect and copy; and/or
- The information is already accurate and complete.
- The Right to Request Confidential Communications:
You have the right to request that we communicate with you about your health matters in a certain way or at a certain location. For example, you may request that we not send any health information about you to a family member’s address. We will agree to your request as long as it is reasonably easy for us to do so. You are not required to reveal nor will we ask the reason for your request. To request confidential communications, you must:
- Notify us in writing;
- Indicate what information you wish to limit;
- Indicate whether or not you wish to limit or restrict our use or disclosure of such information; and
- Identify to whom the restrictions apply (e.g., which family member(s), agency, etc.).
- The Right to Request an Accounting of Disclosures of Protected Health Information:
You have the right to request that we provide you with a listing of when, to whom, for what purpose, and what content of your protected health information we have released over a specified period of time. This accounting will not include any information we have made for the purposes of treatment, payment, or health care operations or information released to you, your family, or the facility directory, disclosures made for national security purposes, or any releases pursuant to your authorization.
- The Right to Receive a Paper Copy of This Notice:
You have the right to receive a paper copy of this notice even though you may have agreed to receive an electronic copy of this notice. You may request a paper copy of this notice at any time or you may obtain a copy of this information from our Website (as applicable).
VI. How to File a Complaint About Our Privacy Practices
If you have reason to believe that we have violated your privacy rights, violated our privacy policies and procedures, or you disagree with a decision we made concerning access to your protected health information, etc., you have the right to file a complaint with us or the Secretary of the Department of Health and Human Services. Complaints may be filed without fear of retaliation in any form.
VII. Effective Date of Notice
This Notice of Privacy Practices is effective April 14, 2003.
See HIPAA Policy & Procedure Manual.
Protecting your private information is a priority for the Holland Christian Home (“the Home”). The Home’s website allows the public to acquire news and information, make inquiries, give donations online, schedule tours, and more. By the using the Home’s website, you consent to the data practices described in this statement.
Users of the Home’s website may submit forms through the website to schedule tours, request information, sign up for mailing lists, make donations, or for other purposes. The content of those forms goes solely and directly to the Home’s staff, and the information provided in these forms is never shared with third parties. Users acknowledge that contact information provided within these forms are considered an opt-in to receive email, phone, or direct mail contact from the Home.
The Home encourages you to review the privacy statements of websites you may visit which are linked from the Home’s website. The Home is not responsible for the privacy statements and content of other websites.
The Home does not knowingly collect personally identifiable information from children under the age of 13. Children under the age of 13 must receive parental or guardian permission to use this website.
We respect your privacy and give you opportunities to opt-our of receiving emails, direct mail, etc. Users may opt-out of receiving any or all communications from the Home by contacting Director of Admissions & Public Relations Philip Kline at email@example.com or (973) 427-4087, extension 667.
Additionally, if you believe the Home has not adhered to this statement, please contact Philip Kline or write to the Home:
Holland Christian Home
151 Graham Ave
North Haledon, NJ 07508