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.
1. General Information
- This Privacy Notice describes how the United Methodist
Homes (“UMH”) may use and disclose your protected health
information to carry out treatment, payment or healthcare
operations and for other purposes that are permitted or
required by law. This notice also describes your
rights to access and control your protected health
information. “Protected health information” is
information about you that may identify you and that relates
to your past, present or future physical or mental health or
condition and related health care services.
- UMH is required to follow the terms of this notice but we
may change the terms of the notice at any time. The
new notice will be effective for all protected health
information that we maintain at that time. Upon your
request, UMH will provide you with any revised notice, which
you can obtain by contacting the privacy officer at UMH as
stated below.
2. Uses and Disclosures of Protected Health
Information
- Treatment: UMH may use or disclose your protected
health information, as needed, to provide, coordinate or
manage your health care and any related services. For
example, we may disclose your protected health information
to health care professionals who become involved in your
care such as physicians, hospice personnel, a pharmacist in
order to fill a prescription or a radiologist to fulfill a
physician’s order.
- Payment: UMH may use or disclose your protected health
information, as needed, to obtain payment for your health
care services. For example, UMH anticipates that your
protected health information may be provided to third-party
payers, such as Medicare, Medicaid, Medical Assistance or
insurance companies, for billing purposes.
- Healthcare Operations:
UMH may use or disclose your protected health
information in order to support the business activities
of UMH. These activities include, but are not
limited to, health care consulting, auditing, and
business planning activities.
- Marketing: In most circumstances, UMH is required by
law to receive your written authorization before using or
disclosing your health information for marketing purposes.
However, UMH may provide you with promotional gifts of
nominal value. UMH will not, under any circumstances,
sell resident lists or your health information to a third
party without your written authorization.
- Newsletters and Other Communications: UMH may use your
name and address to send you a newsletter or other
information about healthcare treatment options or other
related benefits and services that may be of interest or
beneficial to you.
- Fundraising: UMH may use your demographic information
and dates you received treatment for fund raising
activities. If you do not want to receive fund raising
materials, please contact our privacy officer as noted
below.
- Appointment Reminders: UMH may use or disclose your
protected health information to remind you of an
appointment. You may request that UMH provide such
reminders only in a certain way or only at a certain place,
and UMH will endeavor to accommodate all reasonable
requests.
- Business Associates: Whenever UMH has an arrangement
with a third party where UMH shares your protected health
information, UMH will have a written agreement with that
third-party “business associate” that contains terms that
will protect the privacy of your protected health
information.
- Health Related Benefits and Services: UMH may use and
disclose health information to you to tell you about
health-related benefits or services that may be of interest
to you. In face-to-face communications, UMH may tell
you about other products and services that may be of
interest to you.
- Authorizations: Other disclosures and uses will be
made only with your written authorization unless otherwise
permitted by law as described below. You may revoke
the authorization to release protected health information at
any time except to the extent that UMH has relied on the use
or disclosure indicated in the authorization.
- Uses and Disclosures Unless You Object:
- Unless you object, we will use and disclose in our facility
directory your name, location, general condition, and your
religious affiliation, to members of the clergy or
individuals who ask for you by name. You have the
right to notify us that you do not want to be included
within the facility directory.
- Unless you object, UMH may disclose to a member of your
family, a relative, a close friend, or any person you
identify, your protected health information that directly
relates to that person’s involvement in your health care or
payment related to your health care. If you are not
able to agree or object to such disclosure, we may disclose
such information as necessary if we determine that it is in
your best interest based upon UMH’s professional judgment.
- Other Uses and Disclosures:
- UMH may use or disclose your protected health information to
the extent that the use or disclosure is required by law.
- UMH may use and disclose your health information in order to
inform you of alternative treatments.
- Your protected healthcare information may be disclosed to a
public health organization or federal organization in the
event of a communicable disease or to report a defective
device or untoward event involving a biological product
(food or medication), or when required by law.
- Your protected health information may be disclosed for
public health activities and purposes to a public health
authority that is permitted by law to collect or receive the
information.
- UMH may disclose protected health information to a public
health authority authorized to receive reports of abuse or
neglect or where UMH believes you have been a victim of
abuse, neglect or domestic violence.
- UMH may disclose your protected health information as
required by the Food and Drug Administration.
- UMH may disclose your protected health information in the
course of any judicial or administrative proceeding, in
response to an order of a court or administrative tribunal,
in certain conditions in response to a subpoena, discovery
request or other lawful process.
- enforcement purposes, to a coroner or medical examiner for
identification purposes, determining cause of death, or for
other duties of the coroner or medical examiner authorized
by law.
- UMH may disclose health information to funeral directors so
that they may carry out their duties.
- UMH may disclose your health information in disaster relief
situations where disaster relief organizations seek your
health information to coordinate your care, or notify family
and friends of your location and condition. UMH will
provide you with an opportunity to agree or object to such a
disclosure whenever UMH can practicably do so.
- Under most circumstances, without your written authorization
UMH may not disclose the notes a mental health professional
took during a counseling session. However, UMH may
disclose such notes for treatment and payment purposes, for
state and federal oversight of the mental health profession,
for the purposes of medical examiners and coroners, to avert
a serious threat to health or safety, or as otherwise
authorized by law.
- UMH may disclose your protected health information to
researchers when a waiver has been issued by an
institutional review board or a privacy board that has
reviewed the research proposal and protocols for compliance
with standards to ensure the privacy of your protected
health information.
3. Your Rights
- You have the right to request restrictions on certain uses
and disclosures of your protected health information.
However, UMH is not required to agree to that request.
UMH will notify you if UMH does not agree to a requested
restriction. UMH may use or disclose your protected
health information in an emergency treatment situation.
- You have the right to request a restriction or limitation on
the medical information UMH uses or discloses about you for
treatment, payment, or health care operations. If you
paid out-of-pocket in full for a specific item or service,
you have the right to request that medical information with
respect to that item or service not be disclosed to a health
plan for purposes of payment or health care operations, and
UMH is required to honor that request. You also have
the right to request a limit on the medical information UMH
communicates about you to someone who is involved in your
care or the payment for your care.
Except as noted above, UMH is not required to agree to your
request. If UMH does agree, UMH will comply with your
request unless the restricted information is needed to
provide you with emergency treatment.
To request restrictions, you must make your request in
writing to the UMH privacy officer. In your request,
you must tell UMH:
• What information you want to limit;
• Whether you want to limit UMH’s use, disclosure, or both; and
• To whom you want the limits to apply.
- You have the right to inspect and copy any and all portions
of your protected health information, except psychotherapy
notes. If your health information is maintained in an
electronic health record you also have the right to request
that an electronic copy of your health information be sent
to you or to another individual or entity. UMH may
charge you a reasonable cost based fee limited to the labor
costs associated with transmitting the electronic health
record.
- You have the right to request that UMH communicate with you
about medical matters in a certain way or at a certain
location. To request confidential communications, you
must make your request in writing to the UMH privacy
officer. UMH will not ask you the reason for your
request. UMH will accommodate all reasonable requests.
Your request must specify how or where you wish to be
contacted.
- You have the right to request an amendment to your protected
health information.
- You have the right to know who has accessed your protected
health information and for what purpose. In your
accounting, UMH is not required to list certain disclosures,
including:
|
• |
Disclosures made for treatment,
payment, and health care operations purposes or
disclosures made incidental to treatment,
payment, and health care operations, however, if
the disclosures were made through an electronic
health record, you have the right to request an
accounting for such disclosures that were made
during the previous 3 years;
|
|
• |
Disclosures made pursuant to
your authorization;
|
|
• |
Disclosures made to create a
limited data set;
|
|
• |
Disclosures made directly to
you.
|
To request an accounting of disclosures, you must submit
your request in writing to UMH’s privacy officer. Your
request must state a time period which may not be longer
than six years and may not include dates before April 14,
2003. Your request should indicate in what form you
would like the accounting of disclosures (for example, on
paper or electronically by e-mail). The first
accounting of disclosures you request within any 12 month
period will be free. For additional requests within
the same period, UMH may charge you for the reasonable costs
of providing the accounting of disclosures. UMH will
notify you of the costs involved and you may choose to
withdraw or modify your request at that time, before any
costs are incurred. Under limited circumstances
mandated by federal and state law, UMH may temporarily deny
your request for an accounting of disclosures.
- You have the right to obtain a paper copy of this Privacy
Notice from UMH upon request, even if you have agreed to
receive the notice electronically.
- UMH is required to notify you by first class mail or by
e-mail (if you have indicated a preference to receive
information by e-mail), of any breaches of Unsecured
Protected Health Information as soon as possible, but in any
event, no later than 60 days following the discovery of the
breach. “Unsecured Protected Health Information” is
information that is not secured through the use of a
technology or methodology identified by the Secretary of the
U.S. Department of Health and Human Services to render the
protected health information unusable, unreadable, and
undecipherable to unauthorized users. The notice is
required to include the following information:
-
A brief description of the breach, including the date of the
breach and the date of its discovery, if known;
-
A description of the type of Unsecured Protected Health
Information involved in the breach;
-
Steps you should take to protect yourself from potential
harm resulting from the breach;
-
A brief description of actions UMH is taking to investigate
the breach, mitigate losses, and protect against further
breaches;
-
Contact information, including a toll-free telephone number,
e-mail address, Web site or postal address to permit you to
ask questions or obtain additional information.
In the event the breach involves 10 or more residents whose
contact information is out of date UMH will post a notice of
the breach on the home page of UMH’s Web site or in a major
print or broadcast media. If the breach involves more
than 500 residents in a state or jurisdiction, UMH will send
notices to prominent media outlets. If the breach
involves more than 500 residents, UMH is required to
immediately notify the Secretary of Health and Human
Services. UMH also is required to submit an annual
report to the Secretary of a breach that involved less than
500 residents during the year and UMH will maintain a
written log of breaches involving less than 500 residents.
- UMH is required by law to maintain the privacy of protected
health information and to provide individuals with notice of UMH’s legal duties and privacy practices with respect to
protected health information.
- UMH is required to abide by the terms of the notice
currently in effect. UMH reserves the right to make
changes to this notice and the notice will be effective for
all protected health information that UMH maintains at that
time. Upon your request, UMH will provide you with a
copy of the revised notice. UMH will mail a copy of
the revised Privacy Notice to residents when there is a
material change to the notice. A revised notice
reflecting a material change will be mailed promptly after
making the change.
- UMH will accommodate reasonable requests you may have to
communicate health information by alternative means or at
alternative locations.
4. Complaints
- You have the right to complain to UMH and the Department of
Health and Human Services if you believe your rights to
privacy have been violated. If you feel your privacy
rights have been violated and have been unresolved by the
facility administrator, please mail your complaint to UMH:
ATTN: Louis J. Shiber, Privacy Officer
United Methodist Homes
10 Acre Place
Binghamton, New York 13904
- All complaints will be investigated. The individual
making the complaint will not be retaliated against for
filing a complaint.
- For further information about this Privacy Notice, please
contact:
Louis J. Shiber, Privacy Officer
(607) 775-6400, ext. 234 (NY); (570) 883-5635, option
3 (PA)
- This notice is effective as of February 17, 2010.