July 2023


Your privacy is a high priority for us, and it will be treated with the highest degree of confidentiality.  This Notice applies to all information and records related to your care received or created by our employees, staff, volunteers, and physicians.  This Notice informs you about the possible uses and disclosures of your protected health information.  It also describes your rights and obligations regarding your protected health information. 

In order for us to be able to provide you with the best service and care, we need to receive protected health information from you.  However, we want to emphasize that we are committed to maintaining the privacy of this information in accordance with state and federal laws. 

We are required by law to:

  • Maintain the privacy of your protected health information.
  • Provide to you this detailed Notice of our legal duties and privacy practices relating to your protected health information; and
  • Abide by the terms of the Notice that are currently in effect.  We reserve the right to change the terms of this Notice and make the new Notice provisions effective for all protected health information that the community maintains.

Protected health information (PHI) means any individually identifiable health information protected under the Federal Privacy Rules.

While receiving care from the Community, information regarding your healthcare history, treatment, and payment for your health care may be originated and/or received by us. State and federal laws protect information that can be used to identify you, and which relates to your health care or your payment for health care. This is your protected health information.



We collect protected information about you to help us provide the best service, assistance, and care. The type of information collected allows us to provide billing services and to fulfill legal and regulatory requirements.



We continue to assess new technology to evaluate its ability to provide additional protection for your PHI.  We maintain physical, electronic, and procedural safeguards that comply with state and federal standards to guard your PHI.

If we become aware that an item of your PHI may be materially inaccurate, we will make a reasonable effort to re-verify its accuracy and correct any error as appropriate.



You will be asked to sign a Consent allowing us to use and disclose your PHI 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 PHI in providing you with treatment and services.  We may disclose your PHI to community and non-community personnel who also may be involved in your care, such as physicians, nurses, nurse aides, and physical therapists.  Employees' access to such information is on a need-to-know basis.  For example, a nurse caring for you will report any change in your condition to your physician.  We also may disclose PHI to individuals who will be involved in your care after you leave the Community.  Employees who have access to PHI are required to protect it and keep it confidential.

For Payment:  We may use and disclose your PHI so that we can bill and receive payment for the treatment and services you receive at the Community.  For billing and payment purposes, we may disclose your PHI to your legal representative, an insurance or managed care company, Medicare, Medicaid or another third-party payer.  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 PHI for Community operations.  These uses and disclosures are necessary to manage the Community and to monitor the quality of our care.  For example, we may use PHI to evaluate our community’s services, including the performance of our staff.

We can require you to sign Consent as described above as a condition of our providing treatment to you because the uses and disclosures of your PHI are essential to our ability to care for you.



Community Directory:  Unless you object, we will include certain limited information about you in our community directory.  This information may include your name, your location in the Community, 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.

Community Culture: The culture of our community includes informing residents and staff of changes in your health status to maintain our sense of “community.” You may restrict or prohibit these uses and disclosures by notifying the Community in writing.

Individuals Involved in Your Care or Payment for Your Care:  Unless you object, we may disclose your PHI to a family member, a close friend, and any clergy, who are involved in your care.

Emergencies: In the event of an emergency or your incapacity, we will do what is consistent with your known preference (if any), and what we determine to be in your best interest. We will inform you of uses or disclosures of protected health information under such circumstances and give you an opportunity to object as soon as practicable.

Disaster Relief:  We may disclose your PHI to an organization assisting in a disaster relief effort.

As Required By Law:  We will disclose your PHI when required by law to do so. We may also release your protected health information to law enforcement officials for the following purposes:

  • Pursuant to a court order, warrant, subpoena/summons or administrative request;
  • Identifying or locating a suspect, fugitive, material witness or missing person;
  • Regarding a crime victim, but only if the victim consents or the victim is unable to consent due to incapacity and the information is needed to determine if a crime has occurred, non-disclosure would significantly hinder the investigation, and disclosure is in the victim's best interest;
  • Regarding a decedent, to alert law enforcement that the individual's death was caused by suspected criminal conduct; or
  • For reporting suspected criminal activity.

Public Health Activities:  We may disclose your PHI 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 neglect.
  • 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 FDA requirements.
  • 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; or
  • 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 PHI 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 PHI 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 rights laws.

Judicial and Administrative Proceedings:  We may disclose your PHI in response to a subpoena or to prevent fraud.

Appointment Reminders: We may use or disclose PHI to remind you about appointments.

Treatment Alternatives:  We may use or disclose PHI to inform you about treatment alternatives.

Health-Related Benefits and Services:  We may use or disclose PHI to inform you about health-related benefits and services.

Coroner, Healthcare Examiners, Funeral Homes: We may release your personal health information to a coroner, medical examiner, and funeral director.

Organ Donation: We may release information to an organization involved in the donation of organs if you are an organ donor.

Research: Your protected health information may be used for research purposes if it has been de-identified. In most other instances where your protected health information is used or disclosed for research purposes your authorization will be needed unless the Institutional Review Board or a Privacy Board has stated your authorization is not necessary.



You have the following rights regarding your PHI at the Community:

Right to Request Restrictions: You have the right to request restrictions on the use or disclosure of your PHI that is used to carry out treatment, payment or health care operations but we are not obligated to grant your request. You also have the right to restrict our disclosure of your PHI to a family member, friend or other individuals identified by you that is directly involved in your care or payment related to your care.  We are required to agree to your restriction unless you are being transferred to another health care institution, law requires the release of records, or the release of information is needed to provide emergency care. 

Right of Access to PHI:  You have the right to request, either orally or in writing, you’re medical and 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 two days of your request.  We will charge a reasonable fee for our costs in copying and mailing your requested information.

We may deny your request to inspect or receive copies in certain limited circumstances.  If you are denied access to PHI, you may have a right to request review of the denial.  This review will be performed by a licensed health care professional designated by the Community who did not participate in the decision to deny your access.

Right to Request Amendment:  You have the right to request the Community to amend any PHI maintained by the Community for as long as the information is kept by or for the community.  You must make your request 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 Community unless the originator of the information is no longer available to act on our request.
  • Is not a part of the PHI maintained by or for the Community.
  • Is not part of the information to which you have a right of access; or
  • Is accurate and complete, as determined by the Community.

If we deny your request for amendment, we will give you a written denial including the reasons for the denial.  You have a 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 PHI.  This is a list of certain disclosures of your PHI made by the Community or by others on our behalf, but does not include disclosures for treatment, payments and health care operations or certain other exceptions.

To request an accounting of disclosures, you must submit a request in writing, stating a time period beginning after April 13, 2003, that is within six years from the date of your request.  The 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 summary information concerning multiple similar disclosures.  The first accounting provided within a 12-month period will be free; for further requests, we will charge you our costs to provide this information.

Right to a Paper Copy of This Notice:  You have the right to receive a copy of this Notice from us upon request.

Right to Request Confidential Communications:  You 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 requests.



We reserve the following rights:

Right to Deny Requested Restrictions: We have the right not to agree to your requested restrictions on the use or disclosure of your personal health information. If we do agree to accept your requested restrictions, we will comply with your request except as needed to provide you with emergency treatment.

Right to Deny Request for PHI Inspection: We have the right to deny your request to inspect or receive copies of your protected health information in certain circumstances. x We have the right to deny your request for amendment of protected health information if it was not created by us, if it is not part of your personal health information maintained by us, if it is not part of the information to which you have a right of access, or if it is already accurate and complete, as determined by us.



Other uses and disclosures of your PHI not allowed by law under your Consent will only be made with your Authorization.  You can revoke the Authorization as described in your written Authorization.  If you revoke your Authorization, we will no longer use or disclose your PHI for the purposes covered by the Authorization, except where we have already relied on the Authorization.



If you believe your privacy rights have been violated, you may file a complaint with us in writing or contact our Corporate Compliance Hotline at (855) 271-6620.  To enable us to be responsive to concerns that you may have, the following procedure has been developed:

  • You will first be asked to discuss your concern or complaint with a member of the Community's staff who can address the matter or who will proceed in the following manner:
  • Appropriate staff will discuss your concern or complaint with the Executive Director/Administrator of the Community. If there is no resolution of the matter or if you/your family/your representative does not feel comfortable discussing the matter with the Executive Director/Administrator, then
  • You can contact the office of Civil Rights in the U.S. Department of Health and Human Services.

You will not be retaliated against for filing a complaint.



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 PHI already received and maintained by the Community as well as for all PHI we receive in the future.  We will post a copy of the current Notice in the community.  In addition, we will provide a copy of the revised Notice to all Residents by regular U.S. Mail or hand delivery to the resident and/or responsible party.



If you have any questions about this Notice or would like further information concerning your privacy rights please contact:  Kim Myer, Director of Human Resources at (317) 524-6524.

July 2023

HIPAA Privacy Notification