St. Leonard Notice of Privacy Practices

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.

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 campus has received or created. It extends to information received or created by our employees, staff, volunteers and physicians, and all others designated as service providers who provide services at St. Leonard. 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 health information.

We are required by law to:

• Maintain the privacy of your protected health information, as described in this notice.
• 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.

I. We May Use and Disclose Your Personal Health Information For Treatment, Payment and Health Care Operations

We 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 provided 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 campus and non-campus personnel who may be involved in your care, such as physicians, nurses, nurse aides, and physical 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 the campus.

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 campus. 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 care information for campus operations. These uses and disclosures are necessary to manage the campus and to monitor our quality of care. For example, we may use personal health information to evaluate our campus's services, including the performance of our staff.

II. We May Use and Disclose Personal Health Information About You for Other Specific Purposes

Campus Directory. Unless you object, we will include certain limited information about you in our campus directory. This information may include your name, phone number, anniversary, your location on the campus, 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.

Disaster Relief. We may disclose your personal health information to an organization assisting in a disaster relief effort.

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, such as; reporting to a public health or other government authority for preventing or controlling disease, injury, or disability, or reporting abuse or neglect, and other public issues.

Health Oversight Activities. We may disclose your personal health information to a health oversight agency for oversight activities authorized by law.

Judicial and Administrative Proceedings. We may disclose your personal health information in response to a court or administrative order.

Law Enforcement. We may disclose your personal health information for certain law enforcement purposes, when necessary and required by law.

Research. We may allow personal health information of residents from our campus to be used or disclosed for research purposes provided that the researcher has been reviewed and approved by a special Privacy Board or Institutional Review Board.

Coroners, Medical Examiners, Funeral Directors, Organ Procurement Organizations. We may release you 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 of the public or another person.

Military and Veterans. If you are or were 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. We may use or disclose your personal health information for purposes related to receiving benefits.

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.

Fundraising Activities. We may use certain personal health information to contact you in an effort to raise money for the campus and its operations. We may disclose personal health information to a foundation related to the campus so that the foundation may contact you in raising money for the campus.

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.

III. Your Authorization is Required for Other Uses of Personal Health Information

We will use and disclose personal health information (other than as described in this Notice or required by law) only with your written Authorization. You make 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.

IV. Your Rights Regarding Your Personal Health Information

You have the following rights regarding your personal health information:

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 with your requested restriction.

Right Of Access to Personal Health Information. You have the right to inspect and obtain a copy of your personal health information that may be used to make decisions about your care, subject to some limited exceptions. We may charge a reasonable fee for our costs in copying and mailing your requested information.

Right to Request Amendment. You have the right to request the campus to amend any personal health information maintained by the campus for as long as the information is kept by or for the campus.

Right to an Accounting Disclosure. You have the right to request an "accounting" of our disclosures of your personal health information, subject to certain exceptions.

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.

Right to Request Confidential Communications. You have the right to request that we communicate with you concerning personal health matters in a certain manner at a certain location.

V. Complaints

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 contact the campus Privacy Officer.

We will not retaliate against you if you file a complaint.

VI. 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 campus as well as for all personal health information we receive in the future. We will post a copy of the current Notice on bulletin boards throughout the campus. In Addition, we will provide a copy of the revised Notice to all residents by making copies available at the receptionist desk in the Health & Rehabilitation Center or at the front desk in the main building.

VII. For Further Information

If you have any questions about this Notice or would like further information concerning your privacy rights, please contact our Privacy Officer at 937-436-6324.