NOTICE OF PRIVACY PRACTICES
FOR RESIDENTS AND EMPLOYEES OF HARBOURVIEW CARE CENTER, INC.
Effective September 23, 2013
Your Information. Your Rights. Our Responsibilities.
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. If you want more information about any part
of this notice or if you want more information about our privacy practices, please contact:
HIPAA Compliance Officer
This notice applies to the information we have about you, your health, health status and, if you are
a resident, the health care and services you receive from us. If you are our employee, we may
maintain such information about you for purposes including, but not limited to, pre-employment
physicals, disability, or requests relating to the Family and Medical Leave Act.
You have the right to:
• Get a copy of your paper or electronic medical record
• Correct your paper or electronic medical record
• Request confidential communication
• Ask us to limit the information we share
• Get a list of those with whom we’ve shared your information
• Get a copy of this privacy notice
• Choose someone to act for you
• File a complaint if you believe your privacy rights have been violated
You have some choices in the way that we use and share information as we:
• Tell family and friends about your condition
• Provide disaster relief
• Include you in a facility resident directory
• Provide mental health care
• Market our services and sell your information, as allowed by:
• Raise funds
Our Uses and Disclosures
We may use and share your information as we:
• Treat you
• Run our operations
• Obtain payment
• Help with public health and safety issues
• Do research
• Comply with the law
• Respond to organ and tissue donation requests
• Work with a medical examiner or funeral director
• Address workers’ compensation, law enforcement, and other government
• Respond to lawsuits and legal actions
When it comes to your health information, you have certain rights. This section explains your rights
and some of our responsibilities to help you.
You may request an electronic or paper copy of your medical record.
• You can ask to see or get an electronic or paper copy of your medical record and other health
information we have about you.
• We will provide a copy or a summary of your health information, usually within 15 days of your
request. We may charge a reasonable, cost-based fee.
You may ask us to correct your medical record.
• You can ask us to correct health information about you that you think is incorrect or incomplete.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.
You may request confidential communications.
• You can ask us to contact you in a specific way (for example, home or office phone) or to send
mail to a different address.
• We will say “yes” to all reasonable requests.
You may ask us to limit what we use or share.
• You can ask us not to use or share certain health information for treatment, payment, or our
operations. We are not required to agree to your request, and we may say “no” if it would affect
• If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that
information for the purpose of payment or our operations with your health insurer. We will say
“yes” unless a law requires us to share that information.
You may obtain a list of those with whom we have shared information
• You can ask for a list (accounting) of the times we’ve shared your health information for up to 6
years prior to the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, and health care
operations, and certain other disclosures (such as any you asked us to make). We’ll provide one
accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one
within 12 months.
You may obtain a copy of this privacy notice.
You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice
electronically. We will provide you with a paper copy promptly.
You may choose someone to act for you.
• If you have given someone medical power of attorney or if someone is your legal guardian, that
person can exercise your rights and make choices about your health information.
• We will make sure the person has this authority and can act for you before we take any action.
You may file a complaint if you feel your rights are violated.
• You can complain if you feel we have violated your rights by contacting us using the information
on page 1.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil
Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-
877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.
For certain health information, you can tell us your choices about what we share. If you have a clear
preference for how we share your information in the situations described below, talk to us. Tell us what
you want us to do, and we will follow your instructions.
• Sharing information with your family, close friends, or others involved in your care – Unless you
object, we may disclose to a family member, a close friend, or any other person you identify,
your health information that directly relates to that person’s involvement in your health care.
Unless you object, we may also disclose your health information for the purpose of notifying
(including identifying or locating) family members, personal representatives, or others
responsible for your care of your location, general condition, or death. You have a right to
request that your health information not be shared with some or all of your family and friends.
• Share information in a disaster relief situation – Unless you object, we may share your health
information with disaster relief organizations that seek your health information to coordinate
your care, or notify family and friends of your location or condition in a disaster.
• Include your information in a facility resident directory – Unless you object, we may include your
name, general condition, religious affiliation, and location in our facility resident directory. Your
religious affiliation may be given to a member of the clergy. The directory information, except
for religious affiliation, may be given to people who ask for you by name.
If you are able and available to agree or object to such sharing of your health information, we will
give you the opportunity to object prior to sharing it. If you are not able to tell us your preference,
for example if you are unconscious, we may go ahead and share your information if we believe it is in
your best interest. We may also share your information when needed to lessen a serious and
imminent threat to health or safety.
In the following cases we never share your information unless you give us written permission:
• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes, if any.
In the case of fundraising:
• We may use a limited amount of your health information for purposes of contacting you to raise
money for our facility and its operations, but you can tell us not to contact you again.
Our Uses and Disclosures
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
We can use your health information and share it with other professionals who are treating you.
Example for residents : We may need to disclose information to doctors, nurses, technicians, staff, or
other personnel who are involved in taking care of you and your health.
Example for employees: We may need to disclose information to a doctor who is providing ongoing
care, particularly if you are receiving workers’ compensation or disability benefits.
For our operations
We can use and share your health information to run our facility, improve your care, and contact
you when necessary. This includes sharing your health information with our business associates and
subcontractors, who are contracted to perform certain functions on our behalf. Business associates
are required by applicable law to keep your health information confidential.
Example for residents : We use and disclose health information about you to manage our treatment
and services, to evaluate the pe rformance of our staff in caring for you, and for review and learning
purposes for our staff and medical and nursing students.
Example for employees: We may need to disclose medical information to our business associates in
order to receive information for benefit plan renewal, or to receive quotes for disability or other
types of medical insurance.
We can use and share your health information to bill and get payment from health plans or other
Example for residents : We may give information about you to your health insurance plan or other
third party payer so it will pay for our services to you.
Example for employees: As a self-insured organization, we may need to receive or provide medical
information in order to ensure proper payment of claims.
How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to
the public good, such as public health and research. We have to meet many conditions in the law before
we can share your information for these purposes. For more information see:
Help with public health and safety issues
We can share health information about you for certain situations such as:
• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety
We can use or share your information for health research.
Comply with the law
We will share information about you if state or federal laws require it, including with the
Department of Health and Human Services if it wants to see that we’re complying with federal
Respond to organ and tissue donation requests
We can share health information about you with organ procurement organizations.
Work with a medical examiner or funeral director
We can share health information with a coroner, medical examiner, or funeral director when an
Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:
• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective
Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order,
subpoena, warrant, summons, or similar process.
• We are required by law to maintain the privacy and security of your protected health
• We will let you know promptly if a breach occurs that may have compromised the privacy or
security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of
• We will not use or share your information other than as described here unless you tell us we can
in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if
you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about
you. The new notice will be available upon request, in our facilities, and on our web site.
* * * * *
If you would like to have a more detailed explanation of these rights or if you would like to exercise one
or more of these rights, please contact:
HIPAA Compliance Officer
Effective September 23, 2013