Notice of Privacy Practices

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

(409) 763-6000

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.

Your Rights

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

Your Choices

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:

http://www.statutes.legis.state.tx.us/Docs/HS/htm/HS.181.htm

• 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

requests

• Respond to lawsuits and legal actions

Your Rights

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

your care.

• 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.

Your Choices

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.

For treatment

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.

For payment

We can use and share your health information to bill and get payment from health plans or other

entities.

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:

www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html

http://www.statutes.legis.state.tx.us/Docs/HS/htm/HS.181.htm

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

Do research

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

privacy law.

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

individual dies.

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

services

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.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health

information.

• 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

it.

• 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

(409) 763-6000

Effective September 23, 2013

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