JOINT NOTICE OF PRIVACY PRACTICES
Effective Date: January 2016, Revised: January 20, 2020
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
WHAT IS THIS DOCUMENT?
Ascension Living, which is comprised of physicians, skilled nursing facilities, long-term care communities, programs for the elderly and other health care providers who work together to deliver a broad range of health care services, is committed to protecting your health information. We create and maintain a record of your care and services you receive on a variety of media, including paper, film and electronic. This information is available to workforce members, such as physicians, nurses, therapists, business associates and volunteers, who need this information to provide treatment to you, obtain payment for services provided or to support various operational functions necessary to provide health care. We are required by law to:
Have reasonable safeguards in place to discourage improper use or access to your health information;
Maintain and protect your privacy and the confidentiality of your health information and records;
Provide you with this Joint Notice describing your rights and our legal duties regarding your health information; and,
Notify affected individuals in the event of a breach of health information.
HOW DO WE USE OR DISCLOSE YOUR HEALTH INFORMATION?
The following categories describe how we may disclose your health information when required or permitted to do so by federal, state, or local law. THE INFORMATION AUTHORIZED FOR USE AND DISCLOSURE MAY INCLUDE INFORMATION WHICH MAY INDICATE THE PRESENCE OF COMMUNICABLE OR NON-COMMUNICABLE DISEASE. Disclosure may also include psychiatric and drug abuse treatment.
Treatment: We may use your health information for medical treatment and services. We may disclose your health information to physicians, nurses, technicians, and workforce members who are involved in your care.
We may tell your primary care physician, hospital or other health care provider about your condition, so they can provide appropriate follow-up care.
Payment: We may use and disclose your health information to bill for the treatment and services you receive and to collect payments from you, your insurance company or a third party.
We are required to conduct assessments of residents’ functional capacity and health status and complete a Minimum Data Set (MDS) form. The MDS is used to track
changes and outcomes. It is also required for reimbursement of Medicare services.
We may disclose your health information to physicians or their billing agents, so they can send their claims to your insurance company or to you.
Health Care Operations: We may use or disclose your health information for health care operations. These uses, and disclosures are necessary to run our organizations and make sure residents and patients receive quality care.
We may use health information to review our treatment and services, and evaluate staff performance.
Business Associates: We may disclose your health information to Business Associates with whom we contract to provide services on our behalf. We require business associates to take appropriate measures to safeguard your information.
We may contract with a company outside the organization to provide rehabilitation services or to provide collection services for past due accounts.
Electronic Health Information Exchanges: We may access or disclose your health information to other health care members through health information exchange organizations. These organizations are committed to securing the information and allowing your health information to be available when needed for the purposes of treatment, payment or health care operations. You have the right to opt out of participating in a health information exchange.
Facility Directory: Unless you notify us that you object, we will use your name, your room number or other location within the facility, your general medical condition, and your religious affiliation as part of our patient information system. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name.
Individuals Involved in Your Care or Payment of Your Care: We may release health information to a friend, family member, or other person who is involved in your care and those who help pay for your care. We may disclose health information about you to an entity assisting in disaster relief efforts so that your family can be notified about your condition, status and location. If appropriate, communications may be made after your passing, unless you have instructed us otherwise.
Personal Representative: If you have a personal representative such as a legal guardian, we will treat that person as you with regard to disclosure of your health information. If you are deceased, we will treat your executor, administrator, or other person with authority to act on your behalf as your personal representative as required by law.
Photographs and Videotape: We may take photographs or videotape of you for identification or health-related purposes. If you authorize, photographs may be taken for things such as holiday activities, memory boards, cue boxes, and recognition events. Also, if you authorize, we may display a written summary about your life, family, hobbies, interests, and other personal information.
Marketing and Sales: We may contact you to provide information about treatment alternatives or other health-related benefits, goods, and services provided by the facility that may be of interest to you. We must obtain your written authorization before we may use or disclose your health information for marketing purposes, except for face-to-face communications made by us to you.
Fundraising: We may contact you as part of our fundraising activities, but you have the right to opt out of receiving such communications. If you do not want to be contacted about our fundraising efforts, you must notify us in writing.
Research: We may disclose information to researchers when the research project has been approved by an Institutional Review Board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.
Workers’ Compensation: We may disclose your health information for workers’ compensation or similar programs as authorized by state law.
Coroners, Medical Examiners and Funeral Directors: We may disclose health information to a coroner, Medical examiner or funeral director.
To identify a deceased person or determine the cause of death.
To assist the funeral director in completing the death certificate.
Organ and Tissue Procurement Organizations: We may disclose your health information to organizations that handle organ, eye, or tissue procurement or transplantation, or to a donation bank as necessary to facilitate donation and transplantation.
Military: If you are a member of the Armed Forces, we may disclose health information as required by military command authorities. We may also disclose health information about foreign military personnel to the appropriate foreign military authority.
Judicial, Administrative and Law Enforcement Purposes: We may disclose health information about you for judicial, administrative and law enforcement purposes. This may include disclosures in response to subpoenas or court orders.
To Advert a Serious Threat to Health or Safety: We may use and disclose your health information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. This disclosure would only be made to someone able to help prevent the threat.
Health Oversight Agencies: We may disclose health information to a health oversight agency for activities necessary for the government to monitor the health care system, government programs, and compliance with applicable laws; for example, audits, investigations, inspections, medical device reporting and licensure.
Public Health: We may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.
National Security and Intelligence Activities: We may disclose your health information to federal officials for intelligence, counterintelligence or other national security activities authorized by law.
Protective Services for the President and Others: We may disclose your health information to federal officials, so they may provide protection for the President, other authorized persons or foreign heads of state, or to conduct special investigations.
Custodial Situation: If you are an inmate of a correctional institution or in the custody of a law enforcement official, we may disclose your health information to the correctional facility or law enforcement official.
WHAT ARE MY RIGHTS REGARDING MY HEALTH INFORMATION?
You have the following rights regarding your health information. You are required to submit in writing requests to exercise any of these rights for records that the facility creates and maintains.
Right to Inspect and Copy: You have the right to inspect and request a copy of your health record, except as prohibited by law. If you request a copy in either paper or electronic format, you may be charged a fee in accordance with federal and state law. In certain circumstances, we may deny your request to inspect a copy. If you are denied access, you may request that the denial be reviewed.
Right to Amend: If you believe the information in your records is incorrect or incomplete, you have the right to request that we amend your health record. We are not required by law to agree to a request to amend your health record. We will notify you in writing within 60 days if we are unable to grant your request.
Right to Request a Paper Copy of this Notice: You have the right to a paper copy of this notice even if you agreed to receive this notice electronically.
Right to Request Restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or healthcare operations or disclose about you to a family member or friend involved in your care. We are not required by law to agree to a requested restriction, except when you request that we not disclose information to your health plan about services for which you paid out-of-pocket in full. For all other restriction requests, if we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment or the use or disclosure is required by law.
Right to Request Confidential Communications: You have the right to request that we communicate with you about your health information via a certain method or certain location. We will accommodate all reasonable requests.
CAN ASCENSION LIVING CHANGE THIS NOTICE?
We reserve the right to change this notice and to make the revised or changed notice effective for health information we already have about you as well as for any health information we create or receive in the future. Each notice has an effective date. Copies of the current notice are posted. Additionally, the current notice is available to you upon request and on our website.
WHAT IF YOU HAVE QUESTIONS OR NEED TO FILE A COMPLAINT?
If you have questions or would like to file a complaint, you may contact our Privacy Officer. If you believe your privacy rights have been violated, you may file a complaint with us or the Secretary of the Department of Health and Human Services. We will not retaliate against you for filing a complaint.
Ascension Living U.S. Department of Health and Human Services
Attention: Privacy Officer Office for Civil Rights
12250 Weber Hill Road, Suite 200 200 Independence Avenue, S.W.
St. Louis, MO 63127 Washington, D.C. 20201
WHAT IS AN ORGANIZED HEALTH CARE ARRANGEMENT?
Ascension Living, and other health providers are part of a clinically integrated care setting that creates an organized health care arrangement (OCHA) under HIPAA. This allows the sharing of information among these legally separate entities to enhance the delivery of quality care to our patients and residents; however, no entity is responsible for the medical judgement or patient care provided by other entities in the arrangement. Physicians and other independent health care providers may have different privacy practices for medical records they create or maintain in their offices.
These entities are designated as an Affiliated Covered Entity and follow the terms of this Joint Notice:
Ascension Health Senior Care, Inc.
dba Ascension Living
Alexian Brothers Community Services*
dba Alexian PACE
dba Alexian Live at Home
Alexian Brothers Lansdowne Village
dba Lansdowne Place
Alexian Brothers Sherbrooke Village
Alexian Village of Milwaukee, Inc.
Alexian Village of Tennessee
dba Alexian Grove
dba Valley Residence
Arthur Merkle-Clara Knipprath Nursing Home
Ascension Living - Lakeshore at Siena, Inc.
Borgess Nursing Home, Inc.
dba Borgess Place
Carondelet Long Term Care Facilities, Inc.
dba St. Mary’s Village
dba Carondelet Place
dba St. Joseph Place
Cornerstone Assisted Living, Inc.
dba Via Christi Village Broadmoor
dba Via Christi Village Ridge
Our Lady of Peace, Inc.
Presence Life Connections
dba Presence Cor Mariae Center
dba Presence Fox Knoll
dba Presence Heritage Lodge
dba Presence Heritage Village
dba Presence McAuley Manor
dba Presence Our Lady of Victory Nursing Home
dba Presence Sacred Heart Home
dba Presence Saint Anne Center
dba Presence Saint Joseph Center
dba Presence Villa Franciscan
Presence Senior Services Chicagoland
dba Presence Bethlehem Woods Retirement Community
dba Presence Casa San Carlo Retirement Community
dba Presence Maryhaven Nursing and Rehabilitation Community
dba Presence Nazarethville
dba Presence Resurrection Life Center
dba Presence Resurrection Nursing and
dba Resurrection Retirement Community
dba Saint Benedict Nursing and Rehabilitation Center
Providence Park Inc.
dba Providence Village
St. Catherine Laboure Manor, Inc.
dba St. Catherine Laboure Place
St. Joseph’s Ministries, Inc.
dba St. Joseph’s Place
Via Christi Healthcare Outreach for Elders, Inc.
dba Via Christi HOPE
Via Christi Villages, Inc.
Via Christi Village Georgetown
Via Christi Village Hays
Via Christi Village Manhattan
Via Christi Village McLean
Via Christi Village Pittsburg
Via Christi Village Ponca City
Wheaton Franciscan Healthcare - Terrace
dba Franciscan Place
dba St. Francis Place
* Alexian Brothers Community Services (“ABCS”) has designated itself as a hybrid entity under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”). This means ABCS is a single legal entity with some healthcare programs (e.g., its Alexian PACE program) that are subject to HIPAA and other non-healthcare programs (e.g., Alexian Live at Home) that are not subject to HIPAA.