Privacy Notice

Effective June: 2008

THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION (PHI) MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
Pleasant View Retirement Community (PVRC) complies with the Health Insurance Portability & Accountability Act of 1996 (HIPAA). This federal program requires all medical records and other individually identifiable health information used or disclosed by PVRC in any form—orally, electronically, on paper—are kept properly confidential. HIPAA ensures residents are given information on how PHI may be used. HIPAA provides for penalties for covered entities that misuse PHI.
Pleasant View Retirement Community may use and disclose your medical records and other PHI without your permission in these instances:

TREATMENT, PAYMENT AND HEALTHCARE OPERATIONS
• For treatment we may use and disclose your PHI to provide, coordinate or manage health care and related services by one or more providers of health care or health care-related products or services. This also includes third-party vendors such as pharmacies and providers of products and equipment. An example would be disclosing health information for appropriate dietary support, medication, lab work, X-rays, or any other health care services.
• For payment we may use and disclose your PHI to confirm coverage for services rendered, to obtain reimbursement (payment), for billing and collection activities, and for utilization review. An example would be confirming third-party coverage for health care services or billing a third party for services. Your PHI may be included in the information provided on your bill.
• For health care operations we may use and disclose your PHI, as necessary, to run the facility and make sure that all of our residents receive quality care. This includes, but is not necessarily limited to quality assessment and improvement activities, auditing functions, cost management analysis, and customer service. An example would be an internal or external quality review assessment.

USE AND DISCLOSURE OF PHI FOR OTHER SPECIFIC PURPOSES
• Scheduling and treatment we may use and disclose your PHI to make appointments related to your care or treatment.
• Treatment alternatives we may use and disclose your PHI to providers of treatment alternatives that may be of benefit to you.
• Health-related benefits and services We may use and disclose your PHI to third-party vendors of health related products, benefits or services that may be of interest to you. This can include, but is not limited to third-party providers of pharmaceuticals, medical equipment and supplies, non-medical home care services, and supplemental and alternative insurance carriers. We may require third-party vendors to protect that information.
• Fundraising activities we may use your PHI for fundraising activities. In this case, PVRC would release only contact information, such as your name, address and phone number and the dates you received treatment or services at the facility.
• Use of PHI in and outside the Pleasant View community We may share your name, room number and condition with clergy, church, or with people who ask for you by name. We may list your name, spouse’s name, address and phone number in a resident directory that is available to all residents, or is posted on an information board. We may report admission, discharge or transfer information, as needed. We may give your religious or church affiliation to a member of the clergy even if they do not ask for you by name so your family, friends, and clergy can visit you. With your authorization, we may announce or list your name, wedding date, anniversary date or birthday in internal and external communication. With your authorization, we may take photos of you for care purposes, and during activities and other social functions. These photos may be used for displays, on the website, and in newsletters, brochures and other marketing material.
• Individuals involved in your care, who pay for your care, or a contact person identified by you on your application We may disclose your PHI to a friend or family member who is involved in your medical care, or who is paying for your care. We may disclose PHI to individuals assisting in disaster relief efforts so your family can be notified of your condition, status and location.
• Research Under certain circumstances, we may create and distribute de-identified health information by removing all references to individually identifiable information.
• As Required By Law, we will disclose protected health information about you when required to do so by: federal, state or local law; worker’s compensation laws; public health activities; law enforcement activities; as a result of a court order, warrant or similar process; national security or other intelligence activities. We will not disclose any HIV-related information, except in situations where the subject of the information has provided us with a written consent allowing the release of information, or where we are authorized or required by state or federal law to make the disclosure.
• To Avert a Serious Threat to Health or Safety We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety, or the health and safety of the public or another person, but only to those persons who need to use it.
• Organ and Tissue Donation If you are an organ donor, we may release your PHI to organizations that handle organ procurement, or organ, eye or tissue transplantation, or to an organ donation bank.
• Military and Veterans If you are a veteran, we may release your PHI as required by military command authorities. This may include the Department of Veteran Affairs to determine whether you are eligible for certain benefits.
• Lawsuits and Disputes If you are involved in a lawsuit or a dispute, we may disclose your PHI in response to a court or administrative order, a subpoena, a discovery request, or any other lawful process by someone else involved in the dispute. This will be done only after we tell you of such an action and this information is protected by an obtained order.
• Coroners, Medical Examiners and Funeral Directors We may release your PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death, or to arrange for a funeral.

You have the following rights with respect to your PHI:
• You may request to inspect and copy your PHI, with the exception of psychotherapy notes. You must submit your request in writing to the PVRC privacy officer. We may charge a fee to cover the cost of complying with your request. We may deny your request to inspect and copy your PHI in certain very limited circumstances. You may request that denial for your PHI be reviewed. A licensed health care professional chosen by the facility and who was not involved with the denial of your request will review both your request and the denial. PVRC will comply with the outcome of the review.
• You may request to amend your PHI. Submit your written request, including a reason for making the request, to the PVRC privacy officer. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request.
• You have the right to request a list of the disclosures we made of your PHI. Submit a written request to the PVRC privacy officer. The copy will include the date of the disclosure, name (and address, if available) of the person or organization receiving the information, a brief description of the information disclosed, and the purpose of the disclosure.
• You may request a restriction or limitation on the use and disclosure of your PHI.
We are not required to agree to a requested restriction. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
Send your request for a restriction or limitation to the PVRC privacy officer including: the information you want to limit: whether you want to limit our use, disclosure, or both; and to whom you want the limits to apply, for example, disclosures to a family member.
• You may make reasonable requests to receive confidential communication of your PHI, from us, by alternative means or in alternative locations.
• You have the right to a paper copy of this notice. A paper copy of this notice is available at the main reception desk.
Changes to this notice:
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for protected health information currently on file, as well as any information we receive in the future. We will post a current copy of the notice in the facility that states the effective date on the first page. Every time you become a facility resident, or use facility health care services, we will offer you a copy of the current notice in effect
Any other uses and disclosures will be made only with your written authorization:
You may revoke such authorization in writing. We are required to abide by that written request, except to the extent we have already taken actions based on previous authorization.

COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with any of the following people or agencies. You will not be penalized for filing a complaint.

The US Department of Health and Human Services
Office of Civil Rights
200 Independence Ave. SW
Washington, DC 20201
202-619-0257
1-877-696-6775 (toll free)

Pleasant View Retirement Community
Privacy and Compliance Officer
544 N. Penryn Road
Manheim PA 17545
717-664-6293

You may request your PHI not be used for fundraising purposes by sending a written request to:

Director of Development
Pleasant View Retirement Community
544 N. Penryn Road
Manheim, PA 17545