This notice describes how medical information about you may be used and disclosed and how you can obtain access to this information.
Please Review Carefully.
We are required by law to maintain the privacy of medical and health information about you (“Protected Health Information”) and to provide you with this Notice so you will understand how we may use or share your medical and health information and our legal duties and privacy practices relative to this information. We are required to follow the terms of this notice currently in effect.
We reserve the right to change our practices and make the new provisions effective for all health information we maintain. If we make material changes, we will make the revised Notice available to you by posting it in a clear and prominent location. Following your receipt of said notice, please sign, date and return it as specified.
UNDERSTANDING YOUR HEALTH AND MEDICAL RECORD INFORMATION
Every time you access or receive services from our community, documentation in your health/medical record is made. Typically, this record contains information about your condition and the care we provide.
HOW WE MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION
The following categories describe the ways we may use and disclose your medical information. We are unable to describe every possible way that we may use or disclose this information under each category, however, all of the ways we are permitted or required to use and disclose information will fall into one these categories.
For Treatment. We use your medical and health information to provide services to you--for example, to assist with your individual care plan and to coordinate your continuing care. Your health information may be used by doctors and others involved in your care, both within and outside our Community.
For Payment. We may use medical and health information to obtain payment for services that we provide to you--for example, to identify our claims for payment from your health insurer, HMO, or other company, including GAFC, that arranges or pays the cost of some or all of your health care (“Your Payor”).
Health Care Operations. We may use medical and health information for our health care operations, which includes internal administration and planning and various activities that improve the quality and cost effectiveness of the care and customer service that we deliver to you. For example, we may use medical and health information to evaluate the quality and competence of our nurses and other health care workers, and we may provide medical and health information to our Executive Director or Regional Director in order to resolve any complaints you may have and make your stay with us pleasant.
OTHER USES AND DISCLOSURES OF YOUR MEDICAL INFORMATION WE MAY MAKE WITHOUT YOUR WRITTEN AUTHORIZATION
Business Associates. There are some services provided in our organization through contracts with business associates. When we contract with a business associate to provide services, we may disclose your medical information so they can perform the job we have asked them to do. We do require that the business associate appropriately safeguard your information.
Directory Information. Unless you notify us that you object, we will use your name, location in the facility, general condition, and religious affiliation for directory purposes. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name.
Health Care Benefits and Reminders. We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Workers’ Compensation. We may disclose medical information to the extent necessary to comply with laws relating to workers compensation or other similar programs. These programs provide benefits for work-related illness or injuries.
Relatives, Close Friends and Other Caregivers. Unless you object, we may disclose medical and health information to a family member, other relative or a close personal friend involved in your care or for notification purposes.
If you are incapacitated or in an emergency circumstance, we may exercise our professional judgment to determine whether a disclosure is in your best interests. If we disclose information to a family member, other relative or a close personal friend in such circumstances, we would disclose only information that is directly relevant to the person’s involvement with your health care or payment related to your health care. We may also disclose medical and health information in order to notify (or assist in notifying) such persons of your location, general condition or death.
Reporting: Federal and state laws may require or permit Benchmark to disclose certain medical and health information related to the following:
Public Health Activities:
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prevention or control of disease, injury or disability
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reporting deaths
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reporting reactions to medications or problems with products
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notifying people of product recalls
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notifying a person who may have been exposed to a disease
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Reporting abuse, neglect or domestic violence: Notifying the appropriate government agency if we believe a resident has been the victim of abuse, neglect or domestic violence.
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Health Oversight: We may disclose medical information to a health oversight agency for activities such as audits, investigations, inspections and licensure.
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Disaster Relief: We may disclose health information about you to an organization assisting in a disaster relief effort.
Judicial and Administrative Proceedings: If you are involved in a lawsuit or dispute, we may disclose medical information about you in response to a court or administrative order, subpoena, discovery request, or other lawful process.
As Required by Law: Benchmark may use or disclose medical and health information if the use or disclosure is required by law and the use or disclosure complies with and is limited to the relevant requirements of the law.
To Avert A Serious Threat to Health or Safety. Benchmark may, in accordance with the law, disclose medical information that it believes in good faith is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or public. Benchmark would disclose such information to a person reasonably able to prevent or lessen the serious and imminent threat.
Law Enforcement: We may disclose your medical and health information for certain law enforcement purposes, for example, to file reports required by law or to report emergencies or suspected crimes.
Funeral Directors, Medical Examiners and Coroners. We may disclose medical information to a coroner or medical examiner. This may be necessary to identify a deceased person or determine the cause of death. We may also disclose medical and health information to funeral directors as necessary.
Organ and Tissue Donation. If you are an organ donor, we may disclose medical and health information to organizations that handle organ procurement to facilitate donation and transplantation.
Military, National Security and Intelligence Services, Protective Services for the President and Inmates/Law Enforcement Custody. We may disclose health information to the above authorized federal officials under certain circumstances.
YOUR WRITTEN AUTHORIZATION IS REQUIRED FOR ALL OTHER USES OR DISCLOSURES OF YOUR HEALTH INFORMATION
Other uses and disclosures of medical information other than those described above will be made only with your written permission (“Authorization”). If you provide us with an Authorization to use or disclose medical information about you, you may revoke that Authorization, in writing, at any time. If you revoke your Authorization, we will no longer use or disclose medical information about you for the reasons covered by your written Authorization. You understand that we are unable to take back any disclosure we have already made with your permission, and that we are required to retain our records of the care that we provided to you. You also will be unable to revoke written Authorization to disclose medical information that you gave as a condition of obtaining insurance coverage where the law allows the insurer to contest a claim under the policy or the policy itself.
YOUR INDIVIDUAL RIGHTS REGARDING YOUR HEALTH INFORMATION
You have the following rights regarding your health information:
Right to Request Restrictions. You may request restrictions on our use and disclosure of your medical information for a particular reason related to service, payment and health care operations, or that we not disclose medical information to a family member or other specific relative or close friend involved in your care. All requests for such restrictions must be made in writing. While we will consider all requests for additional restrictions carefully, 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. If you wish to request additional restrictions, please obtain a request form from your Executive Director and submit the completed form to the Executive Director. We will send you a written response.
Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a confidential manner or at a specific location. For example, you may ask that we contact you via mail to a post office box.
If you wish to request alternative locations, please obtain a request form from your Executive Director and submit the completed form to the Executive Director.
Right to Inspect and Copy. You may request access to your medical record file and billing records maintained by us in order to inspect and request copies of the records. If you desire access to your records, please contact a record request form from the Director of Business Administration.
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Right to Amend Your Records. You have the right to request that we amend your health information . We will comply with your request unless we believe that the information that would be amended is accurate and complete or other special circumstances apply. If you desire to amend your records, please obtain an amendment request form from the Executive Director and submit the completed form to the Executive Director. All requests for amendments must be in writing
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Right to Receive An Accounting of Disclosures. You may request that we provide you with a written accounting of certain disclosures made by us during a certain time period. This is a list of certain disclosures we made of your medical information. It will not include certain disclosures such as those made for treatment, payment or healthcare operations purposes. You must submit your request in writing to your Executive Director. Your request must state a time period, which may not be longer than 6 years from the date the request is submitted and may not include dates before April 14, 2003.
SPECIAL REGULATIONS REGARDING DISCLOSURE OF SUBSTANCE ABUSE OF PSYCHIATRIC AND HIV-RELATED INFORMATION
For disclosures concerning certain health information such as HIV-related information or records regarding psychiatric care or substance abuse that have been sent to us by another provider, special restrictions apply. Generally, we will disclose such information only with an Authorization, or as otherwise required by law.
TO REPORT A CONCERN REGARDING OUR PRIVACY PRACTICES
If you believe your privacy rights have been violated, you may file a complaint with Benchmark or with the Secretary of the Department of Health and Human Services. To file a complaint with Benchmark, contact Benchmark’s Privacy Officer Designee, Barbara Devereux, at the following telephone number (781) 489-7153 or Office of Civil Rights in the U.S. Department of Health and Human Services at 200 Independence Avenue, S.W., Room 509F, HHH Building, Washington D.C. 20201. All complaints must be submitted in writing. There will be no retaliation for filing a complaint.
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