NOTICE OF PRIVACY PRACTICES
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
Principle, Long Term Care, Inc. (“Principle”), a North Carolina Corporation, are required by law to maintain the privacy of patients’ Protected Health Information (PHI) and to provide individuals with the following Notice of the legal duties and privacy practices with respect to PHI. We are required to abide by the terms of the Notice. We reserve the right to change the terms of this Notice and these new terms will affect all PHI that we maintain at that time.
YOUR HEALTH INFORMATION PRIVACY RIGHTS
Although your medical record is the property of Principle LTC, the information belongs to you. You have legal rights regarding your health information, which are described below. To exercise any of these rights, a written request with applicable supporting reasons, must be submitted to the Corporate Privacy Officer. Requests that do not follow guidelines may be denied. Your legal rights are:
RIGHT TO ACCESS — You have the right to see or get an electronic or paper copy of your medical record and other health information we have about you. All requests must be made in writing. We may charge a reasonable, cost-based fee.
RIGHT TO AMEND — You have the right to request an amendment of your health information when it is incorrect or incomplete. This right exists as long as we keep this information. We may say “no” to your request, but we will tell you why in writing within 60 days.
- Right to an Accounting of Disclosures — You have the right to obtain a listing of those to whom we disclosed your health information. This right applies to disclosures other than those made for treatment, payment, healthcare operations, and those you specifically authorized. You can request an accounting for up to six years prior to the date of the request but not prior to April 14, 2003. The first request in a 12-month period is provided at no cost to you. There may be a charge for subsequent requests within the same 12-month period.
- Right to Request Restrictions — You have the right to request restrictions on the use or disclosing of your health information. We will use our best efforts to comply with all approved requests except when the information is needed to provide emergency treatment. We will provide you with a written explanation for denied requests or when we revoke a previously agreed to restriction. If you pay for a service or healthcare 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.
- Right to Request Alternate Communications — You have the right to specify that communication with you be conducted in a particular manner or be directed to a certain location. We will attempt to accommodate all reasonable requests.
- Right to Paper Copy of This Notice — You may request a paper copy of this Notice at any time.
- Right to Require Written Authorization — Any uses or disclosures of your health information, other than those described below, will be made only with your advance written authorization, which you may grant or revoke at any time.
- Right to File a Complaint – You may submit any complaints with respect to violations of your privacy rights to the Principle LTC Privacy Officer. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services if you feel that your rights have been violated. There will be no retaliation from Principle LTC for making a complaint.
YOUR CHOICES FOR CERTAIN PHI
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.
In these cases, you have both the right and choice to tell us to:
- Share information with your family, close friends, or others involved in your care.
- Share information in a disaster relief situation.
In these cases, we never share your information unless you give us written permission:
- Marketing purposes
- Sales of your information
- Most sharing of psychotherapy notes
In the case of fundraising:
- We may contact you for fundraising efforts, but you can tell us not to contact you again.
USE AND DISCLOSURE OF YOUR HEALTH INFORMATION
Federal privacy laws allow Principle LTC to use and disclose your health information for the following reasons or to the following entities:
- Treatment— We will use health information about you to provide you with medical treatment or services. We will disclose PHI about you to doctors, nurses, therapists, hospitals, and other healthcare facilities who become involved in your care.
- Payment- We can use and share your health information to bill and get payment from health plans or other entities. For example, we may disclose your health information to your health insurance plan, to a third party, or directly to you to request payment for the treatment we provide. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
- Health Care Operations — We can use and share your health information to run our operations, improve your care, and contact you when necessary. These business uses and disclosures are necessary to make sure that our patients receive quality care and cost-effective services. Examples of these activities are state certification surveys, review our services, determine effectiveness of new treatments, evaluate our performance, provide training to our staff, or to identify future services offered and those no longer needed.
- Nursing Home Roster or Directory and Notification Purposes— We may include your name and location in our directory while you are a patient in our care. If you do not want to be included in our directory, or you want to restrict the information we include in the directory, you must notify Principle LTC Privacy Officer of your objection. This information may be released to clergy or to people who ask for you by name. Your name may be included in a list of residents provided to clergy who offer spiritual services.
- Communication — We may contact you to provide appointment reminders, alternative treatments, and other health services that may be of interest.
- Business Associates — We may disclose your information to service providers with whom we have contracted to provide a service on our behalf. We must have written assurances in place before disclosing your information to our business associates.
- Research — We may use and share your health information for research. All research projects, however, are subject to a special approval process.
- Lawsuits, Disputes, Law Enforcement — We can share health information about you in response to a court or administrative order, or in response to a subpoena. We can use or share health information about you for law enforcement purposes or with a law enforcement official. We may share PHI with health oversight agencies for activities authorized by law. PHI may be shared for special government functions such as military, national security, and presidential protective services.
- Funeral Directors, Coroners, and Medical Examiners — We may disclose your health information in order for these individuals to carry out their duties.
- Food and Drug Administration (FDA). Public Health Agencies. Health Oversight Agencies — We may disclose your information to report adverse events with food, drugs, medical devices, dietary supplements, other products, and product recalls; report births, deaths, child abuse, neglect, domestic violence; prevent or control disease, injury, disability; notify people possibly exposed to a disease or that may be spreading a disease; authorized organ donations; or as required by law.
- Workers’ Compensation Programs — We may disclose your information as permitted or required by state law relating to workers’ compensation programs.
- Militant Authorities — Under certain conditions, we may disclose your information when you are a member or veteran of the military.
It is our responsibility to:
- Use or disclose the minimum amount of information required to reasonably provide necessary services.
- Provide and review this Notice with you regarding our legal duties and privacy practices with respect to your health information and to make a good faith effort to obtain your signature acknowledging receipt of this Notice.
- Post the current Notice in our facilities, as well as on our website.
- Abide by the terms of this Notice.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- 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.
We reserve the right to change our practices and to make the new provisions effective for all health information we maintain. The new notice will be available upon request.
STATE LAW REQUIREMENTS
Certain state health information laws and regulations, such as those dealing with mental health, HIV/AIDS, or drug and alcohol records, may be more stringent than the federal privacy laws and further limit the companies uses and disclosures of your health information described above.
CONTACTING THE CORPORATE PRIVACY OFFICER
If you believe your privacy rights have been violated, you may file a complaint with the Corporate Privacy Officer, P.O. Box 6159, Kinston, NC 28501, or you may file a complaint using our Principle Integrity Line (1-800-910-6734). If you think we haven’t protected your privacy, you can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by visiting https://www.hhs.gov/hipaa/filing-a-complaint/what-to-expect/index.html.”
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