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.
Effective September 11, 2019
This Notice applies to residents in skilled units of the facility. It does not apply to assisted or independent living residents.
Our Confidentiality Commitment. Northridge Village takes the privacy of health information very seriously and is committed to protecting your privacy. This notice describes our practices related to the privacy of your health information and how we may use the information we collect and maintain related to your care and we must provide you with a copy of our privacy practices upon your request. We may change what this notice says, but will provide you with information about any changes made the next time you receive services from us or if you request our updated privacy practices from us. We will follow the policies currently in effect.
Meaning of “you,” “we,” “us,” and “our.” In this notice, when we say “we”, “us”, or “our”, we mean our facility and all its employees, staff, and volunteers. Please keep in mind other healthcare providers may treat you in our facility, including physicians or therapists. Those providers may have different Privacy Practices than Northridge Village’s. When we say “you,” “your”, or “yours,” we mean you as an individual and/or your legal personal representative.
Understanding Your Protected Health Information. Protected health information is any information created and used by us, or received from a health care provider, about your health care. Information may include your name, address, birth date, phone number, social security number, health insurance policies, medical information, your diagnoses, and the care or treatments you receive.
How We Use Your Protected Health Information. Except as explained in this notice, we will only use or share your protected health information with your written authorization. Most uses and disclosures of psychotherapy notes, uses and disclosures for marketing purposes, and disclosures for the sale of information require your authorization. If you authorize us to share your protected health information with anyone, you may revoke your authorization at any time and we will no longer share information with that person or entity. Please note that if you choose to revoke an authorization, we may have already relied on your consent to share information and your revocation of consent will only apply to disclosures after it is received by us.
We may use your protected health information for treatment, payment, and health care operations without your written authorization. We may perform other treatment, payment, or healthcare operations not specifically listed below in which we may use your health information. “Treatment” refers to the care we provide to you as well as coordinating and managing your care with other providers. “Payment” includes our activities to collect amounts owed for the services provided to you, or providing information to other providers for their payment activities. These activities may include, for example, sending a bill to your insurance company for services covered under your insurance plan, managing your account internally or with associated businesses we may contract with for the collection of payment, and/or sending statements to collect remaining amounts owed. “Health care operations” means activities related to assessing the quality of care we provide, developing care guidelines, coordinating care, contacting other providers or you to discuss care options, training our workforce, business management and administrative activities, customer service, and investigation and resolution of complaints.
We may also use or disclose your protected health information to:
- Keep you informed about appointments, program information, and benefits and services that may be of interest to you;
- For fundraising activities;
- Notify another person responsible for your care if necessary;
- Confirm your name, room number, and general condition to those who ask for you by name as part of our facility directory, unless you ask to be removed from our directory;
- Communicate with any person you identify about that person’s involvement in your care or payment for your care;
- Business associates that perform functions on our behalf;
- Other agencies as required for oversight activities such as licensure, inspections, investigations, audits, or Facility Accreditation;
- Law enforcement personnel for specific purposes, including reporting suspected abuse or neglect;
- Staff or research projects that ensure the continued privacy and protection of protected health information;
- Public health agencies to prevent or control disease and for statistical reporting, to the Food and Drug Administration for reporting reactions to medications, to Workplace Safety and Insurance (formerly known as Workers Compensation) for benefit coordination, to government agencies in cases of national security or for military purposes, or to correctional institutions;
- Certain other government functions like military and veterans activities, national security, protective services, law enforcement custody, and reporting to the National Instant Criminal Background Check System when an individual is prohibited from possessing a firearm;
- Avert a serious threat to someone’s health or safety;
- Organ procurement or similar organizations to facilitate organ, eye, or tissue donation and transplantation;
- Coroners, medical examiners, and funeral directors as needed for these individuals to carry out their duties;
- A personal representative, including after your death, who is legally authorized to receive your information;
- Comply with any law, regulation, or code that requires us to report certain information;
- Respond to a court order or subpoena, or other legal document; and
- Share with our business partners who perform case management, coordination of care, other assessment activities, or payment activities, and who must abide by the same confidentiality requirements.
Your Health Information Rights. You have the following rights regarding your protected health information:
- You may request restrictions on certain uses and disclosure of your information. If you request we restrict disclosures of your information for payment or operations purposes to your health plan and pay in full for the services you ask be restricted, we must agree to your request unless sharing the information is required by law. You may request other restrictions on the use and disclosure of your information, but we are not required to agree to those requests. You must make these requests in writing to our Privacy Officer. If your request is approved, we will abide by it except in an emergency treatment situation or as required by law;
- If you feel that some information our office has created about you is wrong or incomplete, you may ask that we change that information. You must send us your request to change or correct your information in writing to the Privacy Officer listed at the bottom of this notice and include an explanation of why you would like the information to be changed. In certain situations, we may deny your request. We will notify you if we deny your request and tell you how to request a review of the denial;
- You may view, inspect, and obtain a copy of your health information in our possession. We may limit or deny you access only in very limited circumstances. You have the right to request a review if we deny your request. We will notify you if we deny your request and tell you how to request a review of the denial. We may charge a fee for copies you request;
- You may obtain a paper or electronic copy of this notice upon request;
- You may revoke a signed authorization for the use or disclosure of your protected health information except to the extent we have already acted based on your authorization;
- If you request, we will account for disclosures we have made of your protected health information made by us, except for disclosures made to you, under an authorization, for treatment, payment, or health operations purposes, and a limited other situations. We will not charge for the first accounting given to you in a twelve-month period. We may charge a fee for an additional accounting requested in that twelve-month period for the cost of producing the accounting of disclosures for you;
- You may request that we contact you about personal health care matters only in a certain way (i.e. phone, e-mail, in writing) and/or at a certain location (home, office, at an address you have given);
- If you want to opt out of receiving fundraising communications or from our facility directory, you can contact the Privacy Officer listed below; and
- If there has been a breach of your health information, you will be notified unless we determine, after thorough risk analysis, that there is a low probability the privacy or security of your information has been compromised. You will not be required to waive your right to notice of a breach under any circumstances.
For More Information or to Report a Problem. If you have questions, complaints, or concerns related to our privacy practices, please contact the Privacy Officer whose contact information is provided below. It is our policy to take questions, complaints, and concerns seriously and you will not be retaliated or discriminated against, or penalized in any way if you choose to communicate your concerns about our privacy practices with us.
3300 George Washington Carver Ave.
Ames, IA 50010
You may also file a complaint with the Secretary of the Department of Health and Human Services. Visit the Department of Health and Human Service’s Health Information Privacy website, or contact the Office for Civil Rights to file a complaint.