Notice Of Federal Privacy Practices

I. PURPOSE OF THE NOTICE OF PRIVACY PRACTICES

This Notice of Privacy Practices (the “Notice”) is meant to inform you of the uses and disclosures of protected health information (PHI) that we may make. It also describes your rights to access and control your PHI and certain obligations we have regarding the use and disclosure of your protected health information.

Your “protected health information” is information about you created and received by us, including demographic information, that may reasonably identify you and that relates to your past, present, or future physical or mental health or condition, or payment for the provision of your health care.

The Privacy Rule, a federal law, gives you rights over your PHI and sets rules and limits as to who can look at and/or receive your PHI. The Privacy Rule applies to all forms of individuals’ PHI, whether electronic, written or oral. The Security Rule is a federal law that requires security for PHI in electronic form. This Notice describes how we may use or disclose your PHI to carry out treatment, payment, or health care operations, as well as other purposes permitted or required by law.

We are required by law to maintain the privacy of your protected health information. We are also required by law to provide you with this Notice of our legal duties and privacy practices with respect to your protected health information, to notify you following a breach of your unsecured protected health information, and to abide by the terms of the Notice that is currently in effect.

We reserve the right to change the terms of this Notice, at which time, the provisions of the newer Notice will be effective for all PHI that we maintain.

II. UNDERSTANDING YOUR HEALTH RECORD AND INFORMATION

Each time we provide care to you, a record is made containing health and financial information. Typically, this record contains information about your condition, the treatment we provide and payment for the treatment. We may use and/or disclose this information:

A. to plan your care and treatment B. to communicate with other health professionals involved in your care C. to document the care you receive D. to educate health professionals E. to provide information for medical research F. to provide information to public health officials G. to evaluate and improve the care we provide H. to obtain payment for the care we provide I. for administrative purposes

III. UNDERSTANDING WHAT IS IN YOUR RECORD AND HOW YOUR PHI IS USED HELPS YOU TO:

A. ensure it is accurate B. better understand who may access your PHI C. make more informed decisions when authorizing disclosure to others

IV. HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION

The following categories describe some of the different ways that we may use or disclose your PHI. Even if not specifically listed below, the facility may use and disclose your PHI as permitted or required by law or as authorized by you. We will make reasonable efforts to limit access to your PHI to those persons or classes of persons, as appropriate, in our workforce who need access to carry out their duties. In addition, if required, we will make reasonable efforts to limit the PHI to the minimum amount necessary to accomplish the intended purpose of any use or disclosure and to the extent such use or disclosure is limited by law.

V. USES AND DISCLOSURES OF YOUR PHI THAT MAY BE MADE WITHOUT YOUR AUTHORIZATION OR OPPORTUNITY TO AGREE OR OBJECT

A. For Treatment

We may use and disclose your PHI to provide you with medical treatment and related services. For example, we may also use or disclose PHI about you in order to coordinate your care and provide you with medication, lab work, and x-rays. If we are permitted to do so, we may also disclose your PHI to individuals or facilities that will be involved with your care after you leave the Facility and for other treatment reasons. We may also use or disclose your PHI in an emergency situation.

B. For Payment

We may use and disclose your PHI so that we can bill and receive payment for the treatment and related services you receive. For billing and payment purposes, we may disclose your health information to your payment source, including an insurance or managed care company, Medicare, Medicaid or another third-party payor. For example, we may need to give your health plan information about the treatment you received so your health plan will pay us or reimburse us for the treatment, or we may contact your health plan to confirm your coverage or to request prior authorization for a proposed treatment.

C. For Health Care Operations

We may use and disclose your PHI for our day-to-day health care operations. This is necessary to ensure that you receive quality care. For example, we may use PHI for quality assessment and improvement activities and for developing and evaluating clinical protocols. We may also combine PHI about many residents to help determine what additional services we should offer, what services should be discontinued, and whether certain new treatments are effective. PHI about you may be used for business development and planning, cost management analyses, insurance claims management, risk management activities, and in developing and testing information systems and programs.

D. Business Associates

There may be some services provided by our business associates, such as a billing service, transcription company or legal or accounting consultants. We may disclose your PHI to our business associate so that they can perform the job we have asked them to do. To protect your health information, we require our business associates to enter into a written contract that requires them to appropriately safeguard your information.

E. Providers

Many services provided to you, as part of your care at the Facility are offered by participants in one of our organized healthcare arrangements. These participants may include a variety of providers such as physicians, therapists, psychologists, social workers, and suppliers. We may use and disclose PHI to contact you as a reminder that you have an appointment at a provider.

F. As Required by Law

We will disclose PHI about you when required to do so by federal, state, or local law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, if required by law, of any such uses or disclosures.

G. Public Health Activities

We may disclose your PHI to prevent a serious threat to your health and safety or the health and safety of the public or another person to a public health authority that is authorized by law to collect or receive such information, such as for the purpose of preventing or controlling disease, injury or disability; reporting births, deaths or other vital statistics; reporting child abuse or neglect; notifying individuals of recalls of products they may be using; notifying a person who may have been exposed to a disease or may be at risk of contracting or spreading a disease or condition.

H. Risk of Contracting a Communicable Disease

We may use or disclose PHI about you if you may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition, so long as we are authorized by law to notify you as necessary in the conduct of a public health intervention or investigation.

I. 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 or safety or the health or safety of the public or another person. Any disclosure, however, would be to someone able to help prevent the threat.

J. Coroners, Medical Examiners, Funeral Directors

We may disclose PHI to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose medical information to funeral directors as necessary to carry out their duties, as authorized by law.

K. Organ and Tissue Donation

If you are an organ donor, we may disclose PHI to organizations that handle organ procurement to facilitate donation and transplantation.

L. Military and National Security

If required by law, if you are a member of the armed forces, we may:

1. use and disclose your PHI as required by military command authorities or the Department of Veterans Affairs
2. disclose your PHI to authorized federal officials for the conduct of lawful intelligence, counterintelligence, and other national security activities authorized by law
3. disclose your PHI to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state or conduct special investigations
4. use and disclose your PHI for the purpose of a determination by the Department of Veterans Affairs, and/or to foreign military authorities if you are a member of that foreign military service, of your eligibility for benefits

M. Research Purposes

Your PHI may be used or disclosed for research purposes, but only if the use and disclosure of your information has been reviewed and approved by a special Privacy Board or Institutional Review Board, or if you provide authorization.

N. Workers’ Compensation

We may use or disclose your PHI as permitted by laws relating to workers’ compensation or related programs.

O. Health Oversight Activities

We may disclose your PHI to a health oversight agency for activities authorized by law, such as audits, investigations, inspections, accreditation, licensure, and disciplinary actions.

P. Reporting Abuse, Neglect, or Domestic Violence

We may disclose your PHI to an appropriate government agency if we believe you may have been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

Q. Criminal Activity

We may disclose your PHI if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to health or safety of you, another person or the public. We may also disclosure PHI if it is necessary for law enforcement officials to identify or apprehend an individual.

R. Legal Proceedings

If you are involved in a lawsuit or a dispute, we may disclose PHI about you in response to a court or administrative order. We may also disclose PHI about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

S. Law Enforcement

We may disclose PHI when requested by a law enforcement official:

• In response to a court order, subpoena, warrant, summons or similar process, or otherwise as required by law
• To identify or locate a suspect, fugitive, material witness, or missing person
• To report gunshot wounds
• To report emergencies or suspicious deaths
• About you, the victim of a crime if, under certain limited circumstances, we are unable to obtain your agreement
• About a death we believe may be the result of criminal conduct
• About criminal conduct at our Company
• In emergency circumstances to report a crime; the location of the crime or victims; and/or the identity, description or location of the person who committed the crime
• Where there is a medical emergency (not on our Company’s premises) and it is likely that a crime has occurred

T. National Security and Intelligence Activities

We may disclose PHI about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

U. Food and Drug Administration

We may disclose PHI to a person or company required by the Food and Drug Administration (“FDA”) for the purpose of quality, safety or effectiveness of FDA-regulated products or activities including, without limitation, to report adverse events, product defects or problems, or biologic product deviations; to track products; to enable product recalls; to make repairs or replacement; or to conduct post marketing surveillance, as required.

VI. USES AND DISCLOSURES THAT REQUIRE PROVIDING YOU THE OPPORTUNITY TO AGREE OR OBJECT

A. Treatment Alternatives and Other Health-Related Benefits and Services

We may use and disclose PHI to tell you about or recommend possible treatment options or alternatives and to tell you about health-related benefits, services, or medical education classes that may be of interest to you.

B. Fundraising Activities

We may use information about you to contact you in an effort to raise money for the Facility and its operations. For the same purpose, we may share your information with our institutionally related foundation. The information we use or share will be limited to your name, address, other contact information, age, gender, date of birth, dates that you received health care, department of service information, treating physician, outcome information, and health insurance status. You have the right to opt out of receiving such communications.

C. Facility Directory

Except for individuals admitted to a hospital for psychiatric disabilities or to a substance abuse treatment program, unless you object, we may include limited information about you in our facility directory while you are a resident at the facility, including your name, location in the facility, your general condition (e.g. fair, stable, etc.) and your religious affiliation. The directory information, except for your religious affiliation, may be released to people who ask for you by name.

D. Individuals Involved in Your Care or Payment of Your Care

Unless you object, we may disclose your PHI to a family member, a relative, a close friend or any other person you identify, if the information relates to the person’s involvement in your health care to notify the person of your location or general condition or payment related to your health care.

VII. USES AND DISCLOSURES OF PHI BASED UPON YOUR WRITTEN AUTHORIZATION

A. Other Uses and Disclosures

All other uses and disclosures of PHI not covered by this Notice or the laws that apply to us will be made only with your written authorization, unless otherwise permitted or required by law. You may revoke your written authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose your PHI for the reasons covered by your written authorization.

B. Uses and Disclosures of Psychotherapy Notes

Psychotherapy notes are notes (in any medium) by a health care provider who is a mental health professional documenting or analyzing the contents of a conversation during a private counseling session or a group, joint, or family counseling session. Psychotherapy notes will not be used or disclosed without a valid, written authorization, except to carry out specific treatment, payment, or health care operations.

C. Use and Disclosure of Substance Abuse and HIV-Related Information

For disclosures concerning PHI relating to care for substance abuse or HIV-related testing and treatment, special restrictions may apply. For example, we will generally not disclose this specially protected information unless you sign a specific authorization, or a court orders the disclosure.

D. Marketing

A signed authorization is required for the use or disclosure of your PHI for a purpose that encourages you to purchase or use a product or services except for certain limited circumstances.

E. Disclosures that Constitute a Sale of PHI

A signed authorization is required for the use or disclosure of your PHI in the event that the Facility directly or indirectly receives remuneration for such use or disclosure, except under certain circumstances as allowed by federal or state law.

VIII. WHEN WE MAY NOT USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION

Except as described in this Notice, or as permitted by state or federal law, we will not use or disclose your PHI without your written authorization.

IX. RIGHT TO REQUEST RESTRICTIONS ON CERTAIN USES AND DISCLOSURES

You have the right to request a restriction or limitation on the PHI we use or disclose about you, including information used or disclosed for the purposes of treatment, payment, or health care operations. You may also request that your PHI not be disclosed to family members or friends who may be involved in your care.

We are not required to agree to your requested restriction, unless it involves the disclosure of PHI to a health plan for purposes of carrying out payment or health care operations that pertains solely to a health care item or service for which the Facility has been paid out of pocket in full by you or a third party (other than the health plan) on your behalf.

X. RIGHT TO RECEIVE CONFIDENTIAL COMMUNICATIONS AND/OR ALTERNATE COMMUNICATIONS

You have the right to request a reasonable accommodation regarding how you receive communications of PHI. You have the right to request an alternative means of communication or an alternative location where you would like to receive communications.

XI. RIGHT TO ACCESS, INSPECT, AND COPY YOUR PHI

You have the right to access, inspect, and obtain a copy of your PHI that is used to make decisions about your care for as long as the PHI is maintained by the Facility. To access, inspect, and copy your PHI that may be used to make decisions about you, you must submit your request in writing to the Facility.

XII. RIGHT TO AMEND YOUR PHI

You have the right to request an amendment to your PHI for as long as the information is maintained by or for the Facility. Your request must be made in writing to the Facility and must state the reason for the requested amendment.

XIII. RIGHT TO RECEIVE AN ACCOUNTING OF DISCLOSURES OF PHI

You have the right to receive an accounting of certain disclosures of your PHI by the Facility or by others on our behalf. To request an accounting of disclosures, you must submit a request in writing, stating a time period that is within six (6) years from the date of your request.

XIV. RIGHT TO BE NOTIFIED FOLLOWING A BREACH OF UNSECURED PHI

If there is a breach to your PHI, you will be notified within a reasonable amount of time, as required by law.

XV. RIGHT TO A REVISED COPY OF THIS NOTICE

Upon request, you have the right to receive a copy of revised Notices on or after the effective date of revision.

XVI. RIGHT TO OBTAIN A PAPER COPY OF NOTICE

You have the right to obtain a paper copy of this Notice, even if you have agreed to receive this Notice electronically.

XVII. RIGHT TO COMPLAIN

You may file a complaint with us or the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may also file a complaint with us by notifying our Compliance and Ethics Officer in writing of your complaint. You will not be penalized or retaliated against for filing a complaint and we will make every reasonable effort to resolve your complaint with you.

Location: 2394 Midland Rd
Bay City, MI 48706

Phone: (989) 684-2303
Fax: 989-684-2849