NOTICE OF PRIVACY PRACTICES
FOR CHATSWORTH AND DEVONSHIRE
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
THIS NOTICE IS EFFECTIVE ON May 1, 2007
This Notice describes the privacy policies of Devonshire at PGA National, LLC (Devonshire) and Chatsworth at PGA National, LLC (Chatsworth). It applies to the physicians, health care professionals, employees, staff and other personnel who provide services at Chatsworth or Devonshire. The people and organizations to which this notice applies (referred to as “we,” “our,” and “us”) have agreed to abide by the terms of this notice. We may share your information with each other for purposes of treatment, and as necessary for payment and operations activities as described below.
This notice applies to any information in our possession that would allow someone to identify you and learn something about your health. It is intended to describe the policies that protect medical information relating to your past, present and future medical conditions, health care treatment or services and payment for those services (Protected Health Information). It does not apply to information that contains nothing that could reasonably be used to identify you. For purposes of state and federal health privacy laws only, Chatsworth and Devonshire are operating as an organized health care arrangement.
OUR LEGAL DUTIES
- We are required by law to maintain the privacy of your health information.
- We are required to provide this notice of our privacy practices to anyone who asks for it.
- We are required to abide by the terms of this notice until we officially adopt a new notice.
HOW WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION.
We may use your Protected Health Information, or give it out to others, for a number of different reasons. This Notice describes these reasons. For each reason, we have written a brief explanation. We also provide some examples. These examples do not include all of the specific ways we may use or disclose your information. Any time we use your information, or disclose it to someone else, it will fit one of the reasons listed here.
Treatment. We will use your Protected Health Information to provide you with medical care and services. This means that our employees and staff and others who work under our direct control may read your health information to learn about your medical condition and use it to make decisions about your care. For instance, a nurse may read your medical chart in order to care for you. We will also give your information to others who need it in order to provide you with medical treatment or services. For instance, we may send your doctor the results of medical evaluations.
Payment. We will use your Protected Health Information and other personal information, and disclose it to others, as necessary to obtain payment for the services we provide to you. For instance, an employee in our business office may use your Protected Health Information to prepare a bill. And we may send that bill, and any health information it contains, to your insurance company. We may also disclose some of your health information to companies with whom we contract for payment-related services. We may give information about you to a health plan that pays for your benefits. We will not use or disclose more information for payment purposes than is necessary.
Health Care Operations. We may use your Protected Health Information for activities that are necessary to operate Chatsworth and Devonshire. This includes reading your health information to review the performance of our staff. We may also use your information and the information of other residents to plan what services we may need to provide or expand. For example, we may disclose your Protected Health Information to a company that assists us with quality assurance. We may disclose your health information as necessary to others who we contract with to provide administrative services. This includes our lawyers, auditors, accreditation services, and consultants, for instance.
To Business Associates. We may hire third parties that may need your Protected Health Information to perform certain services on our behalf. These third parties are our “Business Associates." Business Associates must protect any Protected Health Information they receive from, or create and maintain on behalf of, Chatsworth or Devonshire.
Family and Friends. Under certain circumstances, we may disclose your Protected Health Information to a member of your family or to someone else who is involved in your medical care or payment for care. For example, we may notify family or friends if you are in the hospital, and tell them your general condition. In the event of a disaster, we may provide information about you to a disaster relief organization so they can notify your family of your condition and location. We will not disclose your information to family or friends if you object. We may also disclose to your personal representatives who have authority to act on your behalf (for example, to parents of minors or to someone with a power of attorney).
Public Health Oversight. We may disclose your Protected Health Information to a public health oversight agency for oversight activities authorized by law. This includes uses or disclosures in civil, administrative or criminal investigations; licensure or disciplinary actions (for example, to investigate complaints against health care providers); inspections; and other activities necessary for appropriate oversight of government programs (for example, to investigate Medicare fraud).
To Report Abuse. We may disclose your Protected Health Information when the information relates to a victim of abuse, neglect or domestic violence. We will make this report only in accordance with laws that require or allow such reporting, or with your permission.
Legal Requirement to Disclose Information. We will disclose your information when we are required by law to do so. This includes reporting information to government agencies that have the legal responsibility to monitor the health care system. For instance, we may be required to disclose your health information, and the information of others, if we are audited by Medicare.
Law Enforcement. We may disclose your Protected Health Information for certain law enforcement purposes. This includes providing information to help locate a suspect, fugitive, material witness or missing person, or in connection with suspected criminal activity. We must also disclose your health information to a federal agency investigating our compliance with federal privacy regulations.
For Lawsuits and Disputes. We may disclose Protected Health Information in response to an order of a court or administrative agency, but only to the extent expressly authorized in the order. We may also disclose Protected Health Information in response to a subpoena, a lawsuit discovery request, or other lawful process, but only if we have received adequate assurances that the information to be disclosed will be protected. We may also disclose Protected Health Information in a lawsuit if necessary for payment or health care operations purposes.
Specialized Purposes. We may disclose your Protected Health Information for a number of other specialized purposes. We will only disclose as much information as is necessary for the purpose. For instance, we may disclose your information to coroners, medical examiners and funeral directors; to organ procurement organizations (for organ, eye, or tissue donation); or for national security and intelligence purposes, including protection of the President. We may disclose the health information of members of the armed forces as authorized by military command authorities. We also may disclose health information about an inmate to a correctional institution or to law enforcement officials to provide the inmate with health care, to protect the health and safety of the inmate and others, and for the safety, administration, and maintenance of the correctional institution. We may also disclose your health information to your employer for purposes of workers’ compensation and work site safety laws (OSHA, for instance). We may disclose Protected Health Information to organizations engaged in emergency and disaster relief efforts.
To Avert a Serious Threat. We may disclose your Protected Health Information if we decide that the disclosure is necessary to prevent serious harm to the public or to an individual. The disclosure will only be made to someone who is able to prevent or reduce the threat.
Research. We may disclose your Protected Health Information in connection with medical research projects, but only if allowed under federal and state laws and rules. Chatsworth and Devonshire may disclose Protected Health Information for use in a limited data set for purposes of research, public health or health care operations, but only if a data use agreement has been signed.
Information to Residents. We may use your Protected Health Information to provide you with additional information. This may include sending you appointment reminders. This may also include giving you information about treatment options or other health-related services that we provide.
Authorization. We will ask for your written authorization if we plan to use or disclose your Protected Health Information for reasons not covered in this notice. If you authorize us to use or disclose your health information, you have the right to revoke the authorization at any time. If you want to revoke and authorization, send a written notice to the Privacy Official listed at the end of this notice. You may not revoke an authorization for us to use and disclose your information to the extent that we have already given out your information or taken other action in reliance on the authorization. If the authorization is to permit disclosure of your information to an insurance company, as a condition of obtaining coverage, other laws may allow the insurer to continue to use your information to contest claims or your coverage, even after you have revoked the authorization.
Request Restrictions. You have the right to ask us to restrict how we use or disclose your Protected Health Information. We will consider your request, but we are not required to agree. If we do agree, we will comply with the request unless the information is needed to provide you with emergency treatment. We cannot agree to restrict disclosures that are required by law.
Confidential Communication. You have the right to ask us to communicate with you at a special address or by a special means. For example, you may ask us to send mail to a different address rather than to your home. We will not ask you to explain why you are making the request. We will agree to reasonable requests.
Access to and Copies of Health Information. You have a right to access the Protected Health Information about you that we have in our records. This right is limited to information about you that is kept in records that are used to make decisions about you. For instance, this includes medical and billing records. We may charge a fee for the cost of copying and mailing the records, to the extent allowed by state and federal law. To ask to inspect your records, or to receive a copy, send a written request to the Privacy Official listed at the end of this notice. Your request should specifically list the information you want copied. We will respond to your request within a reasonable time, but no later than 30 days. We may deny you access to certain information. If we do, we will give you the reason, in writing. We will also explain how you may appeal the decision.
Amend Health Information. You have the right to ask us to amend Protected Health Information about you which you believe is not correct, or not complete. You must make this request in writing, and give us the reason you believe the information is not correct or complete. We will respond to your request in writing within 30 days. We may deny your request if we did not create the information, if it is not part of the records we use to make decisions about you, if the information is something you would not be permitted to inspect or copy, or if it is complete and accurate.
Accounting of Disclosures. You have a right to receive an accounting of certain disclosures of your information to others. This accounting will list the times we have given your health information to others. The list will include dates of the disclosures, the names of the people or organizations to whom the information was disclosed, a description of the information, and the reason. We will provide the first list of disclosures you request at no charge. We may charge you for any additional lists you request during the following 12 months. You must request this list in writing. You must tell us the time period you want the list to cover. You may not request a time period longer than six years. We cannot include disclosures made before May 1, 2007. Disclosures for the following reasons will not be included on the list: disclosures for treatment, payment, or health care operations; disclosures for national security purposes; certain disclosures to correctional or law enforcement personnel; disclosures that you have authorized; and disclosures made directly to you.
Paper Copy of this Privacy Notice. You have a right to receive a paper copy of this notice. If you have received this notice electronically, you may receive a paper copy by contacting the person listed at the end of this notice.
Complaints. You have a right to complain if you think your privacy has been violated. We encourage you to contact our Privacy Official. You may also file a complaint with the Secretary of the Department of Health and Human Services. We will not retaliate against you for filing a complaint.
OUR RIGHT TO CHANGE THIS NOTICE.
We reserve the right to change our privacy practices, as described in this notice, at any time. We reserve the right to apply these changes to any health information which we already have, as well as to health information we receive in the future. Before we make any change in the privacy practices described in this notice, we will write a new notice that includes the change. We will post the new notice in our waiting rooms. The new notice will include an effective date.
CONTACT THE PRIVACY OFFICIAL FOR MORE INFORMATION
If you have any questions regarding this Notice or if you wish to exercise any of your rights described in this Notice, you may contact the Privacy Official at:
Chatsworth and Devonshire Privacy Official
c/o SHP Health Care Services, LLC
2701 N. Rocky Point Dr., Suite 1160
Tampa, Florida 33607
Copies of this notice are also available at the front desks of Chatsworth and Devonshire.
This notice is also available on our Web sites:
www.DevonshireatPGA.com and www.ChatsworthatPGA.com