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1309 Kempsville Road      Norfolk, VA 23502      757.461.5001
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Lake Taylor Transitional Care Hospital

Privacy Statement

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.

If you have any questions about this Notice please contact Lake Taylor Transitional Care Hospital's Privacy Officer.

GENERAL DESCRIPTION AND PURPOSE OF NOTICE:

This notice describes our information privacy practices and that of:

* Any health care professional authorized to enter information into your medical record created and/or maintained at our facility;
* Any member of a volunteer group which we allow to help you while receiving services at our hospital; and
* All facility employees, staff, and other personnel; and
* Providers that are part of Lake Taylor Transitional Care Hospital's (LTTCH) Organized Health Care Arrangement (OHCA).

All of the individuals or entities identified above will follow the terms of this notice. These individuals or entities may share your health information with each other for purposes of treatment, payment, or health care operations, as further described in this notice.

OUR FACILITY'S POLICY REGARDING YOUR HEALTH INFORMATION:

We are committed to preserving the privacy and confidentiality of your health information created and/or maintained at our facility. Certain state and federal laws and regulations require us to implement policies and procedures to safeguard the privacy of your health information.

This notice will provide you with information regarding our privacy practices and applies to all of your health information created and/or maintained at our facility, including any information that we receive from other health care providers or facilities. The notice describes the ways in which we may use or disclose your health information and also describes your rights and our obligations regarding any such uses or disclosures. We will abide by the terms of this notice, including any future revisions that we may make to the notice as required or authorized by law.

We reserve the right to change this notice and to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in our facility. The first page of the notice contains the effective date and any dates of revision. We retain prior versions of the Notice of Privacy Practices for six (6) years from the revision date.

USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION:

This Notice of Privacy Practices will tell you the ways in which LTTCH will use and disclose medical information about you. We will also describe your rights and certain obligations we have regarding the use and disclosure of medical information.

For Treatment: We may use your health information to provide you with health care treatment and services. We may disclose your health information to doctors, nurses, nursing assistants, medical and nursing students, rehabilitation therapy specialists, or other personnel who are involved in your health care. For example, your physician may order physical therapy services to improve your strength and walking abilities. Our nursing staff will need to talk with the physical therapist so that we can coordinate services and develop a plan of care. We also may disclose your health information to people outside of our facility who may be involved in your medical care after you leave the hospital.

For Payment: We may use or disclose your health information so that we may bill and collect payment from you, an insurance company, or another third party for the health care services you receive at our facility. For example, we may need to give information to your health plan regarding the services you received from our facility so that your health plan will pay us or reimburse you for the services. We also may tell your health plan about a treatment you are going to receive in order to obtain prior approval for the services or to determine whether your health plan will cover the treatment.

Health Care Operations: We may use and disclose medical information about you for medical operations. These uses and disclosures are necessary to make sure all patients receive quality care. For example, we may use medical information to review your treatment and services and to evaluate the performance of the staff caring for you. We may also combine medical information about many patients to determine whether certain services are effective or whether additional services should be provided. We may also disclose information to doctors, nurses, technicians, medical students, and other hospital personnel for review and learning purposes. We also may combine health information with information from other health care providers or facilities to compare how we are doing and see where we can make improvements in the care and services offered to our residents. We may remove information that identifies you from this set of health information so that others may use the information to study health care and health care delivery without learning the specific identities of our residents.

Fundraising activities: We may use a limited amount of your health information for purposes of contacting you to raise money for our facility and its operations. The information which we may use or disclose will be limited to your name, address, phone number, and dates for which you received treatment or services at our facility. If you do not want our facility to contact you for these fundraising purposes, my must notify LTTCH's Privacy Officer in writing.

USES OR DISCLOSURES MADE ACCORDING TO YOUR WRITTEN AUTHORIZATION

We may use or disclose your health information according to your written authorization for purposes other than treatment, payment or health care operations and for purposes which are not permitted or required by law. You have the right to revoke a written authorization at any time as long as your revocation is provided to us in writing. If you revoke your written authorization, we will no longer use or disclose your health information for the purposes identified in the authorization. You understand that we are unable to retrieve any disclosures which we may have made according to your authorization prior to its revocation. Examples of uses or disclosures that may require your written authorization include the following:

* a request to provide certain health information to a pharmaceutical company for purposes of marketing
* a request to provide your health information to an attorney for use in a civil litigation claim
* a request to provide your health information for purposes of including you on a mailing list.

USES OR DISCLOSURES MADE ACCORDING TO YOUR VERBAL AGREEMENT

We may use or disclose your health information, according to your verbal agreement, for purposes of including you in our facility directory or for purposes of releasing information to persons involved in your care as described below.

Facility directory: We may use or disclose certain limited health information about you in our facility directory while you are a patient at our facility. This information may include your name, your assigned unit and room number, your religious affiliation, and a general description of your condition. Your religious affiliation may be given to a member of the clergy. The directory information, except for religious affiliation, may be given to people who ask for you by name.

Individuals involved in your care: We may disclose your health information to individuals, such as family and friends, who are involved in your care or who help pay for your care. We also may disclose your health information to a person or organization assisting in disaster relief efforts for the purpose of notifying your family or friends involved in your care about your condition, status and location.

USES OR DISCLOSURES PERMITTED BY LAW

Some state and federal laws and regulations either require or
permit us to make certain uses or disclosures of your health information without your permission. These uses or disclosures are generally made to meet public health reporting obligations or to ensure the health and safety of the public at large. The uses or disclosures which we may make according to these laws and regulations include the following:

Public health activities: We may use or disclose your health information to public health authorities that are authorized by law to receive and collect health information for the purpose of preventing or controlling disease, injury or disability. We may use or disclose your health information for the following purposes:

* to report deaths
* to report suspected or actual abuse, neglect, or domestic violence involving a child or adult
* to report adverse reactions to medications or problems with health care products
* to notify individuals of product recalls
* to notify an individual who may have been exposed to
a disease or may be at risk for spreading or contracting a disease or condition.

Health oversight activities: We may use or disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. These activities are necessary for the government to monitor the persons or organizations that provide health care to individuals and to ensure compliance with applicable state and federal laws and regulations.

Judicial or administrative proceedings: We may use or disclose your health information to courts or administrative agencies charged with the authority to hear and resolve lawsuits or disputes. We may disclose your health information according to a court order, a subpoena, a discovery request, or other lawful process issued by a judge or other person involved in the dispute, but only if efforts have been made to (i) notify you of the request for disclosure or (ii) obtain an order protecting your health information.

Worker's compensation: We may use or disclose your health information to worker's compensation programs when your health condition arises out of a work related illness or injury.

Law enforcement official: We may use or disclose your health information in response to a request received from a law enforcement official for the following purposes:

* In response to a court order, subpoena, warrant, summons or similar lawful process
* To identify or locate a suspect, fugitive, material witness, or missing person
* Regarding a victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement
* To report a death that we believe may be the result of criminal conduct
* To report criminal conduct at our facility.

Coroners, medical examiners, funeral directors and organ donation: We may use or disclose your health information to a coroner or medical examiner for the purpose of identifying a deceased individual or to determine the cause of death. We also may use or disclose your health information to a funeral director for the purpose of carrying out his/her necessary activities. If you are an organ donor, we may use or disclose your health information for organ, eye or tissue donation purposes.

Research: We may disclose your protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.

To avert a serious threat to health or safety: We may use or disclose your health information when necessary to prevent a serious threat to the health or safety of you or other individuals. Any such use or disclosure would be made solely to the individual(s) or organization(s) that have the ability and/or authority to assist in preventing the threat.

Military and veterans: If you are a member of the armed forces, we may use or disclose your health information as required by military command authorities.

Inmates: We may use or disclose your protected health information if you are an inmate of a correctional facility and your physician created or received your protected health information in the course of providing care to you.

USES OR DISCLOSURES REQUIRED BY LAW

Under the law, we must make disclosures when required by the Secretary of the U.S. Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500 et.seq.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

You have the following rights regarding your health information which we create and/or maintain:

Right to inspect and copy: You have the right to inspect and copy health information that may be used to make decisions about your care. Generally, this includes medical and billing records, but does not include psychotherapy notes.

To inspect and copy your health information, you must submit your request in writing to the Health Information Management Department. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request.

We may deny your request to inspect and copy your health information in certain limited circumstances. If your are denied access to your health information, you may request that the denial be reviewed.

Right to request an amendment: If you feel that medical information about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for our facility.

To request an amendment, your request must be made in writing and submitted to the Health Information Management Department. In addition, you must provide us with a reason that supports your request.

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

* was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
* is not part of the health information kept by or for our facility;
* is not part of the information which you would be permitted to inspect and copy; or
* is accurate and complete.

Right to an accounting of disclosures: You have the right to request an accounting of the disclosures which we have made of your health information. This accounting will not include disclosures of health information that we made for purposes of treatment, payment, or health care operations.

To request an accounting of disclosures, you must submit your request in writing to the Health Information Management Department. Your request must state a time period which may not be longer than six (6) years prior to the date of your request and may not include dates before April 14, 2003. Your request should indicate in what form you want to receive the accounting ( for example, on paper or via electronic means). The first accounting that you request within a twelve (12) month period will be free. For additional accounting, we may charge you for the costs of providing the accounting.

Right to request restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose about you to someone, such as a family member or friend, who is involved in your care or in the payment of your care. For example, you could ask that we not use or disclose information regarding a particular treatment that you received.

We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide emergency treatment to you.

To request restrictions, you must make your request in writing to the Health Information Management Department. In your request, you must tell us 1) what information you want to limit; 2) whether you want to limit our use, disclosure or both; and 3) to whom you want the limits to apply (for example, disclosures to a family member).

Right to request confidential communications: You have the right to request that we communicate with you about your health care in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.

To request confidential communications, you must make your request in writing to the Health Information Management Department. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Right to a paper copy of this notice: You have the right to receive a paper copy of this notice. You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

You may obtain a copy of this notice at our website,
http://www.laketaylor.org. To obtain a paper copy of this notice, contact the Health Information Management Department or Admissions Department.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with our facility or with the Secretary of the Department of Health and Human Services. To file a complaint with our facility, contact the Privacy Officer.

You will NOT be penalized for filing a complaint.

© 2014 Lake Taylor Transitional Care Hospital   •   Privacy Statement