HIPAA and Your Privacy

Notice of Privacy Practices

This retirement community, which will be referred to as “Community” throughout this Notice, is committed to protecting and promoting the rights of each of its residents. This Notice of Privacy Practices for Protected Health Information has been prepared to notify you of the uses and disclosures of protected health information that may be made by this Community, your rights with respect to protected health information, and this Community’s responsibilities, with respect to protected health information.

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review this notice carefully.

I . Who Will Follow This Notice?

This notice describes our Community’s practices and that of:

any health care professional authorized to enter information into your chart at this Community.
all departments and units of this Community.
any member of a volunteer group we allow to help you while you are in this Community.
all employees, staff and other personnel of this Community

Presbyterian Manors of Mid-America Communities covered by this Notice include:

Aberdeen Village,
Arkansas City Presbyterian Manor,
Clay Center Presbyterian Manor,
Emporia Presbyterian Manor,
Farmington Presbyterian Manor,
Fulton Presbyterian Manor,
Kansas City Presbyterian Manor,
Lawrence Presbyterian Manor,
Presbyterian Manor of the Plains,
Newton Presbyterian Manor,
Parsons Presbyterian Manor,
Rolla Presbyterian Manor,
Salina Presbyterian Manor,
Sterling Presbyterian Manor,
Topeka Presbyterian Manor, and
Wichita Presbyterian Manor.

We respect the privacy of your personal health information and we are committed to maintaining the confidentiality of our residents’ health information. This notice applies to all information and records, related to your care, that our Community has received or created. It extends to information received or created by our employees, staff, volunteers and physicians. This notice informs you about the possible uses and disclosures of your personal health information. It also describes your rights and our obligations regarding your personal health information.

We are required by law to:

make sure that health information that identifies you is kept private;
give you this Notice of our legal duties and privacy practices with respect to your personal health information;and
abide by the terms of the Notice that are currently in effect.

II. Our Pledge Regarding Medical Information.

We understand that protected health information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at this Community. We need this record to provide you with quality care and services you receive at this Community. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by this Community, whether made by this Community’s personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your medical information created in the doctor’s office or clinic.

III. How We May Use and Disclose your Protected Health Information.

The following categories describe different ways that we use and disclose protected health information. For each category of uses or disclosures we will explain what we mean and give some examples. Not every use or disclosure in a category will be listed, but the ways we are permitted to use and disclose information will fall within one of the categories.

A. For Treatment/Care.
- We may use protected health information about you to provide you with medical treatment, care, or services. We may disclose protected health information about you to doctors, nurses, certified nurse aides, certified medical aides, technicians, students, or other Community personnel who are involved in taking care of you at this Community. For example, if you are treated for a fall injury, it may be necessary to know if you have diabetes because diabetes may slow the healing process. In addition, the dietitian may need to be told if you have diabetes so that we can arrange for appropriate meals. Different departments of the Community also may share the protected health information about you in order to coordinate the different things you need, such as prescriptions, therapy, etc. We also may disclose protected health information about you to people outside the Community who may be involved in your medical care, either while you are a resident or after you leave the Community, such as family members, home health, chaplain, or others we use to provide services that are part of your care.
B. For Payment.
- We may use and disclose protected health information about you so that the treatment and services you receive at this Community may be billed to, and payment may be collected from you, a government payer, or another third party. For example, we may need to give your health plan or Medicare, information about services you received at our Community so Medicare or the health plan will pay us for the services. We may also tell Medicaid, Medicare or your health plan about a treatment you are going to receive to obtain prior approval or to determine whether they will cover the treatment.
- We may also provide information about you to other health care providers or health care plans so they can obtain or arrange for payment for treatment and services provided to you.
C. For Health Care Operations.
- We may use and disclose protected health information about you for the health care operations of our Community operations. These types of uses and disclosures are necessary to run the Community and make sure that our residents receive quality care. For example, we may use protected health information to review our care and services and to evaluate the performance of our staff in caring for you. We may also combine medical information about many residents to decide what additional services the Community should offer, what services are not needed, and whether certain new services are warranted. We may also disclose information to doctors, nurses, technicians, certified nurse or medical aides, students, and other Community personnel for review and learning purposes. We may also combine the protected health information we have with protected health information from other communities to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of protected health information so others may use it to study health care and health care delivery without knowing the identity of specific residents.
D. Appointment Reminders.
- We may use and disclose protected health information to contact you as a reminder that you have an appointment for medical care or services.
E. Service Alternatives.
- We may use and disclose protected health information to tell you about or recommend possible service options or alternatives that may be of interest to you.
F. Health-Related Benefits and Services.
- We may use and disclose protected health information to tell you about health-related benefits or services that may be of interest to you.
G. Fund-Raising Activities.
- We may use protected health information to contact you in an effort to raise money for the Community and its operations. We may disclose protected health information to a foundation related to the Community so that the foundation may contact you in raising money for the Community. We only would release contact information, such as your name, address and phone number and the dates you received care or services at the Community. If you do not want the Community to contact you for Fund- Raising efforts, you must notify in writing, the Vice President of Fund Development, Presbyterian Manors of Mid-America, P.O. Box 20440, Wichita, Kansas, 67208-1440.
H. Community Directory.
- We may include certain limited information about you in the Community directory while you are a resident at the Community. This information may include your name and room number. The directory information may also be released to people who ask for you by name. This is so your family, friends and clergy can visit you in the Community.
I. Individuals Involved in Your Care or Payment for Your Care.
- We may release protected health information about you to a friend or family member who is involved in your care. We may also give information to someone who helps pay for your care. We may also tell your family or friends your condition.
J. Research.
- Under certain circumstances, we may use and disclose information about you for research purposes. For example, a research project may involve comparing the health and recovery of all residents who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of protected health information, trying to balance the research needs with residents’ need for privacy of their protected health information. Before using or disclosing protected health information for research, the project will have been approved through this research approval process. We may, however, disclose protected health information about you to people preparing to conduct a research project. For example, to help them look for residents with specific medical needs, so long as the protected health information they review does not leave the Community. We will almost always ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at the Community.
K. As Required by Law.
- We will disclose protected health information about you when required to do so by federal, state or local law.
L. To Avert a Serious Threat to Health or Safety.
- We may use and disclose protected health information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
M. Surveys.
- We may use and disclose protected health information to conduct surveys to assess resident satisfaction with the services we provide.
N. Business Associates.
- In the event we arrange for our business associates to provide some of the services we perform, such as having a printing company photocopy your medical record, we may be required to disclose your protected health information to enable the associates to provide the services. Our associates are also required to protect your health information.

IV. Special Situations.

A. Organ and Tissue Donation.
- If you are an organ donor, we may release protected health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
B. Military and Veterans.
- If you are a member of the U.S. or foreign armed forces, we may release protected health information about you as required by appropriate foreign or military authorities.
C. Employers.
- If you are employed and we provide health care services to you at the request of your employer to provide an evaluation of your ability to do a job or in connection with a workrelated illness or injury, we may disclose information to your employer. If so, we will inform you in writing. No health information will be given to your employer for any other purpose unless you authorize us to do so.
D. Workers’ Compensation.
- We may release protected health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
E. Public Health Risk.
- We may disclose protected health information about you for public health activities. These activities generally include the following:
  - to prevent or control disease, injury or disability;
  - to report deaths;
  - to report medication reactions or problems with products;
  - to notify people of recalls of products they may be using;
  - to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
  - to notify the appropriate government authority if we believe a resident has been the victim of abuse, neglect or domestic violence.
  - We will make this disclosure if you agree or when required or authorized by law.
F. Health Oversight Activities.
- We may disclose protected health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, surveys, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
G. Lawsuits and Disputes.
- If you are involved in a lawsuit or a dispute, we may disclose protected health information about you in response to a court or administrative order. We may also disclose protected health information 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.
H. Law Enforcement.
- We may release protected health information if asked to do so by a law enforcement official:
  - In response to a court order, subpoena, warrant, summons or similar process;
  - To identify or locate a suspect, fugitive, material witness, or missing person;
  - About the victim of a crime if, certain circumstances, have prevented our obtaining a person’s agreement;
  - About a death we believe may be the result of criminal conduct;
  - About possible criminal conduct at the Community; and
  - In emergency circumstances to report a crime, a location of a crime or victims, or identity, description or location of a person who committed a crime
I. Coroners, Medical Examiners and Funeral Directors.
- We may release protected health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release protected health information to funeral directors as necessary to carry out their duties.
J. National Security and Intelligence Activities.
- We may release protected health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

V. Your Rights Regarding Your Protected Health Information.

You have the following rights regarding protected health information we maintain about you:

A. Right to Inspect and Copy.
- You have the right to inspect and copy protected health information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include any psychotherapy notes.
- To inspect and copy protected health information that may be used to make decisions about you, you must submit your request in writing to the Community’s Executive Director.
- 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 in certain very limited circumstances. If you are denied access to protected health information, you may request that the denial be reviewed. The Corporate Compliance Office of Presbyterian Manors of Mid-America will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
B. Right to Amend.
- If you feel that protected health information we have 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 the Community.
- To request an amendment, your request must be made in writing and submitted to the Community’s Director of Nursing. In addition, you must provide 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 protected health information kept by or for the Community;
  - is not part of the information which you would be permitted to inspect and copy; or
  - is accurate and complete.
C. Right to an Accounting of Disclosures.
- You have the right to request an “accounting of disclosures.” This is a list of the disclosures we made of protected health information about you, with certain exceptions specifically defined by law. To request this list of accounting of disclosures, you must submit your request in writing to the Community’s Executive Director. Forms for such a request are available at the Community from the Executive Director. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
D. Right to Request Restrictions.
- You have the right to request a restriction or limitation on the protected health information we use or disclose about you for care, payment or health care operations. You also have the right to request a limit on the use or disclosure of the protected health care information we have about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had.
- 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 you emergency treatment.
- To request restrictions, you must make your request in writing to the Community’s Executive Director. 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, disclosure to your spouse.
E. Right to Request Confidential Communications.
- You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
- Confidential communications request must be made in writing to the Community’s Executive Director. We will accommodate all reasonable requests without asking the reason for the request. Request must specify how or where you wish to be contacted.
F. Right to a Paper Copy of This Notice.
- You have the right to 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. To obtain a paper copy of this notice, contact the Community’s Executive Director.

VI. Changes to This Notice.

We reserve the right to change this notice. We reserve the right to make the revised notice effective for protected 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 the Community. The notice will contain on the first page, in the top righthand corner, the effective date. In addition, each time you are admitted as a resident, we will offer a copy of the current notice in effect.

VII. Complaints.

If you believe your privacy rights have been violated, you may file a complaint with the Community or with the Secretary of the Department of Health and Human Services. To file a complaint with the Community, contact the Community’s Executive Director. You may also file a complaint with the Corporate Compliance Office of Presbyterian Manors of Mid-America, P.O., Box 20440, Wichita, Kansas, 67208-1440, Phone: (316) 685-1100, or you may report a concern through the toll free number 800-326-5677. A copy of your complaint should be submitted in writing.

You will not be penalized for filing a complaint.

VIII. Other Uses of Protected Health Information.

Other uses and disclosures of protected health information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose protected health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose protected health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

IX. Acknowledgement.

You will be asked to provide a written acknowledgement of your receipt of this Notice of Privacy Practices. We are required by law to make a good faith effort to provide you with our Notice of Privacy Practices and obtain such acknowledgement from you. However, your receipt of care and treatment from this Community is not conditioned upon your providing the acknowledgement in writing.

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