Notice of Privacy

Effective Date: August 19, 2008

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:

Privacy Officer
Dunwoody Village Care Center 610-359-4454

APPLICATION OF THIS NOTICE

In most cases, this Notice will be provided to the resident. Accordingly, throughout this Notice we use the terms “you” and “your” primarily with reference to the resident. In some cases, however, a resident representative such as a guardian, agent under a power of attorney for healthcare, or conservator, will represent the resident. In those situations in which the resident is unable or unwilling to exercise certain resident rights regarding the control of medical information, “you” may pertain to the resident representative.

This notice applies to information and records regarding your health care maintained at Dunwoody Village, including medical records and payment information (medical information).

WHO WILL FOLLOW THIS NOTICE

This notice describes our practices and that of:

OUR PLEDGE REGARDING MEDICAL INFORMATION

We understand that medical 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. 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, whether made by 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.

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

We are required by law to:

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU

The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories. All categories do fall into one of two main groupings.

1. We May Use And Disclose Your Personal Health Information For Treatment, Payment, And Health Care Operations Without Needing To Obtain Your Consent

2. We May Use And Disclose Personal Health Information About You For Other Specific Purposes

SPECIAL SITUATIONS

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU

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

CHANGES TO THIS NOTICE

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical 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 facility. The notice will contain the effective date on the first page in the top right-hand corner.

COMPLAINTS

Dunwoody may not require you to waive your right to file a complaint as a condition of treatment, payment, and healthcare operations. Dunwoody Village will not intimidate, threaten, coerce, discriminate against or take any other retaliatory action against any individual for exercising their right to file a complaint.

If you believe your privacy rights have been violated, you may file a complaint with Dunwoody Village or with the Secretary of the Department of Health and Human Services. To file a complaint with Dunwoody, please submit complaint in writing to the privacy officer.

OTHER USES OF MEDICAL INFORMATION

Other uses and disclosures of medical 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 medical 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 medical 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.

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