Effective date: April 14, 2003
Notice of Privacy Practices:
This notice decribes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Please contact the Privacy Officer at (716) 639-3311 if you have questions regarding this notice.
A. General description and purpose of notice.
Menorah Campus, Inc. d/b/a The Harry and Jeanette Weinberg Campus and its Subsidiaries (collectively referred to as "Weinberg Campus") provide a variety of health care services, residential services and related services. Due to the nature of certain services provided by Weinberg Campus, we are required by law to maintain the privacy of specific confidential health information, known as Protected Health Information ("PHI"). This notice describes the privacy practices of Weinberg Campus and that of:
1) Any health care professional authorized to enter information into your medical record;
2) Any member of a volunteer group which we allow to help you while receiving services at our facilities;
3) All facility employees, staff, and other personnel.
B. Our pledge regarding your health information.
Weinberg Campus is required by law to maintain the privacy of PHI and to provide individuals with notice of any legal duties or privacy practices with respect to PHI.
This notice will provide you with information regarding our privacy practices and applies to all of your health information created and/or maintained by Weinberg Campus, 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 facilities. The first page of the notice contains the effective date and any dates of revision.
C. How we may use or disclose your health information.
We may use or disclose your health information in the following ways:
1) For treatment, payment and health care operations;
2) Pursuant to your written authorization (for purposes other than treatment, payment or health care operations);
3) Pursuant to your verbal agreement (for use in our facility directory or to discuss your health condition with family or friends who are involved in your care);
4) As permitted by law;
5) As required by law.
The following describes each of these different ways that we may use or disclose your health information. Where appropriate, we have included examples of the different types of uses or disclosures.
1. We may use and disclose your personal health information for treatment, payment and health care operations.
a. Treatment. We will use and disclose your personal health information in providing you with treatment and services. We may disclose your personal health information to facility and non-facility personnel who may be involved in your care. For example our nursing staff will need to talk with the speech therapist so that we can coordinate services and develop a plan of care.
b. 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.
c. Health care operations. We may use or disclose your health information for facility operations. These uses or discloses are necessary to manage the facility and, or monitor our quality of care. For example, we may use your health information to evaluate our facility's services for quality management.
2. Uses or disclosures made pursuant to your written authorization.
We may use or disclose your health information pursuant 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 pursuant to your authorization prior to its revocation.
3. Uses or disclosures with special protections for HIV and Mental Health Information
If your treatment involves HIV or mental health information you will be provided with a separate notice explaining how the information is protected. To request copies of these other notices, please contact the Medical Records Coordinator or Administrative Designee at the facility where your treatment was provided. Some parts of this general Notice of Privacy Practices may not apply to these types of information.
4. Uses or disclosures made pursuant to your verbal agreement.
We may use or disclose your health information, pursuant to your verbal agreement, for purposes of including you in a facility directory or for purposes of releasing information to persons involved in your care as described below.
5. Uses or disclosures permitted by law
Certain 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 use 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 pursuant to these laws and regulations include the following:
a. 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 purpose.
i. To report deaths;
ii. To report suspected or actual abuse, neglect, or domestic violence;
iii. To report adverse reactions to medications or problems with health care products;
iv. To notify individuals of products recalls;
v. 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;
vi. To a person subject to the jurisdiction of the FDA with respect to an FDA-regulated product or activity.
b. Health oversight activities. We may use or disclose your health information to a health oversight agency that is authorized by law to conduct health oversight activities. These oversight activities may Include
audits, investigations, inspections, or licensure and certification surveys.
c. Judicial or administrative proceeding. 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 pursuant to a court order, a subpoena, a discovery request, or other lawful process, but only if efforts have been made to notify you of the request or to obtain an order or agreement protecting your health information.
d. 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.
e. 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:
i. In response to a court order, subpoena, warrant, summons or similar lawful process;
ii. To identify or locate a suspect, fugitive, material witness, or missing person;
iii. Regarding a victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement
iv. To report a death that we believe may be the result of criminal conduct;
v. To report criminal conduct at our facility;
vi. In emergency situations, to report a crime--the location of the crime and possible victims; or the identity, description, or location of the individual who committed the crime.
f. Coroners, medical examiners, or funeral directors. 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.
g. Organ procurement organizations or tissue banks. If you are an organ donor, we may use or disclose your health information to organizations that handle organ procurement, transplantation, or tissue banking for the purpose of facilitating organ or tissue donation or transplantation.
h. Research. We may allow personal health information of patients from our facility to be used or disclosed for research purposes provided that the researcher adheres to certain privacy protections. Your personal health information may be used for research purposes only, if the privacy aspects of the research have been reviewed and approved by the privacy officer, if the researcher is collecting information in preparing a research proposal, if the research occurs after your death, or if you authorize the use or disclose.
i. 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.
j. 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.
k. National security and intelligence activities. We may use or disclose your health information to authorized federal officials for purpose of intelligence, counterintelligence, and other national security activities, as authorized by law.
6. Uses or disclosures required by law
a. We may use or disclose your information where such uses or disclosures are required by federal, state or local law.
7. Other uses or disclosures
a. Fundraising activities. We may use a limited amount of your information for purposes of contacting you to raise money for Weinberg Campus. We may disclose this information to a foundation related to the Weinberg Campus so that the foundation may contact you to raise money for Weinberg Campus. 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 Weinberg Campus or affiliated foundation to contact you for these fundraising purposes, you must notify the Privacy Officer in writing.
b. Facility directories. We may include limited information about you in a facility directory while you are a resident at a Weinberg Campus facility. The information may include your name, the facility that you are located in and your room number. Unless you object, this information may be released to anyone who asks for you by name. Also, unless you object, this limited information, including religious affiliation, will be made available to clergy even if they do not ask for you by name. If you do not want anyone to know this information about you, if you want to limit the amount of information that is disclosed, or if you want to limit who gets this information, you must notify the Privacy Officer in writing.
D. Your rights regarding your health information
You have the following rights regarding your health information which we create and/or maintain:
1. 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 Medical Records Coordinator or Administrative Designee at the facility that provided your treatment. 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 you are denied access to your health information, you may request that the denial be reviewed. Another health care professional chosen by us will review your request and the denial. We will comply with the outcome of this review.
2. Right to request an amendment. If you feel that the health information we have about you is incorrect or incomplete, you may ask to amend the information. You have the right to request an amendment for as long as the information is kept by or for Weinberg Campus. To request an amendment, your request must be made in writing and submitted to the Medical Records Coordinator or Administrative Designee at the facility where your services were provided. In addition, you must provide us with a reason that supports your request.
3. We may deny your request if you ask us to amend information that
a. was not created by us;
b. is not part of the health information kept by or for us;
c. is not part of the information which you would be permitted to inspect and copy;
d. is accurate and complete.
3. 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 Medical Records Coordinator or Administrative Designee at the facility where your services were provided. In your request, you must tell us (a) what information you want to limit; (b) whether you want to limit our use, disclosure or both; and (c) to whom you want the limits to apply (for example, disclosures to a family member).
4. 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 send information to a post office box instead of your home address. To request confidential communications, you must make your request in writing to the Privacy Officer. Your request must specify how and where you wish to be contacted. We will accommodate all reasonable requests.
5. 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 or pursuant to your individual authorization. To request an accounting of disclosures, you must submit your request in writing to the Medical Records Coordinator or Administrative Designee at the facility where your services are provided. Your request must state a time period which may not be longer that 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 and your first request within a twelve (12) month period is free. Additional accountings will be charged at a nominal fee.
7. Right to a paper copy of this notice. You have the right to receive a paper copy of this notice. You will receive a copy of this notice upon admission and/or enrollment. You may obtain a copy of this notice at our website, www.weinbergcampus.org. To obtain a paper copy of this notice send your request in writing to Weinberg Campus Privacy Officer, 2700 North Forest Road, Getzville, NY 14068.
E. Complaints
If you believe your privacy rights have been violated, you may file a complaint with Weinberg Campus or with the Secretary of the Department of Health and Human Services. To file a complaint with Weinberg Campus, submit your request in writing to Weinberg Campus Privacy Officer, 2700 North Forest Road, Getzville, NY 14068.
You will NOT be penalized for filling a complaint.