NOTICE OF PRIVACY PRACTICES
Privacy Office: (727) 345-2775
Effective Date: October 18, 2022
THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY
Who We Are:
This Notice of Privacy Practices (“Notice”) describes the privacy practices of Menorah Life, Inc., its affiliates Samson Nursing Center and Toby Weinman Assisted Living Residence, operated by such entities and their respective physicians, dentists, nurses, therapists, and other personnel (collectively, “Menorah Life”).
Protected Health Information:
Each time you visit a hospital, physician, or other health care provider, a record of your visit is made. Typically, this medical record contains your symptoms, examination and test results, diagnoses, treatment, a plan for future care or treatment, and billing-related information. This Notice applies to all identifiable protected health information (“Protected Health Information”) in the medical records of your care generated by Menorah Life, whether made by Menorah Life personnel, agents of Menorah Life, or other medical personnel.
We are required by law to maintain the privacy of your Protected Health Information and provide you with this Notice of our legal duties and a description of our privacy practices with respect to your Protected Health Information. We will only use and/or disclose your Protected Health Information in accordance with the terms of this Notice while it is in effect.
Uses and Disclosures Without Your Written Consent or Authorization:
The following categories describe examples of the way we may use and disclose your Protected Health Information without your authorization or written consent:
- Treatment, Payment and Health Care Operations:
For Treatment: We may use Protected Health Information to provide, coordinate or manage your health care treatment and related services. We may disclose your Protected Health Information to doctors, nurses, technicians, medical students, or other health care providers who are involved in your treatment. For example, a doctor treating you in our clinic or skilled nursing facility may need to know if you have diabetes because diabetes may slow the healing process. We may also provide your physician or a subsequent health care provider with Protected Health Information to assist him or her in treating you. For example, Protected Health Information may be disclosed to people such as home health care providers who may be involved in your medical care after you leave our care.
For Payment: We may use and disclose Protected Health Information about your treatment and services to bill and collect payment from you, your insurance company, or a third- party payer. For example, we may need to give your insurance company information about your treatment so they will pay us or reimburse you for the treatment provided. We may tell your health plan about treatments you are going to receive to determine whether your plan will cover the services provided. We may also share your medical information with billing and collection departments or agencies, insurance companies and health plans in order to collect payments.
For Health Care Operations: We may use your Protected Health Information for our health care operations, which include internal administration and planning and various activities that improve the quality and cost effectiveness of the care and customer service that we deliver to you. For example, we may use it to evaluate the quality and competence of our physicians, nurses and
other health care workers. In addition, we may disclose your Protected Health Information for certain types of health care operations, including any peer review or utilization review activities we undertake. For example, we may combine Protected Health Information we have with that of hospitals to see where we can make improvements to our services.
For Public Health, Abuse or Neglect, and Health Oversight: We may use and disclose your Protected Health Information, for example, to alert a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease.
Other Authorizations Required by Law: We may disclose your Protected Health Information if required to do so by law for things such as legal proceedings and law enforcement; workers’ compensation matters; activities related to inmates; military, national security and intelligence activities; for the protection of the President; certain approved research purposes; organ donation; for use by coroners, medical examiners and funeral directors; or any other reason such a disclosure would be required by law.
- Business Associates: There are some services provided in our organization through contracts with business associates. Examples may include certain administrative services or a copy service to make copies of your health record. When these services are contracted, we may disclose your Protected Health Information to our business associates so that they can perform the job we have asked them to perform or to bill you or your third-party payer for services rendered. To protect your Protected Health Information, however, we contractually require the business associate to appropriately safeguard your information.
- Directory: Unless you request otherwise, we may include certain limited information about you in our facility directory while you are a patient at Menorah Life. The information may include your name and location, your condition in general terms, and your religious affiliation. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name. If you would like to opt out of being in the facility directory or restrict some or all of the information to be included in the directory, please request such opt out or restriction during the admission process or at the time you are entering into any other agreement for additional services.
- Individuals Involved In Your Care or Payment for Your Care: We may release Protected Health Information to a family member or other relative, a close personal friend, or any person identified by you if it is directly relevant to that person’s involvement in your medical care or payment for your medical care, when you are present for, or otherwise available prior to, the disclosure, and do not object to such disclosure after being given the opportunity to do so. We may also disclose your Protected Health Information to such persons with your verbal agreement or written consent. In addition, we may disclose Protected Health Information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location. You can limit the people to whom we can disclose Protected Health Information about you by requesting such limitation during the admission process or at the time you are entering into any other agreement for additional services.
- Research: We may disclose Protected Health Information to researchers without your consent or authorization when an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your Protected Health Information has approved the research and granted a waiver of the authorization. In addition, certain elements of your Protected Health Information may be reviewed by our clinicians, employees or workforce to determine your potential eligibility for one or more clinical research trials, and we may contact you via telephone to determine your willingness to participate.
- Future Communications: We may communicate to you via newsletters, mail outs or other means regarding treatment options, health related information, disease-management programs, wellness programs, or other community-based initiatives or activities in which Menorah Life is participating.
- Fundraising Communications: We may use Protected Health Information to contact you to request a tax-deductible contribution to support important activities of Menorah Life. We may disclose Protected Health Information to a foundation, or a business associate on behalf of Menorah Life, related to our organization so that the foundation or business associate may contact you in raising money for Menorah Life. We may use, or disclose to a business associate or to an institutionally related foundation, the following Protected Health Information for the purpose of raising funds for Menorah Life’s own benefit, without an authorization: (i) demographic information relating to an individual, including name, address, other contact information, age, gender, and date of birth; (ii) dates of health care provided to an individual; (iii) department of service information; (iv) treating physician;
(v) outcome information; and (vi) health insurance status.
- Public Health Activities: We may disclose your Protected Health Information for the following public health activities: (1) to report health information to public health authorities for the purpose of preventing or controlling disease, injury or disability; (2) to report child abuse and neglect, elder abuse, and disabled persons abuse to public health authorities or other government authorities authorized by law to receive such reports; (3) to report information about products and services under the jurisdiction of the U.S. Food and Drug Administration; (4) if we know or have reason to believe that you are infected with a venereal disease, to alert your fiancée (if you are engaged) or your spouse (if you are married), or your parent or guardian (if you are a minor, unless as a minor you have sought treatment with us for such venereal disease); (5) to report information to your insurer and/or other parties as required under state law addressing work-related illnesses and injuries; (6) to report information related to the birth and subsequent health of an infant to state government agencies as required by law; (7) to file a death certificate and report fetal deaths; and (8) to correctional institutions for inmates.
- Health Oversight Activities: We may disclose your Protected Health Information to a health oversight agency that oversees the health care system or government benefit programs (such as Medicare or Medicaid).
- Law Enforcement/Legal Proceedings: We may disclose Protected Health Information for law enforcement purposes as required by law or in response to a valid subpoena, a court order, or other lawful process.
- State-Specific Requirements: Many states have requirements for reporting including population-based activities relating to improving health or reducing health care costs. Some states have separate privacy laws that may provide additional legal requirements. If the state privacy laws are more stringent than federal privacy laws, the state law preempts the federal law.
- Decedents: We may disclose your Protected Health Information to a coroner or medical examiner as authorized by law.
- Organ and Tissue Procurement: If you are an organ donor, we may disclose your Protected Health Information to organizations that facilitate organ, eye or tissue procurement, banking or transplantation.
- Health or Safety: We may disclose Protected Health Information to prevent or lessen a serious danger to you or to others.
- Specialized Government Functions: We may use and disclose your Protected Health Information to units of the government with special functions, such as the U.S. military or the
U.S. Department of State under certain circumstances.
- Ordered Examinations: We may disclose Protected Health Information when required to report findings from an examination ordered by a court or detention facility.
- As Required By Law: We may use and disclose your Protected Health Information when required to do so by any other law not already referred to in the preceding categories.
- Uses and Disclosures That Require Authorization: Most uses and disclosures of psychotherapy notes (where appropriate), uses and disclosures of Protected Health Information for marketing purposes and disclosures that constitute a sale of Protected Health Information require authorization. Other uses and disclosures not described in this Notice will be made only with authorization from the individual.
Your Rights with Respect to Your Protected Health Information:
Although your health record is the physical property of the health care practitioner or facility that compiled it, you have the following rights.
- Inspect and Copy: You have the right to inspect and obtain a copy of your medical record file containing Protected Health Information. If the record is in electronic format you have the right to receive an electronic copy of your medical record in a form (machine readable) that meets your needs. If you chose to have the electronic Protected Health Information emailed to you, we will send to you via an encrypted email. If you chose to receive the email in an unencrypted format, there is a risk that an unintended person could possibly intercept and open the email with your Protected Health Information attached. Usually, these requests include medical and billing records, but not psychotherapy notes. We may deny your request to inspect and copy a portion of your records in certain limited circumstances. If you are denied access to Protected Health Information, you may request that the denial be reviewed. Another health care professional chosen by Menorah Life will review your request and the denial. If you request copies, we will charge you a reasonable cost- based fee for such copies. You will also be charged postage costs if you request the copies be mailed to you.
- Amend: If you feel that the 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 Menorah Life. We may deny your request for an amendment if we believe the information as currently stated is accurate and complete or other special circumstances apply, and if this occurs, you will be notified of the reason for the denial.
- An Accounting of Disclosures: You have the right to request an accounting of disclosures of your Protected Health Information. This is a list of certain disclosures we make of your Protected Health Information for purposes other than treatment, payment or health care operations where an authorization was not required. If you request an accounting more than once in a twelve (12) month period, we will charge you a reasonable cost-based fee for the accounting.
- 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. Menorah Life has a website from which you may print or view a copy of the Notice by clicking on the Notice of Privacy Practices link at www.menorahlife.org
- Complaints: If you believe your privacy rights have been violated, you may file a complaint with the facility by telephone by calling Menorah Life at 727-345-2775. In addition, you may file a complaint in writing to Menorah Life Privacy Officer or call the Privacy Office at 727-345-2775. You may also file a complaint with the Office of Civil Rights, Secretary of the Department of Health and Human Services, Atlanta Federal Center, 61 Forsyth Street, SW, Suite 3B70, Atlanta, GA 30303-8980. You will not be penalized for filing a complaint.
- Right to Request Additional Restrictions: You have the right to request restrictions on the use and disclosure of your Protected Health Information. However, we are not required to agree to a requested restriction and will only agree to a requested restriction if there is a substantial need or basis for the request and will not do so as a matter of course. If you wish to request such a restriction, please contact our Privacy Office identified in this Notice.
7. Right to Receive Confidential Communications: You may request, and we will accommodate, any reasonable written request to receive your Protected Health Information by alternative means of communication or at alternative locations.
8. Right to be Notified in the Event of a Breach of Unsecured Protected Health Information: You will be notified in the event there is a breach of your unsecured Protected Health Information.
9. Right to Restrict Disclosures of Protected Health Information: You have the right to restrict disclosures to health plans if services have been paid for out of pocket in full. The request to restrict the disclosure shall be made in writing, and the request should identify: (i) the information to be restricted, (ii) the type of restriction being requested (i.e., on the use of information, the disclosure of information, or both), and (iii) to whom the limits should apply.
Other Uses of Protected Health Information: Other uses and disclosures of Protected Health Information not covered by this Notice or the
applicable state or federal laws that apply to us will be made only with your permission in the form of a written authorization. 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. However, we will be unable to take back any disclosures we have previously made based upon your written authorization.
Changes to this Notice:
We reserve the right to change this Notice and the revised or changed Notice will be effective for information we already have about you as well as any information we receive in the future. The current Notice will be posted in the facility and include the effective date. In addition, each time you register at or are admitted for treatment or health care services, we will offer you a copy of the current Notice in effect.
If you have questions concerning Menorah Life Privacy Practices, please call 727-345-2775 and ask for the Privacy Officer. If you have questions concerning patient Medical Records, please call 727-345-2775 and ask for the Medical Records Department.