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, you may contact our Privacy Officer at 718-289-2107.
This notice describes how our facility, outpatient services and any clinics associated with Parker Jewish Institute for Health Care and Rehabilitation uses and discloses our health information. It also describes your rights and certain obligations we have regarding the use and disclosure of medical information. Any health care professional authorized to enter information into your file or record and all employees, staff and other personnel of Parker will follow the terms of this notice. In addition, all Parker programs and locations may share medical information with each other for treatment, payment or for operations purposes described in this notice. This includes Parker clinical affiliations with QLIRI and AgeWell.
We understand that medical information about you and your health is personal. We are committed to protecting your medical information. We create a record of the care and services you receive in our facility. 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.
We are required by law to:
We will post a copy of the current notice in our facility and post it on our website. The notice will contain the effective date. In addition, each time you are in our facility for treatment or health care services, we will offer you a copy of the current notice in effect. We reserve the right to change this notice. We reserve the right 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. If we make material revisions to our privacy practices, we will also post a copy of the revised notice in our facility and on our website. The revised notice will also be available to you at our facility.
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 at 718-289-2107 or in writing c/o Parker Jewish Institute for Health Care and Rehabilitation, 271-11 76th Avenue New Hyde Park, NY 11040-1433. All complaints must be submitted in writing. If you require assistance with putting your complaint in writing, we will have a staff member assist you. You will not be retaliated against for filing a complaint.
The following categories describe different ways that we may use and disclose medical information. Each category of uses or disclosures will be explained but not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose your information will fall within one of the categories.
For Treatment: We may use your health information to provide you with medical treatment or services. We may disclose information about you to doctors, nurses, technicians, medical students, or other personnel who are involved in taking care of you. Different departments of our practice also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work, and x-rays. We also may disclose medical information about you to people outside the nursing home who may be involved in your medical care, such as home care aides who provide health care services to you.
For Payment: We may use and disclose medical information about you so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company, or a third party. For example, we may need to give your health plan information about treatment you received so your health plan will pay us or reimburse you. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
Healthcare Operations: We may use your health information or share it with others in order to conduct our business activities. These activities include, but are not limited to quality assessment activities, training of medical students, and marketing.
Appointment Reminders: We may also use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care.
Health-Related Benefits and Services: We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
To You: We are required to disclose your health information to you or someone who has the legal right to act for you (your personal representative). We must also use and disclose your health information in order to administer your rights as described in this notice.
To the Department of Health and Human Services: We are required to use or disclose your health information to the Secretary of the Department of Health and Human Services, if necessary, to ensure our compliance with HIPAA.
Facility Directory:Unless you object, a directory list containing your name, location, and general status will be created for disclosures to any member of the public asking for you by name and to the clergy of your religious preference.
Individuals Involved in Your Care or Payment for Your Care: We may release medical information to the persons you placed on your notification list who are involved in your care. These names may include friends or family members who are involved in your medical care or who helps pay for your care. When allowed, we may also tell your family or friends your condition. In addition, in certain circumstances we may disclose minimally necessary medical 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.
Research: Parker Jewish Institute for Health Care and Rehabilitation maintains a research program. Your medical information may be important and necessary to further research efforts, and the development of new medical and treatment knowledge. Occasionally, our researchers may contact you about your interest in participating in certain research studies. For those studies, we will obtain your written authorization. In limited circumstances, we may use or disclose your medical information for certain research purposes, without your authorization. All research projects conducted by the Institute, without your authorization, will be approved through a special review process to protect the safety, welfare and confidentiality of you and your medical information. Parker will comply with other applicable state/federal laws, including confidentiality provisions, when using and disclosing your information for research purposes. Our use and disclosure of your medical information for these research studies will not affect your treatment or welfare, and your medical information will continue to be protected.
As Required By Law: We may disclose medical information about you when required to do so by federal, state or local law.
To Avert a Serious Threat to Health or Safety: We may use and disclose minimally necessary medical 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.
Fundraising: We may use or in limited circumstances disclose certain information about you and the services you received, such as demographic information (including name and mailing address etc.) and the dates that you received treatment at Parker, as necessary, to contact you or your family for fundraising activities benefiting the Institute. If you or your family do not wish to receive these materials, you may opt out of receiving future fundraising communications as instructed on each correspondence. We will not condition treatment or payment on your agreeing to receive such communications.
Organ and Tissue Donation: If you are a member of the armed forces, we may release minimally necessary information about you as required by military command authorities. We may also release medical information about you to a foreign military authority, if you are a member of a foreign military authority.
Workers’ Compensation: We may release minimally necessary medical information for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness. State and/or federal law control the release of such information.
Public Health Risks: We may disclose minimally necessary medical information about you for public health activities. These activities generally include the following:
Health Oversight Activities: We may disclose minimally necessary medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes:We may disclose medical information about you in response to a subpoena, discovery request, or other lawful process if a court orders us to do so. If the request for your records is not court-ordered, we may release your records only after we determine if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Law Enforcement:We may release minimally necessary medical information about you if asked to do so by a law enforcement official:
Medical Examiners and Funeral Directors: We may also release minimally necessary medical information about you to a medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release minimally necessary medical information about patient/residents to funeral directors as necessary to carry out their duties.
National Security and Intelligence Activities: We may release minimally necessary medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Abuse, Neglect, or Domestic Violence: We may use or disclose your medical information to certain government authorities authorized by law to receive such information in cases of abuse, neglect, or domestic violence, if you agree or when required or authorized by law.
Business Associates: We may disclose your medical information to our vendors, known as “business associates,” as part of a contracted agreement to perform services for Parker. Our business associates are required, under contract with us and by law, to protect the privacy of your medical information and are not allowed to use or disclose any information other than as specified in our contract and as permitted by federal law.
Other than the purposes described above, we will only use or disclose your medical information if you authorize us in writing. This includes, except as allowed by federal privacy law, (1) using and disclosing your psychotherapy notes, (2) marketing products and services to you by using or disclosing your medical information, and (3) selling you medical information.
If you give us your written permission to use or disclose your medical information, you make revoke that permission (in writing) at any time. You may revoke your authorization by contacting Parker’s Privacy Officer at (718)289-2107 and or in writing c/o Parker Jewish Institute for Health Care Rehabilitation, 271-11 76th Avenue, New Hyde Park, NY 11040-1433. If you revoke your authorization we will no longer use or disclose information about you for the reasons covered by your written authorization, but we cannot take back any uses or disclosures already made with your permission.
You have the following rights regarding medical information we maintain about you:
Inspect and Obtain a Copy: You have the right to inspect and to obtain a copy of medical information that may be used to make decisions about your care. This includes medical and billing records, but does not include psychotherapy notes. If we maintain a copy of your medical information electronically, you also have the right to obtain an electronic copy of this information in the form and format requested, if available. To inspect and/or to obtain a copy of medical information that may be used to make decisions about you, you must complete Parker’s HIPAA Form ADM.001- “Authorization to Release Health Information” or OCA Official form 960 “HIPAA Complaint Authorization for the Release of Health Information Pursuant to HIPAA” and submit your written request to the Medical Records Department. In addition, you may also request that we send a copy of your medical information to a third party you identify. We may deny your request to inspect or copy your medial information in limited circumstances. If you wish to obtain a copy of your medical records or have a copy provided to a third party, Parker may charge a reasonable fee.
Amend Your Medical Information: If you feel that any of the medical information that we use to make decisions 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 maintained by our facility. To request an amendment, your request must be made in writing and submitted to the Medical Records Department at Parker Jewish Institute for Health Care and Rehabilitation,
271-11 76th Avenue, New Hyde Park, NY 11040-1433. 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:
Accounting of Disclosures: You have the right to request an “accounting of disclosures.” This is a list of the disclosures we have made of your medical information. We are not required to account for certain disclosures, including disclosures to you or disclosures you have authorized. To request this accounting of disclosures, you must submit your request in writing, to the Medical Records Department c/o Parker Jewish Institute for Health Care and Rehabilitation 271-11 76th Avenue New Hyde Park, NY 11040-1433. Your request must state a time period, which may not be longer than six years prior to the date that you are requesting the accounting. The first accounting you request within a twelve-month period will be free of charge. For additional accountings, we may charge you for the reasonable 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.
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. To request confidential communications, you must make your request in writing to the Medical Records 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.
Request Restrictions: Even though it is Parker’s policy to make only minimally necessary disclosures of your medical information, you have the right to request a restriction or limitation on information we use or disclose for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose to family members or friends someone who are involved in your care or for the payment of your bill. Parker Jewish Institute for Health Care and Rehabilitation is not required to agree to your request, except if the request involves certain disclosures of your medical information to health plans as described below. However, we will try to accommodate all reasonable requests. If we do agree, we will comply with your request unless the information is needed to provide emergency treatment to you.
You also have the right to request that we not make certain disclosures of your medical information to a health plan, provided the information relates to health care items or services for which you have paid out-of-pocket in full. We are required to agree to all such requests.
You may obtain a “Request for Restriction” form by the contacting Parker’s Privacy Officer at 718-289-2107, asking the Social Work Staff or in writing to either c/o Parker Jewish Institute for Health Care and Rehabilitation 271-11 76th Avenue, New Hyde Park, NY 11040-1433.
Other federal privacy laws may apply and limit our ability to use and disclose your medical information beyond what we are allowed to do under HIPAA. New York state laws may also limit our rights to use and disclose your medical information beyond what we are allowed to do under HIPAA. Below is a list of the categories of medical information that are subject to these more restrictive laws and a summary of those laws. These laws have been taken into consideration in developing our policies of how we will use and disclose your health information.
Receive a Copy of This Notice: You have the right to a paper copy of this notice, even if you agreed to receive this notice electronically. You may ask us to give you a copy of this notice at any time. To request a copy of this notice, you may make your request in writing to Parker’s Privacy Officer c/o Parker Jewish Institute for Health Care and Rehabilitation 271-11 76th Avenue, New Hyde Park, NY 11040-1433 or by visiting Parker’s Admissions Office.
Effective Date: 4/12/03
Revised: 5/2013, 8/2013
271-11 76th Avenue, New Hyde Park, New York 11040-1433 | Tel: 877-727-5373 • 718-289-2100 • 516-247-6500 | Fax: 718-289-2245