This Notice of Privacy Practices describes how we may use and disclose your protect health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
We are required to abide by the terms of this Notice of Privacy Practices. We may change the terms of our notice at any time. The new notice will be effective for all protected health information that we maintain at that time. Upon your request, we will provide you with any revised Notice of Privacy Practices or you may obtain a copy by accessing our website at www.NLH.org, by calling and requesting that a revised copy be sent to you in the mail, or asking for one at the time you next receive services.This notice describes Nathan Littauer Hospital & Nursing Home’s (NLH & NH) practices and that of:

• Any health care professional providing services to you in NLH & NH’s facilities, regardless of whether specific services are provided by NLH & NH’s employees, students or by independent members of the Medical Staff.
• All departments and units of NLH & NH.
• Any member of a volunteer group we allow to help you while you are in NLH & NH.
• All other employees andstaff.
• The entities and individuals participating in the organized health care arrangement will share protected health information with each other, as necessary to carry out treatment, payment, or health care operations within NLH & NH.

1. USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION

Uses and Disclosures of Protected Health Information for Treatment, Payment, and/or Operations (TPO)

This document serves as notification of how NLH & NH will utilize your protected health information to support treatment, payment and health care operations. Your protected health information may be used by and disclosed to your physician, NLH & NH, and others outside of our organization that are involved in your care and treatment for the purpose of providing health care services to you. Your protected health information may also be used and disclosed to pay for your health care bills and to support the operations of NLH & NH.

The following examples highlight the types of uses and disclosures of your protected health care information that NLH & NH is permitted to make. These examples are not meant to be exhaustive; on the contrary, they are provided as educational information that underscores the various types of disclosures that may be made by NLH & NH.

• Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the scheduling, coordination, or management of your health care with a third party or multi-disciplinary evaluation teams of NLH & NH employees and non-employees. For example, we would disclose your protected health information, as necessary, to a nursing home, home health agency or adult home that provides care, equipment, or services to you. We will also disclose protected health information, including by electronic transmission, to other physicians who may be treating or diagnosing you. For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you. We may disclose your protected health information from time-to-time to another physician or health care provider (e.g., a specialist, laboratory, or hospital) who, at the request of your physician, becomes involved in your care by providing assistance with your health care diagnosis or treatment. In addition, we may disclose your protected health information, such as test results, to your primary care physician of record. We will disclose protected health information to suppliers of certain medical devices, such as pacemakers and prosthetic devices, to allow them to inform you in case of recalls.
• Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services we have recommended for you; such as making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to the health plan to obtain approval for the hospital admission. We may provide protected health information to the billing services of providers who have rendered services at NLH & NH so that they may bill for services on your behalf.
• Healthcare Operations: We may use or disclose, as needed, your protected health information in order to support the operational activities of NLH & NH. These activities include, but are not limited to, quality assessment activities, employee review activities, satisfaction surveys, training of medical students, licensing, marketing, and fundraising activities, and conducting or arranging for other business activities.
• For example, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician. We may also call you by name in the waiting room when your physician or technician is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.
• We will share your protected health information with third party “business associates” that perform various activities (e.g., data processing, billing, transcription services, physician professional billing services, record storage, data warehousing activities) for NLH & NH. Whenever an arrangement between NLH & NH and a business associate involves the use or disclosure of your protected health information, we will have a written contract that contains terms that will protect the privacy of your protected health information.
• We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. For example, your name and address may be used to send you a newsletter about our organization and the services we offer. We may also send you information about products or services that we believe may be beneficial to you.

Uses and Disclosures of Protected Health Information Based upon Your Written Authorization

Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization, at any time, in writing, except to the extent that the hospital has taken an action in reliance on the use or disclosure indicated in the authorization.

Other Permitted and Required Uses and Disclosures That May Be Made With Your Consent, Authorization or Opportunity to Object

You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. If you are not present or able to agree or object to the use or disclosure of the protected health information, then your physician may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the protected health information that is relevant to your health care will be disclosed. We may use and disclose your protected health information in the following instances:

• Facility Directories: Unless you object in writing, we will use and disclose in our facility directory your name, the location at which you are receiving care, your condition (in general terms), and your religious affiliation. All of this information, except religious affiliation, will be disclosed to people that ask for you by name and members of the clergy will be told your religious affiliation. You may opt out of the facility directory by filling out an “Opt Out Notification Form”. If you opt out you might not receive any mail or flower deliveries and we will not verify your presence at NLH & NH to any caller or visitor.
• Others Involved in Your Healthcare: Unless you object in writing, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that related to that person’s involvement in your health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary, if we determine that it is in your best interest based on our professional judgment. We may use or disclose your protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family and other individuals involved in your health care.
• Fundraising Activities: We may use your protected health information, such as admission date, discharge date, and demographic information, to identify you for our ongoing philanthropic activities. Philanthropic activities may include mailings, phone calls, etc…that described NLH & NH’s giving opportunities. If we use your protected health information for fundraising activities, we will provide you the opportunity to opt out of receiving further fundraising communications based on using your protected health information.
• Emergencies: We may use or disclose your protected health information in an emergency treatment situation. If this happens, your physician shall try to obtain your authorization as soon as reasonably practicable after the delivery of treatment. If your emergency department physician is required by law to treat you and the physician has attempted to obtain your consent but is unable to obtain your consent, he or she may still use or disclose your protected health information to treat you.
• Communication Barriers: We may use or disclose your protected health information if your physician attempts to obtain consent form you but is unable to do so due to substantial communication barriers and the physician determines, using professional judgment, that you intend to authorize the use or disclosure under the specific circumstances.

Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object

We may use or disclose your protected health information in the following situations without your consent or authorization. These situations include:

• As Required By Law: We will disclose medical information about you when required to do so by federal, state or local law. In New York, this would include: child abuse, births, fetal death, birth defect, congenital abnormalities, immunizations, cancer reporting, communicable diseases, abuse of persons receiving care in nursing homes, Alzheimer’s disease, incident reports, SPARCS program, firearm injuries or certain puncture wounds, pesticide poisoning, coroner’s cases, certain burn injuries, death, Lyme disease, controlled substance prescription, and positive HIV tests.
• Public Health: We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your protected health information, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority.
• Communicable Diseases: We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
• Health Oversight: We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include accrediting bodies, government agencies that oversee the health care system, government benefit programs, other government regulatory programs and civil rights laws.
• Abuse or Neglect: We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.
• Food and Drug Administration: We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.
• Legal Proceedings: We may disclose protected health information in the course of any judicial or administrative proceeding, in response to a subpoena, order of the court or administrative tribunal (to the extent such disclosure is expressly authorized), and/or a search warrant.
• Law Enforcement: We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes (if authorized by law).
• Coroners, Funeral Directors, and Organ Donation: We may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health information to a funeral directors, as authorized by law, in order to permit the funeral director to carry out their duties. We may disclose such information in reasonable anticipation of death. Protected health information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.
• Research: We may disclose your protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.
• Criminal Activity: Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public; however, any disclosure would only be to someone that is believe to be able to help prevent the threat.
• Workers’ Compensation: Your protected health information may be disclosed by NLH & NH as authorized to comply with state workers’ compensation laws and other similar legally established programs.
• Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of CFR Section 164.500 et. seq.

2. YOUR RIGHTS

Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.

You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information. A “designated record set” contains medical and billing records and any other records that your physician and NLH & NH uses for making decisions about you. If you request a copy of your protected health information, you will be charge a fee for the cost of copying and mailing.

Under federal law, however, you may not inspect or copy the following records: psychotherapy notes, information compiles in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed. Please contact our Medical Records Department if you have questions about access to your medical record.

You have the right to request a restriction of your protected health information. This means you may ask us to restrict the use of your protected health information for the purposes o treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply. You may request a restriction by contacting NLH & NH’s Privacy Officer. NLH & NH is not obligated to agree to any restrictions that you request. Although NLH & NH has agreed to your restriction, your physician is not required to agree to a restriction that you may request. If your physician believes it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. If your physician does agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your physician.

You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Privacy Officer.

You may have the right to amend your protected health information. This means you may request an amendment of protected health information about you in a designated record set for as long as we maintain this information. In certain cases, we may deny our request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Medical Records Department if you have questions about amending your medical record.

You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. You have the right to request a listing of certain disclosures of your protected health information made by NLH & NH during the period of up to six (6) years prior to the date on which you make your request. Any accounting you request will not include (1) disclosures made to carry out treatment, payment or health care operations; (2) disclosures made to you; (3) disclosures made pursuant to an authorization given by you; (4) disclosures made to other people, including family members and friends, involved in your care or made for notification purposes, including facility directory and religious affiliation; (5) disclosures made for national security or intelligence purposes; (6) disclosures made to correctional institutions or law enforcement officials; or (7) disclosures made prior to April 14, 2003. The right to receive an accounting is subject to certain other exceptions, restrictions and limitation set forth in applicable statutes and regulations. You may be charged for repeated requests for an accounting. To request an accounting of the disclosures of your protected health information, please send a written request to the Medical Records Department.

You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.

3. COMPLAINTS

You may file a complaint with us or with the Secretary of Health and Human Services if you believe your privacy rights have been violated by NLH & NH. You may file a complaint with us by notifying our Complaint Officer of your complaint. WE WILL NOT RETALIATE AGAINST YOU FOR FILING A COMPLAINT.

You may contact our Complaint Officer at (518) 725-8621 or by e-mailing at complaintofficer@nlh.org for further information about the complaint process.

This notice was published and becomes effective April 14, 2003.

You may contact our Privacy Officer at (518) 725-8621 or by e-mailing at privacyofficer@nlh.org.

Nathan Littauer Hospital & Nursing Home
Attn: Privacy Officer
99 East State Street
Gloversville NY 12078

Nathan Littauer Hospital Nursing Home
Attn: Complaint Officer
99 East State Street
Gloversville NY 12078
04/2003
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