Privacy Notice Regarding Use
and Disclosure of Medical Records
THIS
PRIVACY NOTICE DESCRIBES HOW YOUR MEDICAL INORMATION
MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS
TO THIS MEDICAL INFORMATION. PLEASE REVIEW THIS
NOTICE CAREFULLY BEORE SIGNING ANY DOCUMENTS
1. Purpose of this Notice:
In general, any information that concerns your health, treatment, or payment for treatment, is considered confidential and is protected as confidential by Evangelical Services for the Aging, a non-profit Pennsylvania corporation, and its retirement communities, Wesley Enhanced Living Upper Moreland, Wesley Enhanced Living Doylestown, Wesley Enhanced Living Burholme and Wesley Enhanced Living Pennypack Park, collectively referred to as "WESLEY." This Privacy Notice describes WESLEY'S Privacy Practices, specifically - the uses and disclosures WESLEY may make of your medical information and what rights you have with respect to your medical information. Medical information includes, but is not limited to, your name; address; other personal identifying data; health status; and record of treatment that has been, are being, and will be provided to you in the future. WESLEY requires that all programs, employees, staff, and any party in a working or business relationship with WESLEY comply with WESLEY'S Privacy Practices.
2. Use and Disclosure of Medical Information for Treatment, Payment, and Health Care Operations:
Federal Law permits WESLEY to use and disclose your personal medical information for the purpose of treatment, payment, and health care operations without further authorization from you:
Treatment means the provision, coordination, or management of health care related and therapeutic services provided completely or in part by WESLEY. WESLEY can share your medical information and records with another provider involved in your health care for the benefit of your coordinated care. Also, WESLEY may contact you by phone or other means to remind you about an appointment or address a specific aspect of your care.
Please note that relevant laws prohibit certain medical information, such as psychotherapy notes, from being shared without your knowledge. WESLEY must obtain a written Authorization from you before all or part of that medical information can be used or released. At the time the medical information is being requested, you will be provided with a written Authorization explaining the specific medical information requested and the purpose of the request for the specific medical information. Your signature on the Authorization will provide the consent necessary for the use or release of this information.
Payment refers to reimbursement to WESLEY by your healthcare insurer for services that have been provided to you. In order to process payment, your healthcare insurer may require that WESLEY provide medical information to confirm your eligibility for services provided, to coordinate benefits with other payers who may be responsible for reimbursement for the services, and as part of the payers claims management procedures which covers billings, collections, appeals, medical necessity review activities, utilization review activities, or for disclosure to consumer reporting agencies. For instance, WESLEY can disclose the information required by your insurer's plan to determine whether the services provided to you by WESLEY were medically necessary.
Health Care Operations cover a range of internal operations performed by WESLEY or its Business Associates to manage information, data, and services on behalf of WESLEY and the individuals we serve. These operations include, but are not limited to, quality assessment and improvement activities including research; peer review; credentialing and licensing; training programs; legal and financial services; business planning and development; implementing and monitoring WESLEY'S compliance and privacy practices; customer services; internal grievances; creating de-identified or re-identified information for data aggregation and other purposes including research, fundraising, marketing and due diligence activities. Examples of such operations are evaluation of the performance of therapists to ensure that they meet WESLEY'S quality standards and engaging legal counsel or accountants to represent WESLEY'S interests when required.
3. The Use and Disclosure of Medical Information when your Consent or Authorization are Not Required:
Under the following additional circumstances, WESLEY is permitted by law to use or disclose your medical information without further authorization from you:
Appointment Reminders. Unless you object, WESLEY may use and disclose medical information to contact you as a reminder that you have an appointment for medical care at WESLEY'S facility.
Facility Directory. Unless you object, WESLEY may include certain limited information about you in the WESLEY directory while you are a patient at WESLEY. This information may include your name, location where you are receiving care, condition (in general terms) and your religious affiliation. This directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy even if they don't ask for you by name.
Individuals Involved in Your Care or Payment for Your Care. Unless you object, WESLEY may release related medical information about you to a friend or family member involved in your medical care or any other person you identify. WESLEY may also give information to someone who helps pay for your care. WESLEY may also tell your family or friends your condition and that you are in the facility. In addition, WESLEY may disclose 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.
Health-Related Benefits and Services. Unless you object. WESLEY may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
Research. Under certain circumstances, WESLEY may use and disclose medical information about you for research purposes. All research projects are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with patients' need for privacy of their medical information. Before WESLEY uses or discloses medical information for research, the project will have been approved through this research approval process by an institutional review board.
As Required By Law. WESLEY will 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. WESLEY may use or disclose medical information about you when necessary to prevent a serious threat to the health and safety of yourself, another person or the public. Any disclosure, however, would only be to someone able to help prevent the threat.
Military and Veterans. If you are a member of the armed forces, WESLEY may release medical information about you as required by military command authorities.
Workers' Compensation. WESLEY may release medical information about you for workers' compensation or similar programs that provide benefits for work-related injuries or illness.
Public Health Risks. WESLEY may disclose medical information about you for public health activities. These activities generally include the following:
Health Oversight Activities. WESLEY may disclose medical information to health oversight agencies for activities authorized by law such as audits, investigations and inspections. These agencies monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes. WESLEY may disclose medical information about you in response to a court or administrative order or other process under certain circumstances.
Law Enforcement. WESLEY may release medical information if asked to do so by a law enforcement official:
Coroners, Medical Examiners, Funeral Directors, and Organ/Tissue Donation
WESLEY may release medical information to a coroner or medical examiner, for example, to identify a deceased person or determine the cause of death. WESLEY may also release medical information about patients of WESLEY to funeral directors, as authorized by law, where necessary to carry out their duties. If you are an organ donor, WESLEY may release medical information to entities that handle organ or tissue procurement or transplantation.
National Security and Intelligence Activities. WESLEY may also disclose your medical information to authorized federal officials conducting national security, intelligence and counterintelligence activities. WESLEY may disclose medical information about you to authorized federal officials so they may provide protection to the President or other authorized persons or conduct special investigations.
Inmates. If you are an inmate of a correctional institution or under the custody of law enforcement, WESLEY may release medical information about you to the correctional institution or law enforcement official.
4. Authorization for Other Uses and Disclosures of Medical Information:
WESLEY is prohibited, by law, from using or disclosing your medical information without written Authorization for any purpose other than those purposes listed above.
An Authorization serves as a written permission that specifically identifies the information being sought for use or disclosure and clearly states the purpose for which the use or disclosure is being requested. Further, you may revoke your Authorization at any time except: (1) to the extent that the medical information has been used or disclosed in reliance on your Authorization or (2) your Authorization was obtained as a condition of obtaining insurance coverage.
Please note that WESLEY cannot guarantee that once your medical information has been released to the third party named in an Authorization, that the third party will abide by the rules stated in WESLEY'S Privacy Notice.
5. Individual Rights with respect to Medical Information:
An individual of appropriate age and legal capacity, who understands the nature of the medical information and the purpose for which medical information may be used or disclosed, shall control access to his or her personal medical information.
Please address any written requests for restrictions to: Ken Franiak, Chief Financial Officer, Wesley Enhanced Living, Southampton Office Park, 928 Jaymor Road, Suite B-150, Southampton, PA 18966.
Such request for confidential communication must be made in writing. WESLEY will attempt to accommodate such requests. Please address any requests for confidential communications to: Ken Franiak, Chief Financial Officer, Wesley Enhanced Living, Southampton Office Park, 928 Jaymor Road, Suite B-150, Southampton, PA 18966.
Please direct any requests for amendments and appeals in writing to: Ken Franiak, Chief Financial Officer, Wesley Enhanced Living, Southampton Office Park, 928 Jaymor Road, Suite B-150, Southampton, PA 18966.
Accounting of any and all disclosures made of your medical information for the six (6) years prior to the date of your request shall be available to you within sixty (60) days of the date of your written request. These disclosures do not include those made for certain treatment, payment or operational purposes. The right to an accounting is subject to the effective date of regulatory laws and statutes.
Please direct requests for accountings in writing to: Donna Wood, Executive Vice President, Wesley Enhanced Living, Southampton Office Park, 928 Jaymor Road, Suite B-150, Southampton, PA 18966.
Complaints alleging inappropriate use or disclosure of your medical information by WESLEY employees or agents may be directed to the WESLEY Privacy Officer or to the Secretary of the federal Department of Health and Human Services. Under no circumstances shall WESLEY retaliate against you for filing a complaint.
If you wish to file a complaint, please contact us and obtain an appropriate complaint form and where to file the complaint form.
6. Rights Under State Law.
Depending on the type of treatment you are receiving and the nature of the information requested, state law may require that WESLEY provide greater privacy protection to your medical information or provide you with a greater right of access to the information.
WESLEY has the non-delegable duty to maintain the privacy of your medical information and to provide you with Notice of its legal obligations and Privacy Practices with respect to your medical information. WESLEY must date and comply with the Privacy Notice currently in effect. WESLEY reserves the right to amend and/or update its Privacy Notice from time to time upon change of practices or revision of laws. If its Privacy Notice is revised, copies of the revised and dated Privacy Notice shall be posted in the WESLEY service areas or be made available by contacting us . WESLEY hereby reserves the right to implement the changes prior to issuing the revised Privacy Notice.
1. Purpose of this Notice:
In general, any information that concerns your health, treatment, or payment for treatment, is considered confidential and is protected as confidential by Evangelical Services for the Aging, a non-profit Pennsylvania corporation, and its retirement communities, Wesley Enhanced Living Upper Moreland, Wesley Enhanced Living Doylestown, Wesley Enhanced Living Burholme and Wesley Enhanced Living Pennypack Park, collectively referred to as "WESLEY." This Privacy Notice describes WESLEY'S Privacy Practices, specifically - the uses and disclosures WESLEY may make of your medical information and what rights you have with respect to your medical information. Medical information includes, but is not limited to, your name; address; other personal identifying data; health status; and record of treatment that has been, are being, and will be provided to you in the future. WESLEY requires that all programs, employees, staff, and any party in a working or business relationship with WESLEY comply with WESLEY'S Privacy Practices.
2. Use and Disclosure of Medical Information for Treatment, Payment, and Health Care Operations:
Federal Law permits WESLEY to use and disclose your personal medical information for the purpose of treatment, payment, and health care operations without further authorization from you:
Treatment means the provision, coordination, or management of health care related and therapeutic services provided completely or in part by WESLEY. WESLEY can share your medical information and records with another provider involved in your health care for the benefit of your coordinated care. Also, WESLEY may contact you by phone or other means to remind you about an appointment or address a specific aspect of your care.
Please note that relevant laws prohibit certain medical information, such as psychotherapy notes, from being shared without your knowledge. WESLEY must obtain a written Authorization from you before all or part of that medical information can be used or released. At the time the medical information is being requested, you will be provided with a written Authorization explaining the specific medical information requested and the purpose of the request for the specific medical information. Your signature on the Authorization will provide the consent necessary for the use or release of this information.
Payment refers to reimbursement to WESLEY by your healthcare insurer for services that have been provided to you. In order to process payment, your healthcare insurer may require that WESLEY provide medical information to confirm your eligibility for services provided, to coordinate benefits with other payers who may be responsible for reimbursement for the services, and as part of the payers claims management procedures which covers billings, collections, appeals, medical necessity review activities, utilization review activities, or for disclosure to consumer reporting agencies. For instance, WESLEY can disclose the information required by your insurer's plan to determine whether the services provided to you by WESLEY were medically necessary.
Health Care Operations cover a range of internal operations performed by WESLEY or its Business Associates to manage information, data, and services on behalf of WESLEY and the individuals we serve. These operations include, but are not limited to, quality assessment and improvement activities including research; peer review; credentialing and licensing; training programs; legal and financial services; business planning and development; implementing and monitoring WESLEY'S compliance and privacy practices; customer services; internal grievances; creating de-identified or re-identified information for data aggregation and other purposes including research, fundraising, marketing and due diligence activities. Examples of such operations are evaluation of the performance of therapists to ensure that they meet WESLEY'S quality standards and engaging legal counsel or accountants to represent WESLEY'S interests when required.
3. The Use and Disclosure of Medical Information when your Consent or Authorization are Not Required:
Under the following additional circumstances, WESLEY is permitted by law to use or disclose your medical information without further authorization from you:
Appointment Reminders. Unless you object, WESLEY may use and disclose medical information to contact you as a reminder that you have an appointment for medical care at WESLEY'S facility.
Facility Directory. Unless you object, WESLEY may include certain limited information about you in the WESLEY directory while you are a patient at WESLEY. This information may include your name, location where you are receiving care, condition (in general terms) and your religious affiliation. This directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy even if they don't ask for you by name.
Individuals Involved in Your Care or Payment for Your Care. Unless you object, WESLEY may release related medical information about you to a friend or family member involved in your medical care or any other person you identify. WESLEY may also give information to someone who helps pay for your care. WESLEY may also tell your family or friends your condition and that you are in the facility. In addition, WESLEY may disclose 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.
Health-Related Benefits and Services. Unless you object. WESLEY may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
Research. Under certain circumstances, WESLEY may use and disclose medical information about you for research purposes. All research projects are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with patients' need for privacy of their medical information. Before WESLEY uses or discloses medical information for research, the project will have been approved through this research approval process by an institutional review board.
As Required By Law. WESLEY will 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. WESLEY may use or disclose medical information about you when necessary to prevent a serious threat to the health and safety of yourself, another person or the public. Any disclosure, however, would only be to someone able to help prevent the threat.
Military and Veterans. If you are a member of the armed forces, WESLEY may release medical information about you as required by military command authorities.
Workers' Compensation. WESLEY may release medical information about you for workers' compensation or similar programs that provide benefits for work-related injuries or illness.
Public Health Risks. WESLEY may disclose medical information about you for public health activities. These activities generally include the following:
- to prevent or control disease, injury or disability;
- to report births and deaths;
- to report child abuse or neglect;
- to report reaction to medications or other problems with products related to healthcare;
- to provide notifications that products have been recalled;
- to notify a person who may be at risk of contracting or spreading a disease or condition;
- to notify the appropriate government authority if WESLEY believes a patient has been the victim of abuse, neglect or domestic violence where required by law.
Health Oversight Activities. WESLEY may disclose medical information to health oversight agencies for activities authorized by law such as audits, investigations and inspections. These agencies monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes. WESLEY may disclose medical information about you in response to a court or administrative order or other process under certain circumstances.
Law Enforcement. WESLEY may release medical information if asked to do so by a law enforcement official:
- In response to a court order, warrant, summons or similar legal process;
- To locate or identify a suspect, fugitive, material witness, or missing person;
- About the victim of a crime under certain limited circumstances;
- About a death believed to be the result of criminal conduct;
- About criminal conduct on the premises of WESLEY; and
- In emergency circumstances to report a crime
Coroners, Medical Examiners, Funeral Directors, and Organ/Tissue Donation
WESLEY may release medical information to a coroner or medical examiner, for example, to identify a deceased person or determine the cause of death. WESLEY may also release medical information about patients of WESLEY to funeral directors, as authorized by law, where necessary to carry out their duties. If you are an organ donor, WESLEY may release medical information to entities that handle organ or tissue procurement or transplantation.
National Security and Intelligence Activities. WESLEY may also disclose your medical information to authorized federal officials conducting national security, intelligence and counterintelligence activities. WESLEY may disclose medical information about you to authorized federal officials so they may provide protection to the President or other authorized persons or conduct special investigations.
Inmates. If you are an inmate of a correctional institution or under the custody of law enforcement, WESLEY may release medical information about you to the correctional institution or law enforcement official.
4. Authorization for Other Uses and Disclosures of Medical Information:
WESLEY is prohibited, by law, from using or disclosing your medical information without written Authorization for any purpose other than those purposes listed above.
An Authorization serves as a written permission that specifically identifies the information being sought for use or disclosure and clearly states the purpose for which the use or disclosure is being requested. Further, you may revoke your Authorization at any time except: (1) to the extent that the medical information has been used or disclosed in reliance on your Authorization or (2) your Authorization was obtained as a condition of obtaining insurance coverage.
Please note that WESLEY cannot guarantee that once your medical information has been released to the third party named in an Authorization, that the third party will abide by the rules stated in WESLEY'S Privacy Notice.
5. Individual Rights with respect to Medical Information:
An individual of appropriate age and legal capacity, who understands the nature of the medical information and the purpose for which medical information may be used or disclosed, shall control access to his or her personal medical information.
- Access refers to physical examination of medical information, but does not include physical possession of the information. You do have the right to request a copy of the relevant information. The medical information to which you may have access usually includes medical and billing records, but not psychotherapy notes if, upon documentation by the medical team leader, it is determined that granting such access will constitute a substantial detriment to the medical process. Access may be denied in certain circumstances, such as for the protection of another individual's confidentiality, to safeguard information under the Privacy Act, or in other circumstances set forth by the Privacy Rule. Any review of the denial of access would be performed by a licensed health care professional designated by WESLEY who did not participate in the denial of your request.
- Restrictions. You may request restrictions on the use and disclosure of your medical information for treatment, payment and operational purposes. WESLEY shall be bound by all reasonable and appropriate requests for such restriction to which it agrees in writing, except in emergency circumstances or if you are being transferred to another health care institution. WESLEY reserves the right to request the withdrawal of certain restrictions at any time during treatment. However, WESLEY is not bound to accept your requested restrictions if it does not believe that it reasonably can or should comply with the requested restrictions. WESLEY reserves the right to exercise such discretion and give a written refusal in response to your request for restrictions.
Please address any written requests for restrictions to: Ken Franiak, Chief Financial Officer, Wesley Enhanced Living, Southampton Office Park, 928 Jaymor Road, Suite B-150, Southampton, PA 18966.
- Confidential Communications. You may request that WESLEY communicate with your about medical matters in a certain way or at a certain location. For example, you may request that all communication be directed to your home and not to you at work. Also, as a part of WESLEY'S quality improvement practices, WESLEY may call to remind you about an appointment or follow up by phone after services have been provided to confirm the service and the quality of the service provided. On such phone calls, WESLEY may appear on your "Caller ID" service. You may request that WESLEY call you on a phone which will not identify WESLEY on your "Caller ID."
Such request for confidential communication must be made in writing. WESLEY will attempt to accommodate such requests. Please address any requests for confidential communications to: Ken Franiak, Chief Financial Officer, Wesley Enhanced Living, Southampton Office Park, 928 Jaymor Road, Suite B-150, Southampton, PA 18966.
- Amendments. You may request amendments to your documented medical information in writing. Amendments agreed to by WESLEY shall be documented within sixty (60) days of your written request. However, WESLEY reserves the right to deny requests for amendments when WESLEY finds that: (1) the existing documented medical information is accurate; (2) WESLEY is not the author of the medical information requested to be amended; or (3) the request to amend changes or alters the accuracy of the medical information. You may appeal any denial of your request for amendments within thirty (30) days of receipt of WESLEY'S denial of your requested amendment. All appeals must be made in writing.
Please direct any requests for amendments and appeals in writing to: Ken Franiak, Chief Financial Officer, Wesley Enhanced Living, Southampton Office Park, 928 Jaymor Road, Suite B-150, Southampton, PA 18966.
Accounting of any and all disclosures made of your medical information for the six (6) years prior to the date of your request shall be available to you within sixty (60) days of the date of your written request. These disclosures do not include those made for certain treatment, payment or operational purposes. The right to an accounting is subject to the effective date of regulatory laws and statutes.
Please direct requests for accountings in writing to: Donna Wood, Executive Vice President, Wesley Enhanced Living, Southampton Office Park, 928 Jaymor Road, Suite B-150, Southampton, PA 18966.
Complaints alleging inappropriate use or disclosure of your medical information by WESLEY employees or agents may be directed to the WESLEY Privacy Officer or to the Secretary of the federal Department of Health and Human Services. Under no circumstances shall WESLEY retaliate against you for filing a complaint.
If you wish to file a complaint, please contact us and obtain an appropriate complaint form and where to file the complaint form.
6. Rights Under State Law.
Depending on the type of treatment you are receiving and the nature of the information requested, state law may require that WESLEY provide greater privacy protection to your medical information or provide you with a greater right of access to the information.
WESLEY has the non-delegable duty to maintain the privacy of your medical information and to provide you with Notice of its legal obligations and Privacy Practices with respect to your medical information. WESLEY must date and comply with the Privacy Notice currently in effect. WESLEY reserves the right to amend and/or update its Privacy Notice from time to time upon change of practices or revision of laws. If its Privacy Notice is revised, copies of the revised and dated Privacy Notice shall be posted in the WESLEY service areas or be made available by contacting us . WESLEY hereby reserves the right to implement the changes prior to issuing the revised Privacy Notice.
Wesley Enhanced Living Privacy Policy: Dated February 26, 2010
