PO Box A - 610 224th Rd

Milford, NE 68405

Phone: 402-761-3230

info@sunrisecountrymanor.com

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Notice of Privacy Practices

Each time you are admitted to our facility, a record of your stay is made containing health and financial information. Typically, this record contains information about your condition, the treatment we provide and payment for the treatment. This notice describes how this information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Your Rights

You have the right to:

  • Get a copy of your paper or electronic medical record

  • Correct your paper or electronic medical record

  • Request confidential communication

  • Ask us to limit the information we share

  • Get a list of those with whom we’ve shared your information

  • Get a copy of this privacy notice

  • Choose someone to act for you

  • File a complaint if you believe your privacy rights have been violated

 

Your Choices

You have some choices in the way that we use and share information as we:

  • Tell family and friends about your condition

  • Provide disaster relief

  • Include you in a hospital directory

  • Provide mental health care

  • Market our services and sell your information

  • Raise funds

 

Our Uses and Disclosures

We may use and share your information as we:

  • Treat you

  • Run our organization

  • Bill for your services

  • Help with public health and safety issues

  • Do research

  • Comply with the law

  • Respond to organ and tissue donation requests

  • Work with a medical examiner or funeral director

  • Address workers’ compensation, law enforcement, and other government requests

  • Respond to lawsuits and legal actions

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record

  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.

  • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct your medical record

  • You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.

  • We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

  • You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.

  • We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

  • You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.

  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information

  • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.

  • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

  • You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

  • If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.

  • We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

  • You can complain if you feel we have violated your rights by contacting us using the information on page 5.

  • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.

  • We will not retaliate against you for filing a complaint.

 

 

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in your care

  • Share information in a disaster relief situation

  • Include your information in a facility directory

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

 

In these cases we never share your information unless you give us written permission:

  • Marketing purposes

  • Sale of your information

  • Most sharing of psychotherapy notes

 

In the case of fundraising:

  • We may contact you for fundraising efforts, but you can tell us not to contact you again.

 

Our Uses and Disclosures

How do we typically use or share your health information?

We typically use or share your health information in the following ways.

 

Treat you

We can use your health information and share it with other professionals who are treating you. We may disclose health information about you to doctors, nurses, therapists or other facility personnel who are involved in taking care of you at a facility. . Different departments of a facility also may share health information about you in order to coordinate your care and provide you medication, lab work and x-rays.  We may also disclose health information about you to people outside the facility who may be involved in your medical care after you leave a facility. This may include family members or visiting nurses to provide care in your home.

Example: A doctor treating you for an injury asks another doctor about your overall health condition.

 

Run our organization

We can use and share your health information to run our facility, improve your care, and contact you when necessary. We may also combine health information about many residents to help determine what additional services we should offer, what services should be discontinued, and whether certain new treatments are effective.  Health information about you may be used for business development and planning, cost management analyses, insurance claims management, risk management activities, and in developing and testing information systems and programs.  We may also use and disclose information for professional review, performance evaluation, and for training programs.  Other aspects of health care operations that may require use and disclosure of your health information include accreditation, certification, licensing and credentialing activities, review and auditing, including compliance reviews, medical reviews, legal services and compliance programs.  Your health information may be used and disclosed for the business management and general activities of the facility including resolution of internal grievances, customer service and due diligence in connection with a sale or transfer of the facility.  In limited circumstances, we may disclose your health information to another entity subject to HIPAA for its own health care operations. We may remove information that identifies you so that the health information may be used to study health care and health care delivery without learning the identities of residents. 

Example: We use health information about you to manage your treatment and services.

 

Bill for your services

We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan so it will pay for your services.

 

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health and safety issues

We can share health information about you for certain situations such as:

  • Preventing disease

  • Helping with product recalls

  • Reporting adverse reactions to medications

  • Reporting suspected abuse, neglect, or domestic violence

  • Preventing or reducing a serious threat to anyone’s health or safety

Do research

  • We can use or share your information for health research.

Comply with the law

  • We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

  • We may disclose health information to a health oversight agency for activities authorized by law.  These oversight activities may include 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.

Respond to organ and tissue donation requests

  • We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director

  • We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests

We can use or share health information about you:

  • For workers’ compensation claims

  • For law enforcement purposes or with a law enforcement official

  • With health oversight agencies for activities authorized by law

  • For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions

  • We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Facility Directory

  • Unless you notify us that you object, we may include information about you in the facility directory while you are a resident.  This information may include your name and location in the facility. The directory information may be disclosed to people who ask for you by name.  Your religion may be given to a member of the clergy, such as a priest or rabbi. This is so your family, friends and clergy can visit you in the facility and generally know how you are doing. 

Special Recognition

  • Unless you notify us that you object, we may disclose your age, birth date, photograph and general information about you in the facility newsletter, on activities calendars, birthday or other special recognition bulletin boards within the facility.

Individuals Involved in Your Care or Payment for Your Care

  • Unless you object, we may disclose health information about you to a friend or family member who is involved in your care.  We may also give information to someone who helps pay for your care.  In addition, we may disclose 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.

Business Associates

  • There are some services provided in our facility through contracts with business associates. Examples include medical directors, outside attorneys. When these services are contracted, we may disclose your health information so that they can perform the job we’ve asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

Providers

  • Many services provided to you, as part of your care at our facility, are offered by participants in one of our organized healthcare arrangements.  These participants include a variety of providers such as physicians (e.g., MD, DO, Podiatrist, Dentist, Optometrist), therapists (e.g., Physical therapist, Occupational therapist, Speech therapist), portable radiology units, clinical labs, hospice caregivers, pharmacies, psychologists, social workers, and suppliers (e.g., prosthetic, orthotics). 

 

Our Responsibilities
  • We are required by law to maintain the privacy and security of your protected health information.

  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.

  • We must follow the duties and privacy practices described in this notice and give you a copy of it.

  • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

 

 

Changes to the Terms of this Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website (www.sunrisecountrymanor.com).

 

Sunrise Country Manor Privacy Contact

For questions regarding this notice, please contact the facility administrator:

Seth Stauffer – s.stauffer@sunrisecountrymanor.com | Phone: (402) 761-3230

​Address: Attn: Privacy Officer, Sunrise Country Manor, PO Box A, Milford, NE 68405