600 Farrell Drive
Covington, Ky 41011
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.
St. Charles Care Center, Inc. is required by law to maintain the privacy of protected health information and to provide you with a notice of our legal duties and privacy practices with regard to protected health information. Protected Health Information is any identifiable health information that relates to the past, present or future concerning your health condition or services. This document describes how we may use and disclose your protected 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 concerning protected health information and how you may exercise these rights.
We are required to abide by the terms of the notice that is currently in effect. We reserve the right to change the terms of this notice at any time and to make the new notice provisions effective for all protected health information that we maintain. When we make a material change in our policies, we will change our notice and post the new notice in our lobby. Upon your request, we will provide you with any revised Notice of Privacy Practices. You may pick-up a revised copy while on our campus, call us and request that a revised copy be sent to you in the mail or access our website at www.stcharlescommunity.org. 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.
Treatment: St. Charles Care Center, Inc. will, upon your consent, use your protected health information for treatment purposes to doctors, nurses, technicians, and other caregivers. For example, your health information may be used to coordinate your care with your physician, for consultation with a hospital, or for the referral for health care services by your physician to a third party.
Payment: We will use or disclose medical information about you so that the services we provide may be billed to you and payment may be collected from you, an insurance company, or a third party in accordance with the consent that you signed and provided to us. For example, we may disclose your health information to your insurance company for a determination of your eligibility or coverage of benefits.
Healthcare Operations: To provide you with quality care, we will, upon your consent, use your protected health information for conducting quality management and improvement activities, including outcome evaluations and development of protocols, in order to support our health care operations. For example, we may use your medical information in order for us to review our services and to evaluate our staff’s performance.
Public Health Activities: We may disclose protected health information for public health activities. Disclosures of this type are made for the purpose of controlling disease, injury or disability. Your protected health information may be disclosed to a person who may have been exposed to a communicable disease or may be at risk of contracting or spreading the disease or condition.
Victims of Abuse, Neglect or Domestic Violence: In circumstances of neglect or abuse against a resident or program member, we may disclose protected health information to the appropriate government agency authorized by law to receive such information. In these cases, the disclosure will be made consistent with requirements of the applicable federal and state laws.
Legal Proceedings: In the course of any judicial or administrative proceedings, we may disclose your protected health information in response to an order of a court, in response to a subpoena, a civil or investigative demand or other lawful process.
Law Enforcement/Coroners: For law enforcement purposes, we may disclose your protected health information as long as applicable legal requirements are met. For example, a disclosure would be made to law enforcement and/or a coroner for suspicion that death has occurred as a result of criminal conduct or in the event that a crime occurs on the premises.
Funeral Directors/Organ Donation: We may disclose protected health information, as authorized by law, in order to permit funeral directors to carry out their duties. If you are an organ donor, we may disclose protected health information to the organization handling the organ procurement.
Health Related Benefits/Services/Alternatives: In order to provide you with the best quality of care. We may notify you of information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Health Oversight Activities: As a community providing healthcare services, we are subject to audits, investigations and inspections by government agencies. We may disclose protected health information to a health oversight agency for activities authorized by law. Oversight agencies seeking this information oversee the health care system, civil rights laws and other government regulatory programs.
As Required by Law: St. Charles Care Center, Inc. will disclose protected health information as required by federal, state and local laws.
Others Involved in Your Healthcare: Upon admission to our community and/or services, you will be asked to agree or object to permit disclosure to your spouse, siblings, children, grandchildren, or any other person you identify. The purpose of this disclosure is for the verbal notification and/or verbal description of your condition as required for involvement in your care. It is our policy to work closely with you and your family or responsible party in planning your care.
Community/Program Directory: We may include certain limited personal health information about you while you are a resident of our community or a participant of our services, upon your agreement. This information may include your name, the location at which you are receiving care and your religious affiliation. Your religious affiliation will only be disclosed to members of the clergy. This information is released to members of your family, friends and clergy who call or visit you here at St. Charles Care Center, Inc.
Fundraising Activities: St. Charles Care Center, Inc. is a non-profit organization. We may use your protected health information in order to contact you to raise funds for our ministry and its operations. If you would like to withdraw from receiving information specific to fundraising please reply in writing to the Development Coordinator at 600 Farrell, Covington, KY 41011.
Other uses and disclosures of your protected health information will be made only with your written authorization. You have the right to revoke such authorization, at any time, in writing, except to the extent that St. Charles Care Center, Inc. has taken an action in reliance on the use or disclosure indicated in the authorization.
You have the right to request restrictions on certain uses and disclosures of your protected health information for the purposes of treatment, payment and health care operations or to persons involved in your care. Your request must be in writing and must state the specific restriction requested. In your request, tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse. St. Charles Care Center, Inc. is not required, however, to agree to a requested restriction. If we do agree to the requested restriction we may not disclose your protected health information in violation of that restriction.
You have the right to request that we communicate with you about medical matters by alternative means or at alternative locations. To receive communications of protected health information by alternative means or at alternative locations please specify the alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. We will accommodate reasonable requests.
You have the right to inspect and obtain a copy of your medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. We will respond to your request within 30 days of the request or 60 days if your medical information is not available on site. We will be granted a 30 day extension upon written notice to you providing the reason for the extension of time. Your request to access your designated medical record may be denied, but you have the right to have denials reviewed. You will receive a written notice of denial containing the reason for denial and the procedure for review. In some circumstances, another licensed health care professional chosen by St. Charles may review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review. However, in some circumstances, our denial of a request by you to inspect and/or receive copies of your information is not subject to review. There may be a fee for copies of your record; you will be notified before any charges are applied. St. Charles Care Center, Inc. requires all requests of access to be in writing and sent to the Privacy Officer.
If you feel that medical information we have about you is incorrect or incomplete, you have the right to amend the information as long as we maintain this information. St. Charles Care Center, Inc. requires all requests for amendments to be in writing and you must provide a reason that supports your request for amendment. If we approve your request, we will make the amendment to your medical information, inform you that we have made the amendment, and make a reasonable effort to tell others that need to know about the change to your medical information. 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:
If we deny your request for an amendment, we will provide you with a written statement of the basis for the denial and a description of how you may file a statement of disagreement. If you do not file a statement of disagreement, you may request that your request for amendment and our written denial be provided with any future disclosures of your medical information.
You have the right to receive an “accounting of disclosures.” This is a list of disclosures we made regarding medical information about you. The list will not include: disclosures made for treatment, payment, or health care operations; disclosures made directly to you; disclosures authorized by you pursuant to a signed authorization; disclosures made for national security or intelligence purposes; and disclosures to correctional institutions and for other law enforcement purposes. The list also will not include disclosures made before April 14, 2003.
Your request must include a time period, which may not exceed six (6) years prior to the date of the request and may not include any dates prior to April 14, 2003. Your request should also indicate in what form, i.e., electronic or paper, you would like your request to be processed. We will provide the first list to you at no charge, however if you make more than one request in the same year, we may charge you up to $1.00 per page for each additional request. We will notify you of the cost involved and you may choose to withdraw or modify you request at that time before any costs are incurred.
If you would like to inspect, amend or copy your medical information, receive an accounting of disclosures of your medical information, or to request a restriction on your medical information, please submit your request in writing to:
St. Charles Care Center, Inc.
600 Farrell Drive
Covington, KY 41011
If you have any complaints concerning your privacy rights or believe your privacy rights have been violated, you may contact the Privacy Officer at (859)-331-3224 or the Secretary of Health and Human Services. If you choose to file a complaint, you will not be retaliated against in any way.
Effective April 14, 2003.