THE PINES OF PRESCOTT VALLEY, LLC AND INSIGHT SENIOR LIVING, LLC NOTICE OF PRIVACY PRACTICES 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.
Insight Senior Living, LLC and The Pines of Prescott Valley, LLC dba Ativo Senior Living of Prescott Valley (the “Community”) take the protection of personal information very seriously. This Notice of Privacy Practices (“Notice”) is given to you by the Community to describe the ways in which the Community may use and disclose your information (called “protected health information” or “PHI”) and to notify you of your rights with respect to PHI used and disclosed by the Community. PHI is information that may identify you and that relates to your past, present, or future physical or mental health or condition; the provision of health care services to you; or the payment for such services.
The Community is required by law to maintain the privacy of your PHI, to provide individuals with notice of their legal duties and privacy practices with respect to PHI, and to abide by the terms described in this Notice. The Community reserves the right to change the terms of this Notice and of its privacy policies, and to make the new terms applicable to all of the PHI it maintains. Before the Community makes a material change to its privacy policies, it will promptly revise this Notice and post a new Notice in registration, admitting areas and its website.
This Notice applies to the affiliated covered entities of Insight Senior Living and the Pines of Prescott Valley. The affiliated covered entities of the Community are found on Exhibit A on the back of this Notice and may share protected health information with each other as if they were a single covered entity.
Because the Community comprises operations that are not defined as covered operations as defined by HIPAA, the Community has decided to designate itself as a hybrid entity. This Notice applies to the privacy practices of the following health care components included in the hybrid entity that may share your Protected Health Information as needed for treatment, payment, and health care operations other non-covered operations shall be protected under applicable laws. If you have questions regarding such practices, please let us know.
Uses and Disclosures of PHI for which Authorization is Not Required
The Community may use or disclose your PHI for the purposes of treatment, payment and health care operations, described in more detail below, without obtaining written authorization from you.
FOR TREATMENT: The Community may use and disclose PHI in the course of providing, coordinating, or managing your medical treatment, including the disclosure of PHI for treatment activities at another healthcare facility. These types of uses and disclosures may take place between physicians, nurses, technicians, and other health care professionals who provide your health care services or are otherwise involved in your care. For example, if you are being treated by a primary care physician, that physician may need to use/disclose PHI to a specialist physician whom he or she consults regarding your condition, or to a nurse who is assisting in your care.
FOR PAYMENT: The Community may use and disclose PHI in order to collect payment for the health care services provided to you. For example, the Community may need to give PHI to your health plan in order to be reimbursed for the services provided to you. The Community may also disclose PHI to their business associates, such as billing companies, claims processing companies, and others that assist in processing health claims. The Community may also disclose PHI to other health care providers and health plans for the payment activities of such providers or health plans.
FOR HEALTH CARE OPERATIONS: The Community may use and disclose PHI as part of their operations, including for quality assessment and improvement, such as evaluating the treatment and services you receive and the performance of our staff in caring for you. Other activities include hospital and personnel training, underwriting activities, compliance and risk management activities, planning and development, and management and administration. The Community may disclose PHI to doctors, nurses, technicians, attorneys, consultants, accountants, and others for review and learning purposes. These disclosures help make sure that the Community is complying with all applicable laws and continue to provide quality health care to patients. The Community may also disclose PHI for certain operations, including quality assessment and improvement activities, credentialing and peer review activities, and health care fraud and abuse detection or compliance.
FOR SHARING PHI AMONG THE COMMUNITY AND PROFESSIONAL STAFF: The Community works together with physicians and other care providers on their professional staff to provide medical services to you when you are a resident at the Community and members of their respective professional staff will share PHI with each other as needed to perform their treatment, payment and health care operations activities. In addition to using or disclosing PHI for treatment, payment and health care operations, the Community may use and disclose PHI without your written authorization under the following circumstances:
BUSINESS ASSOCIATES: The Community may use or disclose your PHI with outside companies that perform services for us such as monitoring, operations, accreditation, legal, computer, or auditing services. These outside companies are called “Business Associates” and are required by HIPAA and by contract to keep your medical information confidential.
INDIVIDUALS INVOLVED IN YOUR CARE: The Community may share your PHI with a family member, guardian or other individuals who are involved in your care, or who help pay for your care. If you have any objection to sharing your PHI in this way, please contact the Executive Director, whose contact information is listed at the end of this Notice.
TO YOU OR YOUR PERSONAL REPRESENTATIVE: The Community may disclose your PHI to you, or a representative appointed by you or designated by applicable law.
AS REQUIRED BY LAW AND LAW ENFORCEMENT: The Community may use or disclose PHI when required by law, the Community also may disclose PHI when ordered to in a judicial or administrative proceeding; in response to subpoenas or discovery requests; to identify or locate a suspect, fugitive, material witness, or missing person; when dealing with gunshot and other wounds; about criminal conduct; to report a crime its location or victims, or the identity, description, or location of a person who committed a crime; or for other law enforcement purposes.
JUDICIAL AND ADMINISTRATIVE PROCEEDINGS: Your PHI may be disclosed in response to a court or administration order, subpoena, discovery request, or other lawful process.
FOR PUBLIC HEALTH ACTIVITIES AND PUBLIC HEALTH RISKS: The Community may disclose PHI to government officials in charge of collecting information about births and deaths, preventing and controlling disease, reports of child abuse or neglect and of other victims of abuse, neglect, or domestic violence, reactions to medications or product defects or problems, or to notify a person who may have been exposed to a communicable disease or may be at risk of contracting or spreading a disease or condition.
FOR HEALTH OVERSIGHT ACTIVITIES: The Community may disclose PHI to the government for oversight activities authorized by law, such as audits, investigations, inspections, licensure or disciplinary actions, and other proceedings, actions, or activities necessary for monitoring the health care system, government programs, and compliance with civil rights laws.
CORONERS, MEDICAL EXAMINERS, AND FUNERAL DIRECTORS: The Community may disclose PHI to coroners, medical examiners, and funeral directors for the purpose of identifying a decedent, determining a cause of death, or otherwise as necessary to enable these parties to carry out their duties consistent with applicable law.
ORGAN, EYE, AND TISSUE DONATION: The Community may release PHI to organ procurement organizations to facilitate organ, eye, and tissue donation and transplantation.
RESEARCH: Under certain circumstances, the Community may use and disclose PHI for medical research purposes. A researcher may have access to information that identifies you only through the special review process, or with your written permission. In addition, researchers may contact patients regarding their interest in participating in certain research studies. Researchers may only contact you if they have been given approval to do so by the special review process. You will only become a part of one of these research projects if you agree to do so and sign a consent form.
TO AVOID A SERIOUS THREAT TO HEALTH OR SAFETY: The Community may use and disclose PHI to law enforcement personnel or other appropriate persons, to prevent or lessen a serious threat to the health or safety of a person or the public.
LAWSUITS AND DISPUTES: If you are involved in a lawsuit or a dispute, the Community may disclose health information about you in response to a court or administrative order.
SPECIALIZED GOVERNMENT FUNCTIONS: The Community may use and disclose PHI of military personnel and veterans under certain circumstances and may also disclose PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities, and for the provision of protective services to the President or other authorized persons or foreign heads of state or to conduct special investigations.
WORKERS’ COMPENSATION: The Community may disclose PHI to comply with workers’ compensation or other similar laws that provide benefits for work-related injuries or illnesses.
HEALTH-RELATED BENEFITS AND SERVICES; LIMITED MARKETING ACTIVITIES: The Community may use and disclose PHI to inform you of treatment alternatives or other health-related benefits and services that may be of interest to you, such as disease management programs.
DISASTER RELIEF: The Community 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.
DISCLOSURES FOR HIPAA COMPLIANCE INVESTIGATIONS: The Community may disclose your PHI to the Secretary of the U.S. Department of Health and Human Services (the “Secretary”) when requested by the Secretary to investigate compliance with privacy regulations issued under the federal Health Insurance Portability and Accountability Act of 1996 (“HIPAA”).
Other Uses and Disclosures of PHI for Which Authorization Is Required: Other types of uses and disclosures of your PHI not described above will be made only with your written authorization, which you have the limited right to revoke in writing. Your PHI may not be used or disclosed for marketing purposes or sold by the Community without your prior written authorization. If you sign a written authorization permitting uses and disclosures of your PHI other than those described in this Notice, you may revoke your authorization by submitting a written request to the Executive Director at any time. However, the Community is unable to retract or invalidated any uses or disclosures that were made with your permission before you revoked your authorization.
HIPAA provides additional protection for psychotherapy notes, and most uses or disclosures of psychotherapy notes require your written permission. Psychotherapy notes are the personal notes of a mental health professional about a private or group counseling session.
In addition, other types of information may have greater protection under federal or state law, such as certain drug and alcohol information, HIV/AIDS and other communicable disease information, genetic information, mental health information, or information about developmental disabilities. For this type of information, we may be required to get your written permission before disclosing it to others; we may seek that permission in Insight’s intake forms if permitted by law. If you have any questions about this, contact the Executive Director, whose contact information is provided at the end of this Notice.
You have the following rights regarding your PHI You have the following rights regarding your PHI. All Requests must be submitted in writing to the Executive Director. Please contact the Executive Director for additional information regarding any of these rights. The contact information for the Executive Director can be found at the end of this Notice.
You may request the Community restrict the use and disclosure of your PHI. The Community is not required to agree to any restrictions you request, but if the entity does so it will be bound by the restrictions to which it agrees except in emergency situations. To request restrictions, you must make your request in writing. In your request, you must 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.
You have the right to request that communications of PHI to you from the Community be made by particular means or at particular locations. For instance, you might request that communications be made at your work address, or by e-mail rather than regular mail. Your requests must be in writing and sent to the Executive Director. The Community will accommodate your reasonable requests without requiring you to provide a reason.
Generally, you have the right to inspect and/or copy your PHI in the possession of The Community within a Designated Record Set if you make a request in writing to the Medical Records Department. The Community will inform you of the extent to which your request has or has not been granted. In some cases, the Community may provide you a summary of the PHI you request if you agree in advance to such a summary and any associated fees. If you request copies of your PHI or agree to a summary of your PHI, the Community may impose a reasonable fee to cover copying, postage, and related costs. If the Community denies access to your PHI, it will explain the basis for denial and your opportunity to have the denial reviewed by a licensed health care professional (not involved in the initial denial decision) designated as a reviewing official. If the Community does not maintain the PHI you request, if it knows where that PHI is located it will tell you how to redirect your request.
If you believe that your PHI maintained by the Community in a Designated Record Set contains an error or needs to be updated, you have the right to request that the Community correct or supplement your PHI. Your request must be made in writing, and it must explain why you are requesting an amendment to your PHI. Within sixty (60) days of receiving your request (unless extended by an additional thirty (30) days), the Community will inform you of the extent to which your request has or has not been granted. The Community generally can deny your request if your request relates to PHI: (i) not created by the Community; (ii) that is not part of the records the Community maintains; (iii) that is not subject to being inspected by you; or (iv) that is accurate and complete. If your request is denied, the Community will give you a written denial that explains the reason for the denial and your rights to: (i) file a statement disagreeing with the denial; (ii) submit a request that any future disclosures of the relevant PHI be made with a copy of your request and the Community’s denial attached, if you do not file a statement of disagreement; and (iii) complain about the denial.
You generally have the right to request and receive a list of certain types of disclosures of your PHI the Community has made during the six (6) years prior to your request. The list will not include disclosures (i) for which you have provided a written authorization; (ii) for treatment, payment, and health care operations; (iii) made to you; (iv) for a Community patient directory or to persons involved in your health care; (v) for national security or intelligence purposes; (vi) to correctional institutions or law enforcement officials; or (vii) of a limited data set. You should submit any such request to the Executive Director, and within sixty (60) days of receiving your request (unless extended by an additional thirty (30) days), the Community will respond to you regarding the status of your request. The Community will provide the first accounting you request in any 12-month period free of charge. The Community may impose a reasonable, cost-based fee for each subsequent request for accounting within the 12-month period. The Community will notify you of the fee in advance and provide you with an opportunity to withdraw or modify your request.
You have the right to receive a paper copy of this notice upon request even if you have agreed to receive this notice electronically. You can view a copy of this notice on Insight’s website, https://insightliving.com/. To obtain a paper copy of this notice, please contact the Executive Director, whose contact information is provided at the end of this Notice.
You have the right to receive notice in the event of a breach of confidentiality. As required by law, the Community will notify you of any breach of your PHI that is unsecured, as defined by law
You have the right to restrict disclosures of PHI to health plans if you have paid for services out of pocket in full Complaints
You may complain to the Community if you believe your privacy rights with respect to your PHI have been violated by contacting the Executive Director, whose contact information provided at the end of this Notice and submitting a written complaint. The Community will not penalize you or retaliate against you for filing a complaint regarding their privacy practices.
You also have the right to file a complaint with the Secretary of the Department of Health and Human Services. To submit a complaint to the Department of Health and Human Services, you must contact the Office for Civil Rights of the Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Avenue, SW, Room 509F, Washington, D.C. 20201. Further information and regional contact information is also available on the Office for Civil Rights’ website at www.hhs.gov/ocr/hipaa.
Contact Information If you have any questions about this notice, please contact the Executive Director at the address or telephone number provided below:
Executive Director, Ativo Senior Living of Prescott Valley
3951 N. Viewpoint Drive, Prescott Valley, AZ, 86314
Phone: (928) 888-6246