Promenade at the Beatitudes Campus

Effective April 14, 2003

THIS NOTICE DESCRIBES HOW PROTECTED MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

The Beatitudes Campus is permitted to make uses and disclosures of protected health information for treatment, payment and health care operations, as described in the following examples:

For treatment - We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other skilled nursing facility and assisted living facility personnel who are involved in taking care of you at the skilled nursing facility and assisted living facility. For example, a doctor treating you for a broken hip may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments of the skilled nursing facility and assisted living facility also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work and x-rays. We also may disclose medical information about you to people outside the skilled nursing facility and assisted living facility who may be involved in your medical care after you are discharged, such as family members, clergy or others we use to provide services that are part of your care.
For payment - We may use and disclose medical information about you so that the treatment and services you receive at the skilled nursing facility and assisted living facility may be billed to and payment may be collecting from you, an insurance company or a third party. For example, we may need to give your health plan information about therapy and skilled care you received at the Care Center so your health plan will pay us or reimburse you for the therapy or skilled care. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
For health care operations - We may use and disclose medical information about you for skilled nursing facility and assisted living facility operations. These uses and disclosures are necessary to run the skilled nursing facility and assisted living facility and make sure all of our residents receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff caring for you. We may also combine medical information about many skilled nursing facility and assisted living facility residents to decide what additional services the hospital should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, medical students and other skilled nursing facility and assisted living facility personnel for review and learning purposes. We may also combine the medical information we have with medical information from other hospitals or skilled nursing facilities to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific residents are.

The Beatitudes Campus is permitted or required, under specific circumstances, to use or disclose protected health information without the individual's written authorization. [If a use or disclosure for any purpose prescribed in the Privacy Regulation is prohibited or materially limited by other applicable State law, the description of such use or disclosure must reflect the more stringent law.] 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 The Beatitudes Campus 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.
Other uses and disclosures will be made only with the Individual's written authorization, and the individual may revoke such authorization.
The Beatitudes Campus intends to engage in one or more of the following activities:

Appointment reminders & Alternative treatment - The Beatitudes Campus may contact the individual to provide appointment reminders or information about treatment alternatives or other heath-related benefits and services that may be of interest to the individual or patient.
Fund Raising Activities - The Beatitudes Campus may contact the individual/patient/resident to raise funds for The Beatitudes Campus and its operation. We may disclose medical information to a foundation related to the skilled nursing facility and assisted living facility so that the foundation may contact you in raising money for the skilled nursing facility and assisted living facility. We only would release contact information, such as your name, address and phone number and the dates you received treatment or services at the skilled nursing facility and assisted living facility. If you do not want The Beatitudes Campus to contact you for fundraising efforts, you must notify the director of fund development in writing.
Health Related Benefits or Service - A group health plan, or a health insurance issuer or HMO with respect to a group health plan, may disclose protected health information to the sponsor of the plan to tell you about health-related benefits or services that may be of interest to you.
Campus Directory - We may include certain limited information about you in the campus publications and various directories while you are a patient in the skilled nursing facility and assisted living facility. This information may include your name, room location, your general condition (e.g., fair, stable, etc.) and your religious affiliation. The 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, such as a minister, priest or rabbi, even if they don't ask for you by name. This is so your family, friends and clergy can visit you in the skilled nursing facility and assisted living facility and generally know how you are doing.
Individuals who are involved with or pay for your care - We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family or friends your condition and that you are in the hospital. In addition, we 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.
Research - Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all residents who received one medication to those who received another, for the same condition. All research projects, however, 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 the patient's need for privacy of their medical information. Before we use or disclose medical information about you to people preparing to conduct a research project, for example, to help them look for residents with specific medical needs, so long as the medical information they review does not leave the skilled nursing facility and assisted living facility. We will almost always ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at the skilled nursing facility and assisted living facility.
As Required by Law - We will disclose medical information about you when required to do so by federal, state or local law.
To Avert a Serious Threat to Health and/or Safety - We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent that threat.
SPECIAL SITUATIONS
Organ and Tissue Donation - If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Military and Veterans - If you are a member of the armed forces, may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
Workers' Compensation - We may release medical information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Public Health Risks - We may disclose medical information about you for public health activities. These activities generally include the following:
1. To prevent or control disease, injury or disability
2. To report deaths
3. To report abuse or neglect
4. To report reactions to medications or problems with products
5. To notify people of recalls of products they may be using
6. To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
7. To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
Health Oversight Activities - We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, 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.
Lawsuits and Disputes - If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in a response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Law Enforcement - We may release medical information if asked to do so by a law enforcement official:
1. In response to a court order, subpoena, warrant, summons or similar process
2. To identify or locate a suspect, fugitive, material witness, or missing person
3. About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement
4. About death we believe may be the result of criminal conduct
5. About criminal conduct at the skilled nursing facility and assisted living facility
6. In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person committed the crime
Coroners, Medical Examiners and Funeral Directors - We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about residents of the skilled nursing facility and assisted living facility to funeral directors as necessary to carry out their duties.

The Individual has the following rights regarding protected health information:
1. The right to request restrictions on certain uses and disclosures of protected health information. The Beatitudes Campus is not required to agree to a requested restriction, however. You have a right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or a friend. For example, you could ask that we not disclose information about a surgery you had. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing to the medical records department manager. In your request, you must tell us what information you want to limit, whether you want to limit our use, disclosure or both; and to whom you want the limits to apply, for example, disclosures to your spouse or family.
2. The right to inspect and copy 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. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the medical records manger. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by the skilled nursing facility and assisted living facility will 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.
3. The right to receive confidential communications of protected health information, as applicable. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you in writing or in a private room. To request confidential communications, you must make your request in writing to the medical records manager. We will not ask you the reason for you request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
4. The right to amend protected health information, as provided in the Privacy Regulation. If you feel the medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the skilled nursing facility and assisted living facility. To request an amendment, your request must be made in writing and submitted to the medical records manager. In addition, you must provide a reason that supports your request. If you ask us to amend information that:
  1. Was not created by us, unless the person or entity that created the information is no longer available to make the amendment
  2. Is not part of the medical information kept by the skilled nursing facility and assisted living facility
  3. Is not part of the information which you would be permitted to inspect and copy; or
  4. Is accurate and complete
5. The right to receive an accounting of disclosures of protected health information. This is the list of disclosures we made of medical information about you. To request this list or accounting of disclosures, you must submit your request in writing to the medical records manager. Your request must state a time period which may not be longer than six years and may not include dated before February 26, 2003. Your request should indicate in what form you want the list (e.g., on paper or electronically). The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
6. The right to obtain a paper copy of the Notice of Privacy Practices from the covered entity upon request. This right extends to an individual who has agreed to receive the Notice electronically. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. To obtain a paper copy of this notice, please contact the medical records manager.
The Beatitudes Campus is required by law to maintain the privacy of protected health information and to provide individuals with notice of its legal duties and privacy practices with respect to protected health information.
The Beatitudes Campus is required to abide by the terms of the Notice currently in effect.
The Beatitudes Campus reserves the right to change the terms of this Notice. The new Notice provisions will be effective for all protected health information that it maintains. We reserve the right to make the revised or changed Notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in the skilled nursing facility and assisted living facility. The notice will contact on the first page, under the policy name with the effective date. In addition, each time you register at or are admitted to the skilled nursing facility and assisted living facility for treatment or health care services as an inpatient or outpatient, we will offer you a copy of the current notice in effect.
The Beatitudes Campus will provide individuals or residents with a revised Notice upon request.
Individuals may complain to The Beatitudes Campus and to the Secretary of the Department of Health and Human Services, without fear of retaliation by the organization, if they believe their privacy rights have been violated. A brief description of how the individual may file a complaint follows:
The Beatitudes Campus' contact person for matters relating to complaints is:
1. Brian DeVries, HIPAA / Compliance Officer.
2. 602-995-2611 ext. #6104
3. 1610 W. Glendale Ave., Phoenix, AZ 85021
This Notice is first in effect on April 14, 2003. revised January 15, 2004, and revised January 31, 2005.
The Beatitudes Campus elects to limit the uses or disclosures that it is permitted to make, as follows: Make sure that medical information that identifies you is kept private; give you this notice or our legal duties and privacy practices with respect to medical information about you; and follow the terms of the notice that is currently in effect.