NOTICE OF PRIVACY PRACTICES

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

Effective February 24, 2003
Revised September 9, 2010

The Davis Community, which includes the Health Care Center, Rehabilitation and Wellness Pavilion, and Champions Assisted Living, maintains a serious commitment to ensuring your privacy. We are required to abide by this Notice of Privacy Practices. We may modify the terms of this notice, and the revised notice will be effective for all protected health information in our possession at the time of change and any information created or received after. We will display any revised notice on our campus and on our website. You may request a copy of any revised notice by contacting our office. If you have any questions about this notice, please contact our Quality & Compliance Administrator at 910-686-7195.

Protected Health Information, called PHI, is the demographic, financial, and medical information we collect, create, and maintain in the course of providing care to you. We are required by law to maintain the privacy of protected health information (PHI). This notice will inform you how the The Davis Community may use and disclose protected health information (PHI) created or maintained about you in compliance with the Federal Health Insurance Portability & Accountability Act of 1996 (HIPAA).

Uses and Disclosures of Protected Health Information (PHI): We may use and disclose health information about you for;

• Treatment: We will use and disclose your PHI to provide medical care and assist you in obtaining physician ordered services, tests, consults, and medications. We will share information with Davis Community staff, contracting consultants, your physicians, and other health care professionals or their associates who are directly or indirectly involved in providing treatment or continuity of care to you. We communicate information by phone when scheduling lab work. We may communicate information by fax when ordering medications or obtaining written physician orders.
• Payment: Your PHI may be used and disclosed for business reasons including, but not limited to, verifying insurance benefits, obtaining authorization for services, submitting billing, and securing payment for services. For example, we may telephone your insurance carrier and provide them with demographic information about you in order to verify eligibility. We provide your insurance with disease and treatment information in support of billable services. We copy and submit records to authorized agencies in the course of appealing a treatment or payment denial.
• Health Care Operations: In the process of operating we may use and disclose your PHI in support of our operations which could include quality assessments, financial or medical audits, and medical record management. For example, we disclose protected health information when conducting chart audits. A consultant Pharmacist reviews medication orders. We maintain the name and room number of guests and residents in a resident directory for their convenience and may release that information to visitors or callers unless you request in writing that we exclude your name from the directory. We may contact you to confirm an appointment or remind you of an appointment.

Other Uses and Disclosures We May Make Without Your Written Authorization. We may use and disclose protected health information about you when required by regulation or legally authorized to do so for;

• Public Health Activities, including reporting of communicable diseases, adverse reactions to medications, injury from a health care product, and suspected abuse
• Federal and State Agency Oversight, including NC State Surveyors.
• Court Order, Military Order, Subpoena
• Coroners, Medical Examiners, Funeral Directors, Organ Procurement Agencies

Other Permitted and Required Uses and Disclosures That May Be Made With Your Authorization For uses and disclosures other than for treatment, payment, health care operations, and as required by Law, we are required to obtain your written authorization. You have the right to revoke your authorization in writing and we will abide by your revocation from the time we receive it. However, your revocation will not affect any release or disclosure we may have made based on your previous authorization. If you wish us to release protected health information to individuals or entities not legally entitled to your records, such as a relative, friend, or attorney you must provide us with written authorization each time you wish us to release records. Following discharge, should you move or obtain the services of a new health care professional we will require your signed release to forward copies of our records to the new provider. You may request the appropriate authorization form from our Health Information Technician or staff responsible for managing records.

Your Rights (Please contact the Health Information Technician or staff about your rights.) You have the following rights with respect to your protected health information, which you can exercise by presenting a written request to The Davis Community;

• The right to request restrictions on certain uses and disclosures of protected health information, including those to consultants, family members directly involved in your care and treatment, or any other person identified by you. We are, however, not required to agree to a requested restriction. If we do agree, we must abide by it unless you agree in writing to remove the restriction.
• The right to reasonable requests to receive confidential communications of protected health information from us by alternative means or at alternative locations.
• The right to access protected health information about you that is created by The Davis Community.
• The right to request an amendment to protected health information we create. We may deny your request if it does not contain a reason(s) that supports your request, the information was not created by us, or we believe the record to be accurate.
• The right to receive an accounting of disclosures of protected health information other than for treatment, payment, health care operations, or those made pursuant to your written or verbal authorization or consent.
• The right to obtain a paper copy of this notice from us upon request.

If you have reason to believe that your privacy rights have been violated and/or you wish to file a complaint you may do so with the Quality & Compliance Administrator or the Department of Health and Human Services Office of Civil Rights within 180 days from the date of the incident of complaint. Complaints may be filed without fear of retaliation.