Notice of Privacy Practices
Cedar Lake Nursing Home, Inc.

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.

USE AND DISCLOSURE OF HEALTH INFORMATION
Cedar Lake Nursing Home, Inc. and Affiliates ["Agency'] may use your health information, information that constitutes to protected health information as defined in the Privacy Rule of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996, for purposes of providing you treatment, obtaining payment for your care and conducting health care operations. The Agency has established policies to guard against unnecessary disclosure of your health information.

THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED:

To Provide Treatment. Cedar Lake Nursing Home, Inc. and Affiliates may use your health information to coordinate care within the Agency and with others involved in your care, such as your attending physician and other health care professionals who have agreed to assist the Agency in coordinating care. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. The Agency also may disclose your health care information to individuals outside the Agency involved in your care including family members, pharmacists, suppliers of medical equipment, or other health care professionals.

To Obtain Payment. The Agency may include your health information in invoices to collect payment from third parties for the care you receive from the Agency. For example, the Agency may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or the Agency. The Agency also may need to obtain prior approval from your insurer and may need to explain to the insurer your need for home care and the services that will be provided to you.

To Conduct Health Care Operations
. The Agency may use and disclose health information for its own operations in order to facilitate the function of the Agency and as necessary to provide quality care to all of the Agency's patients. Health care operations include such activities as:

Quality assessment and improvement activities

Activities designed to improve health or reduce health care costs.

Protocol development, case management and care coordination

Contacting health care providers and patients with information about treatment alternatives and other related functions that do not include treatment.

Professional review

Training programs including those in which students, trainees or practitioners in health care learn under supervision.

Training of non-health care professionals.

Accreditation, certification, licensing or credentialing activities.

Review and auditing, including compliance reviews, medical reviews, legal services, and compliance programs.

Business planning and development including cost management and planning related analyses and formulary development.

Business management and general administrative activities of the Agency.

Fundraising. The Agency does not currently conduct Fundraising Activities that require the Use and/or Disclosure of Patient Health Information. It shall be note that in any future business operations, should the need for Fundraising Activity be deemed necessary and become part of the Agency's Business Practices, a Patient Authorization Form will be signed prior to ANY Use or Disclosure of Patient Health Information.

For Appointment Reminders. The Agency may use and disclose your health information to contact you as a reminder that you have an appointment for a home visit.

For Treatment Alternative. The Agency may use and disclose your health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY ALSO BE USED AND DISCLOSED:

When Legally Required. The Agency will disclose your health information when it is required to do so by any Federal, State, or local law.

When There Are Risks to Public Health. The Agency may disclose your information for public activities and purposes in order to:

· Prevent or control disease, injury or disability, report disease, injury, vital events such as birth or death and the conduct of public health surveillance, investigations and interventions.
· Report adverse events, product defects, to track products or enable product recalls, repairs and replacements and to conduct post-marketing surveillance and compliance with requirements of the Food and Drug Administration.
· Notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease.
· Notify an employer about an individual who is a member of the workforce as legally required.

To Report Abuse, Neglect Or Domestic Violence. The Agency is allowed to notify government authorities if the Agency believes a patient is the victim of abuse, neglect, or domestic violence. The Agency will make this disclosure only when specifically required or authorized by law or when the patient agrees to the disclosure.

To Conduct Health Oversight Activities. The Agency may disclose your health information to a health oversight agency for activities including audits, civil administrative or criminal investigations, inspections, licensure or disciplinary action. The Agency, however, may not disclose your health information if you are the subject of an investigation and your health information is not directly related to your receipt of health care or public benefits.
In Connection With Judicial And Administrative Proceedings. The Agency may disclose your health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to an subpoena, discovery request or other lawful process, but only when the Agency makes reasonable efforts to either notify you about the request or to obtain order protecting your health information.

For Law Enforcement Purposes. As permitted or required by State Law, the Agency may disclose your health information to a law enforcement official for certain law enforcement purposes as follows:
§ As required by law for reporting of certain types of wounds or other physical injuries pursuant to the court order, warrant, subpoena or summons or similar process.
§ For the purpose of identifying or locating a suspect, fugitive, material witness or missing person.
§ Under certain limited circumstances, when you are the victim of a crime.
§ To a law enforcement official if the Agency has a suspicion that your death was the result of criminal conduct including criminal conduct at the Agency.
§ In an emergency in order to report a crime.

To Coroners And Medical Examiners. The Agency may disclose your health information to coroners and medical examiners for purposes of determining your cause of death or for further duties, as authorized by law.

To Funeral Directors. The Agency may disclose your health information to funeral directors consistent with applicable law and if necessary, to carry out their duties with respect to your funeral arrangements. If necessary to carry out their duties, the Agency may disclose your health information prior to and in reasonable anticipation of your death.

For Organ, Eye or Tissue Donation. The Agency may use or disclose your health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs, eyes, or tissue for the purpose of facilitating the donation and transplantation.

In the Event of A Serious Threat To Health Or Safety. The Agency may, consistent with applicable law and ethical standards of conduct, disclose your health information if the Agency, in good faith, believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.

For Specified Government Functions. In certain circumstances, the Federal regulations authorize the Agency to use or disclose your health information to facilitate specified government functions relating to military and veterans, national security and intelligence activities, protective services for the President and others, medical suitability determinations and inmates and law enforcement custody.

For Worker's Compensation. The Agency may release your health information for worker's compensation or similar programs.

AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION
Other than is stated above, the Agency will not disclose your health information other than with your written authorization. If you or your representative authorizes the Agency to use or disclose your health information, you may revoke that authorization in writing at any time.

YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
You have the following rights regarding your health information that the Agency maintains:

· Right to request restrictions. You may request restrictions on certain uses and disclosures of your health information. You have the right to request a limit on the Agency's disclosure of your health information to someone who is involved in your care or the payment of your care. However, the Agency is not required to agree to your request. If you wish to make a request for restrictions, please contact the Privacy/Compliance Officer.

· Right to receive confidential communications. You have the right to request that the Agency communicate with you in a certain way. For example, you may ask that the Agency only conduct communications pertaining to your health information with you privately with no other family members present. If you wish to receive confidential communications, please contact the Privacy/Compliance Officer at (903) 489-2043. The Agency will not request that you provide any reasons for your request and will attempt to honor your reasonable requests for confidential communications.
· Right to inspect and copy your health information. You have the right to inspect and copy your health information, including billing records. A request to inspect and copy records containing health information may be made to Cedar Lake Nursing Home, Inc., P.O. Box 2025, Malakoff, TX. 75148 and to the attention of the Privacy/Compliance Officer. If you request a copy of your health information, the Agency may charge a reasonable fee for copying and assembling costs associated with your request.

· Right to amend health care information. You or your representative has the right to request that the Agency amend your records, if you believe that your health information is incorrect or incomplete. That request can be made as long as the information is maintained by the Agency. A request for an amendment of records must be made in righting to: Cedar Lake Nursing Home, Inc., P.O. Box 2025, Malakoff, TX. 75148 and to the attention of the Privacy/Compliance Officer. The Agency may deny the request if it is not in writing or does not include a reason for the amendment. The request also may be denied if your heatlh information records were not created by the Agency, if the records you are requesting are not part of the Agency's records, if the health information you wish to amend is not part of the health in the opinion of the Agency, the records containing your health information are accurate and complete.

· Right to an accounting. You or your representative has the right to request an accounting of disclosures of your health information made by the Agency for certain reasons, including reasons related to public purposes authorized by law and certain research. The request for an accounting must be made in writing to: Cedar Lake Nursing Home, Inc., P.O. Box 2025, Malakoff, TX. 75148 and to the attention of the Privacy/Compliance Officer. The request should specify the time period for the accounting starting on or after April 14, 2003. Accounting requests may not be made for periods of time in excess of six (6) years. The Agency would provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee.

· Right to a paper copy of this notice. You or your representative has a right to a separate paper copy of this Notice at any time even if you or your representative has received this Notice previously. To obtain a separate paper copy, please contact the Privacy/Compliance Officer at (903) 489-2043.

DUTIES OF THE AGENCY
The Agency is required by law to maintain the privacy of your health information and to provide you and your representative this Notice of its duties and privacy practices. The Agency is required to abide by the terms of this Notice as may be amended from time to time. The Agency reserves the right to change terms of its Notice and to make the new Notice provisions effective for all health information that it maintains. If the Agency changes its Notice, the Agency will provide a copy of the revised notice to you or your appointed representative. You or your personal representative has the right to express complaints to the Agency and to the Secretary of DHHS if you or your representative believes that your privacy rights have been violated. Any complaints to the Agency should be made in writing to: Cedar Lake Nursing Home, Inc., P.O. Box 2025, Malakoff, TX. 75148 and to the attention of the Privacy/Compliance Officer. The Agency encourages you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.

CONTACT PERSON
The Agency has designated the Privacy/Compliance Officer as its contact person for all issues regarding patient privacy and your rights under the Federal privacy standards. You may contact this person at Cedar Lake Nursing Home, Inc., P.O. Box 2025, Malakoff, TX. 75148 and by calling (903) 489-2043.

EFFECTIVE DATE:
This Notice is effective April 14, 2003
If you have any questions regarding this notice, please feel free to contact our office at (903) 489-2043. The Privacy/Compliance Officer will be glad to assist in answering any possible questions and/or concerns.

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