THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The Long Island State Veterans Home (herein referred to as LISVH) is required by law to maintain the privacy of your protected health information (herein referred to as health information) and to provide you with a notice of its legal duties and privacy practices with respect to your health information. Your health information includes any individually identifiable information. If you have questions about any part of this notice or if you want more information about the privacy practices at LISVH, please contact the LISVH Privacy Officer.
WHEN LISVH MAY NOT USE/DISCLOSE YOUR HEALTH INFORMATION
Except as described below in this Notice of Privacy Practices or as otherwise required by law, LISVH will not use or disclose your health information without your written authorization. If you do authorize LISVH to use or disclose your health information, you may revoke your authorization in writing at any time except to the extent that LISVH already has taken action in reliance on your authorization.
HOW LISVH MAY USE OR DISCLOSE YOUR HEALTH INFORMATION
LISVH collects health information from you and stores it in written and electronic formats. This is your health information. The health information is the property of LISVH, but the information is accessible to you. LISVH protects the privacy of your health information. The law permits LISVH to use or disclose your health information for the following purposes:
- Treatment: Your health information can be used or disclosed by LISVH to enable the organization to provide you with medical treatment.
- Payment: Your health information can be used or disclosed by LISVH to enable the organization to receive payment.
- Operations: Your health information can be used or disclosed for operational purposes.
- Personal Use: Your health information can be disclosed to you.
LISVH has the right to use and disclose your health information for treatment, payment or operations once you have signed a consent form as required by State law. Once you sign this general written consent form, it will be in effect until you revoke your general written consent. You may revoke your general written consent at any time (in writing), except to the extent that we have already relied on it. For example, if we provide you with treatment before you revoke your general written consent, we may still share your health information with your insurance company in order to obtain payment for that treatment. To revoke your general written consent, please write to the LISVH Privacy Officer.
LISVH will obtain your authorization for the following uses and disclosure of your health information:
- Psychotherapy Notes: Any use and disclosure of psychotherapy notes other than to provide treatment, obtain payment and perform health care operations require your authorization.
- Sale of PHI: LISVH is required to obtain your authorization for any use and disclosure of your PHI for which LISVH is receiving any form of incentive or payment.
- Directory/Census: LISVH may list your name, where you are located in the facility and religious affiliation in its directory/census. This information may be provided to other people who ask for you by name. If you do not want us to list this information in LISVH’s directory/census or provide it to others, you must notify us in writing that you decline to be part of our directory.
- Notification and Communication with Family: LISVH may use or disclose your health information to notify or assist in notifying a family member, your personal representative or another person responsible for your care about your location, your general condition or in the event of your death. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communicating with your family and others.
- Required by Law or Public Health Authorities: LISVH may use and disclose your health information as required by law. Additionally, LISVH may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting child abuse or neglect; reporting abuse, neglect or domestic violence of adults; reporting to the Food and Drug Administration problems with products or services and reactions to medications; reporting disease or infection exposure; or reporting to other authorities as required by law or regulation.
- Health Oversight Activities/Judicial Matters: LISVH may disclose your health information to health agencies during the course of audits, investigations, inspections, licensure and other proceedings. Disclosure may also occur in the course of any administrative or judicial proceeding. LISVH may disclose your health information to a law enforcement official for identifying or locating a suspect, fugitive, material witness or missing person, complying with a court order or subpoena and other law enforcement purposes.
- Deceased Person/Organ Donation Information or Personal Health and Safety: LISVH may disclose your health information to coroners, medical examiners and funeral directors as well as organizations involved in procuring, banking or transplanting organs and tissues. LISVH may also disclose your health information in order to prevent or lessen a serious and/or imminent threat to the health or safety of a particular person or the general public.
- Specialized Government Functions or Worker’s Compensation: LISVH may disclose your information for military, national security or correctional facility purposes. We may also disclose your health information as necessary to comply with worker’s compensation laws.
Part of the mission of the Stony Brook University (SBU) and LISVH is the improvement of health care, in part, through research involving human subjects. You may be asked to participate in such research. If you decide to do so, you will sign a consent form for participation in the study. At that time, you will also be asked to provide your written authorization permitting the use or disclosure of your health information for the research activity. However, certain research activities can include your health information without your written authorization if the researcher is approved through a special review process where it is determined that the use or disclosure of your health information in the research activity poses minimal risk to your privacy. This is achieved, in part, by removing most, if not all, of the information that has the potential to identify you. In some instances, the researcher must sign an agreement that further protects your privacy. We may also, under certain limited circumstances, allow your identifiable health information to be viewed by researchers who are developing ideas for future research studies. However, SBU and LISVH will protect your privacy by a) requiring the researcher to first apply for, and receive, special permission to view your health information, and b) not allowing any health information that identifies you to be written down and used. Health information can also be shared with researchers without authorization if the research involves the study of health information of deceased persons. As just explained, special permission must be granted, and no health information that identifies the deceased person can be written down or used.
Marketing and Fundraising
LISVH may contact you to give information about other treatments or health-related benefits and services that may be of interest to you. Additionally, LISVH may contact you to participate in LISVH marketing and fund-raising activities. You have the option of opting out of receiving marketing and fundraising information. To opt out of fundraising or marketing you may call the LISVH Privacy Officer at (631) 444-8646 or e-mail your request including your name and date of birth to email@example.com.
Emergencies, Disaster Relief or if Information is De-identified
LISVH may use or disclose your health information in an emergency or to assist in disaster relief efforts. Additionally, your information may be used or disclosed if we have removed any information that reveals who you are.
Change of Ownership
In the event that LISVH is sold or divested by the State of New York, your health information will become the property of the new owner/entity and will be subject to their policies on health information as well as federal and state laws.
Finally, while LISVH will take reasonable steps to protect the privacy of your health information, certain incidental uses and disclosures of your health information may occur. Incidental uses and disclosures are the by-products of acceptable disclosure that cannot be reasonably prevented (e.g. service provider’s discussion about your health information may be overheard by another person). LISVH will take reasonable steps to limit incidental disclosures.
Other uses and disclosures not described in the notice will be made only with your written authorization.
YOUR HEALTH INFORMATION RIGHTS
You have the right to request restrictions on certain uses and disclosures of your health information. Although we will attempt to accommodate resident/registrant requests, LISVH is not required to agree or fulfill the restriction requested; except to restrict disclosure of your health information to your health plan/insurance if the disclosure is for payment or health care operations and pertains to a health care item or service for which out of pocket payment in full has been obtained at the time the service is provided.
Request Alternate Method of Receipt
You have the right to receive your health information through a reasonable alternative means or at an alternative location (e.g. work or home).
Inspect and Copy
You have the right to inspect and copy your health information subject to LISVH policies and procedures (e.g. times and modes of access are expected to be followed). If you request a copy of your health information, we may charge you a reasonable fee.
You have the right to request that LISVH amend your health information you may believe is incorrect or inaccurate. LISVH is not required to change your health information if LISVH determines that the information is accurate and correct. Under these circumstances, LISVH will provide you the reason for the denial and information about how you can disagree with an amendment denial.
Receive an Accounting of Disclosures
You have the right, after April 14, 2003, to receive an accounting of disclosures of your health information made by LISVH for the six years prior to your request, but for disclosures no earlier than April 14, 2003. It should be understood that LISVH does not have to account for a variety of disclosures related to treatment, payment, health care operations, information provided to you, disclosed information authorized by you and certain government law enforcement functions.
Request a Detailed Explanation of Rights
You have the right to a paper copy of this Notice of Privacy Practices. If you would like a more detailed explanation of these rights or if you would like to exercise one or more of the rights, contact the LISVH Privacy Officer.
Request Additional Privacy Protections
You have the right to request that we further restrict the way we use and disclose your health information to provide you with treatment or care, collect payment for that treatment or care or run out business operations. You may also request we limit how we disclose information about you to family or fiends involved in your care.
SPECIAL PROTECTIONS for HIV, MENTAL HEALTH and GENETIC INFORMATION
Special Rules apply to these and other types of information. Some parts of this Notice may not apply to these types. If your treatment involves this information, you may be provided with additional information explaining how the information will be protected.
LISVH will notify you, as required by law, following a breach of your protected health information.
CHANGES TO THIS NOTICE OF PRIVACY PRACTICES
LISVH is required by law to comply with this Notice. LISVH reserves the right to amend this Notice of Privacy Practices at any time in the future. We will, from time to time, review our privacy policies and practices to help maintain the security and privacy of health information. Due to changing circumstances, it may become necessary to revise our privacy policies and practices and the terms of this Notice at any time, provided applicable law permits such changes. We reserve the right to make the changes in our privacy policies and practices and the new terms of our Notice effective for all health information that we maintain including health information we created or received before we made changes. You can always request a written copy of our most current Notice of Privacy Practices from the LISVH Privacy Officer.
Complaints about this Notice of Privacy Practices or how LISVH handles your health information should be directed to the LISVH Director of Social Work Services. The Director will coordinate with the LISVH Privacy Officer. No one will retaliate or take action against you for filing a complaint.
If you think we may have violated your privacy rights, or you disagree with a decision we made about access to your protected health information, you may file a written complaint with the Department of Health and Human Services, Office of Civil Rights at https://www.hhs.gov/civil-rights/filing-a-complaint/complaint-process/index.html, or by e-mail at OCRMail@hhs.gov, or by calling (800) 368-1019.
This Notice is effective as of April 14, 2003.
This Notice was revised as of September 23, 2013
LISVH Privacy Officer
Long Island State Veterans Home
100 Patriots Road
Stony Brook, NY 11790
Voice: (631) 444-8646
LISVH Social Work Services Department: (631) 444-8545