Effective date: December 20, 2007
This document describes the type of information FutureCare Health and Management Corporation and its affiliated entities (hereinafter referred to as “FutureCare”) gather about you, with whom that information may be shared, and the safeguards we have in place to protect it. Under law, you have the right to the confidentiality of your medical information and the right to approve or refuse the release of specific information except when law requires the release. If the practices described in this notice meet your expectations, there is nothing you need to do. If you prefer that we not share information, we may honor your written request in certain circumstances described below. If you have any questions regarding this Privacy Notice, please contact our Privacy Officer, at 410-766-1995, or via e-mail at Privacy@futurecarehealth.com.
Who Will Follow This Notice?
This notice describes FutureCare and that of:
- Any health care professional authorized to view or enter information into your chart
- All departments and units of FutureCare and members of our organized healthcare arrangement. These include:
¨Service and treatment providers including pharmacy, x-ray, laboratory, consultant health professionals (such as dietitian, physician, optometrist, ophthalmologist, dentist, podiatrist, etc.), transfer and referring hospitals, transfer and referring facilities, and other service and treatment providers as may be added.
- Any member of a volunteer group we allow to help you while you are in FutureCare
- All employees, staff and other FutureCare personnel
All these entities, sites, locations, and providers follow the terms of this notice. In addition, these entities, sites and locations may share medical information with each other for purposes of treatment, payment, or healthcare operations described in this notice.
Our Pledge Regarding Medical Information
We understand that medical information about you and your health is personal. We are committed to protecting the confidentiality of your medical information. As part of our routine operations, we create a record of the care and services you receive. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by FutureCare, whether made by FutureCare personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor's use and disclosure of your medical information created in the doctor's office or clinic.
This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
Federal law requires us to:
- Make sure that medical information that identifies you is kept private
- Give you this notice of our legal duties and privacy practices with respect to medical information about you
- Follow the terms of the notice that is currently in effect
How We May Use and Disclose Medical Information About You
The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
- For Treatment. We may use medical information about you without your authorization to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other FutureCare personnel who are involved in taking care of you at the facility[A1] or affiliated entity. For example, a doctor treating you for a broken leg 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 FutureCare 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 FutureCare who may be involved in your medical care after you leave the facility or the care of the affiliate, 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 without your authorization so that the treatment and services you receive at FutureCare may be billed to and payment may be collected from you, an insurance company, or a third party. For example, we may need to give your health plan information about therapy you received at FutureCare so your health plan will pay us or reimburse you for the therapy. 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. We will also disclose, upon admission, personal health care information to our pharmacy (unless you have chosen an alternative pharmacy), to radiology, and to laboratory service providers to expedite the provision of care as it is rendered.
- For Health Care Operations. We may use and disclose medical information about you without your authorization for FutureCare operations. These uses and disclosures are necessary to run FutureCare and make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical information about many FutureCare patients to decide what additional services FutureCare 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 FutureCare personnel for review and learning purposes. We may also combine the medical information we have with medical information from other FutureCare facilities or affiliated entities to compare how we are doing and see where we can make improvements in the care and services that 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 the names of specific patients.
- Appointment Reminders. We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care.
- Treatment Alternatives. We may use and disclose medical information without your authorization to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
- Health-Related Benefits and Services. We may use medical information to personally tell you about health-related benefits or services that may be of interest to you. We will not disclose this information to others for this purpose without your written authorization.
- Fundraising Activities. We will not use medical information about you to contact you in an effort to raise money for the facility or affiliated entities and their operations.
- Facility Directory. We may include certain limited information about you in the facility or an affiliated entity’s directory while you are a resident or patient of FutureCare. This information may include your name, location in the facility, your telephone number, 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 priest or rabbi, even if they don’t ask for you by name. FutureCare offer this service so your family, friends, and clergy can visit you, and generally know how you are doing. If you would prefer that FutureCare not include your name or other specific information in a directory, you must notify the facility or affiliated entity’s Administrator.[A2]
- Individuals Involved in Your Care or Payment 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 facility. When a person calls in asking for medical information about you, that person will be asked to provide personal information about you, such as your date and place of birth, so that we can verify that person’s identity as someone involved in your care or in payment for your care. 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. If you do not wish us to release certain information, or if you want certain information released only to certain persons, you must notify the facility or affiliated entity’s Administrator in writing.
- 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 patients 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 patients' need for privacy of their medical information. Before we use or disclose medical information for research, the project will have been approved through this research approval process, but we may, however, disclose medical information about you to people preparing to conduct a research project, for example, to help them look for patients with specific medical needs, so long as the medical information they review does not leave the facility or affiliated entity’s premises. 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 facility or affiliated entity.
- As Required By Law. We will disclose medical information about you without your authorization when required to do so by Federal, State or local law. This disclosure may be, for example, as a part of a State licensure survey.
- To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about you, when necessary and without your authorization, 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 the threat. This disclosure may be necessary, for example, if you have been the victim of a crime.
Special Disclosure 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, we 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 to
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:
- To prevent or control disease, injury or disability
- To report births and deaths
- To report child or adult abuse or neglect
- To report reactions to medications or problems with products
- To notify people of recalls of products they may be using
- 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
- To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will 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 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, including the following situations:
- In response to a court order, subpoena, warrant, summons or similar process;
- To identify or locate a suspect, fugitive, material witness, or missing person;
- About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement;
- About a death we believe may be the result of criminal conduct;
- About criminal conduct at the facility; and
- In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who 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 patients of the facility to funeral directors as necessary to carry out their duties.
- National Security and Intelligence Activities. We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
- Protective Services for the President and Others. We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
- Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
Your Rights Regarding Medical Information About You
You have the following rights regarding medical information we maintain about you:
- Right to Inspect and Copy. You and your authorized representative have 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.
Records disclosed to one party may not be re-disclosed by that party to another.
Requests to inspect medical information may be submitted orally or in writing. Requests to copy medical information must be submitted in writing. All requests to inspect or copy information should be submitted to the facility or affiliated entities’ Administrator. If you or your authorized representative requests a copy of the information, we will charge a fee for the costs of copying or mailing/delivery associated with your request. (See the Admission Contract, Exhibit 1, Attachment)
We may deny your request (or the request of your authorized representative) to inspect and copy your mental health records (if the attending physician believes disclosure may be injurious to your health) and any records not made by the facility or affiliated entity.
- Right to Amend. If you or your authorized representative feels that medical information we have about you is incorrect or incomplete, you or your authorized representative, may ask us to amend the information. You or your authorized representative has the right to request an amendment for as long as the information is kept by or for FutureCare.
To request an amendment, the request must be made in writing and submitted to the facility or affiliated entity’s Administrator. In addition, you or your authorized representative must provide a reason that supports your request.
We may deny this request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny this request if you ask us to amend information that:
- Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
- Is not part of the medical information kept by or for FutureCare
- Is not part of the information which you would be permitted to inspect and copy; or
- Is accurate and complete.
- Right to an Accounting of Disclosures. You or your authorized representative has the right to request an "accounting of disclosures." This is a list of the disclosures we made of personal health information about you which were not for the purposes of treatment, payment, or health care operations. To request this list or accounting of disclosures, you or your authorized representative must submit the request in writing to the facility or affiliated entity’s Administrator. The request must state a time period that may not be longer than six years and may not include dates before April 14, 2003. The request should indicate in what form you want the list (i.e., on paper or electronically). The first list requested within a 12-month period will be free. For additional lists, we may charge you or your authorized representative for the costs of providing the list. We will notify you or your authorized representative of the cost involved and you or your authorized representative may choose to withdraw or modify your request at that time before any costs are incurred.
- Right to Request Restrictions. You or your authorized representative have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or health care operations. We are not required to agree to your request. You or your authorized representative also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care, like a family member or friend. For example, you or your authorized representative could ask that we not use or disclose information about a medical procedure that you had. We are not required to agree to your request. If we do agree, we will comply with this request unless the information is needed to provide you emergency treatment.
- To request restrictions, the request must be made in writing to the facility or affiliated entity’s Administrator. In this request, you or your authorized representative must tell us (1) what information to limit; (2) whether this limitation is for our use, disclosure or both; and (3) to whom the limits will apply, for example, disclosures to your spouse.
- Right to Request Confidential Communications. You or your authorized representative has the right to request that we communicate with you or your authorized representative about medical matters in a certain way or at a certain location. For example, a request that we only contact you at work or by mail.
To request confidential communications, you or your authorized representative must make this request in writing to the facility or affiliated entity’s Administrator. We will not ask you the reason for this request. We will accommodate all reasonable requests. This request must specify how or where you or your authorized representative wish to be contacted.
- Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice. 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. You may view and print a copy of this notice at our website, www.futurecarehealth.com. To obtain a paper copy of this notice, contact the facility or affiliated entity’s Administrator.
Changes to this Notice
We reserve the right to change this notice. 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 facility. The notice will contain on the first page, in the top right-hand corner, the effective date. In addition, each time you are admitted to FutureCare for treatment or health care services, we will offer you or your authorized representative a copy of the current notice in effect.
If you believe your privacy rights have been violated, you may file a complaint. Any complaint may be submitted orally or in writing.
- You may file a complaint with the facility or affiliated entity’s Administrator, or
- You may file a complaint with the FutureCare Privacy Officer
FutureCare Health and Management Corporation
Suite 210, 8028 Ritchie Highway
Pasadena, MD 21122
- You may file a complaint with the:
Region III Office for Civil Rights
U.S. Department of Health and Human Services
150 S. Independence Mall West, Suite 372
Public Ledger Building
Philadelphia, PA 19106-9111
Hotline—800-368-1019 TDD 215-861-4440
You will not be retaliated or discriminated against for filing a complaint.
Other Uses of Medical Information
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with the written permission of you or your authorized representative. If you provide us permission to use or disclose medical information about you, you or your authorized representative may revoke that permission, in writing, at any time. If you or your authorized representative revoke the permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You and your authorized representative understand that we are unable to take back any disclosures we have already made with permission, and that we are required to retain our records of the care that we provided to you.