FATHER JOE’S VILLAGES®
NOTICE OF PRIVACY PRACTICES

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.

Phone Extension for the Privacy & Compliance Administrator

Effective May 12, 2003, the phone extension for the Privacy & Compliance Administrator has been changed to 1580. Please call 619-233-8500 x 1580 if you have any questions.

WHO WILL FOLLOW THIS NOTICE

   This notice describes the practices of the health care components of Father Joe’s Villages ("FJV") and that of any health care professional authorized to enter information into your health record, and all employees, staff and volunteers of FJV as it relates to the covered components as stated in the Hybrid Entity Policy, HIPAA Policy & Procedure Manual. All of these individuals may share health information with each other for treatment, payment or health care operations purposes described in this notice.

OUR PLEDGE REGARDING HEALTH INFORMATION

   We understand that health information about you is personal. We are committed to protecting health information about you. We create a record of the care and services you receive at FJV. 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 the FJV.

   This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of health information.

We are required by law to:

• make sure that health information that identifies you is kept private (with certain exceptions);
  
• give you this notice of our legal duties and privacy practices with respect to health information about you; and
  
• follow the terms of the notice that is currently in effect.
  

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

   The following categories describe different ways that we use and disclose health 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 health information about you to provide you with treatment or services. We may disclose health information about you to doctors, dentists, psychologist, nurses, technicians, professional interns, or other FJV personnel/volunteers who are involved in taking care of you at FJV. 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 Village Health Nurse if you have diabetes so that we can arrange for appropriate education. Different departments of FJV also may share health information about you in order to coordinate the different things you need, such as prescriptions, lab work and special services. We also may disclose health information about you to people outside FJV who may be involved in your health care after you leave FJV, such as skilled nursing facilities or home health agencies.

For Payment.

   We may use and disclose health information about you, as needed, to obtain payment for your health care services. For example, if you are covered by Medi-Cal, Medicare or another insurance company, we may need to give your insurance company information about treatment you received at FJV in order to obtain payment for the services you received. We also may disclose information about you in order to comply with the requirements of certain contracts that result in funding for other services such as housing, food, education, etc.

For Health Care Operations.

   We may use and disclose health information about you for health care operations. These uses and disclosures are necessary to run FJV and make sure that all of our residents/patients receive quality care. For example, we may use health information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine health information about many residents/ patients to decide what additional services FJV should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, professional interns, and other personnel for review and learning purposes. We may also combine the health information we have with health information from others 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 health information so others may use it to study health care and health care delivery without learning who the specific patients are.

Appointment Reminders.

   We may use and disclose health information to contact you as a reminder that you have an appointment for treatment or care at FJV.

Treatment Alternatives.

   We may use and disclose health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

Health-Related Products and Services.

    We may use and disclose health information to tell you about our health-related products or services that may be of interest to you.

Fundraising Activities.

   We may use de-identified (information that cannot be connected to you) health information in an effort to raise money for FJV and its operations. We may disclose de-identified health information to a foundation related to FJV in order to raise money for FJV. We only would release contact information, such as your name, address and phone number if you provide a written authorization.

Roster and Database.

   We may include certain limited information about you in our agency roster and database. This information may include your name, location at which you are receiving services, and demographic information. This information can only be released to people outside of FJV with your written authorization or under certain legal requirements.

Individuals Involved in Your Care or Payment for Your Care.

   We may release health information about you to a friend or family member who is involved in your health care when there is a specific written authorization. We may also give information to someone who helps pay for your care.

   In addition, we may disclose health 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 health 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 health information, trying to balance the research needs with patients’ need for privacy of their health information. Before we use or disclose health information for research, the project will have been approved through a research approval process, but we may, however, disclose health information about you to people preparing to conduct a research project, for example, to help them look for patients with specific health needs, so long as the health information they review does not leave FJV. 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 FJV.

As Required By Law.

   We will disclose health information about you when required to do so by federal, state or local law.

To Avert a Serious Threat to Health or Safety.

   We may use and disclose health 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 the threat.

SPECIAL SITUATIONS

Military and Veterans.

   If you are a member of the armed forces, we may release health information about you as required by military command authorities. We may also release health information about foreign military personnel to the appropriate foreign military authority.

Workers’ Compensation.

   We may release health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.

Public Health Risks.

   We may disclose health information about you for public health activities. These activities may generally include the following:

• to prevent or control disease, injury or disability;
  
• to report births and deaths;
  to report the abuse or neglect of children, elders and dependent adults;
  
• 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 only make this disclosure if you agree or when required or authorized by law.
  

Health Oversight Activities.

   We may disclose health 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 health information about you in response to a court or administrative order. We may also disclose health 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 (which may include written notice to you) or to obtain an order protecting the information requested.

Law Enforcement.

   We may release health information if asked to do so by a law enforcement official:

• 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 or 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 FJV; 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, Health Examiners and Funeral Directors.

   We may release health information to a coroner or health examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release health information about patients of FJV to funeral directors as necessary to carry out their duties.

National Security and Intelligence Activities.

   We may release health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Protective Services for President and Others.

   We may disclose health 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 health 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 HEALTH INFORMATION ABOUT YOU

You have the following rights regarding health information we maintain about you:

Right to Inspect and Copy.

   You have the right to inspect and copy health information that may be used to make decisions about your care. Usually, this includes health and billing records, but may not include some mental health information.

   To inspect and copy health information that may be used to make decisions about you, you must submit your request in writing to the Clinic Coordinator or Program Manager in the specific department. 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 health information, you may request that the denial be reviewed. Another licensed health care professional chosen by FJV 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.

Right to Amend.

   If you feel that health 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 FJV.

   To request an amendment, your request must be made in writing and submitted to the Clinic Coordinator or the Program Manager of the specific department. In addition, you must provide a reason that supports your request.

   We may deny your 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 your 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 health information kept by or for FJV;
• Is not part of the information which you would be permitted to inspect and copy; or
• Is accurate and complete.
  

   Even if we deny your request for amendment, you have the right to submit a written addendum, not to exceed 250 words, with respect to any item or statement in your record you believe is incomplete or incorrect. If you clearly indicate in writing that you want the addendum to be made part of your health record, we will attach it to your records and include it whenever we make a disclosure of the item or statement you believe to be incomplete or incorrect.

Right to an Accounting of Disclosures.

   You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of health information about you other than our own uses for treatment, payment and health care operations, (as those functions are described above) and with other exceptions pursuant to the law.

   To request this list or accounting of disclosures, you must submit your request in writing to the Clinic Coordinator or the Program Manager in the specific department. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper, 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.

Right to Request Restrictions.

  You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a medication you used.

   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 Clinic Coordinator or the Program Manager in the specific department. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.

Right to Request Confidential Communications.

   You have the right to request that we communicate with you about health matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. If you live at FJV and do not want reminders sent to your bed/room for special services, you take the responsibility to keep that appointment.

   To request confidential communications, you must make your request in writing to the Clinic Coordinator or the Program Manager in the specific department. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you 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 obtain a copy of this notice at our website: www.fatherjoesvillages.org

To obtain a paper copy of this notice: Please ask at the front desk of each department.

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 health 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 FJV. The notice will contain on the first page, in the top right-hand corner, the effective date. In addition, each time you receive treatment or health care services, we will offer you a copy of the current notice in effect.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with the Privacy & Compliance Administrator or with the Secretary of the Department of Health and Human Services. To file a complaint with the Privacy & Compliance Administrator, please submit you complaint in writing to the Front Desk in the main lobby.

You will not be penalized for filing a complaint.

OTHER USES OF HEALTH INFORMATION

Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, this will stop any further use or disclosure of your health information for the purposes covered by your written authorization, except if we have already acted in reliance on your permission. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.