Notice of Privacy Practices

Your Information. Your Rights. Our Responsibilities.

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.

We are committed to preserving the privacy and confidentiality of your personal health information. During your residency at Daughters of Sarah Senior Community, we will create, receive, or maintain records that contain personal health information about you. Personal health information is information about you, including information about where you live, that can reasonably be used to identify you and that relates to your past, present, or future physical or mental condition, the provision of health care to you or the payment for that care.

Daughters of Sarah Senior Community is required by certain state and federal regulations to safeguard the privacy of your personal health information. We are also required by the Federal Health Insurance Portability and Accountability Act (“HIPAA”) Privacy Rule to give you this Notice. This Notice informs you about the possible uses and disclosures of your personal health information and describes your rights and our obligations regarding your personal health information. This Notice applies to all information and records related to your care that Daughters of Sarah Senior Community has received or created.

Your Rights

You have the right to:

  • Get a copy of your paper or electronic medical record
  • Correct your paper or electronic medical record
  • Request confidential communication
  • Ask us to limit the information we share
  • Get a list of those with whom we’ve shared your information
  • Get a copy of this privacy notice
  • Choose someone to act for you
  • File a complaint if you believe your privacy rights have been violated

Your Choices

You have some choices in the way that we use and share information as we:

  • Tell family and friends about your condition
  • Provide disaster relief
  • Include you in a hospital directory
  • Provide mental health care
  • Market our services and sell your information
  • Raise funds

Our Uses and Disclosures

We may use and share your information as we:

  • Treat you
  • Run our organization
  • Bill for your services
  • Help with public health and safety issues
  • Do research
  • Comply with the law
  • Respond to organ and tissue donation requests
  • Work with a medical examiner or funeral director
  • Address workers’ compensation, law enforcement, and other government requests
  • Respond to lawsuits and legal actions

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record

  • You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
  • We will provide a copy or a summary of your health information, usually within 10 days of your request. We may charge a reasonable, cost-based fee. For Nursing Facility residents, upon an oral or written request, all your records can be viewed within 24 hours (excluding weekends and holidays); and after inspection, you may purchase them or any portions of them upon request and 2 working days’ advance notice.

Ask us to correct your medical record

  • You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this.
  • We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications

  • You can ask us to contact you in a specific way (for example, home or mobile phone) or to send mail to a different address.
  • We will say “yes” to all reasonable requests.

Ask us to limit what we use or share

  • You can ask us not to use or share certain health information for treatment, payment, or our operations. We aren’t required to agree to your request, and we may say “no” if it would affect your care.
  • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

Get a list of those with whom we’ve shared information

  • You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and
  • We will include all the disclosures, except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free, but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice

  • You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you

  • If you have given someone a health care proxy or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
  • We will make sure the person has this authority and can act for you before we take any action.

File a complaint if you feel your rights are violated

  • You can complain if you feel we have violated your rights by contacting us using the information at the end of this notice.
  • You can file a complaint with the U.S. Dept. of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
  • We will not retaliate against you for filing a complaint.

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and choice to tell us to:

  • Share information with your family, close friends, or others involved in your care
  • Share information in a disaster relief situation
  • Include your information in a facility directory
  • Share psychotherapy notes with certain “qualified persons” defined in NY Public Health Law

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

We never share your information in the following instances, unless you give us written permission:

  • Marketing purposes
  • Sale of your information
  • Most sharing of psychotherapy notes

In the case of fundraising, we may contact you for fundraising efforts, but you can tell us not to contact you again.

Our Uses and Disclosures

How do we typically use or share your health information? We typically use or share your health information in the following ways.

Treat you – We can use your health information and share it with other professionals who are treating you. Example: A doctor treating you for an injury asks another doctor about your overall health condition.

Run our organization – We can use and share your health information to run our practice, improve your care, and contact you when necessary.

Example: We use health information about you to manage your treatment and services.

Bill for your services – We can use and share your health information to bill and get payment from health plans or other entities.

Example: We give information about you to your health insurance plan so it will pay for your services.

How else can we use or share your health information?

We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes.

Help with public health and safety issues

We can share health information about you for certain situations such as:

  • Preventing disease
  • Helping with product recalls
  • Reporting adverse reactions to medications
  • Reporting suspected abuse, neglect, or domestic violence
  • Preventing or reducing a serious threat to anyone’s health or safety
  • Do research – We can use or share your information for health re
  • Comply with the law – We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy la
  • Respond to organ and tissue donation requests
  • We can share health information about you with organ procurement organizati
  • Work with a medical examiner or funeral director
  • We can share health information with a coroner, medical examiner, or funeral director when an individual di

We can use or share health information about you:

  • For workers’ compensation claims
  • For law enforcement purposes or with a law enforcement official
  • With health oversight agencies for activities authorized by law
  • For special government functions, such as military, national security, and presidential protective service
  • To respond to lawsuits and legal actions
  • In response to a court or administrative order, or in response to a

Our Responsibilities

  • We are required by law to maintain the privacy and security of your protected health informatio
  • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your informatio
  • We must follow the duties and privacy practices described in this notice and give you a copy of it.
  • We will not use or share your information other than as described here, unless you tell us we can in writin If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
  • Comply with the law

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

We reserve the right to change this Notice at any time. We reserve the right to make the revised Notice effective for health information we already have about you, as well as any information we receive in the future. A current notice will be available in our admission offices, on our web site, and upon request.

If you have any complaints or questions about our privacy policies, please contact:

Privacy Officer, Daughters of Sarah Senior Community
180 Washington Avenue Extension
Albany, New York 12203

Telephone: 518-456-7831

Fax: 518-456-1563

Daughters of Sarah Senior Community Privacy Group is an Affiliated Covered Entity that includes the Daughters of Sarah Nursing Center, Inc. and the Daughters of Sarah Housing Company, Inc. (d/b/a The Massry Residence at Daughters of Sarah).

Federal regulations require us to ask you for your signature indicating that you have received this Notice of Privacy Practices.

Effective Date: 6/1/2018