You Health Information Rights:
Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you. You have the right to request a restriction on certain uses and disclosures of your information. This includes the right to obtain a paper copy of the notice of information practices upon request. This also includes the right (1) to inspect and obtain a copy of your health record, (2) to obtain an listing of disclosures made after 4/14/2003 that are not covered by this notice, (3) to request communications of your health information by alternative means or at alternative locations, and (4) to revoke your authorization to use or disclose health information except to the extent that action has already been taken. All requests for any of the above items must be made in writing to our Privacy Officer.

Our Responsibilities:
This organization is required to maintain the privacy of your health information and to provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you. We are also required to abide by the terms of this notice, to notify you if we are unable to agree to a requested restriction and to accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations. We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will mail a revised notice to the address you have supplied. We will not use or disclose your health information without your authorization, except as described in this notice.

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 listed below.

We will use your health information for Treatment. For example: Information obtained by physicians, nurses, technicians, health care students and other Brethren Village staff will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document his or her plan for your care in your record. Members of your healthcare team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment. We will also provide your physician or a subsequent healthcare provider with copies of various reports that should assist him or her in treating you should you be discharged from Brethren Village.

We will use your health information for Payment. For example: A bill will be sent to you, your insurance company or a third party payer as listed on your Resident Information Sheet. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, and procedures and supplies used in your care. For any other third party payer we will obtain a separate release of health information. 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 use your health information for Health Care Operations. 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 Brethren Village residents to decide what additional services Brethren Village should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to physicians, nurses, technicians, health care students, and other Brethren Village staff for review and learning purposes. We may also combine the health information we have with health information from other facilities 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 residents are.

Appointment Reminders: We will use and disclose health information when scheduling appointments for your treatment or medical care.

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.

Emergency Services: We will use and disclose health information about you to emergency personnel.

Health-Related Benefits and Services: We may use and disclose health information to tell you about health-related benefits or services that may be of interest to you.

Fundraising: We may contact you in an effort to raise money for Brethren Village and its operations.

Brethren Village Directory: Unless you object, we may include certain limited information about you in the Brethren Village Directory while you are a resident at Brethren Village. This information may include your name and location in the facility, and your religious affiliation. Our directory does not include specific medical information about you. We may release information in our directory, except for your religious affiliation, to people who ask for you by name. We may provide the directory information, including your religious affiliation, to any member of the clergy.

Individuals Involved in Your Care or Payment for Your Care: Unless you object, we may release health information about you to contacts, including clergy, listed on your Resident Information Sheet and/or listed in our computer system, who are involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell the persons listed as contacts on your Resident Information Sheet and and/or listed in our computer system about your condition and the fact that you reside at Brethren Village. 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. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of health information, and attempts to balance the research needs with our residents' need for privacy of their health information. Before we use or disclose health information for research, the project will have been approved through this research approval process. We may, however, disclose health information about you to people preparing to conduct a research project. 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 Brethren Village.

Business Associates: There are some services provided in our organization through contacts with business associates. Examples include certain laboratory tests, x-ray services and pharmacy services. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we've asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

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.

Organ, Tissue and Body Donation: If you are an organ or body donor, we will release health information to organizations that handle organ or body procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ, tissue or body donation and transplantation.

Military and Veterans: If you are a member of the armed forces, we will 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. We may use or disclose to components of the Department of Veterans Affairs health information about you to determine whether you are eligible for certain benefits.

Workers' Compensation: We may release health information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.

Public Health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.

Health Oversight Activities: We may disclose health information to a health oversight agency for activities authorized by law. Examples of these activities include audits, investigations, inspections, and licensure.

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 or to obtain an order protecting the information requested).

Law Enforcement: We may release health information for law enforcement purposes as required by law or in response to a valid subpoena. Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.

Coroners, Medical Examiners and Funeral Directors: We may release health information to a coroner or medical examiner to identify a deceased person or determine the cause of death. We may also release health information about residents of Brethren Village to funeral directors as necessary to carry out their duties.

National Security and Intelligence Activities: We will release health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Your authorization is required for all other used 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 with permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. 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.

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 notify you of any changes. Updated notices will be available upon request. We will post a copy of the current notice in our facility. The effective date of the notice will be displayed on the top right-hand corner of the first page of the notice.

For more information or to file a complaint:
If you have questions and would like additional information or if you believe your privacy rights have been violated, you may file a complaint with Brethren Village or with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing.

To file a complaint with Brethren Village:
Brethren Village Privacy Officer
Brethren Village
P.O. Box 5093
Lancaster, PA 17606-5093
717-581-4210
Contact Us

To file a complaint with the Department of Health and Human Services:
Secretary of the Department of Health and Human Services
Health and Welfare Bldg, Room 802
Harrisburg, PA 17120

You will not be penalized for filing a complaint.