HIPPA 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.
Protected Health Information (“PHI”) includes in general terms individually identifiable health information that is transmitted by electronic media, maintained in electronic media, or transmitted or maintained in any other form or medium. Individually identifiable health information includes demographic information like your name, date of birth, address and social security number, as well as any other information that may identify you and that relates to your past, present or future mental or physical health conditions or treatment.
Our company, its owners, managers, employees, representatives, agents and contractors (collectively “LifeWell Senior Living, L.L.C.”), will possess, store, use, disclose and transmit your PHI. However, LifeWell Senior Living, L.L.C.’s authority to use and disclose your PHI is heavily regulated. Your PHI may not be used or disclosed except as permitted or required by law. For example, LifeWell Senior Living, L.L.C. may use and disclose your PHI for treatment, payment, health care operations. LifeWell Senior Living, L.L.C. is also allowed to use and disclose your PHI without your authorization under limited circumstances. This Notice of Privacy Practices describes how LifeWell Senior Living, L.L.C. may use and disclose your PHI and how you can access and control this information. LifeWell Senior Living, L.L.C. must abide by the terms of this Notice. If LifeWell Senior Living, L.L.C. makes changes or amendments to this Notice it will promptly distribute a copy of the amended Notice to you. Changes or amendments will not be implemented prior to the effective date of the amended Notice.
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
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 resident directory
- Provide 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
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. A form will be provided to you upon request to request your records.
- Texas law specifies that if LifeWell Senior Living, L.L.C. is using an electronic health record system capable of fulfilling the request, the records must be provided to you in electronic form unless you have agreed to accept the records in another form. We will provide a copy or a summary of your health information, within 15 business days after LifeWell Senior Living, L.L.C. receives the written request. We may charge a reasonable, cost-based fee if you request copies and mailing but may not charge a retrieval fee.
- Individual Authorization Required: Pursuant to Texas law, except when disclosure is made to another covered entity for the purpose of treatment, payment, health care operations; or performing an insurance or health maintenance organization function, or as otherwise authorized or required by state or federal law, we cannot electronically disclose your medical records or health information to any person without a separate authorization from you or your legally authorized representative for each disclosure. You may give this authorization in written or electronic form or in oral form if it is documented in writing by us.
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.
- You have the right to submit a statement of disagreement that LifeWell Senior Living, L.L.C. must add to your record.
Request confidential communications
- You can ask us to contact you in a specific way (for example, home or office 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 are not 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 why.
- 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 medical power of attorney 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:
LifeWell Senior Living, L.L.C.
ATTN: Corporate Compliance
675 Bering Drive, Suite 550
Houston, TX 77057
- Under the Texas Medical Records Privacy Act, consumers have the right to file a complaint with the state agencies that regulate covered entities as well as with the Texas Attorney General. The Texas Department of Aging and Disability Services (DADS) regulates assisted living communities in Texas and can be contacted at:
- 7 a.m. to 7 p.m. Monday thru Friday
- Email: email@example.com
- Fax: (512) 438-2724
- Mail complaints to:
Consumer Rights and Services-Complaint Intake
P.O. Box 149030
Austin, TX 78714-9030
- To file an electronic consumer complaint with the Office of the Texas Attorney General, contact https://www.texasattorneygeneral.gov/forms/cpd/form.php
TEXAS BOARD OF NURSING
Type of Covered Entity
- Advanced Nurse Practitioners
- Registered Nurses
- Licensed Vocational Nurses
Agency Contact Information and Complaint Procedure
Complaints must be in writing using a Board approved complaint form is preferred. Complaint form may be obtained by:
- downloading from www.bon.texas.gov/about/complaint.html or
- calling (512) 305-6838 or (800) 821-3205.
Completed complaints may be submitted by faxing or mailing:
Texas Board of Nursing-Enforcement
333 Guadalupe Street, Suite 3-460
Austin, Texas 78701
Fax: (512) 305-6879
TEXAS STATE BOARD OF PHARMACY
Type of Covered Entity
- Pharmacy Technicians
Agency Contact Information and Complaint Procedure
- All complaints must be in writing and a complaint form is provided by the Board. The form can be accessed (for printing and mailing) or for electronic submission at:
www.tsbp.state.tx.us/consumer/complaint.htm Complaints may also be obtained by calling 800-821-3205 or in Austin 305-8080 (recording only).
- If not submitted electronically, complaints can be mailed to the Board at:
Texas State Board of Pharmacy
William P. Hobby Building, Suite 3-600
333 Guadalupe Street, Box 21
Austin, Texas 78701-3942
If you believe your protected health information has been used or disclosed in violation of HIPAA, you have the right to complain to the federal Office of Civil Rights which has authority to investigate complaints against HIPAA covered entities and their business associates:
- Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Room 509F; HHH Bldg.
Washington, D.C. 20201
Or visit www.hhs.gov/ocr/privacy/hipaa/complaints/
- Region VI – Dallas (Arkansas, Louisiana, New Mexico, Oklahoma, Texas)
Ralph Rouse, Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
1301 Young Street, Suite 1169
Dallas, TX 75202
Voice Phone (214) 767-4056
FAX (214) 767-0432
TDD (214) 767-8940
- In December 2013, the Texas Attorney General will prepare and file a report of all complaints received by the OAG and state agencies pursuant to the Texas Medical Records Privacy Act. That report will be made available at this webpage. Also, as required by Section 181.154(d) of the Act, the Attorney General adopted a standard Authorization to Disclose Protected Health Information form and it is available here.
- We will not retaliate against you for filing a complaint.
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 hospital directory
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.
In these cases, we never share your information 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.
We can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for a disease 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. For more information, see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
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
We can use and disclose your information if we attempt to obtain consent from you but we are unable to do so due to substantial communication barriers and we determine, using professional judgment, that you intend to consent to use or disclose under the circumstance.
We can use or share your information for health research.
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 law.
Respond to organ and tissue donation requests
We can share health information about you with organ procurement organizations.
Work with a medical examiner or funeral director
We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law enforcement, and other government requests
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 services
Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena.
Required Disclosure of PHI
LifeWell Senior Living, L.L.C. is required to disclose your PHI to you (or your personal representatives) if you specifically request access to your protected health information. This means that if you ask LifeWell Senior Living, L.L.C. for a copy of your records, in electronic or paper form, for any purpose, LifeWell Senior Living, L.L.C. must give it to you. However, LifeWell Senior Living, L.L.C. is allowed to charge a reasonable fee for the administrative cost of reproducing the information, within certain limits.
LifeWell Senior Living, L.L.C. is also required to disclose your PHI upon request by the U.S. Department of Health and Human Services (“HHS”) when it is undertaking a compliance investigation or review, or enforcement action. For example, if HHS or any of its contractors asks to review your PHI to determine if LifeWell Senior Living, L.L.C. offered to you the care for which it has billed, LifeWell Senior Living, has to disclose your PHI. Disclosure will be limited to the specific information requested. LifeWell Senior Living, L.L.C. will notify you of any request from HHS or any of its contractors, for use or disclosure of your PHI.
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- 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 writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information, see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.
Other Instructions for Notice
- Effective Date of this Notice: January 2016
- The Privacy Official at your site is the Executive Director, please contact the main number of your local office to contact them. You can contact LifeWell Senior Living, L.L.C. Corporate 24 hours a day/7 days a week with any violations of your rights at (713) 255-3500.
- We never market or sell personal information.