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HOLY FAMILY MANOR
OUR POLICY REGARDING YOUR PRIVACY
In order to provide the health care services that meet our residents' diverse needs, Holy Family Manor collects certain personal information. Holy
Family Manor, Inc. does not disclose any nonpublic personal information to any affiliated or nonaffiliated third party for non-patient care related purposes. At Holy Family Manor, maintaining the confidentiality of
our residents' personal information is of the highest importance. Our personal information-handling practices are governed by this privacy policy and are further regulated by law. This notice describes those
practices and how they preserve your privacy in a way that permits us to provide you with the services you demand and require.
Collection of Personal Information
We get most of our information
directly from you. The application you complete, as well as any additional information you provide, generally gives us most of the information we need to know. Sometimes we may contact you in person, by phone or
mail to obtain additional information. Depending on the nature of your needs, we may require additional information about you or from other potential sources such as Social Security Administration records, loss
information reports, credit reports, court records or other public records. For financial assistance, we may send someone to inspect your property and verify information about its value and condition, and a photo of
the property may be taken.
We also may obtain information from third parties such as your physician or health care provider agencies. A report from such an agency assists us in determining the most
appropriate nursing care and care plan for your health needs. Certain reports will require your permission and appropriate release requests will be forwarded to you for signature by our staff. The agency preparing a
report for us may keep the information collected about you as permitted by law, but may not be disclosed to any other health care providers without your permission.
Disclosure of Personal Information
Information which has been collected about you will be contained in either our business office resident transaction records or in your medical record files. We review it in evaluating payment for service options
and for your care needs. We will also use information in our business office transaction records for purposes related to issuing and servicing insurance claims and settling outstanding balances. Holy Family Manor
may disclose personal information to others in order to service, process or administer business such as collection and claims operations. In this context, Holy Family Manor may disclose (i) information we receive
from you on applications and other forms, including information such as assets, income, and identifying information such as name, address and social security number; (ii) transaction information such as information
about balances, payment history and parties to the transaction; and (iii) information from you regarding power of attorney, guardian and or next of kin.
Parties to Whom Information May be Disclosed
Holy Family Manor will not disclose information about you to others without your written consent
unless the disclosure is necessary to conduct our business. By law, Holy Family Manor is permitted to share information about you without prior permission under certain circumstances to certain persons and
organization.
- Law enforcement or other governmental authorities to protect our legal interest, or in cases of suspected fraud or illegal activities,
- Authorized persons as ordered by subpoena, warrant or other court order or as required by law,
- Lien holder, mortgage, assignee, lessor, or other person shown on our records or our agent's as having a legal or beneficial interest in a policy of insurance,
- Parties acting in a fiduciary or representative capacity to you (attorneys, accountants and auditors),
- Parties enforcing Holy Family Manor, Inc. rights in connection with the settlement of a debt, the transfer of interests or an audit,
- Parties administering transaction as requested or authorized by you.
Right of Access to Personal Information
You have the right to know what kind of information we keep in our files about you, to have reasonable
access to it and to receive a copy. Notify us regarding any questions you have about the information. Provide your complete name, address, and resident number that were issued with us. Send of mail your request to:
Privacy Administrator, c/o Holy Family Manor, 1200 Spring Street, Bethlehem, PA. 18018.
Within thirty (30) days of receipt of your request, we will inform you in writing of the nature and substance of
retrievable recorded personal information about you in our files. You may review this information in person or receive a copy by mail. We will also identify the person or organization to which we have disclosed this
information. In addition, you will be given the name and address of any third party and health care provider agency, which prepared a report about you so that you can contact them for a copy.
After you have
reviewed the personal information about you in our file, you can write to us if you believe it should be corrected, amended or deleted. We will consider your request, and within thirty (30) days either change the
information or tell you that we did not and state the reason. If we do not make changes, you will have the right to insert in our file a concise statement containing what you believe to be the correct, relevant or
fair information, and explaining which information on file you believe to be improper. We will notify persons designated by you to whom we have previously disclosed the information of the change or your statement.
Subsequent disclosures we make also will include your statement.
Confidentiality and Security of Personal Information
Our company maintains appropriate standards and procedures to prevent
unauthorized access to your information. Holy Family Manor limits employee access to personally identifiable information to those with a health are or business reason for knowing such information. We educate our
employees so that they will understand the importance of confidentiality of personal information and take appropriate measures to enforce privacy responsibilities.
COMPLAINTS
If you believe that
your Privacy Rights are being violated or that our facility is not doing something it is required by law to do to protect your Privacy Rights, you can file a Complaint with our Privacy Officer (see Contact
Information below) and you can also file a Complaint with the Secretary of the U.S. Department of Health and Human Services and the Office for Civil Rights, which can be contacted at:
Region III Office for Civil Rights
U.S. Department of Health and Human Services 150 South Independence Mall West, Suite 372 Public Ledger Building
Philadelphia, PA 19106-9111
Complaints to the Secretary or
the Office for Civil Rights must: identify the facility where you have the problem; give some information about the problem; be in writing (which includes a fax or e-mail), and usually must be filed within 180 days
of when you knew or should have known about the problem (the Secretary can extend the time for good reasons).
You can obtain additional information about handling or filing a Complaint from our Privacy
Officer.
CONTACT: If you have any questions about this Notice, need more information about your Privacy Rights, or have a complaint that your Privacy Rights may have been violated, you can contact: Privacy
Officer, at_or at [his/her] office in the facility located
Effective: 04/01/2003
FREE COPIES AND REVISIONS:
Copies of this Notice are available free at the Reception Desk for you, your family, on anyone else, to have upon request. Copies of this Notice are also
posted at the Reception Desk, outside the Administrator's Office, and on the Residents' bulletin board (s) in the facility.
If this Notice is revised, a free copy of the revised Notice will be provided to each
resident, free copies will be available at the Reception Desk, and copies of the revised Notice will be posted in the facility. Copies of this Notice and all revisions are retained by the facility in the
Administrator's Office for a period of six (6) years from the date each was last in effect.
Treatment of Personal Information of Former Customers
Holy Family Manor follows this personal information privacy
policy even when a resident relationship no longer exists.
If you have any additional questions about the privacy of your personal information or about your needs in general, please contact the admissions office.
Effective: 04/01/2003
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