Ybor Cityhealthcare & Rehabilitation Center

Ybor CityHealthcare & Rehabilitation Center

1709 Taliaferro Avenue

Tampa, FL 33602

(813) 223-4623

Notice of Privacy Practices

YourInformation. YourRights.

OurResponsibilities.

Thisnoticedescribeshowmedical informationabout youmaybeused anddisclosedandhowyoucanget accesstothisinformation.

Please reviewitcarefully.

YourRights

Whenitcomestoyourhealthinformation,youhave certainrights.Thissectionexplainsyourrightsandsomeofourresponsibilitiestohelpyou.
Geta copyofyour medical record / •Youcanasktoseeorgetacopyofyourmedicalrecord andotherhealthinformationwehaveabout you.Askushowtodothis. Your copy may be electronic only if we maintain the records in electronic form.
•Wewillprovideacopyorasummaryofyourhealthinformation,usually within30daysofyourrequest. Wemaychargeareasonable,cost-basedfee.
Askustocorrectyour medical record / •Youcanaskustocorrecthealthinformationabout youthatyouthinkis incorrectorincomplete. Askushowtodothis.
•Wemaysay“no”toyourrequest, butwe’lltellyouwhyin
writingwithin60days.
Requestconfidential communications / •Youcanaskustocontact youinaspecificway(forexample,home oroffice phone) ortosendmailtoadifferentaddress.
•Wewillsay“yes”toallreasonablerequests.

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YourRightscontinued

NoticeofPrivacyPractices •Page1

YourChoices

Forcertainhealthinformation,youcantellusyourchoicesaboutwhatwe share. Ifyou haveaclearpreferenceforhowweshareyourinformation inthesituationsdescribedbelow,talktous.Tell uswhatyouwantustodo,andwewillfollowyourinstructions.

YourChoices

Inthesecases, youhave both therightandchoice totellusto:

•Shareinformationwithyourfamily,closefriends,orothersinvolvedin yourcare

•Shareinformation inadisasterreliefsituation

•Includeyourinformation inahospitaldirectory

•Contact youforfundraisingefforts

Ifyouarenotabletotellusyourpreference,forexampleifyou areunconscious,wemaygoaheadandshareyourinformationifwebelieveitis inyourbestinterest.Wemayalsoshareyourinformationwhenneededto lessenaseriousandimminentthreattohealthorsafety.

YourChoices

Inthesecases we nevershareyourinformation unless yougive us writtenpermission:

•Marketingpurposes

•Saleofyourinformation

•Mostsharingofpsychotherapy notes

YourChoices

Inthecaseoffundraising: •Wemaycontact youforfundraisingefforts,butyoucan

tellusnotto contact youagain.

OurUses andDisclosures

YourChoices

•We can useandshareyourhealth

informationtobillandgetpayment

fromhealthplansor otherentities.

Example: Wegive information aboutyoutoyourhealthinsurance plansoitwillpayforyourservices.

Howelse canwe useorshareyourhealthinformation?Weareallowedorrequiredtoshareyourinformationinotherways–usuallyinwaysthatcontributetothepublicgood, suchaspublichealthand research. Wehavetomeetmanyconditionsinthelawbeforewecanshareyourinformationforthesepurposes. Formoreinformationsee:
Helpwith publichealth andsafetyissues / •Wecansharehealthinformationabout youforcertainsituationssuchas:
•Preventingdisease
•Helpingwithproduct recalls
•Reportingadversereactionstomedications
•Reportingsuspectedabuse, neglect, ordomesticviolence
•Preventingorreducing aseriousthreat toanyone’shealthorsafety
Doresearch / •Wecanuseorshareyourinformation forhealthresearch.
Complywith thelaw / •Wewillshareinformation about youifstateorfederallawsrequireit, includingwiththeDepartmentofHealthandHumanServicesifitwantsto seethat we’recomplyingwithfederalprivacylaw.
Respondtoorgan and tissuedonationrequests / •Wecansharehealthinformation about youwithorganprocurement organizations.
Workwithamedical examinerorfuneral director / •Wecansharehealth information withacoroner, medicalexaminer,or funeraldirectorwhen anindividualdies.
Address workers’ compensation,law enforcement,andother governmentrequests / •Wecanuseorsharehealthinformationabout you:
•Forworkers’compensationclaims
•Forlawenforcementpurposes orwithalawenforcementofficial
•Withhealthoversightagenciesforactivitiesauthorizedbylaw
•Forspecialgovernmentfunctions suchasmilitary,national security, andpresidentialprotectiveservices
Respond tolawsuitsand legal actions / •Wecansharehealthinformation about youinresponse toa
courtor administrative order,orinresponse toasubpoena.

Other uses and disclosures

Business Associates - We may share your information with third parties, called "business associates," that may need the information to perform certain services on our behalf. Our business associates may create, receive, maintain or transmit your information on our behalf in order for the business associate to provided services to us, or for the proper management and administration of the business associate. Business associates must protect any health information they receive from, or create and maintain on behalf of, the facility. In addition, business associates may re-disclose your health information to business associates that are subcontractors in order for the subcontractors to provide services to the business associate. The subcontractors will be subject to the same restrictions and conditions that apply to the business associate. Whenever such an arrangement involves the use or disclosure of your information, we will have a written contract that contains terms designed to protect the privacy of your information.
De-identified information - We may use or disclose your health information to create de-identified information, and may use and disclose such information as permitted by law.

Our Responsibilities

Wearerequiredbylawtomaintaintheprivacyandsecurityofyourprotectedhealth

information.

•Wewillletyouknowpromptlyifabreachoccursthatmayhavecompromisedtheprivacyorsecurityof yourinformation.

•Wemustfollowthedutiesandprivacypracticesdescribedinthisnoticeandgive

youacopyofit.

•Wewillnotuseorshareyourinformation other than asdescribedhereunlessyoutelluswecanin writing.Ifyoutelluswecan,youmaychange yourmindatanytime.Letusknowinwritingifyou change yourmind.

•If more stringent laws apply, they will be included in an addendum to this Notice.

•We will comply with state law. We will obtain your written consent for certain disclosures if your consent is required under state law.

Formoreinformationsee:

ChangestotheTermsofThisNotice

Wecanchange thetermsofthisnotice,andthechanges willapplytoallinformationwehaveabout you.The newnoticewillbeavailableuponrequest, inourFront Lobby,andonourwebsite.

The effective date of this Notice is February 7, 2014.

ThisNotice ofPrivacyPracticesapplies tothefollowingorganizations:

Ybor City Healthcare & Rehabilitation Centerand providers, staff, contractors and

volunteers serving at the nursing home as part of the organized health care arrangement.

__Risk Manager (813) 223-4623

Privacy OfficialEmail address phone number