Privacy Policy

ACTS RETIREMENT-LIFE COMMUNITIES,® INC. (ACTS*)

Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSEDAND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

“Protected health information,” (PHI) is defined as individually identifiable health information that is transmitted by or maintained in electronic media or any other form or medium. It is information that is created or received by ACTS and relates to the past, present, or future physical or mental health or condition of an individual, the provision of health care,or the payment for the provision of health care that either identifies or has the potential of identifying the individual.

ACTS respects the privacy of your protected health information and is committed to keeping this information confidential. This Notice applies to information and records related to your care that ACTS has received or created. It extends to information received or created by ACTS’ workforce, including employees, volunteers, and those whose conduct is under ACTS’ direct control. This Notice informs you about possible uses and disclosures of your protected health information. It also describes your rights and our obligations regarding your protected health information.

ACTS is required by law to:

• maintain the privacy of your protected health information;
• provide to you this detailed Notice of our legal duties and privacy practices relating to your protected health information; and
• abide by the terms of the Notice that are currently in effect.

I. USE AND DISCLOSURE FOR PAYMENT, TREATMENT, AND HEALTH CARE OPERATIONS

ACTS may use and disclose your protected health information for purposes of payment, treatment, and health care operations. We have described these uses and disclosures below and provide examples of the types of uses and disclosures we may make in each of these categories.

For Payment. We may use and disclose your protected health information so that we can bill and receive payment for the treatment and services you receive at ACTS. For billing and payment purposes, we may disclose your protected health information to your representative, an insurance or managed care company, Medicare, Medicaid or a third party payor. For example, we may contact Medicare to confirm your coverage or request approval for a proposed treatment.
For Treatment. We will use and disclose your protected health information in providing you with treatment and services. We may disclose your protected health information to ACTS and non-ACTS personnel who may be involved in your care, such as physicians, nurses, nurse aides, hospice staff, consultants, and therapists. For example, a nurse caring for you will report any change in your condition to your physician. We also may disclose protected health information to individuals who will be involved in your care after you leave ACTS.
For Health Care Operations. We may use and disclose your protected health information for ACTS operations. These uses and disclosures are necessary to manage ACTS and to monitor our quality of care. For example, we may use protected health information to evaluate ACTS’ services, including the performance of our staff.

II. USE AND DISCLOSURE FOR OTHER SPECIFIC PURPOSES

ACTS Directory. Unless you object, we will include certain limited information about you in ACTS’ directory. This information may include your name, your location in ACTS (e.g. apartment or health care room), your general condition (e.g. “...is improving...”) 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 a member(s) of the clergy.
Individuals Involved in Your Care or Payment for Your Care. Unless you object, we may disclose your protected health information to a family member, other relative, or close personal friend who is involved in your care. If you are present and have the capacity to make health care decisions, ACTS may use or disclose this information to notify these individuals of your location, general condition, or death, as long as ACTS has obtained your agreement, given you an opportunity to object and you do not, or it is reasonable to infer from the circumstances that you do not object. If you are not present or are unable to agree or object due to incapacity or an emergency situation, ACTS may exercise its professional judgment to determine whether disclosure of information relevant to the individual’s involvement in your care is in your best interests.
Business Associates. We may disclose your protected health information to a business associate who provides certain functions or services for us that involves the use and/or disclosure of PHI and with whom we have a contractual relationship to do so. Examples are those who provide legal, accounting, or consulting services.
Disaster Relief. We may disclose your protected health information to assist in a disaster relief effort.
As Required By Law. We will disclose your protected health information when required by law to do so.
Public Health Activities. We may disclose your protected health information for public health activities. These activities may include, for example:

• reporting to a public health or other government authority for preventing or controlling disease, injury or disability, or reporting child abuse or neglect;
• reporting to the federal Food and Drug Administration (FDA) concerning adverse events or problems with products for tracking products in certain circumstances, to enable product recalls or to comply with other FDA requirements;
• to notify a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition, or
• for certain purposes involving workplace illness or injuries.

Reporting Victims of Abuse, Neglect or Domestic Violence. If we believe that you have been a victim of abuse,neglect or domestic violence, we may use and disclose your protected health information to notify a government authority if required, authorized by law, or if you agree.
Health Oversight Activities. We may disclose your protected health information to a health oversight agency for oversight activities authorized by law. These may include, for example, audits, investigations, inspections and licensure actions or other legal proceedings. These activities are necessary for government oversight of the health care system,government payment or regulatory programs, and compliance with civil rights laws.
Judicial and Administrative Proceedings. We may disclose your protected health information that is expressly authorized by a court or administrative order. We may disclose your protected health information in response to a subpoena, discovery request, or other lawful process that is not accompanied by an order of a court or administrative tribunal if ACTS has satisfactory assurance that you have been given notice of the request or to obtain an order or agreement protecting the information.
Law Enforcement. We may disclose your protected health information for certain law enforcement purposes, including:

• as required by law to comply with reporting requirements;
• to comply with a court order, warrant, subpoena, summons, investigative demand or similar legal process;
• to identify or locate a suspect, fugitive, material witness, or missing person (limited to certain categories ofPHI);
• when information is requested about the victim of a crime if the individual agrees or under other limitedcircumstances;
• to report information about a suspicious death;
• to provide information about criminal conduct occurring at ACTS;
• to report information in emergency circumstances about a crime; or
• where necessary to identify or apprehend an individual relevant to a violent crime or escape from lawful custody.

Research. We may allow protected health information to be used or disclosed for research purposes provided that the researcher adheres to certain privacy protections. Your protected health information may be used for research purposes only if the privacy aspects of the research have been reviewed and approved by a special Privacy Board or Institutional Review Board, if the researcher is collecting information in preparing a research proposal, if the research occurs after your death, or if you authorize the use or disclosure.
Coroners, Medical Examiners, Funeral Directors, Organ Procurement Organizations. We may disclose your protected health information to a coroner, medical examiner, funeral director or, if you are an organ donor, to an organization involved in the donation of organs and tissue.
To Avert a Serious Threat to Health or Safety. We may use and disclose your protected health information when ACTS believes in good faith that the disclosure is necessary to prevent a serious threat to your health or safety or the health or safety of the public or another person. However, any disclosure would be made only to someone ACTS, in good faith, reasonably believes is able to help prevent or lessen the threat.
Military and Veterans. If you are a member of the armed forces, we may use and disclose your protected health information as required by military command authorities. We may also use and disclose protected health information about foreign military personnel as required by the appropriate foreign military authority.
Workers’ Compensation. We may use or disclose your protected health information to comply with laws relating to workers’ compensation or similar programs.
National Security and Intelligence Activities: Protective Services for the President and Others. We may disclose protected health information to authorized federal officials conducting national security and intelligence activities or as needed to provide protection to the President of the United States, certain other persons or foreign heads of states or to conduct special investigations.
Fundraising Activities. We may use certain protected health information to contact you in an effort to raise money for ACTS and its operations. You may choose to opt out of receiving this information by so informing your executive director or administrator. We may also disclose demographic information and dates of health care to a business associate or foundation related to ACTS so that the foundation may contact you to raise money for ACTS.
Appointment Reminders. We may use or disclose protected health information to remind you about appointments. If you are not at home, we may leave a message.
Treatment Alternatives. We may use or disclose protected health information to inform you about treatment alternatives that may be of interest to you.
Health-Related Benefits and Services. We may use or disclose protected health information to inform you about health-related benefits and services that may be of interest to you.

III. AUTHORIZATION REQUIRED FOR OTHER USES OR DISCLOSURES

We will use and disclose protected health information (other than as described in this Notice or required by law) only with your written Authorization. You may revoke your Authorization to use or disclose protected health information in writing, at any time. If you revoke your Authorization, we will no longer use or disclose your protected health information for the purposes covered by the Authorization, except where we have already relied on the Authorization.

IV. YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION

You have the following rights regarding your protected health information at ACTS:
Right to Request Restrictions. You have the right to request restrictions in writing on our use or disclosure of your protected health information for payment, treatment, or health care operations. You also have the right to restrict the protected health information we disclose about you to a family member, friend, or other person who is involved in your care or the payment for your care.

(For skilled care center residents: We are required to agree to your requested written restriction unless you are being transferred to another health care institution, the release of records is required by law, or the release of information is needed to provide you emergency treatment.)

We are not required to agree to your requested restriction (except that while you are competent you may restrictdisclosures to family members or friends.). If we do agree to accept your requested restriction, we will comply with your request except as needed to provide you emergency treatment.

Right of Access to Protected Health Information. You have the right to inspect and obtain a copy of your medical or billing records or other written information that may be used to make decisions about your care, subject to limited exceptions such as psychotherapy notes or information compiled in anticipation of litigation.

Your request for access must be made in writing and must be submitted to the executive director or administrator on a form that is available in the office of both individuals. We may charge a reasonable fee for our costs in copying and mailing your requested information.

(For skilled care center residents: You have the right to request, either orally or in writing, your medical or billing records or other written information that may be used to make decisions about your care. We must allow you to inspect your records within 24 hours of your request. If you request copies of the records, we must provide you with copies within 2 business days of that request. We may charge a reasonable fee for our costs in copying and mailing your requested information.)

We may deny your request to inspect or receive copies in certain limited circumstances. Access may be denied, for instance, to protect the confidentiality of another individual, to safeguard information covered by the Privacy Act, or in other circumstances outlined by the Privacy Rule. If you are denied access to protected health information, in some cases you will have a right to request review of the denial, such as those that are based upon endangerment to an other individual or those involving a reference to another individual. This review would be performed by a licensed healthcare professional designated by ACTS who did not participate in the decision to deny your initial request.

Right to Request Amendment. You have the right to request ACTS to amend any protected health information maintained by ACTS for as long as the information is kept by or for ACTS. You must make your request in writing and must state the reason for the requested amendment. We may deny your request for amendment if the information:

• was not created by ACTS, unless the originator of the information is no longer available;
• is not a part of the designated record set (e.g. medical, billing, or other records) maintained by or for ACTS;
• is not a part of the information to which you have a right of access; or
• is already accurate and complete, as determined by ACTS.

If we deny your request for amendment, we will give you a written denial including the reason for the denial and the right to submit a written statement disagreeing with the denial.

Right to an Accounting of Disclosures. You have the right to request an “accounting” of our disclosures of your protected health information. This is a listing of certain disclosures of your protected health information made by ACTS or by others on our behalf, but does not include disclosures for payment, treatment, and health care operations or certain other exceptions.

To request an accounting of disclosures, you must submit a request in writing, stating a time period beginning after April 14, 2003 that is within six years from the date of your request. An accounting will include, if requested: the disclosure date; the name of the person or entity that received the information and address, if known; a brief description of the information disclosed; a brief statement of the purpose of the disclosure or certain summary information concerning multiple similar disclosures. The first accounting provided within a 12-month period will be free; for further requests, we may charge you our costs.

Right to a Paper Copy of This Notice. You have the right to obtain a paper copy of this Notice, even if you have agreed to receive this Notice electronically. You may request a copy of this Notice at any time. You may obtain a copy of this Notice at our website: www.actsretirement.com.
Right to Request Confidential Communications. You have the right to request that we communicate with you concerning protected health information in a certain manner or at a certain location. For example, you can request that we contact you only at a certain phone number. We will accommodate your reasonable requests.

V. COMPLAINTS

If you believe that your privacy rights have been violated, you may file a complaint in writing with ACTS via your executive director or administrator who will forward your complaint to Elsie S. Norton, SVP, ACTS Retirement-Life Communities,® Inc., 7700 W. Camino Real Blvd., Suite 300, Boca Raton, Florida, 33433. You also have the right to file a complaint with the Director, Office of Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue, S. W., Room 509F, HHH Building, Washington, D.C. 20201. We will not retaliate against you if you file a complaint.

VI. CHANGES TO THIS NOTICE

We will promptly revise and distribute this Notice whenever there is a material change to the uses or disclosures, your individual rights, our legal duties, or other privacy practices stated in this Notice. We reserve the right to change this Notice and to make the revised or new Notice provisions effective for all protected health information already received and maintained by ACTS as well as for all protected health information we receive in the future. We will post a copy of the current Notice in all ACTS locations, to include ACTS retirement-life communities, home health agencies, and corporate and regional offices. In addition, we will provide a copy of the revised Notice to all individuals upon request. Please make your request for a copy of this Notice to your executive director or administrator.

VII. FOR FURTHER INFORMATION

If you have any questions about this Notice or would like further information concerning your privacy rights, please contact your executive director or administrator. *”ACTS” is defined as ACTS Retirement-Life Communities,® Inc. and its affiliated entities.