Lucy Corr Village is providing this Notice of Privacy Practices to you in compliance with federal regulations and because the privacy of your health information is important to you and to us. By “your health information,” we mean the information that we maintain that specifically identifies you and your health status. If you have questions about this Notice, please contact our Privacy Officer:
Lucy Corr Village
Attn: Privacy Officer
P.O. Drawer 170
6800 Lucy Corr Boulevard
Chesterfield, VA 23832
(804) 748-1511 (phone)
(804) 796-6285 (fax)

Who will adhere to this Notice: This Notice describes practices towards the privacy of information, and that of:

• Any health care professional authorized to enter information into your Lucy Corr Village records.
• Any member of a volunteer group we allow to help you.
• All departments of Lucy Corr Village.
• All employees, staff and contractors or affiliates of LCV.
• Any healthcare provider requiring medical information for the purpose of treatment, payment or LCV operation purposes as described in this notice Lucy Corr Village includes all domains, which fall under the governance of the Chesterfield County Health Center Commission doing business as “Lucy Corr Village.”

This includes but is not limited to the adult day care, assisted living, clinic, rehabilitation center, special care center, health care center (nursing care) departments, units and areas. All of these departments, units and areas will follow the terms of this Notice. Additionally, these departments, units and areas may share your health information with each other for the treatment, payment, or health care operations and other purposes described in this Notice. OUR PLEDGE:

We understand that information about you and your health is personal.  We are committed to protecting your health information. We create a record of the care and services you receive at Lucy Corr Village.  We need this record to provide you with quality care and to comply with certain legal requirements.  This Notice applies to all of the records of your care generated by Lucy Corr Village, whether made by our staff or your personal physician.  Your personal physician may have different policies or notices regarding the use and disclosure of your health information created in the physician’s office or clinic.

This Notice will tell you about the ways in which we may use and disclose your health information.  We also describe your rights and certain obligations we have regarding the use and disclosure of your health information.  We are required by law to:

• make sure that your health information is kept private;
• give you this Notice of our legal duties and privacy practices concerning your health information; and
• follow the terms of the Notice that is currently in effect.

We reserve the right to change this Notice at any time and to make the revised or changed Notice effective for health information we already have about you as well as any information we receive about you in the future.  Should we revise or change our Notice, we will post a copy of the new or revised Notice in our main lobby.  The notice will indicate the effective date in the top right hand corner of the first page.  You may obtain a copy of our current Notice from our Privacy Officer. 

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

The following describes different ways that we use and disclose health information. For each category below, we explain what we mean and try to give some examples. Not every use or disclosure is listed.  However, all of the ways we are permitted to use and disclose information will fall into one of these categories.

Permitted Uses and Disclosures

For Treatment:  We may use your health information to give you medical treatment or services. We may disclose your health information to doctors, nurses, technicians, therapists, medical students, emergency personnel or others involved in your care at Lucy Corr Village.  For example, a doctor treating you for a broken hip may need to know if you have diabetes because diabetes may slow the healing process. The doctor also may need to tell the dietician if you have diabetes so that appropriate meals can be arranged.  We also may disclose your health information to people outside of Lucy Corr Village who may be involved in your medical care.  Examples of those type of disclosures are:  laboratory, xray and dialysis services or to family members, clergy, home health agencies or other facilities or individuals who provide services that are part of your continuity of care even after you are discharged from LCV.

For Payment:  We may use or disclose your health information so that treatment and services you receive at Lucy Corr Village may be billed for, and payment may be collected from you, an insurance company, or a third party.  For example, we may need to give you’re the company with which you have health insurance information about the services you received from Lucy Corr Village so they will pay us for those services or reimburse you for those services.  Secondly, we may 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 may also give information about you to someone who helps pay for your care.

For Health Care Operations:  We may use or disclose your health information as necessary to operate Lucy Corr Village and make sure all of our residents receive quality care.  For example, we may take your photograph for medication identification purposes or use your health information to review the care and services you are receiving or evaluate the performance of our staff in caring for you.  We may disclose your health information to our staff (nurses, nursing assistants, physicians, staff consultants, therapists, etc.) for auditing, care planning, treatment, and learning purposes.  We may combine medical information about many residents to decide if additional services should be offered, what services are not needed and whether certain services are effective.  We may also combine your health information with information from other health care providers to study how Lucy Corr Village does in comparison to other communities or what we can do to improve the care and services we provide.  When information is combined, we may remove information that would identify you from this set of health information so that others may use the information to study health care or the delivery of health care services without learning your identity.

Fundraising Activities:  We may use a limited amount of your health information when raising money for Lucy Corr Village and its operations.  We may also disclose this information to Lucy Corr Foundation, Inc. so that the foundation may contact you to raise money on our behalf. This information will be limited to your name, address, telephone number, and dates for which you received treatment or services here.  If you do not wish to be contacted for these fundraising purposes or have this information provided to the foundation, you must notify our Privacy Officer in writing at the address at the beginning of this Notice.

Appointment Reminders:  We may use and disclose your health information to contact you as a reminder that you have an appointment for treatment or medical care.

Medical Appointments:  We may use and disclose medical information to make medical appointments for you such as dialysis, eye doctors or to see a medical specialist.

Treatment Alternatives:  We may use and disclose your health information to tell you about or recommend possible treatment options or alternatives .

Health-related Benefits and Services:  We may use and disclose your health information to tell you about health-related benefits or services.

Uses And Disclosures Requiring Your Written Authorization

In most cases, uses and disclosures of your health information beyond treatment, payment and operations require your written authorization, except as required or permitted by law.  You have the right to revoke an authorization at any time and stop our future uses or disclosures of your health information except to the extent that we already may have undertaken an action based on your authorization.  You understand that we are not able to retrieve any disclosures that may have been made by us prior to a revocation of your authorization.  Your revocation request must be in writing and sent to our Privacy Officer at the address at the beginning of this Notice.

Examples of uses or disclosures that would require your written authorization include, but are not limited to, the following:

• A request to provide your health information to an attorney for use in a civil litigation claim.
• A request to provide certain health information to an insurance or pharmaceutical facility for marketing purposes.

Uses Or Disclosures Requiring An Opportunity To Agree Or Object

In the following situations, we may disclose a limited amount of your health information if we inform you in advance and you do not object to such release or such release is not otherwise prohibited by law.  This document serves as that notice to you.

Information Used or Disclosed in Our Directory:  We may use or disclose your name, apartment or room number, and religious affiliation in a resident’s directory.  We may also disclose your religious affiliation to a member of the clergy even if they don’t ask for you by name.  Information concerning your general condition or room location may be provided to callers or visitors when they ask for you by name.  You may object to the release of this information.  If you object, please contact our Privacy Officer.  However, if there is an emergency situation and you are unable to object (because you were not present or you were incapacitated, etc.), this type of disclosure may be made if it is consistent with any prior expressed wishes and disclosure is determined to be in your best interest.  When a disclosure is made for this purpose in an emergency situation, you will be informed and given an opportunity to object to further disclosures of such information as soon as you are able to do so.

Information Disclosed to Family Members, Friends or Others Involved in Your Care: We may disclose to a friend or family member who is involved in your medical care that portion of your health information that is relevant to that person’s involvement in your care or payment for your care.  We may also inform your family or friends where you are located or of your general condition. In addition, we may disclose health information about you to entities assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.  You may object to the release of this information.  If you object, please contact our Privacy Officer. 

Uses And Disclosures Of Information That Do Not Require Your Authorization Or An Opportunity To Agree Or Object

State and federal laws and regulations either require or permit us to use or disclose your health information for certain purposes without your permission.  The uses or disclosures that we may make without your permission include the following:

When Required by Law:  We may disclose health information about you when required to do so by federal, state or local law, or in response to a court order or subpoena, such as:  when there is suspected abuse, neglect, or domestic violence, reporting adverse reactions to medications or injury from a health care product. 

For Public Health Activities for the Purpose of Preventing or Controlling Disease, Injury or Disability:  We may disclose your health information to the public health authority when we are required to collect information about diseases or injuries.  Examples of this are:

• To prevent or control disease, injury or disability.
• To report reactions to medications or problems with products.
• To notify people of recalls of products they may be using.
• To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
• To notify the appropriate government authority if we believe a resident has been the victim of abuse or neglect as required by law.

For Health Oversight Activities:  We may disclose your health information to a health oversight agency such as a protection and advocacy agency, the state agency responsible for inspecting our facility or to other agencies responsible for monitoring the health care system for such purposes as reporting or investigation of unusual incidents or to ensure that we are in compliance with applicable state and federal laws and regulations and civil rights issues.  Your medical information may also be reviewed by surveyors for the Joint Commission on Accreditation of Healthcare Organizations (JCAHO).

Lawsuits and Disputes:  If you are involved in a lawsuit or dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical 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.  We may also disclose medical information about you to our insurance carrier, in the event you are injured in any way on our premises.

To Coroners, Medical Examiners, Funeral Directors, Organ Procurement Organizations or Tissue Banks:  We may disclose your health information to a coroner or medical examiner for the purpose of identifying a deceased individual or to determine the cause of death.  We may also disclose your health information to a funeral director for the purposes of carrying out your wishes and/or for the funeral director to perform his/her necessary duties.  If you are an organ donor, we may disclose your health information to the organization that will handle your organ, eye or tissue donation for the purposes of facilitating your organ or tissue donation or transplantation.

For Research Purposes:  Under certain circumstances, we may disclose and use your health information for research purposes.  For example, a research project may involve comparing the health and recovery for all residents who receive one medication to those who received another, for the same condition.  All research projects are subject to a special approval process.  The process evaluates a proposed research project and its use of health information, trying to balance the research needs with the residents’ need for privacy of their health information.  Before we use or disclose your health information for research, the project will have been approved through the research approval process.  We may, however, disclose your health information to people preparing to conduct a research project, for example, to help them look for subjects with specific medical needs, as long as the health information they review does not leave Lucy Corr Village.  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.

To Avert a Serious Threat to Health or Safety:  We may disclose your health information to avoid a serious threat to your health or safety or to the health or safety of others. When such disclosure is necessary, information will only be released to those law enforcement agencies or individuals who have the ability or authority to prevent or lessen the threat of harm.

For Specific Government Functions:  We may disclose health information of military personnel and veterans, when requested by military command authorities, to authorized federal authorities for the purposes of intelligence, counterintelligence, and other national security activities (such as protection of the President), or to correctional institutions.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

You have the following rights regarding your health information, which we create and/or maintain about you:

Right To Inspect And Copy:  You have the right to inspect and copy health information that may be used to make decisions about your care.  Usually, this includes medical and billing records, but does not include psychotherapy notes.  To inspect and copy your health information that may be used to make decisions about you, you must submit your request in writing, to our Privacy Officer at the address at the beginning of this Notice.  We will respond appropriately, once we have that information.  If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.  We may deny your request to inspect and copy your health information in certain circumstances.  If you are denied access to your health information, you may request that the denial be reviewed.  Another licensed health care professional chosen by Lucy Corr Village will review your request and the denial. The person conducting the review will not be the person who denied your request.  We will comply with the outcome of the review.

Right To Request an Amendment:  If you feel that the health information we have about you is incorrect or incomplete, you may ask us to amend the information.  You have the right to request an amendment for as long as the information is kept by or for Lucy Corr Village. Your requests must be submitted in writing to our Privacy Officer at the address at the beginning of this Notice.  We will respond within sixty (60) days of receiving the written request.  You must provide a reason that supports your request.  If we approve your request, we will make such amendments or corrections and notify those with a need to know of such amendments or corrections.  We may deny your request for an amendment if it is not in writing or does not include a reason to support the request.  In addition, we may deny your request if:

• The information was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
• It is not a part of the health information kept by or for Lucy Corr Village;
• It is not part of the information which you would be permitted to inspect and copy; and/or
• The information is already accurate and complete.

Right To Request Restrictions:  You have the right to ask for limits on the health information we use or disclose about you for treatment, payment or healthcare operations.  You also have the right to request a limit on the health information we disclose about you to someone who is involved in the care or the payment for your care, like a family member or friend.  For example, you could ask that we not disclose information about a surgery you had.  In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use or disclosure, or both; and (3) to whom you want the limits to apply (for example, disclosures to your spouse, family or friends). You must submit your request in writing to our Privacy Officer at the address at the beginning of this Notice.

We are not required to agree to your restriction request.  However, should we agree, we will comply with your request not to release such information unless the information is needed to provide emergency care or treatment to you.

The Right To Request Confidential Communications:  You have the right to request that we communicate with you about medical matters in a certain way or at a certain location.  For example, you may ask that we only contact you in person or by mail.  To request confidential communications, please submit your request in writing to our Privacy Officer, at the address at the beginning of this Notice.  We will agree to all reasonable requests.  Your request must specify how or where you wish to be contacted.

The Right To Request An Accounting Of Disclosures Of Your Health Information:  You have the right to request an accounting of the disclosures we have made of your health information.  This accounting will not include any information we have made for the purposes of treatment, payment, or health care operations or information released to you, your family, or our directory, disclosures made for national security purposes, or any releases you authorized.  You must submit your request to our Privacy Officer at the address at the beginning of this Notice.  Your request must state a time period, which may not be longer than six years and may not include dates prior to April 14, 2003.  Your request should indicate in what form you want the list (for example, on paper, electronically, etc.).  The first list you request within a twelve-month period will be free.  For additional lists, we may charge you the cost of providing the list.  We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

The Right to Receive a Paper Copy of This Notice:  You have the right to receive a paper copy of this Notice at anytime.  If you would like a paper copy of this Notice, please contact our Privacy Officer.

How to File a Complaint About Our Privacy Practices:  If you have reason to believe that we have violated your privacy rights, violated our privacy policies and procedures, or you disagree with a decision we made concerning access to your health information, etc., you have the right to file a complaint with Lucy Corr Village’s Privacy Officer at the address at the beginning of this Notice.  Secondly, you have a right to make a complaint to the U.S. Department of Health and Human Services Office of Civil Rights.

You will not be penalized or retaliated against in any way for filing a complaint.