This notice describes how information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Each time you visit a hospital, physician, or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination, test results, diagnosis, treatment, and plan of care. This information, often referred to as your health or medical record, serves as a:

• basis for planning your care and treatment
• means of communication among the many health professionals who contribute to your care
• legal document describing the care you received
• means by which you or a third-party payer can verify that services billed were actually provided
• a tool in educating healthcare professionals
• a source of information for public health officials charged with improving the health of the nation
• a source of data for facility planning and marketing
• a tool with which we can assess and continually work to improve the care we render and the outcomes we achieve

• ensure its accuracy
• better understand who, what, when, where, and why others may access your information
• make more informed decisions when authorizing disclosures to others

Although your health record is the physical property of the healthcare facility that compiled it, the information belongs to you. You have the right to:

• request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522. For example, you may ask not to give information on a particular treatment that you receive. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide emergency treatment to you. You must make your request for restrictions in writing to the Privacy Officer at Garden Spot Village. You must tell us what information to limit, and to whom you want the limits to apply.
• obtain a paper copy of the Notice of Privacy Practices upon request.
• inspect and copy your health record and billing information as provided for in 45 CFR 164.524. This does not include psychotherapy notes. If you want to inspect or obtain copies of your protected health information, you must submit your request in writing to the Privacy Officer at Garden Spot Village, and complete the Request for Access Form. If you request a copy of this information you will be charged a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect or obtain copies in certain limited circumstances. If you are denied access, you may request a review of the denial. Another licensed professional at Garden Spot Village will review your request and the denial. We will comply with the outcome of this review.
• amend your health record as provided for in 45 CFR 164.528. If you think your protected health information is wrong or incomplete you have the right to request an amendment as long as the information is kept by or for Garden Spot Village. Your request must be submitted in writing to the Privacy Officer at Garden Spot Village, and complete the Request for Amendment Form. We may deny your request if it does not include a reason to support the request, the information was not created by us, is not part of the protected health information kept by or for Garden Spot Village, the information is accurate and complete, or is not part of the information that you have a right to inspect or copy. If your request is denied, a written reason for the denial will be given to you and instructions on how you can give us a statement of disagreement. Your statement of disagreement may be added to your protected health information.
• obtain an accounting of disclosures of your health information as provided for in 45 CFR 164.528, except for: those that we made to carry out treatment, payment or healthcare operations, those that were given to you or your personal representative, those that were given out for law enforcement purposes, or as a part of a limited set of information which does not contain certain information which would identify you. To request a listing of disclosures you must submit your request in writing to the Privacy Officer at Garden Spot Village. You must state a time period (it cannot be longer than six years prior to the date of your request). It cannot include dates before April 14, 2003. You will not be charged for the disclosure for the first time in a twelve month period. You will be charged for any additional requests you make within that time frame and will be told the cost of each. You can then decide whether to withdraw or modify your request before any costs are incurred.
• request communication of your health information by alternative means or at alternative addresses.
• revoke your authorization to use or disclose health information except to the extent that action has already been taken.

This organization is required to:

• maintain the privacy of your health information.
• provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you.
• abide by the terms of this notice.
• notify you if we are unable to agree to a requested restriction.
• accommodate reasonable requests you may have to communicate health information by alternative means or at alternative addresses. We reserve the right to change our practices and make the new provisions effective for all protected health information we maintain. Should our information practices change, we will mail a revised notice to the address you have supplied to us.
We will not use or disclose your health information without your authorization, except as described in this notice.

If you have questions and would like additional information, you may contact the Privacy Officer at Garden Spot Village by calling 717-355-6285. If you believe your privacy rights have been violated, you can file a complaint with the Privacy Officer or with the Secretary of Health and Human Services at 200 Independence Ave. SW, Washington, DC 20201, phone # 202-619-0257. There will be no retaliation for filing a complaint.

> We will use your information for treatment.
For example: Information obtained by a nurse, physician, or other member of your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your healthcare team. Members of your healthcare team will then record the actions they took and their observations. In that way the physician will know how you are responding to treatment. We will also provide your physician or subsequent healthcare provider with copies of various reports that should assist him or her in treating you once you are discharged from this facility.
 
> We will use your health information for payment.
For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.
We will use your health information for regular health operations.
For example: Members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your medical record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide.
 
> Business Associates
There are some services provided in our organization through contacts with business associates. Examples include physician services in the emergency department and radiology, laboratory services, inpatient and outpatient services at hospitals, physician medical practice groups, ambulance associations, hearing aid services, therapy groups and regulatory associations. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job that we’ve asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.
 
> Directory
Unless you notify us that you object, we will use your name, photograph, location in the facility, and phone number for directory purposes. This information may be provided to members of clergy and to other people who ask for you by name.
 
> Notification
We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition.
 
> Communication with family
Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend, or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care.
 
> Funeral directors
We may disclose health information to funeral directors consistent with applicable law to carry out their duties.
 
> Organ procurement organizations
Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
 
> Marketing
We may contact you to provide appointment reminders or information about treatment alternatives or other health related benefits and services that may be of interest to you.

We may contact you as part of a fund-raising effort. Food and Drug Administration: We may disclose to the FDA health information relative to adverse effects with respect to food, supplements, products, or product defects, or post marketing surveillance information to enable product recalls, repairs or replacements.

We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena. Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a workforce member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers, or the public.