Your Information. Your Rights. Our Responsibilities.



We respect the privacy of your protected health information and are committed to maintaining our residents’ confidentiality. This Notice applies to all information and records related to your care that our facility has received or created. It extends to information received or created by our employees and physicians. This Notice informs you about the possible uses and disclosures of your protected health information. It also describes your rights and our obligations regarding your protected health information.

We are required by law to:

  • Maintain the privacy and security of your protected health information
  • Provide this detailed Notice to you describing our legal duties and privacy practices relating to your protected health information
  • Abide by the terms of the Notice that are currently in effect
  • Notify you promptly if a breach has occurred that may have compromised the privacy and security of your information

We will not use or share your information other than as described here.


The following categories describe different ways that we use and disclose medical information. For each category of uses and disclosures there is an explanation and some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

Ø 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 facility and non-facility personnel who may be involved in your care, such as physicians, nurses, nurse aides, personal care aides and therapists. For example, a nurse or personal care aide caring for you will report any change in your condition to your doctor. We may also disclose protected health information to individuals who will be involved in your care after you leave our facility.

Ø 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 our facility. For example, we may disclose your protected health information to an insurance or managed care company, Medicare, Medicaid or another third-party payor for billing and payment purposes. We may also contact Medicare or your health plan to confirm your coverage or to request prior approval for a proposed treatment or service.

Ø For Health Care Operations. We may use and disclose your protected health information for facility operations. These uses and disclosures are necessary to manage the facility and make sure all of our residents receive quality care. For example, we may use protected health information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine the medical information we have with medical information from other facilities to compare how we are doing and see where we can make improvements in the care and services we offer.

Ø For Payment and Health Care Operations of Another Facility. We may disclose protected health information about you to another health care provider if the disclosure is for the payment activities of that provider. For example, we may disclose insurance information about a resident to an ambulance company. In addition, we may disclose protected health information about you to another provider if the provider has or had a relationship with you, and the purpose of the disclosure is related to their health care operational activities, i.e., accreditation, licensing or credentialing activities. We will limit the information disclosed to the minimum amount needed in accordance with the request.

Ø Facility Directory. Unless you object, we may include certain limited information about you in the facility directory. This information may include your name, room number, phone number, general condition (e.g., fair, stable, etc.) and 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 any member of the clergy.

Ø Fundraising and Marketing Activities. Unless you object, we may use demographic information to contact you in an effort to raise money for the facility and its operations. We would only use contact information, such as your name, address and phone number, and the dates you received treatment or services. We may contact you about fundraising and marketing, and you have a right to opt out of receiving future fundraising communication.

Ø Individuals Involved in Your Care or Payment for Your Care. We will only disclose protected health information with those friends and family members that you have designated to be involved with your medical care. We may also give information to someone who helps pay for your care.

Ø Disaster Relief. We may disclose protected health information to an organization assisting in a disaster relief effort so that your family can be notified about your condition, status and location.

Ø As Required By Law. We will disclose protected health information when required to do so by federal, state or local law.

Ø Public Health and Safety Activities. We may disclose your protected health information for public health and safety activities. Such activities generally include the following reasons:

  • To prevent or control disease, injury or disability
  • To report deaths
  • To report abuse, neglect or domestic violence
  • To report to the FDA (Food and Drug Administration) reactions to medications problems with products
  • To notify residents of recalls of products they may be using
  • To notify a person who may have been exposed to a communicable disease or may be at risk of contracting or spreading a disease or condition
  • For certain purposes involving workplace illness or injuries
  • To prevent a serious threat to your health and safety, or the health and safety of the public or another person

Ø Health Oversight Activities. We may disclose your protected health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections and licensure actions. These activities are necessary for the government to monitor the health care system, government payment or regulatory programs and compliance with civil rights laws.

Ø Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose your protected health information in response to a court or administrative order. We may also disclose information 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 contact you about the request or to obtain an order protecting the information requested.

Ø Law Enforcement. We may disclose your protected health information for certain law enforcement purposes, including:

  • In response to a court order, subpoena, warrant, summons or similar process
  • To identify or locate a suspect, fugitive, material witness or missing person
  • When information is requested about the victim of a crime, if, under certain limited circumstances, we are unable to obtain the person’s agreement
  • To report information about a death we believe may be the result of criminal conduct
  • To provide information about criminal conduct occurring at the facility
  • To report information in emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime

Ø 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 release medical information about foreign military personnel to the appropriate foreign military authority.

Ø Workers’ Compensation. We may use or disclose your protected health information to comply with laws relating to workers’ compensation or similar programs.

Ø Coroner, Medical Examiners and Funeral Directors. We may release 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. This may be necessary, for example, to identify a deceased person or determine the cause of death.

Ø 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 state, or to conduct certain special investigation.


Several state laws may apply to your protected health information that set a stricter standard than the protections offered under the federal health privacy regulations. Stricter state law in Pennsylvania will, for example, limit us from disclosing medical records containing HIV-related information; medical records containing drug and alcohol abuse information; and medical records containing psychiatric and psychological treatment. State law dictates to whom and under what circumstances disclosure is appropriate. Generally, release of this information is contingent upon your specific consent, or pursuant to a court order.


Other uses and disclosures of your protected health information not covered by this Notice or the laws that apply to us will be made only with your written Authorization. In the cases of marketing purposes, we never share your information unless you give us written permission.

You may revoke your Authorization to use and 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. We are unable to take back any disclosures we have already made with your permission, and we are required to retain our records of the care that we provided to you.


You have the following rights regarding medical information we maintain about you:

Ø Right to Inspect and Copy. You have the right to inspect and copy medical or billing records (electronic or paper) that may be used to make decisions about your care, subject to some limited exceptions. We must allow you to inspect your records within 24 hours of your request, excluding holidays and weekends. If you request copies of the records, we must provide you with copies within 2 business days of the request. We may charge a reasonable fee for the cost of copying and mailing your requested information.

We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to protected health information, you may request that the denial be reviewed. Another licensed health care professional chosen by the facility will review your request and the denial. The person conducting the review will not be the person who originally denied your request. We will comply with the outcome of the review.

Ø Right to Correct. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to correct the information. You have the right to request the facility to correct any protected health information maintained by the facility for as long as the information is kept by or for the facility. To request a correction, your request must be in writing and must state the reason for the requested correction.

We may deny your request for a correction if the information:

  • Is not in writing or does not include a reason to support the request
  • Was not created by us, unless the originator of the information is no longer available to make the amendment
  • Is not part of the protected health information maintained by or for the facility
  • Is not part of the protected health information to which you have a right or access
  • Is already accurate and complete, as determined by the facility

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

Ø Right to Request Restrictions. You have the right to request a restriction or limitation on the protected health information we use or disclose about you for treatment, payment, 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. This request must be made in writing. For example, you could ask that we not use or disclose information about a surgery you had. If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.

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 you emergency treatment or the release of information is required by law.

Ø Right to an Accounting of Disclosures. You have the right to request an “Accounting of Disclosures” of your protected health information. This is a listing of certain disclosures of your medical information made by the facility on your behalf.

To request this list of Accounting of Disclosures, you must submit your request in writing to the Director of Health Information. Your request must state a time period that may not be longer than six years from the date of your request and may not include dates before April 14, 2003. We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). 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; and a brief statement of the purpose of the disclosure. The first accounting provided in a 12-month period will be free. For providing additional lists, we may charge you our costs.

Ø Right to Request Confidential Communications. You have the right to request that we communicate with you concerning protected health matters 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.

Ø Choose Someone to Act for You. If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. We will make sure the person has this authority and can act for you before we take any action.

Ø Right to a Paper Copy of This Notice. You have the right to a paper or electronic copy of this Notice. You may ask us to give you a copy of this Notice at any time. You may also obtain a copy of this Notice at our website,


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 the facility, as well as for all protected health information we receive in the future. 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 will post a copy of the Notice in the facility and on our website. In addition, we will distribute a copy of the revised Notice to all residents currently residing in the facility at the time of the revision.


If you feel your privacy rights have been violated, you may file a complaint in writing to the facility. To file a complaint with the facility, contact Melody Sell, Director of Clinical Social Work, at 610-769-4319 or Michael Lackman, Privacy Officer, at 610-769-4347. We will not retaliate against you if you file a complaint. You can also file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 877-696-6775, or visiting


If you have any questions about this Notice or would like further information concerning your privacy rights, please contact Melody Sell, Director of Clinical Social Work, at 610-769-4319 or Michael Lackman, Privacy Officer, at 610-769-4347.

EFFECTIVE DATE: April 14, 2003

REVISED: December 14, 2011, and September 18, 2013