This notice of Privacy Practices (the “Notice”) describes the Facility’s practices and those of Facility employees, staff, volunteers, and other personnel who are involved in your or your loved one’s care.

The Facility’s Pledge Regarding Medical Information

The facility understands that medical information about you or your loved one is personal. The facility is committed to protecting medical information about you or your loved one. To provide you with quality care and to comply with certain state and federal legal requirements, the Facility creates a record of the services you or your loved one will receive at the facility. This notice applies to all of the records of your care generated by the Facility.

The Facility is required by law to:

How the Facility may use and disclose medical information about you or your loved one

The following categories describe different ways that the Facility may use or disclose protected medical information.

Changes to this Notice

The facility reserves the right to change the terms of this notice at any time.

Questions and Complaints

If you have any questions or believe that your privacy rights have been violated, you may contact the Facility’s HIPPA Privacy Officer in person or mail a written summary of your concern.

You may also file a written complaint with the Department of Health and Human Services at the following address:

U.S. Department of Health and Human Services

Office of Civil Rights

Centralized Case Management Operations

200 Independence Ave., S.W.

Suite 515F, HHH Building

Washington, D.C. 20201

Phone: 800-368-1019 Fax: 202-619-3818

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

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