• basis for planning care and treatment
• means of communication among the many health professionals who contribute to care
• legal document describing care received
• means by which a third party payer (e.g. Medicaid, Medicare) can verify that services billed were actually provided
• a tool for education health professionals
• a source for data for medical research
• a source of information for public health officials who oversee the delivery of health care in the United States
• a source for facility planning and marketing
• a tool to assess the quality of care provided

• maintain the privacy of residents' health information
• provide residents/responsible parties with a notice to our legal duties and privacy practices with respect to the medical information collected and maintained
• abide by the terms of this notice
• notify residents/responsible parties if Birmingham Green is unable to agree to a requested restriction
• accommodate reasonable requests the resident/responsible party may have to communicate health information by alternative means or at alternative locations
• Birmingham Green reserves the right to change our practices and to make the new provisions effective for all protected health information we maintain and we will provide residents/responsible parties with a revised notice as needed.
  

• Treatment of Resident Illness
• Payment to a third-party payer
• Promoting improved quality and effectiveness of health care and services
• Business Associates (consultants, accountants, medical director, etc.) are required to appropriately safeguard medical information
• Directory giving resident's name, location in the facility, general condition and religious affiliation will be provided unless a resident/responsible party objects.
  
• Notification to responsible party of the resident's changes in condition via phone, answering machine, in person, or via mail
  
• Disclose or notify family members, close personal friend or any other person identified by the resident of health information relevant to that person's involvement in care or payment related to resident care
  
• Funeral Directors and coroners may need health information disclosed (e.g. infectious diseases) to carry out their duties consistent with applicable law
  
• Organ procurement organizations authorized by resident/responsible parties consistent with applicable law
  
• Provide appointment reminders, treatment alternative or other health related benefits of interest to resident/responsible party
  
• We may contact residents/responsible parties as a part of a fund-raising effort
  
• We may disclose to the Food and Drug Administration (FDA) adverse events related to food, supplements, product and product defects to enable product recalls, repairs or replacement
  
• We may disclose to the Center for Disease Control (CDC) and/or the local public health department or legal authorities charged with preventing or controlling diseases, injury or disability as required by State statute
  
• Workman's Compensation may need health information disclosed 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
  
• Law enforcement officials may be entitled to specific health information 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 work force 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
  

Although resident health records are the physical property of Birmingham Green, the information in them belongs to the resident. The resident has the following rights:

• The resident may request that the Facility not use or disclose personal health information for a particular reason related to treatment, payment, the Facility's general health care operations, and/or to a particular family member, other relative or close personal friend. Such requests must be made in writing on the Facility form. "Although the Facility will consider the resident's requests with regards to use of health information, please be aware that we are under no obligation to accept or to abide by it. We (the Facility), will abide by resident requests with regard to the disclosure of person and clinical records to anyone outside of the facility, except in an emergency, if the resident is being transferred to another health care institution, or the disclosure is required by law." 42 C.F. R * 483.10(e) provides that a nursing facility must abide by a resident's right to refuse the release of his/her personal or clinical records to any individual outside of the facility, unless the release is necessary because the resident is being transferred to another health care institution, or if it is required by law.
  
• If a resident/responsible party is dissatisfied with the manner in which or the location where the he/she is receiving communications from the Facility, they may request that they be provided with information by alternative means. Such a request must be made in writing and submitted to:

Privacy Officer
C/O Birmingham Green
8605 Centreville Road
Manassas, VA 20110

• Residents/Responsible parties may request to inspect and/or obtain copies of personal health information orally or in writing. The Facility has (2) working days to comply and you will be charged a reasonable fee for photocopying records.
  
• If the resident/responsible party believes that any health information is incorrect or missing, a correction may be requested. Such requests must be made in writing, and must provide a reason to support the amendment.
  
• Residents/responsible parties may request the Facility provide a written accounting of all disclosures made by the Facility during the time period requested (not to exceed 6 years). All requests must be made in writing on a Facility form provided by the Privacy Officer. Please note that an accounting will not apply to: disclosures made for reasons of treatment, payment or health care operations; disclosures made to the resident/responsible party, or any other individual involved with care; disclosures to law enforcement officials; and disclosures for national security. No charges will be accrued for the first accounting request in any 12-month period. However, for any request made thereafter, a reasonable cost based fee will be charged.
  
• Residents/responsible parties have the right to obtain a paper copy of our Notice of Information Practices upon request.
  
• Residents/responsible parties may revoke an authorization to use or disclose health information, except to the extent that action has already been taken. Such a request must be made in writing.

Contact the Facility's Privacy Officer at (703) 257-0935.

If a resident/responsible party believes that privacy rights have been violated, a complaint form may be obtained from the Privacy Officer or his/her designee. Return the completed form to the Privacy Officer for processing. You may also file a complaint with the Secretary of the Department of Health and Human Services. There will be no retaliation for filing a complaint.

Effective Date: January 1, 2003