To ensure that a Notice of Privacy Practices is provided to, and acknowledged by, each resident or his/her personal representative upon admission to the Facility.
The Facility’s policy is to provide a Notice of Privacy Practices (“Notice”) to each resident upon each admission to the Facility, and make a good faith effort to obtain a signed Acknowledgement of Receipt of Notice of Privacy Practices (“Acknowledgement”) from the resident.
(See sample Notice and Acknowledgement forms following this Policy.)
The Notice shall include all elements and statements that are required by law. The Notice shall inform the residents of:
- Uses and disclosures of Protected Health Information (“PHI”) that may be made by the Facility;
- The resident’s rights with respect to his PHI; and
- The Facility’s legal duties with respect to such PHI.
- The Notice and Acknowledgement forms will be included in the standard Admission Packet.
- The Facility Admission Staff will provide the Notice to the resident at the time of admission.
Note: In the case of an emergency treatment situation, the Facility will provide the Notice to the resident as soon as reasonably practicable after the emergency treatment situation.
- The Admission Staff will make a good faith effort to obtain the resident’s signature on the Acknowledgement at the time the Notice is provided. The Notice and signed Acknowledgement will be kept in the resident’s Business Office File.
- If the resident refuses or is otherwise unable to sign the Acknowledgement, the Admission Staff will document, on the Acknowledgement form, what actions were taken to obtain the resident’s signature on the Acknowledgementand the reason(s) why a signed Acknowledgement was not obtained. This document will then be placed in the resident’s Business Office File.
- The Facility will provide a copy of the written Notice to residents and to other persons upon request.
- The Facility will post a copy of the Notice in a clear and prominent location such as the entrance lobby or similar location.
- A current version of the Notice will be maintained on the Facility’s website, if any.
- Whenever the Notice is revised, the Facility Privacy Official will assure that:
- The revised Notice is made available upon request on or after the effective date of the revision; and
- The revised Notice is posted in a clear and prominent location.
- Material changes shall not be implemented prior to the effective date of the revised Notice.
- A copy of each Notice issued by the Facility will be maintained for at least six years from the date it was last in effect.
Any member of the workforce who has knowledge of a violation or potential violation of this Policy must make a report directly to the Privacy Official. (See the Policy “Sanctions.”)
Licensed by the State Department of Health Care Services
License and Certification Number 430053AP
Expiration Date 04/30/2024