HIPPA NOTICE OF PRIVACY PRACTICES

Your Information. Your Rights. Our Responsibilities.

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

Protected Health Information (“PHI”) includes in general terms individually identifiable health information that is transmitted by electronic media, maintained in electronic media, or transmitted or maintained in any other form or medium. Individually identifiable health information includes demographic information like your name, date of birth, address and social security number, as well as any other information that may identify you and that relates to your past, present or future mental or physical health conditions or treatment.

Our company, its owners, managers, employees, representatives, agents and contractors (collectively “LifeWell Senior Living, L.L.C.”), will possess, store, use, disclose and transmit your PHI. However, LifeWell Senior Living, L.L.C.’s authority to use and disclose your PHI is heavily regulated. Your PHI may not be used or disclosed except as permitted or required by law. For example, LifeWell Senior Living, L.L.C. may use and disclose your PHI for treatment, payment, health care operations. LifeWell Senior Living, L.L.C. is also allowed to use and disclose your PHI without your authorization under limited circumstances. This Notice of Privacy Practices describes how LifeWell Senior Living, L.L.C. may use and disclose your PHI and how you can access and control this information. LifeWell Senior Living, L.L.C. must abide by the terms of this Notice. If LifeWell Senior Living, L.L.C. makes changes or amendments to this Notice it will promptly distribute a copy of the amended Notice to you. Changes or amendments will not be implemented prior to the effective date of the amended Notice.

Your Rights

You have the right to:

Your Choices

You have some choices in the way that we use and share information as we:

Our Uses and Disclosures

We may use and share your information as we:

Your Rights

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record

Ask us to correct your medical record

Request confidential communications

Ask us to limit what we use or share

Get a list of those with whom we’ve shared information

Get a copy of this privacy notice

Choose someone to act for you

File a complaint if you feel your rights are violated

TEXAS BOARD OF NURSING

Type of Covered Entity

Agency Contact Information and Complaint Procedure

Complaints must be in writing using a Board approved complaint form is preferred. Complaint form may be obtained by:

Completed complaints may be submitted by faxing or mailing:
Texas Board of Nursing-Enforcement
333 Guadalupe Street, Suite 3-460
Austin, Texas 78701
Fax: (512) 305-6879

TEXAS STATE BOARD OF PHARMACY

Type of Covered Entity

Agency Contact Information and Complaint Procedure

If you believe your protected health information has been used or disclosed in violation of HIPAA, you have the right to complain to the federal Office of Civil Rights which has authority to investigate complaints against HIPAA covered entities and their business associates:

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions. In these cases, you have both the right and choice to tell us to:

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases, we never share your information unless you give us written permission:

In the case of fundraising:

Our Uses and Disclosures

How do we typically use or share your health information?
We typically use or share your health information in the following ways.

Treat you
We can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for a disease asks another doctor about your overall health condition.

Run our organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.

Bill for your services
We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.

How else can we use or share your health information?
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information, see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.

Help with public health and safety issues
We can share health information about you for certain situations such as:

Communication Barrier
We can use and disclose your information if we attempt to obtain consent from you but we are unable to do so due to substantial communication barriers and we determine, using professional judgment, that you intend to consent to use or disclose under the circumstance.

Do research
We can use or share your information for health research.

Comply with the law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Respond to organ and tissue donation requests
We can share health information about you with organ procurement organizations.

Work with a medical examiner or funeral director
We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:

Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Required Disclosure of PHI
LifeWell Senior Living, L.L.C. is required to disclose your PHI to you (or your personal representatives) if you specifically request access to your protected health information. This means that if you ask LifeWell Senior Living, L.L.C. for a copy of your records, in electronic or paper form, for any purpose, LifeWell Senior Living, L.L.C. must give it to you. However, LifeWell Senior Living, L.L.C. is allowed to charge a reasonable fee for the administrative cost of reproducing the information, within certain limits.

LifeWell Senior Living, L.L.C. is also required to disclose your PHI upon request by the U.S. Department of Health and Human Services (“HHS”) when it is undertaking a compliance investigation or review, or enforcement action. For example, if HHS or any of its contractors asks to review your PHI to determine if LifeWell Senior Living, L.L.C. offered to you the care for which it has billed, LifeWell Senior Living, has to disclose your PHI. Disclosure will be limited to the specific information requested. LifeWell Senior Living, L.L.C. will notify you of any request from HHS or any of its contractors, for use or disclosure of your PHI.

Our Responsibilities

For more information, see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html

Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.

Other Instructions for Notice