Lincoln Lutheran of Racine Wisconsin Incorporated
Notice of Privacy Practices
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.
USE AND DISCLOSURE OF HEALTH INFORMATION
Lincoln Lutheran of Racine may use your health information, that is, information that constitutes protected health information as defined in the Privacy Rule of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996, for purposes of providing you treatment, obtaining payment for your care and conducting health care operations. Lincoln Lutheran of Racine has established a policy to guard against unnecessary disclosure of your health information.
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED:
To Provide Treatment.
Lincoln Lutheran of Racine may use your health information to provide care and/or services to you and disclose your health information to others who provide care to you, such as your attending physician and other health care professionals who are involved in your care. For example, physicians involved in your care will need information about your symptoms in order to prescribe appropriate medications. Lincoln Lutheran of Racine also may disclose your health care information to individuals outside of Lincoln Lutheran of Racine involved in your care including family members, pharmacists, suppliers of medical equipment or other health care professionals.
To Obtain Payment.
Lincoln Lutheran of Racine may include your health information in invoices to collect payment from third parties for the care and/or services you may receive from Lincoln Lutheran of Racine. For example, Lincoln Lutheran of Racine may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or Lincoln Lutheran of Racine. Lincoln Lutheran of Racine may also need to obtain prior approval from your insurer and may need to explain to the insurer your need for health care and the services that will be provided to you.
To Conduct Health Care Operations.
Lincoln Lutheran of Racine may use and disclose health information for its own operations in order to facilitate the functions of Lincoln Lutheran of Racine and as necessary to provide quality care to all of Lincoln Lutheran of Racine¹s residents and/or clients. Health care operations include activities such as:
- Quality assessment and improvement activities. - Activities designed to improve health or reduce health care costs. - Protocol development, case management and care coordination. - Contacting health care providers and residents and/or clients with information about treatment alternatives and other related functions that do not include treatment. - Professional review and performance evaluation. - Training programs including those in which students, trainees or practitioners in health care learn under supervision. - Training of non-health care professionals. - Accreditation, certification, licensing or credentialing activities. - Review and auditing, including compliance reviews, medical reviews, legal services and compliance programs. - Business planning and development including cost management and planning related analyses and formulary development. - Business management and general administrative activities of Lincoln Lutheran of Racine. - Fundraising for the benefit of Lincoln Lutheran of Racine and certain marketing activities.
For example, Lincoln Lutheran of Racine may use your health information to evaluate its staff performance, combine your health information with other Lincoln Lutheran of Racine residents and/or clients in evaluating how to more effectively serve all of Lincoln Lutheran of Racine¹s residents and/or clients, disclose your health information to Lincoln Lutheran of Racine staff and contracted personnel for training purposes, use your health information to contact you or your family as part of general fundraising and community information mailings (unless you tell us you do not want to be contacted).
For the Lincoln Lutheran of Racine Directory.
Lincoln Lutheran of Racine may disclose certain information about you including your name, your general health status, your religious affiliation and where you are located, in a Lincoln Lutheran of Racine directory while you are in Lincoln Lutheran of Racine. Lincoln Lutheran of Racine may disclose this information to people who ask for you by name. However, religious affiliation will only be disclosed to clergy. If you do not want Lincoln Lutheran of Racine to include your information in the directory, you must notify the facility contact person as listed on the last page.
For Fundraising Activities.
Lincoln Lutheran of Racine may use information about you including your name, address and telephone number to contact you or your family to raise money for Lincoln Lutheran of Racine. If you do not want Lincoln Lutheran of Racine to contact you or your family, you must notify the facility contact person as listed on the last page, and indicate that you do not wish to be contacted. Lincoln Lutheran does not sell information about residents or clients.
For Treatment Alternatives.
Lincoln Lutheran of Racine may use and disclose your health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED WITHOUT YOUR WRITTEN CONSENT OR AUTHORIZATION:
When Legally Required.
Lincoln Lutheran of Racine will disclose your health information when it is required to do so by any Federal, State or local law.
When There Are Risks to Public Health.
Lincoln Lutheran of Racine may disclose your health information for the following public activities and purposes:
- To prevent or control disease, injury or disability, report disease, injury, vital events such as birth or death and the conduct of public health surveillance, investigations and interventions. - To report adverse events, product defects, to track products or enable product recalls, repairs and replacements and to conduct post-marketing surveillance and compliance with requirements of the Food and Drug Administration. - To notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease. - To an employer about an individual who is a member of the workforce as legally required.
To Report Abuse, Neglect, Or Domestic Violence.
Lincoln Lutheran of Racine is allowed to notify government authorities if Lincoln Lutheran of Racine believes a resident and/or client is the victim of abuse, neglect, or domestic violence. Lincoln Lutheran of Racine will make this disclosure only when specifically required or authorized by law or when the resident agrees to the disclosure.
To Conduct Health Oversight Activities.
Lincoln Lutheran of Racine may disclose your health information to a health oversight agency for activities including audits; civil, administrative or criminal investigations; inspections; licensure or disciplinary action. Lincoln Lutheran of Racine, however, may not disclose your health information if you are the subject of an investigation and the investigation does not arise out of and is not directly related to your receipt of health care or public benefits.
In Connection With Judicial And Administrative Proceedings.
As permitted or required by State law, Lincoln Lutheran of Racine may disclose your health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a subpoena, discovery request or other lawful process, but only when Lincoln Lutheran of Racine makes reasonable efforts to either notify you about the request or obtain an order protecting your health information.
For Law Enforcement Purposes.
As permitted or required by State law, Lincoln Lutheran of Racine may disclose your health information to a law enforcement official for certain law enforcement purposes, including, under certain limited circumstances, if you are a victim of a crime or in order to report a crime.
To Coroners And Medical Examiners.
Lincoln Lutheran of Racine may disclose your health information to coroners and medical examiners for purposes of determining your cause of death or for other duties, as authorized by law.
To Funeral Directors.
Lincoln Lutheran of Racine may disclose your health information to funeral directors consistent with applicable law and if necessary, to carry out their duties with respect to your funeral arrangements. If necessary to carry out their duties, Lincoln Lutheran of Racine may disclose your health information prior to and in reasonable anticipation of your death.
For Organ, Eye Or Tissue Donation.
Lincoln Lutheran of Racine may use or disclose your health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs, eyes or tissue for the purpose of facilitating the donation and transplantation.
For Research Purposes.
Lincoln Lutheran of Racine may, under very select circumstances, use your health information for research. Before Lincoln Lutheran of Racine discloses any of your health information for such research purposes, the project will be subject to an extensive approval process. Lincoln Lutheran of Racine will almost always request your written authorization before granting access to your individually identifiable health information.
In the Event of A Serious Threat To Health Or Safety.
Lincoln Lutheran of Racine may, consistent with applicable law and ethical standards of conduct, disclose your health information if Lincoln Lutheran of Racine, in good faith, believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.
For Specified Government Functions.
In certain circumstances, the Federal regulations authorize Lincoln Lutheran of Racine to use or disclose your health information to facilitate specified government functions relating to the military and veterans, national security and intelligence activities, protective services for the President and others, medical suitability determinations, and inmates in law enforcement custody.
For Worker¹s Compensation.
Lincoln Lutheran of Racine may release your health information for worker¹s compensation or similar programs.
AUTHORIZATION TO USE OR DISCLOSE HEALTH INFORMATION
Other than as stated above, Lincoln Lutheran of Racine will not disclose your health information without your written authorization. If you or your representative authorizes Lincoln Lutheran of Racine to use or disclose your health information, you may revoke that authorization in writing at any time.
YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
You have the following rights regarding your health information that Lincoln Lutheran of Racine maintains:
Right to Request Restrictions.
You may request restrictions on certain uses and disclosures of your health information. You have the right to request a limit on Lincoln Lutheran of Racine¹s disclosure of your health information to someone who is involved in your care or the payment of your care. However, Lincoln Lutheran of Racine is not required to agree to your request. If you wish to make a request for restrictions, please contact the appropriate facility contact person as listed on the last page.
Right to Receive Confidential Communications.
You have the right to request that Lincoln Lutheran of Racine communicate with you in a certain way. For example, you may ask that Lincoln Lutheran of Racine only conduct communications pertaining to your health information with you privately with no other family members present. If you wish to receive confidential communications, please contact the facility contact person as listed on the last page. Lincoln Lutheran of Racine will not request that you provide any reasons for your request and will attempt to honor your reasonable requests for confidential communications.
Right to Inspect and Copy Your Health Information.
You have the right to inspect and copy your health information, including billing records. A request to inspect and copy records containing your health information may be made to the facility contact person as listed on the last page. If you request a copy of your health information, Lincoln Lutheran of Racine may charge a reasonable fee for copying and assembling costs associated with your request.
Right to Amend Your Health Information.
You or your representative have the right to request that Lincoln Lutheran of Racine amend your records, if you believe your health information records are incorrect or incomplete. That request may be made as long as the information is maintained by Lincoln Lutheran of Racine. A request for an amendment of records must be made in writing to the facility contact person as listed on the last page. Lincoln Lutheran of Racine may deny the request if it is not in writing or does not include a reason for the amendment. The request also may be denied if your health information records were not created by Lincoln Lutheran of Racine, if the records you are requesting are not part of Lincoln Lutheran of Racine¹s records, if the health information you wish to amend is not part of the health information you or your representative are permitted to inspect and copy, or if, in the opinion of Lincoln Lutheran of Racine, the records containing your health information are accurate and complete.
Right to an Accounting.
You or your representative have the right to request an accounting of disclosures of your health information made by Lincoln Lutheran of Racine for any reason other than for treatment, payment or health operations. The request for an accounting must be made in writing to the facility contact person as listed on the last page. The request should specify the time period for the accounting starting on April 14, 2003. Accounting requests may not be made for periods of time in excess of six (6) years. Lincoln Lutheran of Racine will provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee.
Right to a Paper Copy of this Notice.
You or your representatives have a right to a separate paper copy of this Notice at any time even if you or your representatives have received this Notice previously. To obtain a separate paper copy, please contact the facility contact person as listed on the last page. A resident or a resident¹s representative may also obtain a copy of the current version of Lincoln Lutheran of Racine¹s Notice at its Web site, www.lincolnlutheran.com.
DUTIES OF LINCOLN LUTHERAN OF RACINE
Lincoln Lutheran of Racine is required by law to maintain the privacy of your health information and to provide to you and your representative this Notice of its duties and privacy practices. Lincoln Lutheran of Racine is required to abide by the terms of this Notice as may be amended from time to time. Lincoln Lutheran of Racine reserves the right to change the terms of its Notice and to make the new Notice provisions effective for all health information that it maintains. If Lincoln Lutheran of Racine changes its Notice, Lincoln Lutheran of Racine will make a copy of the revised Notice available to you or your appointed representative. You or your representative has the right to express complaints to Lincoln Lutheran of Racine and to the Secretary of Health and Human Services if you or your representative believes that your privacy rights have been violated. Any complaints to Lincoln Lutheran of Racine should be made in writing to the facility contact person as listed on the last page. Lincoln Lutheran of Racine encourages you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.
CONTACT PERSONS
Manager Pennoyer Home 262-564-8241
Manager Schmidt Home 414-762-5118
Manager The Atrium 262-639-1100
Manager Lincoln Manor 262-632-8036
Manager Lincoln Villas 262-637-7877
Manager Lincoln Villas North 262-639-1166
Manager Meal on Wheels 262-634-2334
Manager Trinity Terrace 262-634-1426
Administrator Lincoln Village 262-637-9751
Administrator Becker Shoop 262-637-7486
HR/Benefits 262-633-0500
Privacy Officer 262-633-0500
Fundraising 262-633-0500
PRIVACY OFFICER
The Officer supervises the execution of Lincoln Lutheran of Racine's Privacy Policy. The officer may be contacted at: Lincoln Lutheran of Racine, 2000 Domanik Drive, Racine, WI 53404, 262-633-0500
EFFECTIVE DATE
This Notice is effective April 14, 2003.
IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE contact Lincoln Lutheran of Racine¹s Privacy Officer. | 
