FutureCare
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.

This Notice of Privacy Practices (“Notice”) describes the type of information FutureCare Health and Management Corporation and the members of its Affiliated Covered Entity (ACE) gather about you, with whom that information may be shared, and the safeguards we have in place to protect it. An ACE is a group of legally separate health care providers under common ownership or control that designates itself as a single entity for purposes of compliance with the Health Insurance Portability and Accountability Act (“HIPAA”). The terms “FutureCare” and “we” as used throughout this Notice refer to each member of the FutureCare ACE and, when appropriate, the ACE members collectively.

FutureCare is required by HIPAA to maintain the privacy of Protected Health Information (PHI), to provide individuals with notice of its legal duties and privacy practices with respect to PHI, and to notify affected individuals following a breach of unsecured PHI. PHI is information that may identify you and that relates to your past, present, or future physical or mental health or condition; the provision of health care products and services to you; or the payment for such services. For purposes of this Notice, “medical information” means PHI.

We are required to follow the terms of this Notice as well as any changes to it that may be in effect. We reserve the right to change our practices, and any updated Notice will be posted on our website. Upon request, we will provide additional copies of our current Notice to you.

If you have any questions regarding this Notice, please contact FutureCare’s Privacy Officer, whose contact information is provided at the end of this Notice.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU

Except where prohibited by federal or state laws that require special privacy protections, we may use and disclose your medical information for treatment, payment, and health care operations without your prior authorization, described below. For each category of uses or disclosures we will explain what we mean and provide some examples. While this Notice includes examples of certain uses and disclosures for treatment, payment, and health care operations, it does not list every potential use or disclosure.

• For Treatment. We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other FutureCare personnel who are involved in taking care of you at a FutureCare facility. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments of FutureCare also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work, and x-rays. We also may disclose medical information about you to people outside FutureCare who may be involved in your medical care after you leave a FutureCare facility, such as family members, clergy, or others we use to provide services that are part of your care.

• For Payment. We may use and disclose medical information about you so that the treatment and services you receive at FutureCare may be billed and payment may be collected from you, an insurance company, and/or a third party. We will, however, comply with your request not to disclose your medical information to your insurance company if the information relates solely to a health care item or service for which you have paid out of pocket and in full to us. For example, we may need to provide your health plan information about therapy you received at FutureCare so your health plan will pay us or reimburse you for the therapy. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.

• For Health Care Operations. We may use and disclose medical information about you for FutureCare operations. These uses and disclosures are necessary to run FutureCare and make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical information about many FutureCare patients to decide what additional services FutureCare should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, medial students, and other FutureCare personnel for review and learning purposes.

Outlined below are additional situations in which FutureCare may disclose your medical information without your authorization:

• Within the FutureCare ACE. The members of the FutureCare ACE may use and disclose your medical information with each other for the treatment, payment, and health care operations of the FutureCare ACE and as otherwise permitted by this Notice. A list of the members of the FutureCare ACE is included at the end of this Notice.

• Business Associates. We may share your medical information with outside companies that perform services for FutureCare such as accreditation, legal, computer, or auditing services. These outside companies are called “Business Associates” and are required by HIPAA and by contract to keep your medical information confidential.

• Appointment Reminders. We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care.

• Treatment Alternatives. We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

• Health-Related Benefits and Services. We may use medical information to tell you about health-related benefits or services that may be of interest to you.

• Facility Directory. We may include certain limited information about you in the directory of the FutureCare facility while you are a resident or patient of FutureCare. This information may include your name, location in the facility, your general condition (e.g., fair, stable, etc.), and your religious affiliation. The directory information may be given: (1) to a member of the clergy, such as a priest or rabbi and (2), except for religious affiliation, to other persons who ask for you by name. FutureCare offers this service so your family, friends, and clergy can visit you, and generally know how you are doing. If you would prefer that FutureCare not include your name or other specific information in a directory, you must notify the facility or affiliated entity’s Executive Director.

• To You or Your Personal Representative. We may disclose your medical information to you or to a representative appointed by you or designated by applicable law.

• Individuals Involved in Your Care or Payment for Your Care. We may disclose medical information about you to a family member, guardian, or other individual who is involved in your medical care. We may also give information to someone who helps pay for your care.

• Disaster Relief. We may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location. If you do not wish us to release certain information, or if you want certain information released only to certain persons, you must notify the facility or affiliated entity’s Executive Director in writing.

• Research. Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, to balance the research needs with patients’ right of privacy with respect to their medical information.

• As Required by Law. We will disclose medical information about you when required to do so by Federal, State or local authorities, laws, rules, and/or regulation.

• To Avert a Serious Threat to Health or Safety. We may use and disclose medical information about you, when necessary, to prevent a serious threat to your health and safety or the health and safety of another person or the public.

• Organ and Tissue Donation. If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

• Military and Veterans. If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.

• Worker’s Compensation. If you seek treatment for a work-related illness or injury, we may release medical information about you in accordance with state-specific laws regarding workers’ compensation claims.

• Public Health Purposes. We may disclose medical information about you for public health activities, such as activities to prevent or control disease, injury, or disability; to report deaths; and to report reactions to medications or problems with products.

• Abuse, Neglect, and Domestic Violence. Subject to certain limitations, we may disclose your medical information to an appropriate government authority that is authorized by law to receive reports of abuse, neglect, or domestic violence.

• Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

• Lawsuits and Disputes. Your medical information may be disclosed in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process.

• Law Enforcement. Your medical information may be disclosed to law enforcement, as authorized or required by law.

• Coroners, Medical Examiners, and Funeral Directors. We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients of the facility to funeral directors as necessary to carry out their duties.

• National Security and Intelligence Activities. We may disclose medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

• Protective Services for the President and Others. We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state or conduct special investigations.

• Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official.

• Chesapeake Regional Information System for our Patients (CRISP). FutureCare participates in the Chesapeake Regional Information System for our Patients, Inc. (CRISP), a statewide health information exchange (HIE). As permitted by law, your medical information will be shared with this HIE in order to provide faster access, improve coordination of care, and assist providers and public health officials in making more informed decisions. You may “opt-out” and disable all access to your medical information available through CRISP by calling 1-877-952-7477 or completing and submitting an Opt-Out form to CRISP by mail, fax or through their website at www.crisphealth.org.

• Any Other Disclosure Allowed By Law. We may disclose medical information about you as otherwise permitted or required by applicable federal, state or local laws.

USES AND DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION

FutureCare will not use or disclose your medical information for any purpose other than those described in this Notice, unless you give FutureCare your written authorization to do so. Your medical information may not be used or disclosed for marketing purposes or sold by FutureCare without your prior written authorization. If you sign a written authorization permitting uses and disclosures of your medical information other than those described in this Notice, you may revoke your authorization by submitting a written request to notify the facility or affiliated entity’s Executive Director at any time. However, FutureCare is unable to retract or invalidate any uses or disclosures that were made with your permission before you revoked your authorization.

HIPAA provides additional protection for psychotherapy notes, and most uses or disclosures of psychotherapy notes require your written permission. Psychotherapy notes are the personal notes of a mental health professional about a private or group counseling session.

In addition, other types of information may have greater protection under federal or state law, such as certain drug and alcohol information, HIV/AIDS and other communicable disease information, genetic information, mental health information, or information about developmental disabilities. For this type of information, we may be required to get your written permission before disclosing it to others; and we may seek that permission if permitted by law.

YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION

You have the following rights regarding medical information we maintain about you:

• Right to Inspect and Copy. With certain exceptions, you and your authorized representative have the right to inspect and copy medical information that may be used to make decisions about your care. To inspect or obtain a copy of your medical information, you must submit a written request to Medical Records Department at the FutureCare Facility. If you request a paper copy of your information, we may charge a fee for the cost of copying, mailing, or other supplies associated with your request. There is no fee to see your medical information. FutureCare may deny your request to inspect or copy your medical information in certain limited situations. If you are denied access to your medical information, you will be notified in writing.

• Right to Amend. If you or your authorized representative feels that medical information we have about you is incorrect or incomplete, you or your authorized representative, may ask us to amend the information. To request an amendment, you must submit a written request to notify the facility or affiliated entity’s Executive Director. Please be specific about the information that you believe is incorrect or incomplete, and include a reason to support the request. In some situations, FutureCare may deny your request to amend your medical information. If your request is denied, you will be notified in writing.

• Right to an Accounting of Disclosures. You or your authorized representative have the right to request an “accounting of disclosures.” The accounting will not include all disclosures of your medical information. For example, you do not have the right to request an accounting of disclosures of your medical information made (1) for purposes of treatment, payment, and health care operations; (2) to you and pursuant to your authorization; or (3) for other purposes for which federal law does not require us to provide an accounting. To request this list or accounting of disclosures, you or your authorized representative must submit the request in writing to the facility or affiliated entity’s Executive Director. The request must state a time period that may not be longer than six (6) years and may not include dates before April 14, 2003. The request should indicate in what form you want the list (i.e., in paper or electronic format). The first accounting requested within a 12-month period will be free. For additional accountings requested within the same 12-month period, we may charge you or your authorized representative for the costs of providing the accounting. We will notify you or your authorized representative of the cost involved in writing and you or your authorized representative may choose to withdraw or modify your request at that time before any costs are incurred.

• Right to Request Restrictions. You or your authorized representative have the right to request that we change the way we use or disclose your medical information. To request restrictions, the request must be made in writing to FutureCare’s Privacy Office In this request, you or your authorized representative must tell us (1) what information to limit; (2) whether this limitation is for our use, disclosure or both; and (3) to whom the limits will apply, for example, disclosures to your spouse. We are not required to agree to your request, except that we will not share your medical information with your health insurance company if you pay for the entire amount due for the services you receive (unless we are otherwise required by law to share the information with your health insurance company).

• Right to Request Confidential Communications. You or your authorized representative have the right to request that we communicate with you or your authorized representative about medical matters in a certain way or at a certain location. For example, a request that we only contact you at work or by mail. To request confidential communications, you or your authorized representative must make this request in writing to the facility or affiliated entity’s Executive Director. We will not ask you the reason for this request. This request must specify how or where you or your authorized representative wish to be contacted. We will accommodate all reasonable requests.

• Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice. You may ask us to give you a copy at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice.

If you have any questions or wish to exercise any of the rights described in this Notice, please contact FutureCare’s Privacy Officer, whose contact information is provided at the end of this Notice. All requests must be submitted in writing.

CHANGES TO THIS NOTICE

We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for medical information we already have about you, as well as any information we receive in the future. We will post a copy of the current Notice on our website and in our facilities with the effective date.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with FutureCare or with the Secretary of the Department of Health and Human Services. To submit a complaint to the Department of Health and Human Services, you may contact the Office for Civil Rights of the Department of Health and Human Services, Hubert H. Humphrey Building, 200 Independence Avenue, SW, Room 509F, Washington, D.C. 20201. Some States may allow you to file a complaint with State’s Attorney General, Office of Consumer Affairs, or other State agency as specified by applicable State law. To file a complaint with FutureCare, submit your complaint to our Privacy Officer in writing.

Please contact our Privacy Officer at the address and telephone number provided below:

FutureCare Health and Management Corporation
8028 Ritchie Highway, Suite 210
Pasadena, MD 21122
410-766-1995
E-mail – Privacy@futurecarehealth.com

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

FutureCare Ace Members
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FutureCare Old Court
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