RAPPAHANNOCK WESTMINSTER-CANTERBURY, INC. IS PROVIDING THIS NOTICE OF PRIVACY PRACTICES BECAUSE THE PRIVACY OF YOUR HEALTH INFORMATION IS VERY IMPORTANT TO YOU AND TO US, AND IN COMPLIANCE WITH FEDERAL REGULATIONS. BY "YOUR HEALTH INFORMATION" WE MEAN THE INFORMATION THAT WE MAINTAIN THAT SPECIFICALLY IDENTIFIES YOU AND YOUR HEALTH STATUS.

SUMMARY

This Notice describes how we use your health information within Rappahannock Westminster-Canterbury, Inc. and disclose it outside Rappahannock Westminster-Canterbury, Inc., and why.

The Notice covers:

• Uses or disclosures that do not require your written authorization.
• Treatment, payment, and health care operations.
• Uses or disclosures of your health information to which you may object.
• Uses or disclosures required or permitted.
• Uses or disclosures that require your written authorization.
• Your rights as a resident regarding privacy of your health information.
• Our duties in protecting your health information.
• Complaints, contact person, effective date, and acknowledgement.

Uses or Disclosures That Do Not Require Your Written Authorization

Treatment, Payment, and Health Care Operations
We use or disclose your health information to carry out your treatment; to obtain payment for your treatment; and to conduct health care operations. For example:

• For treatment, we use your health information to plan, coordinate, and provide your care. We disclose your health information for treatment purposes to physicians and other health care professionals outside our facility who are involved in your care.
• For payment, we use your health information to prepare documentation required by your insurance company or HMO or by Medicare or Medicaid. We disclose that part of your health information that these organizations require to pay us.
• For health care operations, we use or disclose your health information, for example, to improve the quality of our services, to plan better ways of treating residents, and to evaluate staff performance.

Uses or Disclosures of Your Health Information
to Which You May Object
We may use or disclose your health information for the following purposes, unless you ask us not to.

• Facility directories. We maintain a resident directory including, for each resident, name, location in our facility, health condition in general terms, and religious affiliation. We may disclose this information to people who ask for you by name. We will make known your religious affiliation, on a prayer list, only to clergy. We also maintain a hospital visitation list so that other residents may know when to visit you in the hospital.
• Informing family and friends. We may disclose your health information to family, friends, or others identified by you who are involved in your care or payment for your care. If we are unable to reach your family member or personal representative, we may leave a message for them at the phone number that they have provided us, e.g., on an answering machine.
• Assistance in disaster relief efforts.
• For fundraising activities. We may contact you or your family for fundraising purposes. If you do not wish to be contacted for this purpose, please contact the Privacy Officer and indicate that you do not wish to receive fundraising communication from us.
• Confirming appointments.
• Informing you about treatment alternatives or other health-related benefits and services that may be of interest to you.

If you object to our use of your health information for any of these purposes please contact the Privacy Officer in writing at the address listed below.

Uses or Disclosures Required or Permitted
Where we are required or permitted to do so, we may use or disclose your health information in the following circumstances without your written authorization.

• Federal government investigation, when required by the Secretary of Health and Human Services to investigate or determine our compliance with federal regulation.
• Federal, state or local law requirements.
• Public health activities, for example to report communicable diseases or death; or for matters involving the Food and Drug Administration (FDA). For example, we may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.
• Reporting of abuse, neglect or domestic violence.
• Health oversight activities by a health oversight agency. (A health oversight agency is an organization authorized by the government to oversee eligibility and compliance and to enforce civil rights laws.)
• Judicial or administrative proceedings, for example responding to a court order or subpoena.
• Law enforcement purposes, for example to report certain types of wounds or other physical injuries or to identify or locate a suspect, fugitive, material witness, or missing person.
• Use by coroners, medical examiners, or funeral directors.
• Facilitating organ, eye, or tissue donation.
• Averting a serious threat to your health or safety or that of the public.
• Specialized government functions such as military or veterans' affairs; national security, and intelligence activities.
• Workers' compensation. We may disclose health information 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.

Uses or Disclosures That Require Your Written Authorization
Your written authorization, which you may revoke (in writing), is required if we use or disclose your health information for any other purpose, in particular:

• Our use of psychotherapy notes beyond treatment, payment, and health care operations.
• Marketing of goods or services to you.

Your Rights As A Resident to Privacy Of Your Health Information

Right to Request Restrictions
You have the right to request restrictions on our uses and disclosures of your health information, however we may refuse to accept the restriction. We are required to notify you if we are unable to agree to a requested restriction.
Right to Request Confidential Communications
You have the right to request that we communicate with you confidentially, for example to speak with you only in private; to send mail to an address you designate; or to telephone you at a number you designate. Your request must be in writing. We will make every attempt to honor your request.
Right to Request Access to Your Health Information
You have the right to request access to your health information in order to inspect or copy it. Your request must be in writing. We may deny your request and, if so, you may request a review of the denial. However, we will make every attempt to honor your request within the timeframes established by law.
Right to Request an Amendment of Your Health Information
You have the right to request an amendment to your health information.
Your request must be in writing and must provide a reason for the amendment.
We may deny your request and, if so, you may submit a statement of disagreement.
However, we will make every attempt to honor your request.
Right to Request an Accounting of Disclosures of Your Health Information
You have the right to request an accounting of our disclosures of your health information for purposes other than treatment, payment, and health care operations. We will make every attempt to honor your request. We are not required to provide an accounting for disclosures before April 14, 2003 or for more than 6 years prior to the date of your request.
Right to Obtain a Paper Copy of this Notice
If you received this Notice electronically, you have the right to receive a paper copy.
Right to Revoke Authorization
You 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.
To exercise any of these rights please write or telephone the Privacy Officer.

Our Duties in Protecting Your Health Information

• We are required by law to maintain the privacy of your health information.
• We must inform residents or their legal representatives of our legal duties and privacy practices with respect to health information. This Notice discharges that duty.
• We must abide by the terms of the Notice currently in effect.
• We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all health information that we maintain. At any time, you may obtain a copy of the current notice from the Privacy Officer.
• Complaints, Contact Person, Effective Date, and Acknowledgement
• You may complain to us and to the Secretary of Health and Human Services if you believe your privacy rights have been violated.
• You will not be retaliated against for filing a complaint.
• You may file your complaint with our facility by writing to the Privacy Officer. Your complaint will be acknowledged in writing within seven (7) days of receipt.

Chris K. Gardner, MHSA, LNHA
Privacy Officer
Rappahannock Westminster-Canterbury, Inc.
132 Lancaster Drive
Irvington, VA 22480
(804) 438-4030