NOTICES OF PRIVACY PRACTICES: HIPPA

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION — PLEASE READ THIS IN ITS ENTIRETY CAREFULLY

Treatment

Your health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of laboratory tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted by staff members.

Payment

Your health information may be used to seek payment from your health plan or other sources appropriately assigned by you. For example, your health plan may request information on dates of service, the services provided and the medical condition being treated.

Health Care Operations

Your health information may be used as necessary to support the day to day activities and management of Little Brook Nursing and Convalescent Home. For example, information on the service you receive may be used to support budgeting and financial reporting, and activities to evaluate and promote quality.

Under certain circumstances, your health information may be disclosed without your consent or authorization. For example,

– Transmitting MDS information to the State of New Jersey as required by state and federal regulations
– Disclosing the facility directory which includes name, room number and general condition to insurers
– Eliciting emergency treatment, a coroner, or medical examiner
– Complying with the law
– Reporting to Public Health Agencies
– Contacting a Funeral Director
– Disclosing information about victims of abuse, neglect or domestic violence or other crimes
– Responding to government audits, investigations, inspections or other similar activities

Authorization

Disclosure of your health information or its use for any purpose other than those listed above requires your specific written authorization. If you change your mind after authorizing a use or disclosure of your information, you may submit a written revocation of the authorization. However, your decision to revoke the authorization will not affect or undo any use or disclosure of information that occurred before you notified us of your decision. (Please refer to Little Brook’s Authorization Form)

Individual Rights

You, the resident, have certain rights under the federal privacy standards. These include:

– The right to request restrictions on the use and disclosure of your protected health information
– The right to receive confidential communication concerning your medical condition and treatment
– The right to inspect, copy, amend or submit corrections of your protected health information
– The right to receive an accounting of how and to whom our protected health information has been disclosed
– The right to receive a written copy of this notice
– The right to file a complaint to the Privacy Officer or designee (John Kasarda)
– The right to contact the Office of Civil Rights with any complaints unresolved by the Privacy Officer or designee within a reasonable time frame

Quick Facts

– Cozy 36 Bed Country Inn Nestled in Northeastern Hunterdon County
– Awarded a 5-STAR Government Rating in 2016, 2017 and 2018 ¹
– U.S. News & World Report ² 2018-2019 award recipient — “One of the Best Nursing Homes in the U.S.”
– Serving Our Community’s Rehab & Long-term Care Needs
– A Licensed Skilled Long-Term Care Nursing Home since 1960
– Little Brook is Now Accepting Transfer Applications
– Single Level for Easy Access to All Rooms in Our Home
– Alzheimer’s Disease and Dementia Sensitive Staff
– Geriatrics Medical Director and Physical Therapist on Staff
– Home-Like, Non-Institutional Setting on 6 Acre Estate
– No Deposits Required (when payor source confirmed); All Inclusive Flat Rate; No End-of-Month Surprise Add-on Charges for Equipment, Supplies or Services
– Private and Semi-Private (Double Only) Rooms Available
– 24 Hour Nursing Care; Short-Term/Medicare Rehab; Respite Stays
– Staffed by Certified, Local, Long-Term Employees
– Home Cooked Meals on Site; Organized Daily Activities
– Free Access to LED TV & Cable, Telephone and Internet
– Medicare/Medicaid Certified
– Local Family Owned and Operated

78 Sliker Road #398
Califon, NJ 07830
Phone: 908-832-2220
Fax: 908-832-6565
general@littlebrooknursinghome.com

* A division of Little Brook Home, Inc.

¹   CMS Rating (December 2018): https://www.medicare.gov/nursinghomecompare/search.html
²  U.S. News & World Report (October 2018): https://www.usnews.com/info/blogs/press-room/articles/2018-10-30/us-news-names-best-nursing-homes-for-2018-19