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

MARINA BAY SKILLED NURSING AND REHABILITATION CENTER is committed to protecting health information about you. We create a record of the care and services you receive at MARINA BAY for use in your care and treatment.

This Notice tells you about the ways in which we may use and disclose health information about you. It also describes your rights and certain obligations we have regarding the use and disclosure of your health information.

We are required by law to:

• Make sure that your medical information is protected.
• Give you this Notice describing our legal duties and privacy practices with respect to medical information about you and
• Follow the terms of the Notice that is currently in effect

How We May Use and Disclose Health Information About You

The following sections describe different ways that we may use and disclose your medical information without obtaining your written authorization. For each category of uses or disclosures, we will describe them and give some examples. Some information such as certain drug and alcohol information, HIV information and mental health information is entitled to special restrictions related to its use and disclosure. MARINA BAY abides by all applicable state and federal laws related to the protection of this information. Not every use or disclosure will be listed. All of the ways we are permitted to use and disclose information, however, will fall within one of the following categories.

For Treatment. We may use health information about you to provide you with health care treatment and services. We may disclose your health information to doctors, nurses, nursing assistants, medication aides, technicians, medical and nursing students, rehabilitation therapy specialists, or other personnel who are involved in your health care. For example, your doctor may order Physical Therapy services to improve your strength and walking abilities. We will need to talk with the Physical Therapist so that we can coordinate services and develop a plan of care. We may also share information about you with other Marina Bay personnel or other Health Service Providers, Agencies or Facilities in order to provide or coordinate the different things you need, such as prescriptions, lab work and X-rays. We may also disclose health information about you to people who may be involved in your continuing care after you leave Marina Bay, such as other health care providers, transport companies, community agencies and family members.

For Payment. We may use or disclose your health information so that we may bill and receive payment from you, an insurance company, or another third party for the health care services you receive from us or other entities such as ambulance companies. We also may disclose health information about you to your health plan in order to obtain prior approval for the services we provide to you, or to determine that your health plan will pay for the treatment. For example, we may need to give health information to your health plan in order to obtain prior approval to refer you to a health care specialist, such as a neurologist or orthopedic surgeon, or to perform a diagnostic test such as a magnetic resonance imaging scan (“MRI”) or a CT scan.

Health Care Operations. We may use or disclose your health information in order to perform the necessary administrative, educational, quality assurance and business functions of our facility. For example, we may review your health information to find ways to improve our services. We may also disclose information doctors, nurses, technicians, medical and other students, and other health system personnel for performance improvement and educational purposes.

Treatment Alternatives & Health-Related Products and Services. We may use or disclose your health information for purposes of discussing with you treatment alternatives or health-related products or services that may be of interest to you. For example, if you are a resident of our facility for purposes of a post-surgical hip replacement, we may talk with you about a gait training program that we offer at our facility to improve your walking and balance.

Facility Directory. We may use or disclose certain limited health information about you in our facility directory. This is so your family, friends, and clergy can visit you in the Facility. This information may include your name, location in the Facility and your religious affiliation. The Directory Information, except for your religious affiliation, may be released to people who ask for you by name. Your religious affiliation may be given to members of the clergy, such as ministers or rabbis, even if they don’t ask for you by name. You may restrict or prohibit the use or disclosure of this information by notifying the Social Service Department.

Individuals Involved in Your Care or Payment for Your Care. We may disclose your health information to anyone involved in your care, such as family members, friends, a personal representative or any individual you identify. We may make such disclosures when:

• We have your verbal agreement to do so;
• We make such disclosures and you do not object; or
• We can infer from the circumstances that you would not object to such disclosures.

For example, if your medical condition prevents you from either agreeing or objecting to disclosures made to your family or friends, we may share information with the family member or friend that comes to visit you at our facility, but we will share only that information which relates to their involvement in your care.

Disaster Relief Efforts. We may disclose your health information to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.

As Required By Law. We may disclose your health information when required by federal, state, or local law to do so. For example, we are required by the Department of Health and Human Services (HHS) to disclose your health information in order to allow HHS to evaluate whether we are in compliance with the federal privacy regulations.

Public Health Disclosures. We may disclose health information about you for public health purposes. These purposes generally include:

• Preventing or controlling disease (such as cancer and tuberculosis), injury or disability
• Reporting vital events such as births and deaths
• Notifying the appropriate government authority of instances of abuse or neglect
• Reporting adverse events or surveillance related to food, medications or defects or problems with products.
• Notifying persons of recalls, repairs or replacements of products they may be using
• Notifying a person who may have been exposed to a disease or may be at risk of contracting or spreading a disease or condition,.

Health Oversight Activities. We may disclose your health information to a health oversight agency that is authorized by law to conduct health oversight activities, including audits, investigations, inspections, or licensure and certification surveys. These activities are necessary for the government to monitor the persons or organizations that provide health care to individuals and to ensure compliance with applicable state and federal laws and regulations.

Legal Proceedings. We may disclose health information about you to courts, attorneys and court employees in the course of guardianship, conservatorship and other judicial or administrative proceedings.

Lawsuits and Other Legal Actions. We may disclose health information about you in response to a court or administrative order, or in response to a subpoena, discovery request, warrant, summons or other lawful process.

Worker’s Compensation. We may use or disclose health information about you for Worker’s Compensation Programs when your health condition arises out of a work-related illness or injury.

Law Enforcement Official. We may disclose health information about you in response to a request received from a law enforcement official to report criminal activity or to respond to a subpoena, court order, warrant, summons, or similar process.

Coroners, Medical Examiners, or Funeral Directors. In most circumstances, we may disclose health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or to determine the cause of death. We also may disclose health information about residents to funeral directors as necessary to carry out their duties.

Organ Procurement Organizations or Tissue Banks. If you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye or tissue transplantation, or to an organ donation bank, as necessary to facility organ or tissue donation or transplantation.

To Avert a Serious Threat to Health or Safety. We may use or disclose health information about you when necessary to prevent or lessen a serious and imminent threat to the your health and safety or the health and safety of the public or another person. Any disclosure would be to someone able to help stop or reduce the threat.

Military and Veterans. If you are or were a member of the armed forces, we may use or disclose your health information as required by military command authorities.

National Security and Intelligence Activities. As authorized or required by law, we may disclose health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities.

When Your Written Authorization is Required

Except for the purposes identified above, we will not use or disclose your health information for any other purposes unless we have your specific written authorization. You have the right to revoke a written authorization at any time as long as you do so in writing. If you revoke your authorization, we will no longer use or disclose your health information for the purposes identified in the authorization, except to the extent that we have already taken some action in reliance upon your authorization.

Your Rights Regarding Health Information About You

Your medical record is the property of MARINA BAY, however, you have the following rights regarding the health information we maintain about you:

Right to Inspect and Copy. You have the right to inspect and/receive a copy of your health information

To inspect and/or to receive a copy of your health information, you must submit your request in writing, using the Facility-designated form that you can obtain from the Social Service Department, Marina Bay Skilled Nursing and Rehabilitation Center 2 Seaport Drive, Quincy, MA 02171, phone 617-769-5100. If you request a copy of the information, there is a fee for these services.

Right to Amend. If you feel that the health information that we have about you is incorrect or incomplete, you may ask us to amend the information or add an addendum (addition to the record). You have the right to request an amendment or addendum for as long as the information is kept by Marina Bay.

To request an amendment or to add an addendum, your request must be made in writing using the Facility-designated form that you can obtain from the Social Service Department, Marina Bay Skilled Nursing and Rehabilitation Center 2 Seaport Drive, Quincy, MA 02171, phone 617-769-5100.

We may deny your request if it is not properly submitted or does not include a reason to support your request. We may also deny your request if the information sought to be amended:

• Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
• Is not part of the information that is kept by or for our facility;
• Is not part of the information which you are permitted to inspect and copy; or
• Is accurate and complete.

Right to an Accounting of Disclosures. You have the right to receive a list of the disclosures we have made of your health information.

To request this accounting of the disclosures, you must submit your request in writing using the Facility-designated form that you can obtain from the Social Service Department, Marina Bay Skilled Nursing and Rehabilitation Center 2 Seaport Drive, Quincy, MA 02171, phone 617-769-5100.Your request may not be longer than the six previous years and may not include dates before April 14, 2003. Your accounting will not include any disclosures that we made for the purposes of TREATMENT, PAYMENT OR HEALTH CARE OPERATIONS

Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the health information we disclose about you to someone, such as a family member or friend, who is involved in your care or in the payment of your care. For example, you could ask that we not use or disclose information regarding a particular treatment that you received.

To request a restriction, you must make your request in writing using the Facility-designated form that you can obtain from the Social Service Department, Marina Bay Skilled Nursing and Rehabilitation Center 2 Seaport Drive, Quincy, MA 02171, phone 617-769-5100. We are not required to agree to your request. If we do agree, our agreement must be in writing, and signed by you and us.

Right to Request Confidential Communications. You have the right to request that we communicate with you about your health care in a certain way or at a certain location. For example, you can ask that we communicate with you in a private room or secure area of the facility.

To request confidential communications, you must make your request in writing using the Facility-designated form that you can obtain from the Social Service Department, Marina Bay Skilled Nursing and Rehabilitation Center 2 Seaport Drive, Quincy, MA 02171, phone 617-769-5100.

Right to a Paper Copy of this Notice. You have the right to receive a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time

Questions or Complaints

If you have any questions regarding this Notice or wish to receive additional information about our privacy practices, please contact the Rosemary McLaughlin, Administrator who is our Privacy Officer and who can be reached at 617-769-5100 Extension 106. If you believe your privacy rights have been violated, you may file a complaint with our facility or with the Secretary of the Department of Health and Human Services (HHS). To file a complaint with our Facility, contact our Privacy Officer at 2 Seaport Drive, Quincy, MA 02171. All complaints must be submitted in writing
You will not be penalized for filing a complaint.