NIGHTINGALE NURSING
NOTICE OF PRIVACY PRACTICES
EFFECTIVE APRIL 14, 2003

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.

Nightingale Nursing is required by law to protect the privacy of certain confidential health care information we have about you, known as Protected Health Information or PHI. Your PHI includes such things as your name, address, personal data, medical history, and medical treatment. We are required to provide you with this notice of how the law allows us to use and share your PHI.

Use and Disclosure of PHI for Treatment, Payment, and Operations Nightingale Nursing may use and share PHI for the purposes of treatment, payment, and health care operations, in most cases without your written permission. Examples of our use of your PHI:

For treatment. This includes such things as obtaining information about your medical condition and treatment from you and others, such as doctors and hospital staff who refer you to us for care. We may share your PHI with others in order to get you the care you need
For payment. This includes any activities we must undertake in order to get reimbursed for the services we provide to you, including such things as submitting bills to insurance companies, making medical necessity determinations, and collecting outstanding accounts.
For health care operations. This includes quality assurance and supervisory activities, as well as planning, administration, and other management functions.
Other Uses and Disclosures of PHI Not Requiring Written Authorization The law also allows Nightingale Nursing to use or share PHI without your written permission in these situations:
For the treatment, payment or health care operations activities of another health care provider who treats you;
For health care and legal compliance activities;
To a family member, other relative, or close personal friend or other individual involved in your care if we obtain your verbal agreement to do so or if we give you an opportunity to object to such a disclosure and you do not raise an objection, and in certain other circumstances where we are unable to obtain your agreement and believe the disclosure is in your best interests;
For purposes required by law, such as reporting abuse or neglect, or workers' compensation;
To agencies that oversee the health care system, for audits or investigations;
For judicial and administrative proceedings, as required by a court or administrative order, or in response to a subpoena or other legal process;
For law enforcement activities in limited situations, such as when responding to a warrant;
For military, national defense and security and other special government functions;
To avert a serious threat to the health and safety of a person or the public at large;
To coroners, medical examiners, and funeral directors for identifying a deceased person, determining cause of death, or carrying on their duties as authorized by law;
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 facilitate organ donation and transplantation;
For research projects, subject to strict oversight and approvals;
We may also use or disclose health information about you in a way that does not personally identify you or reveal who you are.
When state law places stricter limits on sharing the information listed above, we will comply with the stricter law.
When Written Authorization is Needed Before using your PHI for any reason not listed above, we need your written permission. If you give us written authorization, you may revoke it, in writing, at any time except to the extent that we have already used or disclosed medical information in reliance on that authorization.
Patient Rights: As a patient, you have a number of rights with respect to your PHI, including: The right to access, copy, or inspect your PHI. You have the right to see and get a copy of most of your PHI that we maintain. We will normally provide you with access to this information within 30 days of your request. We may charge you a reasonable fee for to copy records. In limited circumstances, the law may allow us to deny you access to some or all of your PHI. If we do deny you access, we will provide you with information on how to file an appeal of our decision.
The right to amend your PHI. You have the right to ask us to amend written PHI that we may have about you. We will normally amend your PHI within 60 days of your request. We are permitted by law to deny your request in certain circumstances, including if we believe our records are correct or if we did not create the information. You may submit a written statement disagreeing with our decision which we will keep with your records.
The right to request listing of disclosures. You may request a list of the times on or after April 14, 2003, when we disclosed your PHI to other parties. The list will identify the parties with whom we shared your PHI, when, for what reason, and what was shared. The list will not include the times that we gave your PHI to you; disclosures of your PHI for purposes of treatment, payment or health care operations; or disclosures already covered by your written authorization.
The right to request that we restrict the uses and disclosures of your PHI. You have the right to ask us not to use or share your PHI in any of the ways listed above. The law does not require us to agree to any restrictions you request, but any restrictions to which we agree in writing will be binding.
The right to obtain a copy of Notice on request. You have the right to get a paper copy of this Notice upon request. We will also post this Notice on our website at: www.nightingalenursing.com
How to exercise your rights: To exercise any of the rights explained in this Notice, or if you have any concerns, contact:
PRIVACY OFFICER
Nightingale Nursing
101 Callan Avenue, Suite 405
San Leandro, CA 94577
(510) 357-4222

Complaints: You may file a complaint by contacting the Privacy Officer as listed above. You may also contact the Secretary of the U.S. Department of Health and Human Services or the U.S. Office of Civil Rights. We will not retaliate against you in any way for filing a complaint with us or with the government.
Revisions to the Notice: Nightingale Nursing has the right to change our privacy practices at any time. If we make any changes, we will promptly mail out the revised Notice as well as post it on our website.