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Notice of Privacy Practices

I. 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.

"Medical information", as used in the paragraph above, may not completely describe the type of information Immaculate Mary Home may use and disclose. Information about your past, present, or future health or condition, the provision of health care or other services to you, or payment for services rendered, if such information does or could be used to identify you, is considered "Protected Health Information" ("PHI") under the Federal Health Insurance Portability and Accountability Act of 1996 ("HIPAA") and federal regulations issued thereunder (collectively, the "HIPAA Privacy Rule"). Included in your PHI, for example, are your treatment or service records, your name and address, and your insurance or other health benefit information. This Notice describes potential uses and disclosures of your PHI, as well as your rights with respect to your PHI.

You should read this Notice of Privacy Practices before signing the "Acknowledgement of Receipt of Notice of Privacy Practices"

II. Our Duty to Safeguard Your Protected Health Information.

Under the HIPAA Privacy Rule, Immaculate Mary Home is required to extend certain protections to your PHI, and to give you this notice about our privacy practices that explains how, when and why we may use or disclose your PHI. Except in specified circumstances, we must use or disclose only the minimum PHI to accomplish the purpose of the use or disclosure.

We are required to follow the privacy practices described in this notice, though we reserve the right to change our privacy practices and the terms of this Notice at any time. If we do so, we will post a new notice at the facility. You may request a copy of any new notice by contacting John Miller, the facility privacy officer, at 215-335-2100. Any changes shall be effective for all protected health information that we maintain.

We are required to notify you of a breach of your unsecured protected health information.

III. How We May Use and Disclose Your Protected Health Information.

We use and disclose PHI for a variety of reasons. For some uses and disclosures, we must have your written authorization, for others, no authorization is required. The following offers more description and examples of our potential uses/disclosures of your PHI.

IV. Your Rights Regarding Your Protected Health Information. You have the following rights relating to your protected health information:

V. How to Make a Complaint About a Violation of our Privacy Practices:

If you think we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a complaint with the person listed in Section VI below. You also may file a written complaint with the Office for Civil Rights of the Federal Department of Health and Human Services. We will take no retaliatory action against you if you make such complaints.

VI. Contact Person for Information, or to Submit a Complaint:

If you have questions about this Notice or any complaints about our privacy practices, please contact: John Miller, 2990 Holme Ave, Philadelphia, PA 19136-1829 or by calling 215-335-2100.

VII. Effective Date: This Notice was effective on April 14, 2003. Revised September 22, 2013.