GOLDEN STATE HEALTH CENTERS, INC.

NOTICE OF PRIVACY PRACTICES

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW TO GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY

WHO WILL FOLLOW THIS NOTICE

This notice describes our facility practices and that of:

· Any healthcare professional authorized to enter information into your medical record chart
· All departments and units of the facility
· Any member of a volunteer group we allow to help while you are in the facility
· All employees, staff and other facility personnel.

The following facilities will follow the terms of this notice. They are:

Foothill Health and Rehabilitation Center
Glenoaks Convalescent Hospital
Golden State Care Center
Golden State West Valley Convalescent Hospital
Oceanview Convalescent Hospital
Olympia Convalescent Hospital
Santa Anita Convalescent Hospital
Sylmar Health and Rehabilitation Center
Virgil Convalescent Hospital

In addition the facilities may share information with each other for treatment, payment or health care operations purposes described in this notice.

OUR PLEDGE REGARDING MEDICAL INFORMATION

We understand that protected health information about you and your health is personal. We are committed to protecting health information about you. We create a record of the care and services you receive at the facility. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by the facility and your personal physician. Your physician may have different policies or notices regarding the physician's use and disclosure of your medical information created in the physician's office or clinic.

This notice will tell you about the ways in which we may use and disclose protected health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of protected health information.

We are required by law to:
· Make sure that protected health information that identifies you is kept private (with certain exceptions);
· Give you this notice of our legal duties and privacy practices with respect to protected health information about; and
· Follow the terms of the notice that is currently in effect.

HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH INFORMATION ABOUT YOU

The following categories describe different ways that we use and disclose protected health information. For each category of uses or disclosures we will explain what we mean and give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

YOUR CARE AND TREATMENT

We may use or disclose your protected health information to provide you with medical treatment, care and services. For example, we may disclose your protected health information to health care providers who are involved in your care to assist them in your diagnosis and treatment as necessary. We may also disclose your protected health information to individuals who will be involved in your care if you leave the facility such as home health agencies.

FOR PAYMENT

We may use and disclose your protected health information so that treatment and services you receive at the facility may be billed to and payment may be collected from you, an insurance company or a third party. The information on an accompanying bill may include information that identifies you as well as your diagnosis, procedures and supplies used.

We may also disclose your protected health information to health care providers in order to allow them to determine if they are owed any reimbursement for care that they have furnished to you and how it is owed. We will have a contract with the health care provider that obligates the provider to maintain the confidentiality of your protected health information.

FOR HEALTH CARE OPERATIONS

We may use and disclose protected health information about you for health care operations. These uses and disclosures are necessary to manage the facility and to make sure that all of our residents receive quality care. For example, we may use your protected health information to review our services and to evaluate the performance of our staff caring for you. We may also disclose information to doctors, nurses, technicians, and other personnel for review and learning purposes.

APPOINTMENT REMINDERS

We may use or disclose your protected health information to remind you about appointments.

TREATMENT ALTERNATIVES OR HEALTH RELATED BENEFITS OR SERVICES

We may use or disclose your protected health information to inform you about treatment alternative or health related benefits and services that may be of interest to you.

HOSPITAL DIRECTORY

Your name, location, general condition ( e.g. fair, stable, etc) and your religious affiliation may be put into our hospital directory for use by clergy and may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy such as a priest or rabbi even if they do not ask for you by name. This information is released so your family, friends and clergy can visit you in the hospital and generally know how you are doing.

INDIVUDALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE

We may release protected health information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. Unless there is specific written request from you, we may also tell your family or friends your condition and that you are in the facility. In addition, we may also disclose your protected health information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.

RESEARCH

Under certain circumstances, we may use and disclose your protected health information for research purposes. For example, a research project may involve comparing the health and recovery of all residents who received one medication to those who received another for the same condition. All research projects are subject to a special approval process through an outside Institutional Review Board. We will usually ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are or will be involved in your care at the facility.

AS REQUIRED BY LAW

We will disclose protected medical information about a resident when required to do so by federal, state or local law.

TO AVERT A SERIOUS THREAT TO HEALTH OR SAFETY

We may disclose protected medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure would only be to someone able to help prevent the threat.

SPECIAL SITUATIONS

ORGAN AND TISSUE DONATION

We may disclose protected medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank in order to aid in using your organs or tissues for transplantation following your death.

VETERANS

The facility may use and disclose to components of the Department of Veterans Affairs medical information about you to determine whether you are eligible for certain benefits.

WORKERS' COMPENSATION

We may use or disclose your protected health information to comply with laws relating to workers' compensation or similar programs. These programs provide benefits for work related injuries or illness.

PUBLIC HEALTH RISKS

We may disclose protected health information about you for public health activities. These activities generally include the following:

· To prevent or control disease, injury or disability
· To report deaths
· To report the abuse or neglect of children, elders and dependent adults
· To report reactions to medications or problems with products
· To notify people of recalls of products they may be using
· To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition
· To notify the appropriate government authority if we believe a resident has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

HEALTH OVERSIGHT ACTIVITIES

We may disclose your protected health information to a health oversight agency for activities authorized by law. These oversight activities include audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.

LAWSUITS AND DISPUTES

If you are involved in a lawsuit or dispute, we may disclose protected health information about you in response to a court or administrative order. We may also disclose protected health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if reasonable efforts have been made to tell you about the request (which may include a written notice to you) or to obtain an order protecting the information requested.

LAW ENFORCEMENT

We may release protected health information if asked to do so by a law enforcement official:

· In response to a court order, subpoena, warrant, summons or similar process
· To identify or locate a suspect, fugitive, material witness, or missing person
· About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement
· About a death we believe may be the result of criminal conduct
· About criminal conduct at the facility
· In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.

CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS

We may release protected medical information to a coroner or medical examiner. This may be necessary to identify a deceased person or determine the cause of death. We may also release protected health information about residents of our facility to funeral directors as to carry out their duties.

NATIONAL SECURITY AND INTELLIGENCE ACTIVITIES

We may release protected health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

PROTECTIVE SERVICES FOR THE PRESIDENT AND OTHERS

We may disclose protected health information about you to authorized federal officials so that they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.

YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION ABOUT YOU

You have the following rights regarding your protected health information that we maintain about you:

RIGHT TO INSPECT AND COPY

You have the right to inspect and copy protected health information that may be used to make decisions about your care. Usually, this includes medical and billing records, but may not include some mental health information.

To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to Privacy Officer, Golden State Health Centers, Inc., 13347 Ventura Blvd, Sherman Oaks, CA 91423. If you request a copy of the information, we may charge a fee for costs of copying, mailing or other supplies associated with your request.

We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another independent licensed health care professional chosen by the facility will review your request and the denial. We will comply with the outcome of the review.

RIGHT TO AMEND

If you feel that the protected health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by the facility.

To request an amendment, your request must be made in writing and submitted to the Privacy Officer, Golden State Health Centers, Inc, 13347 Ventura Blvd., Sherman Oaks, CA 91423. In addition, you must provide a reason that supports your request.

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

· 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 medical information kept by or for the facility
· Is not part of the information which you would be permitted to inspect and copy; or
· Is accurate and complete.

Even if we deny your request for an amendment, you have the right to submit a written addendum not to exceed 250 words with respect to any item or statement in your record you believe is incomplete or incorrect. If you clearly indicate in writing, you want the addendum to be made part of your medical record we will attach it to your records and include it whenever we make a disclosure of the item or statement you believe to be incomplete or incorrect.

RIGHT TO AN ACCOUNTING OF DISCLOSURES

You have the right to receive an accounting of disclosures of your protected health information. This is a list of the disclosures we made of protected health information about you other than our own uses for treatment, payment, and health care operations and with other expectations pursuant to the law.

To request this list or accounting of disclosures, you must submit your request in writing to Privacy Officer, Golden State Health Centers, Inc., 13347 Ventura Blvd, Sherman Oaks, CA 91423. Your request must state a time period, which may not be longer than six (6) years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

RIGHTS TO REQUEST RESTRICTIONS

You have the right to request restrictions on the use and disclosure of your protected health information for treatment, payment or health care operations. You also have the right to request a limit on the protected health information we disclose about to someone who is involved in your care or the payment for your care such as family member or friend. For example, you could ask that we not use or disclose information about a surgery you had.

We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

To request restrictions, you must make your request in writing to Privacy Officer, Golden State Health Centers, Inc., 13347 Ventura Blvd, Sherman Oaks, CA 91423. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for examples disclosures to your spouse.

RIGHT TO REQUEST CONFIDENTAL COMMUNICATIONS

Your have the right to request that we communicate with you about protected health information by alternative means or at alternative locations. For example, you can ask that we only contact you at work or by mail.

To request confidential communications, you must make your request in writing to Privacy Officer, Golden State Health Centers, Inc., 13347 Ventura Blvd., Sherman Oaks, CA 91423. We will not ask you the reason for the request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

RIGHT TO RECEIVE A PAPER COPY OF THE NOTICE OF PRIVACY PRACTICES

You have the right to request and receive a paper copy of this notice. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, please contact the business office of the facility. You may also obtain a copy of the notice by downloading the notice from our web site of www.goldenstatehealth.com/privacy.

CHANGES TO THIS NOTICE

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effect for protected health information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the facility. The notice will contain on the last page, in the lower right hand corner the effective date. In addition, each time you are admitted to the facility, we will offer you a copy of the current notice in effect.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with the facility or with the Secretary of the Department of Health and Human Service, 50 United Nations Plaza - Room 322, San Francisco, CA 94102, Attention OCR Regional Manager. To file a complaint with the facility, contact the Privacy Officer, Golden State Health Centers, Inc, 13347 Ventura Blvd., Sherman Oaks, CA 91423 or telephone 1-877-535-6789. All complaints must be submitted in writing.

You will not be penalized for filing a complaint.

OTHER USES OF MEDICAL INFORMATION

Other uses and disclosures of protected health information not covered by the notice or laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose protected health information, you may revoke that permission, in writing at any time. If you revoke your permission, this will stop any further use or disclosure of protected health information for the purposes covered by your written authorization, except if we have already acted in reliance on your permission. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

FURTHER INFORMATION

If you have questions about this Notice of Privacy Practices and would like further information about your privacy rights, contact the Privacy Officer, Golden State Health Centers, Inc. 13347 Ventura Blvd., Sherman Oaks, CA 91423. The telephone number is 1-877-535-6789.

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