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.

The Home must maintain the privacy of your medical information, and give you this Notice that tells you how we will keep your information private. We will tell youif we are unable to agree to a limit on a use or disclosure which you request. We will carry out reasonable requests to communicate medical information to you by special means or at other locations and get your written permission to use or disclose your medical information in ways other than those set out in this Notice. We have the right to change our practices regarding the medical information we keep. If practices are changed, we will tell you by giving you a new Notice, or you may request one at any time. The Notice will be posted in the Home and on our Web site at www.nysvets.org.

The following is a description of the types of uses and disclosures of medical and health information about you that the Home, or contractors using or disclosing medical information on behalf of the Home, may make:

We may use medical information about you in order to provide you with medical treatment and care. For example, a doctor treating you for dementia may need to know if you have diabetes because diabetes may affect the course of treatment. We may disclose medical information about you to the Home's personnel or another health care provider involved in treating you. For example, a doctor may need to tell the dietitian if you have diabetes so that the Home can arrange for appropriate meals, or a doctor may consult and share information with an off-site specialist to whom you have been referred for care, treatment or diagnosis. We also may disclose medical information about you, with your permission, to people outside the Home who may be involved in your medical care after you leave the Home.

We may, with your permission, use and disclose medical information about you so that the Home can get paid for the services it gives you. For example, we may need to give your health plan (i.e., Blue Cross, Medicare, Medicaid, VA Benefits Program) information about the treatment you received at the Home so it will pay us or reimburse you for services provided. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.

We may use and disclose medical information about you for general administrative and business functions necessary for operation of the Home. For example, we may use medical information about you to assess the quality of care we are giving to our residents, to review the competence of health care professionals working at the Home, to train medical/nursing staff and students, to make sure we are complying with legal rules and regulations or to conduct business planning, management or other general administrative activities.

We may use and disclose medical information about you to contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

If you do not object, we may disclose to a family member, other relative or close personal friend, medical information directly relevant to that person's involvement with your care or payment related to your health care. We may also notify your family or other person involved with your health care that you are in the Home.

If you do not object, we may include certain limited information about you in the Home's directory while you are a resident at the Home. This information may include your name, location in the Home, a description of your condition in general terms that does not communicate specific medical information about you and your religious affiliation. The directory information, except for your religious affiliation, may be disclosed to people who askfor you by name. If you do not object, your religious affiliation may be given to members of the clergy, such as priests or rabbis, even if they do not ask for you by name. This is so your family, friends and clergy can visit you in the Home and generally know how you are doing.

If you do not object, we may use medical information about you to contact you to raise funds for the Home. We may disclose medical information to an agent acting on behalf of the Home such as a foundation or auxiliary organization so that the organization may contact you to raise money for the Home. We would only release contact information, such as your name, address and phone number and the dates you received treatment or services at the Home. If you do not want the Home to contact you for fundraising efforts, you must notify the Home's Privacy Contact in writing. (See listing for each Home under Questions.)

We may use and disclose medical information about you without your consent if necessary for reviews preparatory to research, but none of your medical information would be removed from the Home in the course of such reviews and no public disclosure of your name will be made without your consent. For example, in order to prepare for research on dementia-related treatments, it would be necessary to review the Home's medical records to determine which residents might be appropriate for such research.

Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of residents with a particular condition who received one type of treatment to those who received another. Before we use or disclose medical information about you for research, the project would have to be approved through a review board process that the Home uses for the protection of human research subjects, and your permission and consent is required. If the researcher will be using or disclosing medical information about you for research and will have access to your name, address or other information that could be used to identify who you are, you will be asked for your permission. No public disclosure of your name will be made without your permission.

Our contractors, agents and partners may be given medical information about you if it is necessary for them to perform certain services for us. For example, the Home may share information with evaluators, auditors, attorneys, if they agree to keep such information confidential.

We may disclose information as required by the U.S. Food and Drug Administration to monitor and repair products. For example, the Home determines that a hoyer lift malfunctions during a resident lift and causes injury to the resident, the Home is required to disclose this information in order to avert a future threat to the public and public safety.

We may release medical information about you for Workers' Compensation or similar programs. These programs provide benefits for work-related injuries or illness.

If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, when certain protections are in place.

We may disclose medical information to a coroner or medical examiner for the purpose of identifying a deceased person or determining a cause of death, or to funeral directors as necessary for them to carry out their duties.

If you are an organ donor, the Home may use or disclose medical information about you to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of cadaveric organs, eyes, or tissue for the purpose of facilitating organ, eye or tissue donation and transplantation.

We may use and disclose medical information about you when necessary to report evidence of a crime or to prevent a serious threat to your health or safety or the health or safety of the public or another person, including the reporting of cases of suspected child abuse, adult abuse, domestic violence or maltreatment.

We will disclose medical information about you when required to do so by federal, State or local law. For example, we are required by law to disclose certain information about residents to public health authorities and health oversight agencies.

As permitted by law, we may share information with authorized Federal officials engaged in national security activities and also disclose information about Armed Forces personnel and foreign military personnel to military authorities.

We may disclose medical information about you as permitted or required by federal Standards for Privacy of Individually Identifiable Health Information issued by the U.S. Department of Health and Human Services.

There are special laws, rules and regulations that may apply to the use and disclosure of psychotherapy notes, HIV/AIDS information, and drug and alcohol information. The Home shall comply with such laws, rules and regulations, and may seek special authorizations and consents from you as they relate to these special circumstances.

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written authorization. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. 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.

Unless otherwise required by law, your medical and health information and records are the physical property of the Home, but the information in it belongs to you and you have a right to have your medical and health information kept confidential. You have the following rights regarding the medical and health information we maintain about you:

• Right to a Paper Copy of This Notice.
• You have the right to a paper copy of this notice upon request.

You have the right to inspect and copy medical and health information that may be used by the Home to make decisions about you.

To inspect and copy the information that may be used to make decisions about you, you must submit your request in writing to Medical Records (addresses listed at the end of this document). If you request a copy of the information, we may charge a fee for the 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 and health information, you may request that the denial be reviewed as required by law. We will comply with the outcome of the review.

You have the right to request a restriction or limitation on the medical and health information we use or disclose about you. 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 Medical Records (addresses listed at the end of this document). In your request, you must tell us:

• what information you want to limit;
• whether you want to limit our use, disclosure or both; and
• to whom you want the limits to apply.

You have the right to request that we communicate with you about medical and health matters by alternative means or at alternative locations. For example, you can ask that we only contact you at work or that information be mailed to an alternate address or post office box.

To request confidential communications, you must make your request in writing to Medical Records (addresses listed at the end of this document). We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

If you feel that medical or health information we have about you is incorrect or incomplete, you may ask us to amend the information.

To request an amendment, your request must be made in writing and submitted to Medical Records (addresses listed at the end of this document). 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 information which you would be permitted to inspect and copy; or
• is accurate and complete.

You have the right to request an "accounting" of disclosures. This is a list of disclosures we made of medical and health information about you, but the list does not include certain disclosures, such as those made for treatment, payment or health care operations, those specifically authorized by you or certain disclosures for law enforcement purposes.

To request this accounting of disclosures, you must submit your request in writing to Medical Records (addresses listed at the end of this document). Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. 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.

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical 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 Home. The notice will contain the effective date. In addition, upon admission and/or re-admission to the Home for treatment or health care services, we will offer you a copy of the current notice in effect.

If you believe your privacy rights have been violated, you may file a complaint with the Home by contacting the Home's Privacy Contact (see listing for each Home under Questions). All complaints must be submitted in writing. You may also complain to the Office for Civil Rights, the United States Department of Health and Human Services, Jacob Javits Federal Building, 26 Federal Plaza, Suite 3312, New York, New York 10278, telephone number (212) 264-3313, fax number (212) 264-3039, or TDD (212) 264-2355. You will not be retaliated against for filing a complaint or assisting an investigation.

If you have any questions about this Notice, please contact the following persons for further information:

• NYSVH @ Oxford: Director Of Social Services. (607) 843-3100.
• NYSVH @ St. Albans: Director Of Nursing. (718) 990-0300.
• NYSVH @ Batavia: Director Of Medical Records: (585) 345-2000.
• NYSVH @ Montrose: Director Of Social Services. (914) 788-6000.