THE FOLLOWING NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THE INFORMATION CAREFULLY.
1. Your confidential healthcare information may be released to other healthcare professionals within or contracting with the Sears Methodist Retirement System, Inc. (“SMRS”) for the purpose of providing you with quality healthcare.
2. Your confidential healthcare information may be released to your insurance provider in order for SMRS to receive payment for providing you with needed healthcare services.
3. Your confidential healthcare information may be released to public or law enforcement officials in the event of an investigation in which you are a victim of abuse, a crime or domestic violence.
4. Federal and Texas law makes provision for your confidential healthcare information to be released to an appropriate health oversight agency, such as the Centers for Medicare and Medicaid Services or the Texas Department of Aging and Disability Services to ensure compliance with applicable laws, rules and regulations.
5. Your confidential healthcare information may be released to other healthcare providers in the event you need emergency care.
6. Your confidential healthcare information may be released to a public health organization or federal organization in the event of a communicable disease or to report a defective device or untoward event to a biological product (food or medication).
7. Your confidential healthcare information may not be released for any other purpose than those that are identified in this notice.
8. Your confidential healthcare information may be released for any other purpose only after receiving written authorization from you. You may revoke your permission to release confidential healthcare information at any time.
9. You may be contacted by an SMRS operating entity to remind you of any appointments, healthcare treatment options, or other health services that may be of interest to you.
10. You may be contacted by the Sears Methodist Foundation for the purposes of raising funds to support the SMRS operating entity’s operations or benevolent funds.
11. You have the right to restrict the use of your confidential healthcare information. However, the SMRS operating entity may choose to refuse your restriction if it conflicts with the provision of quality healthcare for you by SMRS or in the event of an emergency situation.
12. You have the right to receive confidential communication about your health status.
13. You have the right to review and photocopy any/all portions of your healthcare information.
14. You have the right to make changes to your healthcare information to the extent it is incorrect.
15. You have the right to know who has accessed your confidential healthcare information and for what purpose.
16. You have the right to a copy of this Privacy Notice upon request. This copy can be in the form of an electronic transmission or on paper.
17. Each SMRS operating entity is required by law to protect the privacy of its residents. It will keep confidential any and all resident healthcare information and will provide residents with a list of duties or practices that protect confidential healthcare information.
18. Each SMRS operating entity will abide by the terms of this notice. SMRS reserves the right to make changes to this notice and continue to maintain the confidentiality of all healthcare information. Residents will receive a mailed copy of any changes to this notice within 60 days of changes made.
19. You have the right to complain to SMRS if you believe your rights to privacy have been violated. If you feel your privacy rights have been violated, please mail your complaint to:
ATTN: Privacy Officer
Sears Methodist Retirement System, Inc.One Village Drive, Suite 400
Abilene, Texas 79606
All complaints will be investigated. No personal issue will be raised for filing a complaint with SMRS.
20. For further information about this Privacy Notice, please contact:
21. This notice is effective as of April 14, 2003.