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(Revised September 2013) 

SmileGeneral Description and Purpose of Notice

We will limit access to your health information to those to whom it is necessary to carry our treatment, payment or health care operation duties.

Our Policy on Your Health Information

We are committed to preserving the privacy and confidentiality of your health information created and/ or maintained at our facility.

Uses or Disclosures of Your Health Information  

We may use or disclose your health information in one of the following ways:

1- To you or your legal representative(to extent permitted by law).

2- For treatment,payment or health care operations.

3- Persuant to your verbal agreement.

4- As permitted by law.

5- Incidental uses and disclosures that may occur as a by-product of permissable use or disclosure.

6- As required by law.

7- Persuant to your written authorization for any and all other uses and disclosures of your health information.

Your Rights Regarding Your Health Information

  1. Right to inspect and copy
  2. Right to request an amendment
  3. Right to an accounting of disclosures
  4. Right to request restrictions
  5. Right to request confidential communications
  6. Right to a paper copy of the full privacy notice


If you believe your privacy rights have been violated, you may file a complaint with our facility or with the Department of Health and Human Services. To file a complaint with our facility, contact:
Pamela Lindsay, Director of Resident and Family Services
Wells Nursing Home, Inc.
201 W. Madison Ave.,
Johnstown, NY 12095
(518) 762-4546 ext 224. 
All complaints must be submitted in writing. To file a complaint with the DHH Office of Civil Rights:
Office of Civil Rights, US Department of Health and Human Services
Jacob Javits Federal Building
Linda Colon, Regional Manager, Region II
26 Federal Plaza-Suite 3312 
New York, NY 10278
TELEPHONE (800) 368-1019 
FAX ( 212) 264-3039
TDD (800) 537-7697

You will NOT be penalized for filing a complaint. 

Smile If you would like a copy of the complete


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