General Description and Purpose of Notice
will limit access to your health information to those to whom it is necessary to carry our treatment, payment or health care
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
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.
As permitted by law.
5- Incidental uses and disclosures that may
occur as a by-product of permissable use or disclosure.
6- As required
7- Persuant to your written authorization for any and all
other uses and disclosures of your health information.
Your Rights Regarding Your Health Information
to inspect and copy
Right to request an amendment
Right to an accounting of disclosures
Right to request restrictions
to request confidential communications
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
Colon, Regional Manager, Region II
26 Federal Plaza-Suite 3312
York, NY 10278
TELEPHONE (800) 368-1019
FAX ( 212) 264-3039
You will NOT be penalized for filing a complaint.
If you would like a copy of the complete
"NOTICE OF PRIVACY PRACTICES"
Please call or stop in.