THIS NOTICE DESCRIBES HOW PROTECTED INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

1. Catholic Eldercare is permitted to make uses and disclosures of protected health information for treatment, payment and health care operations, as described in the following examples:

a. For treatment - medical, physical, and emotional daily care, etc.
b. For payment - insurance co., supply co. providing authorization for treatment, etc.
c. For health care operations - legal services, medical review, business management, quality assessments, auditing, development, cost management, etc.

2. Catholic Eldercare is permitted or required, under specific circumstances, to use or disclose protected health information without the individual's written authorization.

3. Other uses and disclosures will be made only with the individual's written authorization, and the individual may revoke such authorization.

4. Catholic Eldercare intends to engage in none, one or more of the following activities:

a. Catholic Eldercare may contact the individual to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to the individual or patient.
b. Catholic Eldercare may contact the individual/patient to raise funds for Catholic Eldercare; or
c. A group health plan, or a health insurance insurer or HMO with respect to a group health plan, may disclose protected health information to the sponsor of the plan.

5. The individual has the following rights regarding protected health information:

a. The right to request restrictions on certain uses and disclosures of protected health information. Catholic Eldercare is not required to agree to a requested restriction, however.
b. The right to receive confidential communications of protected health information, as applicable.
c. The right to inspect and copy protected health information, as provided in the Privacy Regulation.
d. The right to amend protected health information, as provided in the Privacy Regulation.
e. The right to receive an accounting of disclosures of protected health information.
f. The right to obtain a paper copy of the notice from the covered entity upon request. This right extends to an individual who has agreed to receive the notice electronically.

6. Catholic Eldercare is required by law to maintain the privacy of protected health information and to provide individuals with notice of its legal duties and privacy practices with respect to protected health information.

7. Catholic Eldercare is required to abide by the terms of the notice currently in effect.

8. Catholic Eldercare reserves the right to change the terms of this notice. The new notice provisions will be effective for all protected health information that it maintains.

9. Catholic Eldercare will provide individuals, staff, volunteers, family members, residents and business associates with a revised notice by one or more of the following: mail, enclosed with paychecks, care conference, new admissions, website, and at general orientation of new staff.

10. Individuals may place a complaint to Catholic Eldercare and to the Secretary of the Department of Health and Human Services, without fear of retaliation by the organization, if they believe their privacy rights have been violated. A brief description of how the individual may file a complaint follows:

11. Catholic Eldercare's contact person for matters relating to complaints is:

Administrator
Catholic Eldercare
817 Main Street N.E.,
Minneapolis, MN 55413
612-362-2429

12. This notice is first in effect on April 14, 2003.