Notice of Privacy Practices

Clear Creek Village takes the privacy of your health information seriously. This notice describes how we may use and disclose information about your care and your rights regarding that information. We are required by law to maintain the privacy of protected health information ("PHI"), provide this notice, and follow the terms of the notice currently in effect. If we change this notice, we will make the updated version available and provide it on request.

In this notice, "we," "us," and "our" refer to Clear Creek Village and our employees, staff, contractors, and volunteers. Other healthcare providers who treat you at our community (such as physicians or therapists) may have their own privacy practices. "You" and "your" refer to you as a resident and, where applicable, your legal personal representative.

Treatment. We may use and share your PHI to provide, coordinate, or manage your care, including sharing it with nurses, physicians, therapists, and other providers involved in your treatment.

Payment. We may use and disclose PHI to bill and obtain payment for the services we provide, including verifying coverage with insurers, Medicare, or Medicaid.

Healthcare Operations. We may use PHI for activities necessary to run our community, such as quality assessment, staff training and evaluation, accreditation, audits, and general administration.

• Family and friends involved in your care — we may share information directly relevant to a person's involvement in your care or payment for care, unless you object.
• Public health activities — to authorities for disease prevention or control, reporting of births and deaths, and similar purposes.
• Required by law — when federal, state, or local law requires disclosure.
• Health oversight — to agencies for audits, investigations, inspections, and licensure.
• Judicial and administrative proceedings — in response to court or administrative orders, subpoenas, or discovery requests with appropriate safeguards.
• Law enforcement — for limited purposes such as identifying or locating a suspect, victim, or missing person, or reporting certain wounds or injuries.
• Coroners, medical examiners, and funeral directors — to carry out their duties.
• Organ and tissue donation — when applicable.
• Research — subject to approval by an Institutional Review Board or privacy board.
• To avert a serious threat to health or safety — consistent with applicable law and ethical standards.
• Workers' compensation — as authorized and necessary to comply with workers' compensation laws.
• Military, veterans, national security, and protective services — as permitted by law.
• Inmates — to correctional institutions or law enforcement officials with lawful custody.
• Abuse, neglect, or domestic violence — to appropriate authorities as permitted or required by law.
• Facility directory — limited information may be shared with people who ask for you by name, unless you object.

Other uses and disclosures of your PHI will be made only with your written authorization. This includes most uses and disclosures of psychotherapy notes, uses and disclosures for marketing purposes, and disclosures that constitute a sale of PHI. You may revoke an authorization at any time, in writing, except to the extent we have already acted in reliance on it.

• Inspect and copy your health and billing records, in most cases.
• Request an amendment if you believe information in your record is incorrect or incomplete.
• Receive an accounting of certain disclosures we have made of your PHI.
• Request restrictions on certain uses or disclosures. We are not required to agree to every request, but we will agree when required by law.
• Request confidential communications by alternative means or at alternative locations.
• Receive a paper copy of this notice, even if you accepted it electronically.
• Be notified of any breach of your unsecured PHI.
• File a complaint with us or with the U.S. Department of Health and Human Services without fear of retaliation.

We are required by law to maintain the privacy of your PHI, provide you with this notice of our legal duties and privacy practices, notify you following a breach of unsecured PHI, and follow the terms of the notice currently in effect.

We reserve the right to change this notice and to make the revised notice effective for PHI we already have and any we receive in the future. The current notice will be posted at our community and on this website, and copies will be available on request.

If you believe your privacy rights have been violated, you may file a complaint with our Privacy Officer or with the Secretary of the U.S. Department of Health and Human Services. We will not retaliate against you for filing a complaint.

Clear Creek Village — Privacy Officer
Tiffin, Iowa 52340
Phone: (319) 992-2500
Email: Katie.Chism@ccv-tiffin.com