HIPAA Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

Please Review It Carefully

If you have any questions about this notice, please contact our Privacy Officer at 814-836-5300.

Who Will Follow This Notice:

  • Any health care professional authorized to enter information into your medical record.
  • All departments of Saint Mary's Home of Erie d/b/a/ Saint Mary's at Asbury Ridge (referred to henceforth as Saint Mary's)
  • Any member of a volunteer group we allow to assist you while you are at Saint Mary's
  • All employees, staff and other Saint Mary's personnel.

Our Pledge Regarding Your Protected Health Information (PHI):

Saint Mary's understands that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at Saint Mary's. We need this record to provide you with quality care and to comply with certain legal and regulatory requirements. This notice applies to all of the records of your care generated by Saint Mary's, whether made by Saint Mary's personnel, your personal doctor or other practitioner. This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.

Saint Mary's is required by law to:

  • Make sure that your protected health information is kept private
  • Provide you with this notice of our legal duties and privacy practices with respect to your protected health information
  • Follow the terms of the notice that is currently in effect.

How We May Use and Disclose PHI About You (Without Your Written Consent):

The following categories describe different ways that we use and disclose PHI. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

For Treatment

We may use medical information about you to provide you with medical treatment or services. We may disclose PHI about you to doctors, nurses, technicians, medical students, or other personnel who are involved in taking care of you at Saint Mary's. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments at Saint Mary's also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work and x-rays. We also may disclose PHI about you to people outside of Saint Mary's who may be involved in your medical care after you leave, such as family members, healthcare agencies, or others who provide services as part of your care.

For Payment

We may use and disclose PHI about you so that the treatment and services you receive at Saint Mary's may be billed and payment may be collected from you, an insurance company or a third party. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.

For Health Care Operations

We may use and disclose PHI about you for operations. These uses and disclosures are necessary to run Saint Mary's and make sure that all of our residents receive quality care. For example, we may use PHI to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine PHI about many residents to decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, and medical students for review and learning purposes. We may also combine the medical information we have with medical information from other nursing homes to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific residents are.

Business Associates

We may use or disclose your PHI to an outside company that assists us in operating our business. They perform various services for us. This includes, but is not limited to, pharmacy and therapy services. These outside companies are called “Business Associates” and they contract with us to keep PHI received from us confidential in the same way we do. These companies may create or receive PHI on our behalf.

Treatment Alternatives

We may use and disclose PHI to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

Health-Related Benefits and Services

We may use and disclose PHI to tell you about health-related benefits or services that may be of interest to you.

Resident Directory

We may include certain limited information about you in the directory while you are a resident at Saint Mary's. This information may include your name, location at Saint Mary's, your general condition (e.g. fair, stable, etc.) and your religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest or minister even if they don't ask for you by name. This is so your family, friends and clergy can visit you at Saint Mary's and generally know how you are doing. You may request that no information from the directory be disclosed. To do this, see a Saint Mary’s administrator (or designee).

Individuals Involved in Your Care or Payment for Your Care

If you agree, do not object or we can reasonably infer that there is no objection, we may release PHI about you to a family member, friend, or emergency contact who is involved in your medical care. We may also give information to someone such as a responsible party who helps pay for your care. We may also tell your family or friends your condition and that you are a resident of Saint Mary's. You have a right to request a restriction on our disclosures of your PHI to someone involved in your care. To do this, see a Saint Mary’s administrator (or designee). In addition, we may disclose PHI about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.

As Required or Permitted By Law

We will disclose PHI about you when required to do so by federal, state or local law.

To Avert a Serious Threat to Health or Safety

We may use and disclose PHI about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.


We may contact you to raise funds for Saint Mary’s. We may disclose personal health information to a foundation related to the facility so that the foundation may contact you in raising money for the facility. In doing so, we would only release contact information, such as your name, address and phone number and the dates you received treatment or services at the facility. If you do not want Saint Mary’s to contact you, you may opt-out of this. To do this call (814)-528-0194 or e-mail optout@stmaryshome.org.

Organ, Eye and Tissue Donation

If you are an organ donor, we may release your PHI to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

Military and Veterans

If you are a member of the armed forces, we may release PHI about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.

Workers' Compensation

We may release PHI about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.

Public Health Risks

We may disclose PHI about you for public health activities. These activities generally include the following:

  • to prevent or control disease, injury or disability
  • to report births and deaths
  • to report child abuse or neglect
  • to report reactions to medications or problems with products
  • to notify people of recalls of products they may be using
  • to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition
  • to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

Health Oversight Activities

We may disclose PHI to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.

Lawsuits and Disputes

If you are involved in a lawsuit or a dispute, we may disclose PHI about you in response to a court or administrative order. We may also disclose PHI about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement

We may release PHI if asked to do so by a law enforcement official:

  • In response to a court order, subpoena, warrant, summons or similar process
  • To identify or locate a suspect, fugitive, material witness, or missing person
  • About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement
  • About a death we believe may be the result of criminal conduct
  • About criminal conduct at the facility
  • In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.

Coroners, Medical Examiners and Funeral Directors

We may release your PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about residents to funeral directors as necessary to carry out their duties.

National Security and Intelligence Activities

We may release PHI about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Marketing Communications

Our discussions involving possible products and services offered by outside entities are considered “marketing communications.” For example, if an outside vendor requests that we recommend their product or service to you, or provide you with a pamphlet or other written brochures, a “marketing discussion” has occurred. Generally, speaking, before we can engage in these conversations with you, or provide you with the materials, we will need to receive your authorization. The only current exceptions to this process are for communications made:

  • (a) to provide refill reminders or otherwise communicate about a drug or biologic that is currently being prescribed for you, and so long as any payment received by us from the outside supplier in exchange for making this communication is reasonably related to our cost of making the communication; or
  • (b) for the following treatment and health care operations purposes, except where we receive payment in exchange for making the communication (i) For treatment of an individual by a health care provider, including case management or care coordination for the individual, or to direct or recommend alternative treatments, therapies, health care providers, or settings of care to the individual;(ii) To describe a health-related product or service (or payment for such product or service) that is provided by, or included in a plan of benefits of, the covered entity making the communication, including communications about: the entities participating in a health care provider network or health plan network; replacement of, or enhancements to, a health plan; and health-related products or services available only to a health plan enrollee that add value to, but are not part of, a plan of benefits; or (iii) For case management or care coordination, contacting of individuals with information about treatment alternatives, and related functions to the extent these activities do not fall within the definition of treatment.

      Your Rights Regarding PHI About You

      Right to Inspect and Copy

      You have the right to inspect and copy your PHI that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to a Saint Mary's administrator (or designee). If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to your PHI, you may request that the denial be reviewed. Another licensed health care professional chosen by Saint Mary's will review your request and the denial. The person conducting the review will not be the person who denied your request.

      Right to Amend

      If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for Saint Mary's. To request an amendment, your request must be made in writing and submitted to Saint Mary's administrator (or designee). In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:

      • Was not created by us, unless the person or entity that created the information is no longer available to make the amendment
      • Is not part of the medical information kept by or for the facility
      • Is not part of the information which you would be permitted to inspect and copy; or
      • Is accurate and complete.

      Right to a Summary Accounting of Disclosures

      You have the right to request an "accounting of disclosures." This is a list of certain of the disclosures we made of your PHI. The report does not include disclosures related to treatment, payment, operations, when an authorization is obtained or other disclosures permitted by law as long as minimum information was released. To request this list or summary accounting of disclosures, you must submit your request in writing to a Saint Mary's administrator (or designee). Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper). The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.

      Right to Request Restrictions

      You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the PHI we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had.

      • We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing to a Saint Mary's administrator (or designee). In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse. Note that we are required to report PHI to Medicare and Medicaid for payment purposes.
      • Saint Mary’s will agree to restrict disclosure of PHI about you to a health plan if the purpose of the disclosure is to carry out payment or health care operations and the PHI pertains solely to a service for which you, or a person other than the health plan, has paid in full.

      Right to Request Confidential Communications

      You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. To request confidential communications, you must make your request in writing to a Saint Mary's administrator (or designee). We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

      Right to a Paper Copy of This Notice

      You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

      Right to be Notified of a Breach

      You have the right to be notified in the event we (or one of our Business Associates) discovers a breach of unsecured PHI involving your medical information.

      Changes To This Notice

      We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for PHI we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the facility. The notice will contain on the first page, in the top right-hand corner, the effective date. In addition, each time you are admitted to the facility for treatment or health care services, we will offer you a copy of the current notice in effect.


      If you believe your privacy rights have been violated, you may file a complaint with Saint Mary's or with the Secretary of the Department of Health and Human Services. To file a complaint with Saint Mary's, contact our Privacy Officer at 814-836-5300.

      All complaints must be submitted in writing. You will not be penalized for filing a complaint.

      Other Uses of Medical Information

      Other uses and disclosures of PHI not covered by this notice or the laws that apply to us will be made only with your written permission through a signed authorization. If you provide us permission to use or disclose PHI about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose PHI about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

      Effective Date

      This Notice, effective 09/23/13 revises the original dated 4/14/03.

      Additional Information

      To obtain additional information about this notice or how Saint Mary's will use your information, please contact our Privacy Officer at 814-836-5300.