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.

OUR RESPONSIBILITIES
Granite VNA takes the privacy of your health information seriously. Granite VNA is required by law to
maintain that privacy, to provide you with this Notice of Privacy Practices, and to notify you should a breach of your protected health information occur. This Notice is provided
to tell you about our duties and practices with respect to your information.

HOW GRANITE VNA MAY USE AND DISCLOSE YOUR HEALTH INFORMATION The
following categories describe different ways that Granite VNA uses and discloses your health
information.

Not every use or disclosure in a category will be listed. However, all of the ways Granite VNA is
permitted to use and disclose your health information will fall into one of these categories.

Treatment: Granite VNA may use and disclose your health information to coordinate care
within Granite VNA and with others involved in your care, such as your attending physician,
members of Granite VNA interdisciplinary team and other health care professionals who have
agreed to assist Granite VNA in coordinating care. For example, Granite VNA may disclose
your health information to a physician involved in your care who needs information about your
symptoms to prescribe appropriate medications. Granite VNA also may disclose health
information about you to individuals outside of Granite VNA involved in your care, including
family members, other relatives, close personal friends, pharmacists, suppliers of medical
equipment or other health care professionals.

Payment: Granite VNA may use and disclose your health information to receive payment for
the care you receive from Granite VNA. For example, Granite VNA may be required by your
health insurer to provide information regarding your health care status, your need for care and
the care that Granite VNA intends to provide to you so that the insurer will reimburse you or
Granite VNA.

Healthcare Operations: Granite VNA may use and disclose health information for its own
operations to facilitate the functioning of Granite VNA and as necessary to provide quality care
to all of Granite VNA’s patients. Healthcare operations include such activities as:
o Quality assessment and improvement activities.
o Activities designed to improve health or reduce health care costs.
o Protocol development, case management and care coordination.
o Secure electronic sharing for the purpose of treatment.
o Contacting health care providers and patients with information about treatment
alternatives and other related functions that do not include treatment.
o Professional review and performance evaluation.
o Training programs, including those in which students, trainees or practitioners in health
care learn under supervision.
o Training of non-healthcare professionals.
o Accreditation, certification, licensing or credentialing activities.
o Review and auditing, including compliance reviews, medical reviews, legal services and
compliance programs.
o Business planning and development, including cost management and planning related
analyses and formulary development.
o Business management and general administrative activities of Granite VNA.
o Fundraising for the benefit of Granite VNA.

Fundraising Activities: Granite VNA may use information about you, including your name,
address, telephone number and the dates you received care, in order to contact you to raise
money for Granite VNA. If you do not want Granite VNA to contact you, notify our
Development Office and indicate that you do not wish to be contacted.

Treatment Alternatives: Granite VNA may use and disclose your health information to tell
you about or recommend possible treatment options or alternatives that may be of interest to
you.

As Required by Law: Granite VNA will disclose your health information when it is required
to do so by any Federal, State, or local law.

Public Health Risks: Granite VNA may disclose your health information for public activities
and purposes in order to:
o Prevent or control disease, injury or disability, report disease, injury, vital events such as
birth or death and the conduct of public health surveillance, investigations and
interventions.
o Report adverse events, product defects, to track products or enable product recalls,
repairs and replacements and to conduct post-marketing surveillance and compliance
with requirements of the Food and Drug Administration.
o Notify a person who has been exposed to a communicable disease or who may be at risk
of contracting or spreading a disease.

Abuse or Neglect: Granite VNA is required to notify government authorities if Granite VNA
believes a patient is the victim of abuse or neglect.

Health Oversight Activities: Granite VNA may disclose your health information to a health
oversight agency for activities including audits, inspections, licensure or disciplinary action.
Granite VNA, however, may not disclose your health information if you are the subject of an
investigation and your health information is not directly related to your receipt of health care
or public benefits.

Judicial and Administrative Proceedings: Granite VNA may disclose your health
information in the course of any judicial or administrative proceeding in response to an order
of a court as expressly authorized by such order or in response to a subpoena, discovery
request, or other lawful process.

Serious Threat To Health or Safety: Granite VNA may, consistent with applicable law
and ethical standards of conduct, disclose your health information if Granite VNA, in good
faith, believes that such disclosure is necessary to prevent or lessen a serious and imminent
threat to your health or safety or to the health and safety of the public.

OTHER USES OR DISCLOSURES OF HEALTH INFORMATION
Except as otherwise permitted or required by this Notice of Privacy Practices, Granite VNA will not
use or disclose your health information unless you provide written authorization. If you or your
representative authorize Granite VNA to use or disclose your health information, you may revoke that
authorization, in writing, at any time. If you revoke your authorization, Granite VNA will no longer
use or disclose health information about you for the reasons covered by your written authorization,
except to the extent that Granite VNA has taken action in reliance thereon. You understand that
Granite VNA is unable to take back any disclosures it has already made under the authorization, and
that Granite VNA is required to retain our records of the care that it has provided you.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have the following rights regarding your health information that Granite VNA maintains:

Right to request restrictions: You have the right to request restrictions on certain uses and
disclosures of your health information. You have the right to request a limit on Granite VNA’s
disclosure of your health information to someone who is involved in your care or the payment
of your care. Granite VNA is not required to agree to your request, unless your request is for a
restriction on a disclosure to a health plan for purposes of payment or health care operations
(and is not for purposes of treatment) and the medical information you are requesting to be
restricted from disclosure pertains solely to a health care item or service for which you have
paid out of pocket in full. If you wish to make a request for restrictions, please contact our
Chief Financial Officer.

Right to receive confidential communications: You have the right to request that
Granite VNA communicate with you in a certain way. For example, you may ask that Granite
VNA only conduct communications pertaining to your health information with you privately
with no other family members present. Granite VNA will not request that you provide any
reasons for your request and will attempt to honor your reasonable requests for confidential
communications.

Right to inspect and copy your health information: You have the right to inspect and
copy your health information, including billing records. A request to inspect and copy records
containing your health information may be made to our Keeper of Medical Records. If you
request a copy of your health information, Granite VNA may charge a reasonable fee for
copying and assembling costs associated with your request. You have the right to request that
Granite VNA provide you, an entity or a designated individual with an electronic copy of your
electronic health record containing your health information. Granite VNA may require you to
pay the labor costs incurred by Granite VNA in responding to your request.

Right to amend health care information: You or your representative have the right to
request that Granite VNA amend your records, if you believe that your health information is
incorrect or incomplete. That request may be made as long as the information is maintained by
Granite VNA. A request for an amendment of records must be made in writing to our Keeper of
Medical Records. Granite VNA may deny the request if it is not in writing or does not include a
reason for the amendment. The request also may be denied if your health information records
were not created by Granite VNA, if the records you are requesting are not part of Granite
VNA’s records, if the health information you wish to amend is not part of the health
information you or your representative are permitted to inspect and copy or if, in the opinion
of Granite VNA, the records containing your health information are accurate and complete.

Right to an accounting: You or your representative have the right to request an accounting
of disclosures of your health information including the disclosure of your electronic health
records made by Granite VNA for certain reasons, including reasons related to public purposes
authorized by law. The request for an accounting must be made in writing to our Keeper of
Medical Records specifying the time period for the request. Accounting requests may not be
made for periods of time in excess of six (6) years. Granite VNA would provide the first
accounting you request during any 12-month period without charge. Subsequent accounting
requests may be subject to a reasonable cost-based fee.

Right to a paper copy of this notice: You or your representative have the right to a
separate paper copy of this Notice at any time, even if you or your representative have received
this Notice previously. To obtain a separate paper copy, please contact our Keeper of Medical
Records. You may also obtain a copy of the current version of Granite VNA’s Notice of Privacy
Practices at www.granitevna.org.

CHANGES TO THIS NOTICE
Granite VNA reserves the right to change this Notice. Granite VNA reserves the right to make the
revised Notice effective for health information we already have about you, as well as any health
information we receive in the future. We will post a copy of the current Notice in a clear and
prominent location to which you have access. The Notice also is available to you upon request. The
Notice will contain, at the end of this document, the effective date. In addition, if Granite VNA revises
the Notice, Granite VNA will offer you a copy of the current Notice in effect.

IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE
Granite VNA has designated a Privacy Officer as its contact person for all issues regarding patient
privacy and your rights under the Federal privacy standards. You may contact this person at 30
Pillsbury Street or (603) 224-4093.

COMPLAINTS
You or your personal representative has the right to express complaints to Granite VNA and to the
Secretary of the U.S. Department of Health and Human Services if you or your representative believe
that your privacy rights have been violated. Any complaints to Granite VNA should be made in writing
to President/CEO at 30 Pillsbury Street, Concord, NH 03301. Granite VNA encourages you to express
any concerns you may have regarding the privacy of your information. You will not be retaliated
against in any way for filing a complaint