Privacy Policy


This Notice applies to all information related to your care that we have or will receive, or have created. It extends to information received or created by our employees, staff, volunteers, physicians and healthcare personnel. This Notice informs you about the possible uses and disclosures of your protected health information. It also describes your rights and obligations regarding your protected health information.

In order for us to be able to provide you with the best service and care, we need to receive protected health information from you. However, we want to emphasize that we are committed to maintaining the privacy of this information in accordance with DC and federal laws.

We are required by law to:

  • Maintain the privacy of your protected health information;
  • Provide to you this detailed Notice of our legal duties and privacy practices relating to your protected health information; and
  • Abide by the terms of the Notice that is currently in effect. We reserve the right to change the terms of this Notice and make the new Notice provisions effective for all protected health information in accordance with DC and federal laws.


While receiving care from Forest Hills of DC, information regarding your healthcare history, treatment, and payment for your health care may be originated and/or received by us. DC and federal law protect information that can be used to identify you and which relates to your health care or your payment for health care. This is your protected health information.

We maintain physical, electronic and procedural safeguards that comply with current DC and federal standards to guard your protected health information.

Using and disclosing your Protected Health Information for:

  • Treatment
  • Payment
  • Healthcare Operations

We have described the uses and disclosures below and provide examples of the types of uses and disclosures we may make in each of these categories.

For Treatment:

We will use and disclose your protected health information in providing you with treatment and services. We may disclose your protected health information to persons who also may be involved in your care, including, but not limited to, physicians, nurses, nurse aides, and rehabilitation staff. Our workforce has access to such information on a need to know basis. For example, a nurse caring for you will report any change in your condition to your physician. Your physician may need to know the medications you are taking before prescribing additional medications. It may be necessary for the physician to inform the nurses or staff of the medications you are taking so they can administer the medications and monitor any possible side effects. In addition, we may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services, which may be of interest to you.

We may also disclose protected health information to individuals who will be involved in your care after you leave the organization. Anyone who has access to protected health information is required to protect it and keep it confidential.

For Payment:

We may use and disclose your protected health information so that we can bill and receive payment for the treatment and services you receive. Bills requesting payment will usually include information that identifies you, your diagnosis and any procedures performed or supplies used. For billing and payment purposes, we may disclose your protected health information to your legal representative, an insurance or managed care company, Medicare, Medicaid or another third-party payor. For example, we may contact Medicare or your health plan to confirm your coverage or to request prior approval for a proposed treatment or service.

For Healthcare Operations:

We may use and disclose your protected health information for the operations for which we are licensed. These uses and disclosures are necessary to monitor the health status of residents, manage the organization and monitor the quality of our care. For example, we may use protected health information to evaluate our services, including the performance of our staff. In addition, we may release your protected health information to another covered entity for quality assessment and improvement activities or for review of or evaluation of healthcare professionals. Health Care Operations may also include the use of information for quality assurance, training, accreditation, medical review, auditing and business planning.


Facility Directory: The organization maintains a directory of resident names and their location within the facility. Unless you object, we will include certain limited information about you in our directory. This information includes your name and your location in the facility. Our directory does not include health information about you. We may release information in our directory, to people who ask for you by name. We may provide the directory information, to a member of the clergy.


The culture of our organization includes informing residents and staff of special events you may have and changes in your health status to maintain our homelike environment. You may restrict or prohibit these uses and disclosures by notifying the organization in writing.

Individuals Involved in Your Care or Payment for Your Care: Unless you object, we may disclose your protected health information to a family member, a close personal friend, your legal representative and any clergy, who are involved in your care. You may restrict or prohibit these uses and disclosures by notifying the organization in writing of your restriction or prohibition.

Disaster Relief:

We may disclose your protected health information to an organization assisting in a disaster relief effort.

As Required By Law:

We will disclose your protected health information when required by law to do so.

Public Health Activities:

We may disclose your protected health information for public health activities.

These activities may include, for example:

  • Reporting for preventing or controlling disease, injury or disability;
  • Reporting deaths;
  • Reporting abuse or neglect of a dependent adult;
  • Reporting reactions to medications or problems with products;
  • Notifying a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition; or
  • Disclosing for certain purposes involving workplace illness or injuries.

Reporting Victims of Abuse, Neglect or Domestic Violence:

We may use or disclose protected health information to protective services or social services agency or other similar government authorities, if we reasonably believe you have been the victim of abuse, neglect or domestic violence.

Health Oversight Activities:

We may disclose your protected health information to a health oversight agency for oversight activities authorized by law. These may include, for example, audits, investigations, inspections and licensure actions, judicial/administrative proceedings to which you are not a party, or other legal proceedings. In most cases, the oversight activity will be for the purpose of overseeing the care rendered by the organization or the organizations compliance with certain laws and regulations.

Judicial and Administrative Proceedings:

We may disclose your personal health information in response to a court or administrative order. We may also disclose information in response to a subpoena, discovery request, or other lawful legal process; efforts will be made to contact you regarding the request or to obtain an order or agreement protecting the information.

Law Enforcement:

We may also release your protected health information to law enforcement officials for the following purposes:

  • Pursuant to a court order, warrant, subpoena/summons, or administrative request;
  • Identifying or locating a suspect, fugitive, material witness or missing person;
  • Regarding a crime victim, but only if the victim consents or the victim is unable to consent due to incapacity and the information is needed to determine if a crime has occurred, non-disclosure would significantly hinder the investigation, and disclosure is in the victim’s best interest;
  • Regarding a decedent, to alert law enforcement that the individual’s death was caused by suspected criminal conduct; or
  • For reporting suspected criminal activity.

Coroner, Healthcare Examiners, Funeral Homes:

We may release your personal health information to a coroner, medical examiner, and funeral director. We may also release information to an organization involved in the donation of organs if you are an organ donor.


You have the following rights regarding your protected health information at Forest Hills of DC:

  • The right to receive notice of our policies and procedures used to protect your protected health information;
  • The right to request that certain uses and disclosures of your protected health information be restricted;
  • The right to access to your protected health information;
  • The right to request that your protected health information be amended; and
  • The right to revoke any prior authorizations for use or disclosure of protected health information, except to the extent that the organization has acted on your Authorization.


  • We have the right to use and disclose your protected health information for the purpose of treatment, payment and healthcare operations.
  • We have the right not to agree to your requested restrictions on the use or disclosure of your protected health information. If we do agree to accept your requested restrictions, we will comply with your request except as needed to provide you with appropriate treatment.

If you believe your privacy rights have been violated you may file a complaint with our Privacy Officer. The Privacy Officer will review and respond to you in a timely manner. At any time, you can contact the Office of Civil Rights if you feel your complaint has not been resolved.


If you have any questions about this Notice or would like further information concerning your privacy rights please contact the Home’s Privacy Officer or the Administrator.

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