HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
|
|
- Ira Ray
- 6 years ago
- Views:
Transcription
1 January 1, 2014: NOTICE OF PRIVACY PRACTICES THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. Centre Crest is required by law t prvide yu with this ntice s that yu will understand hw we may use r share yur medical infrmatin. We are required t adhere t the terms utlined in this ntice. If yu have any questins abut this ntice, please cntact the Administratr. This ntice describes the practices f Centre Crest and its affiliates (tgether the affiliated cvered entity r Centre Crest ). Centre Crest is required by law t prvide yu with this ntice regarding ur legal bligatins with respect t yur prtected health infrmatin and t adhere t the terms f the ntice currently in effect. UNDERSTANDING YOUR HEALTH RECORD AND INFORMATION Each time yu visit Centre Crest, a recrd f yur visit is made. Typically, this recrd cntains infrmatin abut yur cnditin and the treatment that we prvide. We use and/r disclse this infrmatin t: plan yur care and treatment cmmunicate with ther health prfessinals invlved in yur care dcument the care yu receive educate health prfessinals prvide infrmatin fr medical research prvide infrmatin t public health fficials evaluate and imprve the care we prvide Understanding what is in yur recrd and hw yur health infrmatin is used helps yu t: ensure it is accurate better understand wh may access yur health infrmatin make mre infrmed decisins when authrizing disclsure t thers HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU The fllwing categries describe the ways that we use and disclse medical infrmatin. Nt every use r disclsure in a categry will be listed. Hwever, all f the ways we are permitted t use and disclse infrmatin will fall int ne f the categries. Fr Treatment. We may use medical infrmatin abut yu t prvide yu with medical treatment. We may disclse medical infrmatin abut yu t dctrs, nurses, therapists r ther Centre Crest facility persnnel wh are invlved in taking care f yu at Centre Crest. Ntice f Privacy Practices #3 revised december Page 1 f 8 Last printed 0/0/0000
2 Fr example, a dctr treating yu fr a brken leg may need t knw if yu have diabetes because diabetes may slw the healing prcess. In additin, the dctr may need t tell the dietitian if yu have diabetes s that we can plan yur meals. Different departments f Centre Crest facility als may share medical infrmatin abut yu in rder t crdinate yur care and prvide yu medicatin, lab wrk and x rays. We may als disclse medical infrmatin abut yu t peple utside the Centre Crest facility wh may be invlved in yur medical care after yu leave an Centre Crest facility. This may include family members, r visiting nurses t prvide care in yur hme. Fr Payment. We may use and disclse medical infrmatin abut yu s that the treatment and services yu receive at Centre Crest facility may be billed t yu, an insurance cmpany r a third party. Fr example, in rder t be paid, we may need t share infrmatin with yur health plan abut services Centre Crest prvided t yu. We may als tell yur health plan abut a treatment yu are ging t receive t btain prir apprval r t determine whether yur plan will cver the treatment. Fr Health Care Operatins. We may use and disclse medical infrmatin abut yu fr health care peratins. This is necessary t ensure that all f ur residents receive quality care. Fr example, we may use medical infrmatin t review ur services and t evaluate the perfrmance f ur staff. We may als cmbine medical infrmatin abut many Centre Crest residents t decide what additinal services Centre Crest shuld ffer, what services are nt needed, and whether certain new treatments are effective. We may als disclse infrmatin t dctrs, nurses, therapists, and ther Centre Crest persnnel fr review and learning purpses. We may remve infrmatin that identifies yu s thers may use it t study health care and health care delivery withut learning the identities f residents. OTHER ALLOWABLE USES OF YOUR MEDICAL INFORMATION The fllwing categries describe ther ways that we may use yur infrmatin. Business Assciates. There are sme services prvided in ur rganizatin thrugh cntracts with business assciates. Examples include medical directrs, utside attrneys and a cpy service we use when making cpies f yur health recrd. When these services are cntracted, we may disclse yur health infrmatin s that they can perfrm the jb we ve asked them t d and bill yu r yur third party payer fr services rendered. T prtect yur health infrmatin, hwever, we require the business assciate t apprpriately safeguard yur infrmatin. Prviders. Participants in ne f ur rganized healthcare arrangements ffer many services prvided t yu as part f yur care at ur facility. These participants include a variety f prviders such as physicians (egs. MD, DO, Pdiatrist, Dentist, Optmetrist), therapists (egs. Physical therapist, Occupatinal therapist, Speech therapist), prtable radilgy units, clinical labs, hspice caregivers, pharmacies, psychlgists, LCSWs, and suppliers (egs. prsthetic, rthtics). Treatment Alternatives. We may use and disclse medical infrmatin t tell yu abut Ntice f Privacy Practices #3 revised december Page 2 f 8 Last printed 0/0/0000
3 pssible treatment ptins r alternatives that may be f interest t yu. Health Related Benefits and Services. We may use and disclse medical infrmatin t tell yu abut health related benefits r services that may be f interest t yu. Fundraising Activities. We may use medical infrmatin abut yu t cntact yu in an effrt t raise mney as part f a fundraising effrt. We may disclse medical infrmatin t a fundatin related t Centre Crest s that the fundatin may cntact yu in raising mney fr Centre Crest. We will nly release cntact infrmatin, such as yur name, address and phne number and the dates yu received treatment r services at Centre Crest. Yu may request that we d nt cntact yu fr these fundraising effrts. If yu d nt want Centre Crest facility t cntact yu fr fundraising effrts, yu must ntify the Administratr in writing. Centre Crest Facility Directry. We may include infrmatin abut yu in the Centre Crest facility directry while yu are a resident s lng as we prvide yu an pprtunity t agree t, prhibit, r restrict the use f yur infrmatin. This infrmatin may include yur name, lcatin in Centre Crest facility, yur general cnditin (e.g., fair, stable, etc.) and yur religin. The directry infrmatin, except fr yur religin, may be disclsed t peple wh ask fr yu by name. Yur religin may be given t a member f the clergy, such as a priest r rabbi, even if they dn t ask fr yu by name. This is s yur family, friends and clergy can visit yu in the Centre Crest facility and generally knw hw yu are ding. Individuals Invlved in Yur Care r Payment fr Yur Care. We may disclse medical infrmatin abut yu t a friend r family member wh is invlved in yur care. We may als give infrmatin t smene wh helps pay fr yur care. Hwever, we can nly give family and friends infrmatin that relates t their invlvement r payment fr yur care. We may als tell yur family r friends yur cnditin and that yu are in Centre Crest. In additin, we may disclse medical infrmatin abut yu t an entity assisting in a disaster relief effrt s that yur family can be ntified abut yur cnditin, status and lcatin. As Required By Law. We will disclse medical infrmatin abut yu when required t d s by federal, state r lcal law. T Avert a Serius Threat t Health r Safety. We may use and disclse medical infrmatin abut yu t prevent a serius threat t yur health and safety r the health and safety f the public r anther persn. We wuld d this nly t help prevent the threat. Fr example, we may disclse medical infrmatin abut yu fr public health purpses, including: Preventin r cntrl f disease, injury r disability Reprting births and deaths; Reprting child abuse r neglect; Reprting reactins t medicatins r prblems with prducts; Ntice f Privacy Practices #3 revised december Page 3 f 8 Last printed 0/0/0000
4 Ntifying peple f recalls f prducts; Ntifying a persn wh may have been expsed t a disease r may be at risk fr cntracting r spreading a disease; Ntifying the apprpriate gvernment authrity if we believe a resident has been the victim f abuse, neglect r dmestic vilence. We will nly make this disclsure if yu agree r when required r authrized by law. Research. We may disclse infrmatin t researchers when an institutinal review bard that has reviewed the research prpsal and established prtcls t ensure the privacy f yur health infrmatin has apprved their research. Funeral Directrs, Crners and Medical Examiners. We may disclse health infrmatin t funeral directrs, crners and medical examiners t carry ut their duties cnsistent with applicable law. Organ prcurement rganizatins. Cnsistent with applicable law, we may disclse health infrmatin t rgan prcurement rganizatins r ther entities engaged in the prcurement, banking, r transplantatin f rgans fr the purpse f tissue dnatin and transplant. Fd and Drug Administratins (FDA). We may disclse t the FDA health infrmatin relative t adverse events with respect t fd, supplements, prduct and prduct defects, r pst marketing, surveillance infrmatin t enable prduct recalls, repairs, r replacement. Wrkers cmpensatin. We may disclse health infrmatin t the extent authrized by and t the extent necessary t cmply with laws relating t wrkers cmpensatin r ther similar prgrams established by law. Military and Veterans. If yu are a member f the armed frces, we may disclse medical infrmatin abut yu as required by military authrities. We may als disclse medical infrmatin abut freign military persnnel t the apprpriate freign military authrity. Health Oversight Activities. We may disclse medical infrmatin t a health versight agency fr activities authrized by law. These versight activities may include audits, investigatins, inspectins, and licensure. These activities are necessary fr the gvernment t mnitr the health care system, gvernment prgrams, and cmpliance with civil rights laws. Lawsuits and Disputes. If yu are invlved in a lawsuit r a dispute, we may disclse medical infrmatin abut yu in respnse t a curt r administrative rder. We may als disclse medical infrmatin abut yu in respnse t a subpena, discvery request, r ther lawful prcess by smene else invlved in the dispute, but nly if effrts have been made t tell yu abut the request r t btain an rder prtecting the infrmatin requested. Law Enfrcement. We may disclse medical infrmatin when requested by a law Ntice f Privacy Practices #3 revised december Page 4 f 8 Last printed 0/0/0000
5 enfrcement fficial: In respnse t a curt rder, subpena, warrant, summns r similar prcess; T identify r lcate a suspect, fugitive, material witness, r missing persn; Abut yu, the victim f a crime if, under certain limited circumstances, we are unable t btain the yur agreement; Abut a death we believe may be the result f criminal cnduct; Abut criminal cnduct at Centre Crest; and In emergency circumstances t reprt a crime; the lcatin f the crime r victims; r the identity, descriptin r lcatin f the persn wh cmmitted the crime. USES OF YOUR HEALTH INFORMATION THAT REQUIRE PRIOR AUTHORIZATION We must btain prir authrizatin frm yur prir t disclsing r using yur prtected health infrmatin fr certain purpses. Psychtherapy Ntes. We must receive prir authrizatin frm yu prir t using t disclsing yur psychtherapy ntes, unless the disclsure is fr treatment, payment r healthcare peratins, r is used fr ther very limited purpses. Marketing purpses. We must receive prir authrizatin frm yu befre disclsing yur medical infrmatin fr marketing purpses except in very limited circumstances. Sale f prtected health infrmatin. We must receive prir authrizatin frm yu befre selling yur prtected health infrmatin, except in limited situatins State Restrictins. Many states prvide greater prtectin fr certain types f health infrmatin. Fr example, in many states, drug and alchl treatment infrmatin may nly be released in limited circumstances. Additinally, HIV related infrmatin may nly be released in very limited situatins. Where the state requirements are mre stringent than federal requirements, we will cmply with the state requirements. OUR RESPONSIBILITIES WITH RESPECT TO YOUR MEDICAL INFORMATION We are required t maintain the privacy and security f yur prtected health infrmatin. In rder t fulfill these respnsibilities we must: Ntify yu prmptly if the privacy r security f yur health infrmatin has been cmprmised. Fllw the duties and privacy practices described in this ntice and give yu a cpy f it. Only use r share yur infrmatin as described in this Ntice unless yu authrize us in writing t use r share yur infrmatin in anther manner. If yu give us authrizatin, yu can change yur mind at any time. Hwever, if yu change yur mind, yu must infrm us in writing. If yu revke yur permissin, we will n lnger use r disclse medical infrmatin abut yu fr the reasns cvered by yur written authrizatin. Yu understand that we are unable t take back any disclsures we have already made with yur permissin, and that we are required t retain ur recrds f the care that we prvided t yu. Ntice f Privacy Practices #3 revised december Page 5 f 8 Last printed 0/0/0000
6 YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU Althugh yur health recrd is the prperty f Centre Crest, the infrmatin belngs t yu. Yu have the fllwing rights regarding yur medical infrmatin: Right t Inspect and Cpy. With sme exceptins, yu have the right t review and cpy yur medical infrmatin. Yu must submit yur request in writing t Health Infrmatin Management. We may charge a fee fr the csts f cpying, mailing r ther supplies assciated with yur request. Right t Amend. If yu feel that medical infrmatin in yur recrd is incrrect r incmplete, yu may ask us t amend the infrmatin. Yu have this right fr as lng as the infrmatin is kept by r fr Centre Crest facility. Yu must submit yur request in writing t the Administratr. In additin, yu must prvide a reasn fr yur request. We may deny yur request fr an amendment if it is nt in writing r des nt include a reasn t supprt the request. In additin, we may deny yur request if yu ask us t amend infrmatin that: Was nt created by us, unless the persn r entity that created the infrmatin is n lnger available t make the amendment; Is nt part f the medical infrmatin kept by r fr Centre Crest; r Is accurate and cmplete. Right t an Accunting f Disclsures. Yu have the right t request an "accunting f disclsures". This is a list f certain disclsures we made f yur medical infrmatin, ther than thse made fr purpses such as treatment, payment, r health care peratins. Yu must submit yur request in writing t the Administratr. Yur request must state a time perid, which may nt be lnger than six (6) years frm the date f the request is submitted and may nt include dates befre April 14, Yur request shuld indicate in what frm yu want the list (fr example, n paper r electrnically). The first list yu request within a 12 mnth perid will be free. Fr additinal lists, we may charge yu fr the csts f prviding the list. We will ntify yu f the cst invlved and yu may chse t withdraw r mdify yur request at that time befre any csts are incurred. Right t Request Restrictins. Yu have the right t request a restrictin r limitatin n the medical infrmatin we use r disclse abut yu. Fr example, yu may request that we limit the medical infrmatin we disclse t smene wh is invlved in yur care r the payment fr yur care. Yu culd ask that we nt use r disclse infrmatin abut a surgery yu had t a family member r friend. We typically are nt required t agree t yur request. Hwever, we must cmply with yur request if yu request that we d nt disclse infrmatin t a health plan r ther third party payer abut services which yu r sme ther persn (ther than the third party payer) has paid fr in full, unless a law requires us t share the infrmatin. If we d agree, we will cmply with yur request unless the infrmatin is needed t prvide yu emergency treatment. Ntice f Privacy Practices #3 revised december Page 6 f 8 Last printed 0/0/0000
7 Yu must submit yur request in writing t the Administratr. In yur request, yu must tell us (1) what infrmatin yu want t limit; (2) whether yu want t limit ur use, disclsure r bth; and (3) t whm yu want the limits t apply, fr example, disclsures t yur spuse. Right t Request Alternate and Cnfidential Cmmunicatins. Yu have the right t request that we cmmunicate with yu abut medical matters in a cnfidential manner r at a specific lcatin. Fr example, yu may ask that we nly cntact yu via mail t a pst ffice bx. Yu must submit yur request in writing t the Administratr. We will nt ask yu the reasn fr yur request. Yur request must specify hw r where yu wish t be cntacted. We will accmmdate all reasnable requests. Right t a Paper Cpy f This Ntice. Yu have the right t a paper cpy f this ntice even if yu have agreed t receive the ntice electrnically. Yu may ask us t give yu a cpy f this ntice at any time. Yu may btain a cpy f this ntice at ur website, T btain a paper cpy f this ntice, cntact CHANGES TO THIS NOTICE We reserve the right t change this ntice. We reserve the right t make the revised r changed ntice effective fr medical infrmatin we already have abut yu as well as any infrmatin we receive in the future. We will pst a cpy f the current ntice in the Centre Crest facility r n the website ( The ntice will specify the effective date n the first page, in the tp left hand crner. In additin, if material changes are made t this ntice, the ntice will cntain an effective date fr the revisins and cpies can be btained by cntacting Centre Crest facility administratr. COMPLAINTS If yu believe yur privacy rights have been vilated, yu may file a cmplaint with the Centre Crest facility r with the Secretary f the Department f Health and Human Services. T file a cmplaint with Centre Crest, cntact the Administratr at All cmplaints must be submitted in writing. Yu will nt be penalized fr filing a cmplaint. ACKNOWLEDGEMENT I acknwledge receipt f the Facility Ntice f Privacy Practices prvided in accrdance with the HIPAA Privacy Standards. Resident/Respnsible Party Ntice f Privacy Practices #3 revised december Page 7 f 8 Last printed 0/0/0000
8 Date Reference: Disclaimer: This plicy and prcedure has been prvided by cnsultants f Cmplete HealthCare Resurces, Inc. fr the use f engaged facilities. This dcument is nt t be cnsidered as facility specific plicy, but is meant fr the purpses f example t establishing facility plicy. Ntice f Privacy Practices #3 revised december Page 8 f 8 Last printed 0/0/0000
RENEW DERMATOLOGY NOTICE OF PRIVACY PRACTICES
RENEW DERMATOLOGY NOTICE OF PRACTICES Effective Date: September 21, 2013 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
More informationNote this is a NPP that reflects Omnibus changes as of March Tucson Gastroenterology Specialists Tucson Gastroenterology Institute
Nte this is a NPP that reflects Omnibus changes as f March 2013 Tucsn Gastrenterlgy Specialists Tucsn Gastrenterlgy Institute NOTICE OF PRACTICES Effective Date: 9/11/13 THIS NOTICE DESCRIBES HOW MEDICAL
More informationJOHN L. LITTLE, D.D.S, P.A ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES. May Refuse to Sign This Acknowledgement-
JOHN L. LITTLE, D.D.S, P.A ACKNOWLEDGEMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES -Yu I, Privacy Practices. May Refuse t Sign This Acknwledgement- ---, have received a cpy f this ffice's Ntice f {Please
More informationLake Internal Medicine Associates Phone: (352) Prevatt Street ~ Eustis, FL
Lake Internal Medicine Assciates Phne: (352) 589-4774 2101 Prevatt Street ~ Eustis, FL 32726 www.steventangmd.cm LAKE INTERNAL MEDICINE ASSOCIATES NOTICE OF PRIVACY PRACTICES Effective Date: 10/17/2016
More informationNotice of Privacy Practices for the S.U. Theatre Corporation Health Benefits Plan
Ntice f Privacy Practices fr the S.U. Theatre Crpratin Health Benefits Plan Ntice THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THE INFORMATION.
More informationNebraska Total Care Notice of Privacy Practices
Nebraska Ttal Care Ntice f Privacy Practices PRIVACY NOTICE There are times we need t use yur medical infrmatin t help yu get care. This ntice tells yu hw medical infrmatin abut yu may be used. It tells
More informationCONSENT FOR TREATMENT
Thank yu fr chsing 2 nd Street Dental, LLC as yur dental prvider. We are cmmitted t yur treatment being successful. Please understand that payment f yur fees is cnsidered part f yur treatments. The fllwing
More informationHIPAA Privacy Rule LINKS AND RESOURCES AFFECTED ENTITIES IMPACT ON EMPLOYERS. Provided by Brown & Brown of Louisiana, LLC
Prvided by Brwn & Brwn f Luisiana, LLC HIPAA Privacy Rule The HIPAA Privacy Rule establishes natinal standards t prtect individuals medical recrds and ther persnal health infrmatin. The Privacy Rule applies
More informationYou can get help from government organizations that are not connected with us
2011 Evidence f Cverage fr Medi-Pak Advantage MA (PFFS) Chapter 9: What t d if yu have a prblem r cmplaint (cverage decisins, appeals, cmplaints) BACKGROUND SECTION 1 Intrductin Sectin 1.1 What t d if
More informationWhat do you need? Copy of the HIPAA Policy on Amendment of Protected Health Information
HIPAA Privacy Prcedure #4 Effective Date: April 14, 2003 Reviewed Date: February, 2011 Amendment f Prtected Health Revised Date: February, 2011 Infrmatin Scpe: Radiatin Onclgy ************************************************************************************
More informationHEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) COMPLIANCE TRAINING
1 HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) COMPLIANCE TRAINING Part 1: Privacy The HIPAA Privacy Rule requires the apprpriate use and disclsure f a patient's persnal health infrmatin
More informationHIPAA HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
HIPAA HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT COMPLIANCE TRAINING Part 1: Privacy The HIPAA Privacy Rule requires the apprpriate use and disclsure f a patient's persnal health infrmatin and
More informationSubject Access Requests
Subject Access Requests The Data Prtectin Act 1998 gives rights t individuals in respect f the persnal data that rganisatins hld abut them. One f thse rights is the right t get a cpy f the infrmatin that
More informationEuropa Group Privacy Policy
Eurpa Grup Privacy Plicy The privacy and security f yur persnal infrmatin is very imprtant t us (Eurpa Grup). This plicy explains hw we cllect and use yur persnal infrmatin. Please read it carefully. This
More informationPERSONAL. Guarantor Name Last First MI (Preferred)
PATIENT INFORMATION We are pleased t welcme yu t ur ffice. Please take a few minutes t fill ut this frm as cmpletely as yu can. If yu have any questins we ll be glad t help yu. PERSONAL Patient Name Last
More informationPrivacy & Data Protection Policy
Privacy & Data Prtectin Plicy Whitby & District Fishing Industry Training Schl Limited and 54 Nrth Maritime Training ("Whitby Fishing Schl", WDFITS, 54 Nrth Maritime "we" r "us") are cmmitted t prmting
More informationHIPAA Privacy. Provided by Coverys Risk Management
Prvided by Cverys Risk Management What s the Risk? The HIPAA Standards f Privacy f Individually Identifiable Health Infrmatin (Privacy Rule) was published in final frm in August 2002. Enfrcement f the
More informationREFERENCE NUMBER: PFS.PDS.115. TITLE: Patient Billing and Collections CURRENT EFFECTIVE DATE: 01/01/2018. PAGE 1 of 8 SCOPE:
PAGE 1 f 8 SCOPE: This Patient Billing and Cllectins Plicy applies t all Presbyterian Healthcare Services (Presbyterian) hspital facilities, including inpatient, utpatient, hme health care services and
More informationGrant Application Guidelines
Grant Applicatin Guidelines The prgram staff f the Cmmunity Fundatin f Greater New Britain lks frward t wrking with yu. This frm is fr rganizatins that have submitted a Letter f Intent t us and were invited
More informationOSHA INSPECTION CHECKLIST
OSHA INSPECTION CHECKLIST HANDLING AN OSHA INSPECTION The Occupatinal Safety and Health Act (OSH Act) authrizes the Occupatinal Safety and Health Administratin (OSHA) t cnduct wrkplace inspectins and investigatins
More informationHIPAA Privacy & Security Omnibus Changes 2013
HIPAA Privacy & Security Omnibus Changes 2013 The Federal Gvernment has published mdificatins t 45 CFR Parts 160 and 164: Mdificatins t the HIPAA Privacy, Security, Enfrcement, and Breach Ntificatin Rules
More informationPSNC Briefing on the NHS Complaints procedure (from 1 April 2009)
PSNC Briefing n the NHS Cmplaints prcedure (frm 1 April 2009) Under the prvisins f the Natinal Health Service (Pharmaceutical Services) Regulatins 2005 1 pharmacy cntractrs are required t make arrangements
More informationPolicy on Requesting Reasonable Accommodations from the Zoning Code
Plicy n Requesting Reasnable Accmmdatins frm the Zning Cde Backgrund The Americans with Disabilities Act (ADA), as amended, is a federal anti-discriminatin statute designed t remve barriers that prevent
More informationResearch Data Request Form
1 NC Department f Public Instructin Research Data Request Frm The fllwing frm may be used t request student data frm the Nrth Carlina Department f Public Instructin (NCDPI). Please understand that the
More informationBECCLES INDOOR BOWLS CLUB
. BECCLES INDOOR BOWLS CLUB PRIVACY NOTICE FOR OUR MEMBERS We are cmmitted t respecting yur privacy. This ntice is t explain hw we may use persnal infrmatin we cllect befre, during and after yur membership
More informationFSB Press Release 20 August 2015
Retirement funds must take all reasnable steps t trace and pay millins f their members and beneficiaries wh remain untraced, the Deputy Registrar f Pensin Funds, Rsemary Hunter said n Wednesday. Addressing
More informationEmployee Rights & Responsibilities Page 1 of 4 Traumatic Injury/Form CA-1
Emplyee Rights & Respnsibilities Page 1 f 4 Traumatic Injury/Frm CA-1 The Federal Emplyees Cmpensatin Act (FECA) utlines the benefits fr federal emplyees injured in the perfrmance f their duties. The Office
More informationPrivacy Notice for Applicants and Tenants
Privacy Ntice fr Applicants and Tenants What we need Scttish Brders Husing Assciatin (SBHA) will be a "cntrller" f the persnal infrmatin that yu prvide t us thrugh yur cmpleted Husing Applicatin Frm, and
More informationARIZONA FIRE DISTRICT ASSOCIATION FINANCIAL PROCEDURES POLICY
FINANCIAL PROCEDURES POLICY 1. PURPOSE The purpse f these Financial Prcedures is t prvide cnsistent applicatin f cnduct and prper internal cntrls t safeguard the assets f the Arizna Fire District Assciatin
More informationWhat credit related information do we collect and hold and how do we collect it?
In this Credit Reprting Plicy, ORIX, we, us and ur mean ORIX Australia Crpratin Limited and ur related cmpanies. Thse related cmpanies may als have their wn privacy r credit reprting plicies which set
More informationCODE OF CONDUCT AND ETHICS POLICY ON CONFLICTS OF INTEREST
CODE OF CONDUCT AND ETHICS POLICY ON CONFLICTS OF INTEREST Magna Internatinal Inc. Plicy n Gifts & Entertainment 1 POLICY ON CONFLICTS OF INTEREST Magna emplyees have a duty t act in Magna s best interest.
More informationPershing Financial Services Guide (FSG) including its Privacy Policy
Pershing Financial Services Guide (FSG) including its Privacy Plicy Issued by Pershing Securities Australia Pty Ltd ABN 60 136 184 962 Australian Financial Services License N. 338 264 Date FSG was prepared:
More informationTHE CLOROX COMPANY AUDIT COMMITTEE CHARTER. [Effective May 8, 2017]
THE CLOROX COMPANY AUDIT COMMITTEE CHARTER [Effective May 8, 2017] PURPOSE AND AUTHORITY The Audit Cmmittee ( Cmmittee ) is established by the Bard f Directrs ( Bard ) fr the purpses f: 1. Representing
More informationPAYMENT BY CARD TERMS & CONDITIONS
PAYMENT BY CARD TERMS & CONDITIONS Versin 2.0 - June 2013 Effective frm 1 st June 2013 Issued n 1 st June 2013 Terms & Cnditins fr use f Credit/Debit card fr Payments (POS) Intrductin This Service is ffered
More informationThe Company is a public company incorporated in Bermuda and its securities are listed on AIM.
(Incrprated in Bermuda Registratin N. 44512) POLICY FOR TRADING IN COMPANY SECURITIES The Cmpany is a public cmpany incrprated in Bermuda and its securities are listed n AIM. Schedule 1 t this Plicy cntains
More informationThe kinds of personal information (including credit-related information) we collect, and the purposes for which we do that;
At Flexigrup it is imprtant t us that we manage yur persnal infrmatin securely and cnsistently with relevant legislatin, including the Privacy Act 1988 (Cth) ( Privacy Act ) as well as the Credit Reprting
More informationUnderstanding Self Managed Superannuation Funds
Understanding Self Managed Superannuatin Funds Hw t read this dcument Managing yur finances t meet yur day t day requirements as well as yur lng-term gals can be a cmplex task. There are all srts f issues
More informationTERMS OF REFERENCE FOR THE PROVISION OF OUTSOURCED INTERNAL AUDIT SERVICE
W&RSETA Standard Bidding Dcuments Terms f Reference TERMS OF REFERENCE FOR THE PROVISION OF OUTSOURCED INTERNAL AUDIT SERVICE 1 W&RSETA Standard Bidding Dcuments Terms f Reference 1. BACKGROUND TO W&RSETA
More informationWelcome To Advanas Foot & Ankle Specialists
Welcme T Advanas Ft & Ankle Specialists We want t thank yu fr trusting Advanas Ft & Ankle Specialists with yur healthcare needs. At Advanas Ft & Ankle Specialists we pride urselves n being a pleasant envirnment
More informationA-1110 Wien. Privacy Notice
Eurfins Lebensmittelanalytik Tel. +43 (1) 944 33 44-0 ffice@eurfins.at www.eurfins.at Privacy Ntice Table f cntents 1 Cntrller infrmatin... 2 2 What infrmatin shuld yu give Eurfins?... 2 3 Why d we use
More informationBest Execution & Client Order Execution Policy. October P age 1 6. BE31/10/17 v1
Best Executin & Client Order Executin Plicy Octber 2017 BE31/10/17 v1 P age 1 6 Cntents 1. Backgrund... 3 2. Order placement... 3 3. Order executin factrs... 3 4. Order executin plicy... 3 5. Order executin
More informationSummit Asset Managers Limited
Irish Infrastructure Trust Privacy Ntice Intrductin This ntice sets ut details f hw and why Summit Asset Managers Limited, f Beresfrd Curt,, Dublin 1, Ireland, acting n behalf the Irish Infrastructure
More informationSt. Paul s Lutheran Grade School Tuition Agreement Form
St. Paul s Lutheran Grade Schl Tuitin Agreement Frm Schl Year: 2017-2018 2017-18 tuitin schedule is listed n the bttm f this dcument. St. Paul s Lutheran Grade Schl strives t prvide an envirnment cnducive
More informationAAFMAA CAP FAQs. General Questions:
Overview: AAFMAA has prvided Career Assistance Prgram ( CAP ) lans as a benefit f membership fr many years. We have cmpiled this list f Frequently Asked Questins fr yur cnvenience and t prvide yu with
More informationT E M P L A T E. Tenancy Management Requirements. 1. General. a. Compliance obligations
age 1 enancy anagement s 1. General a. Cmpliance bligatins b. SD Husing Client System c. enant placement he rvider is t cmply with all aws, each enancy greement and the plicies and prcedures applicable
More informationAudit and Risk Management Committee Charter
Audit and Risk Management Cmmittee Charter Pivtal Systems Crpratin ("Cmpany") 1. Objectives The Audit and Risk Management Cmmittee (Cmmittee) has been established by the bard f directrs (Bard) f the Cmpany.
More informationDATA PROTECTION POLICY FOR PUPILS AND PARENTS
DATA PROTECTION POLICY FOR PUPILS AND PARENTS This Plicy is relevant t the whle schl including EYFS Cntents 1.0 Intrductin 2.0 Respnsibility fr data prtectin 3.0 Types f persnal data prcessed by the schl
More informationNCTJ Conflicts of Interest Policy and Procedures
NCTJ Cnflicts f Interest Plicy and Prcedures Purpse This plicy aims t draw attentin t the pssibility f cnflicts, minimise r prevent a cnflict ccurring and manage cnflicts that have arisen. Definitin f
More informationEnding Your Membership in the Plan
Ending Yur Membership in the Plan Yu must be eligible fr a valid disenrllment perid. Yur cverage will end the first day f the mnth after we receive yur request t disenrll. When can yu end yur membership
More informationWindham School District Procurement Policy for Federal Funds
1 f 5 Windham Schl District Prcurement Plicy fr Federal Funds DJB-FED The fllwing Prcurement Plicies shall apply t all Cntracts fr and Purchases f gds and services. All prcurements made with Federal funds
More informationBACKGROUND CHECK DISCLOSURE DOCUMENT
NOTICE TO SAFESTHIRES CLIENT: The sample dcuments included in this PDF shuld NOT be cnstrued as legal advice, guidance r cunsel. Emplyers shuld cnsult their wn attrney abut their cmpliance respnsibilities
More informationABORIGINAL ECONOMIC PARTNERSHIPS Program Grant Application Guidelines
ABORIGINAL ECONOMIC PARTNERSHIPS Prgram Grant Applicatin Guidelines Abriginal Ecnmic Partnerships Prgram (AEPP) grant funding supprts Indigenus cmmunities, cmmunity-wned businesses and nt-fr-prfit nn-gvernmental
More informationSNAKK MEDIA LIMITED FINANCIAL PRODUCTS TRADING POLICY AND GUIDELINES
SNAKK MEDIA LIMITED FINANCIAL PRODUCTS TRADING POLICY AND GUIDELINES Date adpted: 5 Nvember 2015 Versin: 1 1 SCOPE OF POLICY FINANCIAL PRODUCTS TRADING POLICY AND GUIDELINES This plicy applies t all directrs,
More informationTownship. Public Summary of FOIA Procedures and Guidelines
Twnship Public Summary f FOIA Prcedures and Guidelines It is the public plicy f this state that all persns (except thse persns incarcerated in state r lcal crrectinal facilities) are entitled t full and
More informationProducer Statements will be accepted only in accordance with this policy.
Prducer Statements Plicy This plicy has been prepared t ensure that Cuncil has clearly dcumented plicies and prcedures fr the request fr and acceptance f Prducer Statements in cnnectin with applicatins
More informationAAFMAA CAP FAQs. Q: What are the requirements for a CAP loan? A: The following items are required to receive a CAP Loan: Eligible military status: o
Overview: AAFMAA has prvided Career Assistance Prgram ( CAP ) lans as a benefit f membership fr many years. We have cmpiled this list f Frequently Asked Questins fr yur cnvenience and t prvide yu with
More informationNHCAC North Hudson Community Action Corporation
NHCAC Nrth Hudsn Cmmunity Actin Crpratin RFP 340B Prgram Auditing Services INQUIRIES SHOULD BE DIRECTED TO: Name: Title: Entity: Address: Manny Diaz Directr f Cmmunity Develpment Nrth Hudsn Cmmunity Actin
More informationStakeholder Relations and Communications Policy
Stakehlder Relatins and Cmmunicatins Plicy Effective January 15, 2008 Apprved by the Bard f Directrs n January 15, 2008 TABLE OF CONTENTS Sectin I Stakehlder Relatins and Cmmunicatins Plicy 1 NOVA SCOTIA
More informationHandling Complaints at Lloyd s: Guidance for managing agents and their representatives
Cmplaints May 2017 Llyd s cmplaints Handling Cmplaints at Llyd s: Guidance fr managing agents and their representatives This guidance nte prvides a practical prcess fr handling UK cmplaints received frm
More informationCOMPLAINTS POLICY ARUNSIDE PRIMARY SCHOOL. POLICY ADOPTED: 20 th JUNE 2016 THE POLICY IS TO BE REVIEWED: November 2017
COMPLAINTS POLICY ARUNSIDE PRIMARY SCHOOL POLICY ADOPTED: 20 th JUNE 2016 THE POLICY IS TO BE REVIEWED: Nvember 2017 Arunside Primary Schl Blackbridge Lane West Sussex RH12 1RR Cmplaints Plicy (Parents
More informationNorthwest Battle Buddies
Serving ur Veterans, wh served us all! www.nrthwestbattlebuddies.rg Clubs & Organizatins Third Party Event Apprval We are hnred that yu have selected fr yur next third-party fundraising event. The cntributins
More informationHuntington Bancshares Incorporated
Audit Cmmittee Apprved By: Bard f Directrs Huntingtn Bancshares Incrprated Apprval Date 1 f 6 Purpse f Cmmittee The Audit Cmmittee (Cmmittee) is established by the Bard f Directrs (Bard) t assist the Bard
More informationGOVERNMENT OF THE DISTRICT OF COLUMBIA
GOVERNMENT OF THE DISTRICT OF COLUMBIA INSTRUCTIONS FOR 917 LEAD DISCLOSURE FORM IN THE DISTRICT OF COLUMBIA This disclsure frm is intended t satisfy Federal disclsure requirements under 42 U.S.C. 4852d,
More informationFrequently Asked Questions: Broader Public Sector Procurement Directive
Frequently Asked Questins: Brader Public Sectr Prcurement Directive 1. What is the Brader Public Sectr (BPS) Prcurement Directive? The Brader Public Sectr Accuntability Act, 2010 prvides the authrity fr
More informationLapeer Conservation District
Lapeer Cnservatin District Public Summary f FOIA Prcedures and Guidelines (Adpted by actin f the Lapeer Cnservatin District Bard n Sept. 16, 2015) It is the public plicy f this state that all persns (except
More informationIntellectual Property Policy
Apprved by Academic Affairs Cuncil, June 24, 2014 Intellectual Prperty Plicy Purpse Statement This plicy is intended t supprt faculty, staff, and students in identifying and prtecting intellectual prperty,
More informationComplaints Resolution Process for Clients of. Consilium Securities (Pty) Ltd a member of the JSE Ltd
Cmplaints Reslutin Prcess fr Clients f Cnsilium Securities (Pty) Ltd a member f the JSE Ltd Table f cntents 1. Intrductin 2. Definitin f a Cmplaint 3. Cmplaints Plicy 4. Cmplaints Prcedure 5. Unreslved
More informationNEW PATIENT COMPLETE EYE EXAM WILL TAKE 1-2 HOURS - YOUR EYES WILL BE DILATED
PLEASE COMPLETE ALL OF THE ENCLOSED FORMS AND BRING THEM WITH YOU AT THE TIME OF YOUR APPOINTMENT. FAILURE TO DO SO WILL DELAY YOUR APPOINTMENT. Cancellatins require 24 business hurs ntice. Appintments
More informationClosing Out Award. The PI will work with ORA in obtaining the applicable resolution. Residuals
Clseut All spnsred prject awards must be frmally clsed-ut as sn as pssible after the prject end date t ensure that all expenses psted t this prject are allwable, n additinal charges are psted, all payments
More informationDetails of Rate, Fee and Other Cost Information
Details f Rate, Fee and Other Cst Infrmatin Accunt terms are nt guaranteed fr any perid f time. All terms, including fees and APRs fr new transactins, may change in accrdance with the Credit Card Agreement
More informationBest Practice in Gift Agreements
Best Practice in Gift Agreements Date: September 5, 2010 Updated August 6, 2016 Prepared By: Ann Huse Categry: Recrds Management Cmments T: ahuse@miami.edu Cmment Perid: Octber 1 December 31, 2016 Descriptin
More informationSocial Security Administration
Scial Security Administratin 1329 S. Divisin St. Traverse City MI 49684 September 25, 2018 Clumns & Features Mnthly Infrmatin Package Octber 2018 WORKERS' COMPENSATION AND CERTAIN DISABILITY PAYMENTS MAY
More informationWe process personal data for some or all of the following purposes depending on our relationship with the individual data subject:
PRIVACY POLICY Our purpses fr prcessing yur persnal data We prcess persnal data fr sme r all f the fllwing purpses depending n ur relatinship with the individual data subject: T adhere with all statutry
More informationInternational Complaints Handling: New Procedures in Italy. To advise of new complaints handling arrangements for Italy
market bulletin Ref: Y5041 Title Purpse Type Frm Internatinal Cmplaints Handling: New Prcedures in Italy T advise f new cmplaints handling arrangements fr Italy Event Paul Brady Head f Market Cnduct Date
More informationAlabama Department of Revenue Driver Or Vehicle Data Information Request
Alabama Interactive, Inc 104 Nrth Jacksn Street Mntgmery, AL 36104 (866) 353-EGOV www.alabamainteractive.rg subscriptins@alabamainteractive.rg Alabama Department f Revenue Driver Or Vehicle Data Infrmatin
More informationTerms and Conditions 19 December 2018
Stck and Shares Lifetime ISA (Prperty Saver) Terms and Cnditins 19 December 2018 These Terms, tgether with the Applicatin Frm, frm a legal agreement between yu and us which sets ut hw the Lifetime ISA
More information1. REIMBURSEMENTS FOR EXPENSES: 2. REQUESTING CHECKS:
Mnetary Plicies and Prcedures PTO funds are intended t benefit the students thrugh the enhancement f schl prgrams and activities. The PTO Officers are the guardians f these funds and have an bligatin t
More informationKitsap County Telecommuting Policy
Kitsap Cunty Telecmmuting Plicy A. Intrductin As an emplyer, Kitsap Cunty is required t implement cmmute trip reductin prgrams, cnsistent with state law and lcal rdinances t reduce the number f trips and
More informationCity of Southfield Written Public Summary of FOIA Procedures and Guidelines
City f Suthfield Written Public Summary f FOIA Prcedures and Guidelines It is the public plicy f this state that all persns (except thse persns incarcerated in state r lcal crrectinal facilities) are entitled
More informationCRG PATIENT REGISTRATION FORM
CRG PATIENT REGISTRATION FORM PATIENT INFORMATION Patient s Name: Birth : (Last) (First) (Middle) Scial Security Number: Male: Female: Hme Address: (Street / RR Bx # / Apt. #) (City/State) (Zip) Preferred
More informationFlexible Working Policy
Our HR Plicies Flexible Wrking Plicy Aim f the plicy The Kelda Grup is cmmitted t prmting flexibility in the wrkplace and believes that this flexibility can increase mtivatin, prmte wrk-life balance, wellbeing
More informationNEWPORT-MESA UNIFIED SCHOOL DISTRICT
NEWPORT-MESA UNIFIED SCHOOL DISTRICT BELIEVE IN YOURSELF. WE DO. Cigna FAQ Belw please find details and frequently asked questins regarding the Cigna Netwrk (HMO), St. Jseph Hag Health (SJHH) Select Netwrk
More informationConsent to Request Consumer Report & Investigative Consumer Report Information
Cnsent t Request Cnsumer Reprt & Investigative Cnsumer Reprt Infrmatin Applicant's First Name r Initial Last Name I understand that [Cmpany Name] ( COMPANY ) will utilize the services f Sterling InfSystems
More informationPROCESS FOR NATIONAL CAPITOL AREA GARDEN DISTRICTS, CLUBS AND COUNCILS CHOOSING TO FILE FOR 501(C)3 GROUP EXEMPTION
PROCESS FOR NATIONAL CAPITOL AREA GARDEN DISTRICTS, CLUBS AND COUNCILS CHOOSING TO FILE FOR 501(C)3 GROUP EXEMPTION What is a grup exemptin letter? The IRS smetimes recgnizes a grup f rganizatins as tax-exempt
More informationABORIGINAL ECONOMIC PARTNERSHIPS Program Application Guidelines
ABORIGINAL ECONOMIC PARTNERSHIPS Prgram Applicatin Guidelines The Abriginal Ecnmic Partnerships Prgram (AEPP) supprts Abriginal cmmunities, businesses and rganizatins t increase participatin in ecnmic
More informationTERMS AND CONDITIONS FOR APPOINTMENT OF INDEPENDENT DIRECTOR
TERMS AND CONDITIONS FOR APPOINTMENT OF INDEPENDENT DIRECTOR 1 PRIVATE & CONFIDENTIAL Date: T, Independent Directrs, Subject: Appintment as an Independent Directr InfBeans Technlgies Limited Dear Sir/Madam,
More informationPATIENT LIABILITY STATEMENT
PATIENT LIABILITY STATEMENT (Updated 6/17) We will nt initiate therapeutic services until signed authrizatin is prvided. I understand that I am persnally respnsible fr charges incurred fr services rendered
More informationAnnual Return Guidance
Annual Return Guidance Updated July 2018 Scttish Charity Regulatr Annual Return Guidance CONTENTS Pg 3. 1. INTRODUCTION Pg 4. 2. SECTION A Pg 8. 3. SECTION B Pg 11. 4. SECTION C 1. Intrductin What this
More informationTenancy Application Form
Tenancy Applicatin Frm Applicatins will nly be prcessed nce this applicatin is fully cmpleted. Shuld the applicant fail t prvide the fllwing details the applicatin will nt be prcessed. If yur applicatin
More informationGifts & Hospitality. Effective Date Author Owner Approval Last Review Revise Date August 2017
Gifts & Hspitality Effective Date Authr Owner Apprval Last Review Revise Date August 2017 Iain Simm Jeremy Arn Miles Rberts Nvember 2011 August 2019 The Pwer f Less www.dssmith.cm Gifts and Hspitality
More informationClub and Organization Conduct Procedures
Club and Organizatin Cnduct Prcedures Purpse The purpse f the Student Cde f Cnduct ( Cde ) is t maintain the general welfare f the University cmmunity and supprt cmmunity safety and student grwth by helping
More informationEmployee Hardship Assistance Policy
Emplyee Hardship Assistance Plicy Functinal Area: Human Resurces Applies T: All Faculty and Staff Plicy Reference(s): N/A Number: TBD Date Issued: March 4, 2013 Page(s): 6 Respnsible Persn The Directr
More informationAUDIT COMMITTEE CHARGE
AUDIT COMMITTEE CHARGE Number f Members 5-7 Must be an dd number fr purpses f vting. Cmpsitin Members shall include the Secnd Past President, the Secretary and Treasurer, at least ne ther Bard member and
More informationGuidelines for submission to the NSW Population and Health Services Research Ethics Committee. Version June 2015
Guidelines fr submissin t the NSW Ppulatin and Health Services Research Versin 3.0 18 June 2015 Cntents Sectin 1: Intrductin... 3 Sectin 2: Research Gvernance... 4 Sectin 3: Submissins t the NSW PHSREC...
More informationRenewing an Insurance Policy
AGENTS, BROKERS Renewing an Insurance Plicy This renewal prcedure is designed t help representatives respect their bligatins when renewing an insurance plicy. Essentially, these bligatins are spelled ut
More informationDesignated Fund Contribution Form
1 Designated Fund Cntributin Frm Name(s) Address Street City State Zip Alternate Address: Business Seasnal Street City State Zip Telephne Wrk Hme Cell Email: Alternate email: Hw did yu hear abut the Cmmunity
More informationApplicantCare is an online application and candidate management tool that automates the hiring process.
Plicy Overview It is the plicy f Kelis t prvide equal emplyment pprtunities. Emplyment decisins and actins will be cnducted withut regard t gender, sexual rientatin, race, clr, age, natinal rigin, ancestry,
More informationFINANCIAL SERVICES GUIDE
PART N: iinvest Securities Financial Services Guide (FSG) FINANCIAL SERVICES GUIDE DATED: Octber 2017 Cntents f this FSG This Financial Services Guide ( FSG ) is an imprtant dcument that iinvest Securities
More informationaddress: Driver license number: Date of birth: Occupation:
MEMBERSHIP APPLICATION PRIMARY MEMBER INFORMATION Name: Scial security Member Number: Hme phne: Cell phne: Business phne: Mther s Maiden Name: Security passwrd: Mailing address: City: State: ZIP Cde: Street
More informationBernard W Lynch, DMD, FAGD
Bernard W Lynch, DMD, FAGD Dental Care Burke 703.596.1555 9239 Old Keene Mill Rad Burke VA 22015 NEW PATIENT INFORMATION Patient Name: Date: Please answer the fllwing cmpletely and thrughly: 1. What specifically
More information