Bethany Village Privacy Notice
The following notice describes how your medical information may be used and disclosed, and how you can get access to this information. Please review the information carefully.
1. Your confidential healthcare information may be released to other healthcare
professionals for the purpose of providing you with quality healthcare.
2. Your confidential healthcare information may be released to Medicare, Medicaid, or
your insurance provider for the purpose of Bethany Village receiving payment for
providing you with needed health care services.
3. Your confidential healthcare information may be released to public or law
enforcement officials in the event of an investigation in which you are a victim of
abuse, a crime, or domestic violence.
4. Your confidential healthcare information may be released to other healthcare
providers in the event you need emergency care.
5. Your confidential healthcare information may be released to a public health
organization or federal organization in the event of a communicable disease or to
report a defective device or adverse reaction to a biological product (food or
6. Your confidential healthcare information may not be released without your written
approval for any other purpose than that which is identified above in this notice.
7. Your confidential healthcare information may be released to others not identified
above only after receiving written authorization from you. You may revoke your
permission to release confidential healthcare information at anytime.
8. You may be contacted by Bethany Village for the purposes of raising funds to support
Bethany Village’s operations.
10. You have the right to receive confidential communication about your health status, and
have the right to review and photocopy any or all portions of your healthcare information.
11. You have the right to restrict the use of your confidential healthcare information.
However, Bethany Village may choose to refuse your restriction if it is in conflict with
providing you quality healthcare in the event of an emergency situation.
12. You have the right to know who has accessed your confidential healthcare information and
for what purpose.
13. You have the right to possess a copy of the Privacy Notice upon request. This copy can be
in the form of an electronic transmission or on paper.
14. Bethany Village is required by law to protect the privacy of its residents. It will keep
confidential any all resident healthcare information and will provide residents a list of
duties or practices that protect confidential healthcare information.
15. Bethany Village will abide by the terms of this notice. Bethany Village reserves the right to
make changes to this notice and continue to maintain the confidentially of all healthcare
information. Residents will receive a mailed copy of any changes to this notice within 60
days of making the changes.
16. You have the right to complain to Bethany Village if you believe your rights to privacy have
been violated. If you feel your privacy rights have been violated, please mail your
complaint to Bethany Village:
Attn: Director of Corporate Compliance
3005 Watkins Road
Horseheads, NY 14845
17. For further information about this Privacy Notice, please contact us at
18. All complaints will be investigated. No personal issue will be raised for filing a complaint
with Bethany Village.
This notice is effective as of March 26, 2013.