Bridges at Brookline

Notice of Information 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.

Uses and Disclosures of Health Information

        We use health information about you for treatment, to obtain payment for treatment, for administrative purposes, for educating health professionals, and to evaluate the quality of care that you receive.

        We may use or disclose identifiable health information about you without your authorization for several other reasons.  Subject to certain requirements, we may give out health information without your authorization for public health purposes, for auditing purposes, for research studies, for review by the Long-Term Care Ombudsman Program, and for emergencies.  We provide information when otherwise required by law, such as for law enforcement in specific circumstances.  In any other situation, we will ask for your written authorization before using or disclosing any identifiable health information about you.  If you choose to sign an authorization to disclose information, you can later revoke that authorization to stop any future uses and disclosures. 

        We may change our policies at any time.  Before we make a significant change in our policies, we will change our notice and post the new notice on our website  You can also request a copy of our notice at any time.  For more information about our policy practices, contact the person listed below.

Individual Rights

        In most cases, you have the right to look at or obtain a copy of health information about you that we use to make decisions about you.  If you request copies, we will charge you $ .10 (10 cents) for each page.  You also have the right to receive a list of instances where we have disclosed health information about you for reasons other than treatment, payment or related administrative purposes.  Your first request for an “Accounting of Disclosures” will be free of charge.  Subsequent requests will be granted for a $5.00 fee.  If you believe that information in your record is incorrect or if important information is missing, you have the right to request that we correct the existing information or add any missing information.

        You may request in writing that we not use or disclose your information for treatment, payment, and administrative purposes except when specifically authorized by you, when required by law, or in emergency situations. We will consider your request, but are not legally required to accept it and may refuse to admit or treat you in any manner.

        You may object to the use of your health information for directory purposes.  Otherwise, we may use your name, location in the facility, general condition, and religious affiliation for directory purposes.  This information would be provided to people who may ask for you by name such as members of the clergy.  We may also use your name on a name plate next to or on your door in order to identify your room.


        If you are concerned that we have violated your privacy rights or you disagree with a decision we made about access to your records, you may contact the person listed below.  You also may send a written complaint to the U.S. Department of Health and Human Services.  The person listed below can provide you with the appropriate address upon request.

Our Legal Duty

        We are required by law to protect the privacy of your information, provide this notice about our information practices, and follow the information practices that are described in this notice.

        If you have any questions or concerns, please contact:


HIPAA Privacy Officer

Cathy Kirkham


Brookline Manor

RR#1 Box 463

Mifflintown, PA 17059



Effective Date: April 14, 2003