Effective Date: April 14, 2003

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED (SHARED) AND HOW YOU CAN GET ACCESS TO (SEE AND COPY) THIS INFORMATION. PLEASE REVIEW THIS CAREFULLY.

What is a Notice of Privacy Practices? Ron Joy / Sateri understands that your health information is personal. We create and maintain a record with information about the care and services you receive at Ron Joy / Sateri. We need this information to provide you with Quality care and to comply with the law. This Notice of Privacy Practices applies to all information about your care that Ron Joy / Sateri (and all of the people and places that make up Ron Joy / Sateri which we have described below) may create, maintain or receive, Including information we receive from other doctors and medical facilities that are not part of Ron Joy / Sateri, but that we maintain to give you better care. The Notice tells you about the ways we may use and share your health information, and the legal duties we have about your health information. The Notice also tells you about your rights under the laws of the United States and the State of Ohio. For purposes of this Notice, the use of the words "we," "us," and "our" mean Ron Joy / Sateri and all the people and places that make up Ron Joy / Sateri which are described below.

Who Follows This Notice of Privacy Practices? Ron Joy / Sateri is made up of many people and places including physicians, rehabilitation services, skilled nursing services, home health, hospice care, pharmacy services, laboratory services and other related health care providers. This also includes all departments, units and staff within our health care facilities, all health care professionals permitted by us to provide services to you, and students, residents, trainees, volunteers and others who may be involved in providing your care. These places and people may share your health information with each other for the treatment, payment, or health care operations that this Notice describes. This Notice does not apply to Ron Joy / Sateri as an employer. This is not meant to be a complete listing of all the Ron Joy / Sateri places and people who may provide you with care. If you have any questions as to whether care you receive is covered under this Notice, please contact the Compliance and Privacy Officer at (330) 758-8106.

Our Pledge to Protect Your Health Information. We are required by law to make sure that information that identifies you is kept private; to make available to you this Notice of Privacy Practices that describes how we use and share your health information and your rights under the law about your health information and to follow the Notice of Privacy Practices that is currently in effect.

How We May Use and Share Your Health Information with Others. The law permits us to use and share your health information in certain ways. The list below tells you about different ways that we may use your health information and share it with others, as well as some examples of what we mean. When sharing this information with others outside of Ron Joy / Sateri, we share only what is reasonably necessary, unless we are sharing information to help treat you in response to your written permission, or as the law requires.

In these three cases we share all information that you, your health care provider or the law has asked for. We will use health information that does not identify you whenever possible, if requested. Every possible example of how we may use or share information is not listed, however, all of the ways we are permitted to use and share information fall into one of the groups below.

1) Ways we are allowed to use and share your health information with others without your consent:

a) Treatment. We may use your health information to give you medical treatment or services. We may share your health information with people and places that provide treatment to you.

For example, if you have diabetes, the doctor may need to tell the dietitian about your diabetes so that you get the kind of meals you need. We may share health information about you with people outside of Ron Joy / Sateri who provide follow-up care to you, such as assisted living centers and home care agencies.

b) Payment. In order to receive payment for the services we provide to you, we may use and share your health information with your insurance company or a third party. We may also share your health information with another doctor or facility that has treated you so that they can bill you, your insurance company or a third party. For example, some health plans require your health information to pre-approve you for admission and require pre-approval before they pay us.

c) Health Care Operations. We may use and share your health information so that we, or others that have provided treatment to you, can better operate the office or facility. For example, we may use your health information to review the treatment and services we gave you and to see how well our staff cared for you. We may share your health information to our interdisciplinary staff so they can develop plans to improve the quality of care. We may share information with our students, trainees and staff for review and learning purposes.

d) Business Associates. We may share your health information with others who perform services on our behalf that we call "Business Associates." The Business Associate must agree in writing to protect the confidentiality of the information. For example, we may share your health information with a billing company that bills for the services provided.

e) Appointment Reminders. We may use and share your health information to remind you of your appointment for treatment or medical care. For example, if your doctor has sent you for a test, the place where the testing will be done may call you to remind you of the date you are scheduled.

f) Treatment Options and Other Health Related Benefits and Services. We may use and share your health information so we may tell you about possible treatment options and other health related benefits and services that may interest you. For example, if you suffer from a certain disease we may tell you about a special treatment or research protocol that is being offered for people with your condition.

g) Fund-Raising Activities. We may use and share with a Business Associate or a foundation that is related to us only your name, address, phone number and other such information (demographic information) and dates that health care was provided to you. For example, you may receive a letter from Ron Joy / Sateri regarding fund-raising. Any fund-raising materials will explain how you can tell us, a Business Associate or Ron Joy / Sateri's related foundation that you do not want to be contacted in the future for a donation, and we will make reasonable efforts to ensure that you are not contacted again.

h) Marketing Activities: We may use or share your health information for marketing purposes without your permission only when we discuss such products or services with you face to face or to provide you with an inexpensive promotional gift related to the product or service. For other types of marketing activities we will obtain your written permission. We will not sell your name to others.

i) Research in Celtam Cases: We may use and share your health information for research if permission from a special Ron Joy / Sateri committee is granted who decides if the request meets certain standards required by law. You may participate in a research study that requires you to obtain facility and other health care services. In this case, we may share the information that we create with the researcher and your insurance company in order to receive payment for services that your insurance will pay for.

We may also use and share with a researcher your health information if certain parts of your information that would identify you, such as your name and other items that the law describes, are removed before we share it with the Ron Joy / Sateri researcher. This will be done only if the researcher signs a written agreement with us that the information will not be shared again and that the researcher will not try to contact you and that he will obey other requirements that the law provides. We may also share your health information with a Business Associate who will remove information that identifies you so that the remaining information can be used for research.

i) Special Situations. In the following situations, the law permits, and under some circumstances requires us to use or share your health information with others. These disclosures may be furthered limited by the requirements of the State of Ohio law, including, but not limited to, behavioral health information, drug and alcohol treatment information, and HIV status.

i) As Required By Law. We will share your health information with others when federal, state or local law requires us to do so and only to the extent such law requires. If we believe that you have been a victim of abuse, neglect or domestic violence, we may share your health information with an authorized government agency if you either agree to our sharing this information or if the law allows us to do so. We believe that we need to share the information in order to protect you or someone else. If we decide to share your health information for this purpose, we will tell you that we have made a report unless we believe that to tell you would put you at risk of harm or if you are a personal representative of the victim and may be involved in the abuse, neglect, or injury.

We may also share your health information in response to an administrative or court order or in response to a subpoena, discovery request or other legal process, but only if we are advised that you have been made aware of the request or we receive notice that you either agree or if you disagree with the request that you are taking action to prevent the disclosure.

We may share your information with a law enforcement official to comply with laws, including laws that require the reporting of injury or death suspected to have been caused by criminal means, to report a crime committed on our property or information of a crime that we learn about while providing emergency services, or in response to a court order, warrant, subpoena or summons. We will provide your health information in response to an administrative request, investigation, or similar authorized legal process if the information requested is necessary to the request, reasonably limited in scope, and identified information could not reasonably be used.

If asked to do so by a law enforcement official, we may share your health information to: 1) identify or locate a suspect, fugitive, material witness or missing person, or 2) about a victim of a crime if, in certain limited cases, we are unable to obtain the victim's permission if he/she is an adult and the law enforcement official meets certain conditions described by law.

ii) To Prevent a Serious Threat to Health or Safety. We may use and share your health information with persons who may be able to prevent or lessen the threat or help the potential victim of the threat when necessary, to prevent a serious threat to your health and safety or the health and safety of the public or another person, unless in the case of a threat to public health, such information is discovered in the course of request for or actual treatment, counseling, or therapy of the condition that may cause or contribute to such threat. Ohio law may require such disclosure when an individual or group has been specifically identified as the target or potential victim.

iii) Organ and Tissue Donation. In the event of your death, we may share your health information with organizations that obtain, store, or transplant organs, eyes or tissue to assist in the process of eye, organ, or tissue transplants.

iv) Special Government Purposes. We may use and share your health information with certain government agencies.

1) Military and Veterans. We may share your health information with military authorities as the law permits if you are a member of the armed forces (either USA or foreign government).

2) National Security and Intelligence. We may share your health information with authorized federal officials for intelligence. counterintelligence and other national security activities authorized by law and.

3) Protective Services for the President and Others. We may share your health information with authorized federal officials to protect the President of the United States, other authorized persons, or foreign heads of state or for purposes of conducting special investigations as authorized by law.

v) Workers' Compensation. We may share your health information for Workers' Compensation or similar programs that provide benefits for work related injuries or illness.

vi) Public Health. We may share your health information with public health authorities for public health purposes to prevent or control disease, injury, or disability, including, but not limited to, reporting disease, injury, important events such as birth or death and to conduct public health monitoring, investigations, or activities. We may share you health information to report child abuse or neglect to collect and report on the quality, safety, and effectiveness of products and activities that are regulated by the Food and Drug Administration (FDA) such as drugs and medical equipment, which could include product recalls, repairs, and monitoring or to notify a person who may have been exposed to or is at risk of spreading a disease.

vii) Health Oversight. We may share your health information to a health oversight agency for purposes of monitoring the health care system; benefit eligibility for Medicare, Medicaid and other government benefit programs, monitoring compliance with government regulations and civil rights laws.

viii) Coroners Medical Examiners and Funeral Directors. We may share your health information with a coroner or medical examiner in order to identify a deceased person, determine the cause of death, or for other reasons allowed by law.

We may also share your health information with funeral directors, as necessary, so they can carry out their duties.

ix) Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may share your health information to the correctional institution or law enforcement official. This would be necessary: 1) for the institution to provide you with health care, 2) to protect your health and safety or the health and safety of others, or 3) for the safety and security of the correctional institution.

2) Ways we are allowed to use and give your health information to others with your verbal permission:

a) Facility Directory. We may include limited information about you in the facility directory while you are a resident at Ron Joy / Sateri. The information may include your name, location in the building, general condition, such as "stable," "serious," "critical," and your religious affiliation. Except for your religious affiliation, the directory information may be released to people who ask for you by name. We may give your religious affiliation to a member of the clergy, such as a priest or rabbi, even if they don't ask for you by name.

This helps your family, friends, and clergy who visit you to know how you are doing. You have the right to ask that all or part of your information not be given out. If you do so, we will not be able to tell your family or friends your room number or that you are in the facility.

b) People Involved in Your Care or Payment for Your Care. We may share your health information with a friend, family member, or other person identified by you who is involved in your medical care or the payment of your medical care. We may also share your health information with these persons if you are present or available prior to our sharing your health information with such family, friends, or other persons and you do not object to our sharing your health information with them or we reasonably believe based on the circumstances and our professional judgment that you would not object to this.

If you are not present and certain circumstances are present that in our judgment it would be in your best interests to do so, we will share information with a friend, family member, or someone else identified by you, but only to the extent necessary. This could include sharing information with your friend so that they could pick up a prescription or a medical supply. We may tell your family or friends that you are in our facility and your general condition. We may share medical information about you with an organization assisting in a disaster relief effort.

Exception to a) and b) above: If you are in a psychiatric, mental behavioral health or drug and alcohol facility, or being treated for these conditions, none of the above information will be given to anyone outside of Ron Joy / Sateri unless you have given written permission.

3) IN ALL OTHER WAYS, WE WILL REQUIRE YOUR WRITTEN PERMISSION BEFORE YOUR HEALTH INFORMATION IS USED OR SHARED WITH OTHERS. Except as stated above, your written permission is required before we can use or share your health information to anyone outside of Ron Joy / Sateri. This permission is provided through a form. If you give us permission to use or share health information about you, you may cancel that permission, in writing, at any time. If you cancel your permission, we will no longer use or share your health information for the reasons you have given us in your written permission. However, we are unable to take back any information that we have already shared with your permission.

The Law gives you the following rights about your health information

1. Right to Ask To See and Copy. You have the right to ask to see and copy the health information we used to make decisions about your care. This request can be oral, however, Ron Joy / Sateri prefers to receive such requests in writing. If you ask to see or copy your health information, you may have to pay for costs for copying, mailing or other costs. We may tell you that you cannot see or copy some or all of your health information. If we tell you this, you may ask that someone else at Ron Joy / Sateri reviews this decision. A licensed health care professional chosen by Ron Joy / Sateri will review this decision. This person will not be the same person who refused your request. Whatever this person decides, we will do.

2. Right to Ask for a Correction. If you feel that health information we have about you is incorrect or incomplete, you may ask us to correct the information. You have the right to ask for a correction for as long as the information is kept by or for Ron Joy / Sateri. You must put your request in writing. If you do not ask in writing or give your reasons in writing, we may tell you that we will not do as you have asked.

We have the right to refuse your request if you ask us to correct information that 1) was not made by us, unless the person or place that originally made the information is no longer available to make the correction, 2) is not part of the health information kept by or for Ron Joy / Sateri, 3) is not part of the information you are permitted by law to see and copy, or 4) that we decide is correct and complete.

3. Right to Ask for an "Accounting of Disclosures". You have the right to ask us for an "accounting of disclosures." This is a list of those people outside of Ron Joy / Sateri that have received your health information except for information shared for treatment, payment or health care operations or when you have provided us with permission to do so. You must put your request in writing. You must include in your written request how far back in time you want us to go. It may not be longer than six years and may not include dates before April 14, 2003, which is the date when, by law, we are required to begin keeping track of the disclosures.

4. Right to Ask for Limits on Use and Sharing. You have the right to ask us to limit the health information we use or share with others about you for treatment, payment, health care operations, or that we share with someone who is involved in your care or payment for your care, like a family member or friend.

In your request, you must tell us 1) what information you want to limit, 2) whether you want to limit our use, disclosure or both, and 3) the person or institution the limits apply to (for example, your spouse). For example, you could ask that we not use or share information about your diagnoses. You must put your request in writing and give it to the facility. We are not required to agree to your request. If we do agree to your request, the only time we will not follow your request is if the information you wanted us to limit is needed to give you emergency treatment.

5. Right to Ask for Confidential Communications. You have the right to ask that we contact you about your health information in a certain way or at a certain location that you may believe provides you with greater privacy. You can ask that we only contact you at work or by mail. Your request must state how or where you wish to be contacted. You must make your request in writing to Ron Joy / Sateri. We will not ask you the reason for your request. We will comply with all reasonable requests.

6. Right to Ask for a Paper Copy of This Notice. You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. Contact the Privacy Officer or Admissions Department of Ron Joy / Sateri Nursing Home for a copy.

If you believe your privacy has been violated by us, you may file a complaint directly with us. You can do this by contacting the Compliance and/or Privacy Officer at (330) 758-8106 or by calling the Ron Joy / Sateri Compliance Help line at (330) 758-8106.

Complaints to us can be oral (by contacting the above numbers) or tn writing addressed to: Compliance and/or Privacy Officer, Ron Joy / Sateri, 830 Boardman Canfield Rd., Boardman, OH, 44512.

You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with the Secretary of Health and Human Services. you must: 1) name Ron Joy / Sateri or the person that you believe violated your privacy rights and describe how that person/place violated your privacy rights, and 2) file the complaint within 180 days of when you knew or should have known that the violation occurred. All complaints to the Secretary of the U.S. Department of Health and Human Services must be in writing. You will not be penalized for filing a complaint.

Changes to This Notice

We reserve (have) the right to change this Notice. We reserve (have) the right to make the revised or changed Notice effective for health information we already have about you and for any health information we received in the future. We will post a copy of the current Notice in the places where we provide medical services, readily available to residents, families, and responsible parties. The Notice will contain the effective date on the first page, in the top left-hand corner.

We will provide to you, if you ask us, a copy of the Notice that is currently in effect each time you are admitted for treatment or health care services.

If You Have Questions About This Notice

If you have any questions about this Notice, please contact the Compliance and/or Privacy Officer at (330) 758-8106.