Your Rights
You have the right to:
- Get a copy of your paper or electronic medical record
- Correct your paper or electronic medical record
- Request confidential communication
- Ask us to limit the information we share
- Get a list of those with whom we’ve shared your information
- Get a copy of this privacy notice
- Choose someone to act for you
- File a complaint if you believe your privacy rights have been violated
Your Choices
You have some choices in the way that we use and share information as we:
- Tell family and friends about your condition
- Provide disaster relief
- Include you in a hospital directory
- Provide mental health care
- Market our services and sell your information
- Raise funds
Our Uses and Disclosures
We may use and share your information as we:
- Treat you
- Run our organization
- Bill for your services
- Help with public health and safety issues
- Do research
- Comply with the law
- Respond to organ and tissue donation requests
- Work with a medical examiner or funeral director
- Address workers’ compensation, law enforcement, and other government requests
- Respond to lawsuits and legal actions
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. For more information visit: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Your Rights As a Patient/Resident
Get an electronic or paper copy of your medical record
- You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you.
- We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
- You can ask us to correct health information about you that you think is incorrect or incomplete.
- We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications
- You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
- We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
- You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
- If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information
- You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
- We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
- You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically.
Choose someone to act for you
- If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
- We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
- You can complain if you feel we have violated your rights by contacting us at (716) 826-2010.
- You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/ privacy/hipaa/complaints/.
- We will not retaliate against you for filing a complaint.
Your Choices
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the saturations described below, talk to us. Tell us what you want us to do and we will follow your instructions.
You have the right and choice to tell us to:
- Share information with your family, close friends, or others involved in your care
- Share information in a disaster relief situation
- Include your information in a hospital directory
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety
In these cases, we never share your information unless you give us written permission:
- Marketing purposes
- Sale of your information
- Most sharing of psychotherapy notes
In the case of fundraising:
- We may contact you for fundraising efforts, but you can tell us not to contact you again.
Our Uses and Disclosures
How do we typically use or share your health information?
We typically use or share your health information in the following ways.
Treat you
We can use your health information and share it with other professionals who are treating you.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Run our organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use health information about you to manage your treatment and services.
Bill for your services
We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services
How else can we use or share your health information? We are allowed or required to share your
information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html
Help with public health and safety issues
- We can share health information about you for certain situations such as:
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medications
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to anyone’s health or safety
Do research
- We can use or share your information for health research.
Comply with the law
- We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Respond to organ and tissue donation requests
- We can share health information about you with organ procurement organizations.
Work with a medical examiner or funeral director
- We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law enforcement, and other government requests
- We can use or share health information about you:
- For workers’ compensation claims
- For law enforcement purposes or with a law enforcement official
- With health oversight agencies for activities authorized by law
- For special government functions such as military, national security, and presidential protective services
Respond to lawsuits and legal actions
- We can share health information about you in response to a court or administrative order, or in response to a subpoena.
Our Responsibilities
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know if a breach occurs that may have compromised the privacy or security of your information.
- We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Changes to the Terms of this Notice
We can change the terms of this notice, and the changes will apply to all information we have about you. Please inquire with our staff if you have any questions.
Anti-Discrimination Disclaimers
Our enterprise does not discriminate in the admission, retention or care given to patients/residents in terms of age, race, creed, color, religion, national origin, actual or perceived sexual orientation, gender, gender identity or expression, HIV status, marital status, handicap, blindness, disability or sponsor.
Our organization is an Equal Opportunity Employer (EOE) and considers all candidates for employment regardless of race, color, age, sex, sexual orientation, genetic history, national origin, marital status, disability, Vietnam or disabled veteran status or arrest record.
Disclosure in accordance with Section 2829(1) of the New York State Public Health Law Maximum Rates for Residency and Services effective January 1, 2021:
Medicare: $576 – $1,025
Private: $317 – $775
Managed Care: $200 – $540
Medicaid: $210 – $323
VENT: $596-$1,554
Facility
Owners
Landlord
Landlord Address
Dunkirk Operating LLC
Edward Farbenblum, Anthony Bacchi, Isaac Hersh, Deena Hersh
Dunkirk Realty Holdings LLC
c/o Amalgamated Realty LLC
2537 Route 52, Suite 18
Hopewell Junction, New York 12533
Roscoe Regional Healthcare, LLC
Edward Farbenblum, Orly Lieberman
Roscoe Regional Holdings, LLC
c/o Amalgamated Realty LLC
2537 Route 52, Suite 18
Hopewell Junction, New York 12533
Sunset Nursing & Rehabilitation Center, Inc.
Edward Farbenblum, Aharon Bleier, Joel Schwartz, Orly Lieberman, Jamie Beaver Ingham, Anthony Thomas DePinto, Jr, Scott William West, Susan Jennifer Grigg, Patrick Joseph McFeely, Andrea Rose Czora, Henry Shayovitz
Sunset Propco LLC
c/o Amalgamated Realty LLC
2537 Route 52, Suite 18
Hopewell Junction, New York 12533
Susquehanna Nursing & Rehabilitation Center LLC
Edward Farbenblum, Anthony Bacchi, Tibor Lebovich, Julia Vinocurova, Alex Berger,
SUSQUEHANNA REALTY, LLC
c/o Amalgamated Realty LLC
2537 Route 52, Suite 18
Hopewell Junction, New York 12533
Summary of all contracts for the provision of goods and services for which the facility pays with any portion of Medicaid or Medicare funds or other agreements entered by the facility within 30-days of execution:
255 Greenwich Medical Services | Podiatry |
255 Greenwich Medical Services | Dermatology |
Airgas | O2 Tanks |
Allscripts | Admissions referral system |
AMT | DME |
ARJO | PM program |
Bates Troy | Linen Service |
Bates Troy | Linen Services – rental |
BMA | Licensed Under the Broadcast Music |
Broome County DSS | Home Health |
Central Solutions Staffing | Staffing – Dietary |
CHE | Psychological Services |
Claimex LLC | Collections |
Dedicated Nursing Associates | Staffing – Nursing |
Delta Health | Home Care Scheduling Program |
DentServ | Dental |
Eastern Managed Print | Copier/Fax |
Ecolab | Dish Machine |
Elevateitt | Elevator Service |
Ferguson Electric | Electrical Services |
Great Lakes Building Sys | Life Safety Systems |
Guardian Consulting Services | Pharmacy Consultant |
Health Care Services Group | Housekeeping/Laundry Contract Services |
Health Care Services Group | Maintenance Services |
Health System Services | Part B Supplies – Enterals, wound care, trach, ostomy, urologic |
Healthcare Staffig | Staffing – nursing |
Healthcare Staffing | Staffing – Nursing |
HealtheConnections | Health Information Exchange |
Healthlinkny | PHI |
HealthStream – Renewal | Abaqis |
ILS Community Network | MLTC |
Infinity Medical Solutions | Rentals & Disposals |
Integrity Cost Consulting | Audit Telephone and Waste Expenses |
Johnson Controls | Life Safety Systems |
JW Danforth | Plumbing/HVAC Services |
Kinney Services | Exclusion Checking |
Lucent Group LLC | Dietary Contracted Services |
Luzon Environmental | UST Service |
Marywood University | RD Students |
MealTracker | Menu |
Medline | Supplies and Abaqis |
Medline | Supplies PPD |
MedServ | Eye Care |
Norton Nursing Services | Staffing |
Nova Healthcare Solutions | Consulting Services Agreement |
Nurse Connection Staffing | Staffing – Nursing |
Otis Elevator | Elevator Service |
Patient Care Associates | Portable X-Ray |
Penn Power | Generator Service |
Pharmscript | Pharmacy |
Premier Medical Equipment | Equipment Rental – Negative Pressure Wound Therapy |
Premier Rebate ACH | Rebate Direct Deposit |
Procare | Pharmacy |
ProValidus | Staffing – Nursing |
Rogers Service Group | Record Storage |
Scent Air | Environmental Scent |
Stericycle | Medical Waste Disposal |
Summit Health Care | Medicaid Applications |
SUNY Binghamton | Social Work Interns |
Support Care Psychology | Psychiatric Services |
Tembo Health (Simple Access) | Medical Management Services |
TK Elevator | Elevator Service |
TotalKare | Wanderguard system |
Twomagnets | Staffing – Nursing |
UHS Medical Director | Medical Director/Physician Services |
UNS | Building System Controls |
US Bank | Copier/Fax |
Vohra Wound Physicians | Medical Director/Physician Services |
|
Facility
Agency
Chautauqua
Dedicated Nursing Assoc., Favorite Healthcare, Trusted Nursing
Roscoe
No Agency
Sunset
Nurse Connection, Twomagnets, Fortus/Breakout Capitol, ESP/Medical Referral Network
Susquehanna
The Nurse Connection, ESP/Medical Referral Network, Stonebridge/Relyus, All American, Provalidus
Vendor Name | Service Type |
Abbie A. Wright | Pharmacy Services |
Airgas, Inc. | Medical Services |
All American Healthcare Services, inc. | Contracted Nursing |
Bates Troy Healthcare Services | Administrative Services |
Bert Adams Disposal (main acct) | Maintenance & Plant Services |
BJ QUEEN ENTERPRISES LLC | Maintenance & Plant Services |
Black Bear Fuel | Gas Utility |
Boulevard Produce | Food Service |
Caleo Consulting Services Inc. | Pharmacy Services |
Care Stat Staffing, LLC | Contracted Nursing |
CARLO MASI AND SONS | Food Service |
Casella Waste Systems, Inc. | Maintenance & Plant Services |
Casilio Communications, LLC | Marketing and Advertising |
CBI Waterworks | Water Utility |
Central Solutions Staffing, LLC | Contracted Dietary |
Charter Communications | Telecom Services |
Chudy Paper Company, Inc. | Office Supplies |
CICERO CONSULTING ASSOCIATES VCC, I | Administrative Services |
City of Dunkirk Water Department | Water Utility |
Constellation NewEnergy, Inc. | Electric Utility |
Dedicated Nursing Associates, Inc. | Contracted Nursing |
Dentserv Dental Services PC | Contracted Dental Services |
Dialyze Direct NY, LLC | Dialysis Services |
Eastern Managed Print Networks , LLC | Office Supplies |
Energo Power & Gas LLC | Utility Services |
FOODFEASIBLE, LLC | Contracted Dietary |
FreedMaxick CPAs, P.C. | Accounting and Audit Fees |
FRONTIER COMMUNICATIONS | Telecom Services |
Get Swagged LLC | Marketing and Advertising |
GRAINGER | Maintenance & Plant Services |
GUARDIAN CONSULTING SERVICES, INC. | Maintenance & Plant Services |
Hall Booth Smith, P.C. | Legal Services |
Haun Specialty Gases, Inc. | Medical Supplies |
HEALTH SYSTEM SERVICES | Medical Supplies |
INDEED, INC. | Marketing and Advertising |
Independent Computer Maintenance | Information Technology Service |
IPC Hospitalist Services of NY | Medical Services |
John W. Danforth Company, Inc. | Maintenance & Plant Services |
Johnson Controls Fire Protection Lp | Maintenance & Plant Services |
Kent A. Lieber, MD | Medical Services |
Koberlein Incorporated | Maintenance & Plant Services |
Kone | Maintenance & Plant Services |
Lucent Group LLC | Food Service |
Maplevale Farms, Inc. | Food Service |
Medical Referral Network International | Contracted Nursing |
MEDLINE INDUSTRIES, INC. | Medical Supplies |
Mi’lan Jones | Contracted Nursing |
Mirabito Power & Gas | Maintenance & Plant Services |
MUNICIPAL COMMISSION OF BOONVILLE | Utility Services |
NATIONAL GRID | Electric Utility |
NET HEALTH SYSTEMS, INC. | Information Technology Service |
Noco Electric, LLC | Electric Utility |
Noco Natural Gas, LLC | Gas Utility |
Norton and Associates, Inc. | Contracted Nursing |
NYSEG | Electric Utility |
NYSHFA | Administrative Services |
Otis Elevator Company | Maintenance & Plant Services |
Pease Bell CPAs, LLC | Tax Services |
Penn Detroit Diesel Allison, LLC | Maintenance & Plant Services |
PENN POWER SYSTEMS | Plant & Equipment Rental |
Pointclickcare Technologies Inc. | Information Technology Service |
Preventive Diagnostics | Radiology Services |
Privatel, Inc. | Telecom Services |
Procare LTC Syracuse, LLC | Pharmacy Services |
ProValidus Medical Staffing | Contracted Nursing |
REAL TIME MEDICAL SYSTEMS, LLC | Medical Services |
Roscoe-Rockland Water District | Water Utility |
RushKing Promotions | Marketing and Advertising |
Sanico, Inc. | Food Service & Cleaning Supplies |
Schwartz Sladkus Reich Greenberg Atlas LLP | Collection Services |
SGA H. Care Staffing LLC | Contracted Nursing |
Six 22 LLC | Marketing and Advertising |
Stephen J. Evans, MD | Medical Services |
Stericycle, Inc. | Administrative Services |
Stonebridge Financial Services | Contracted Nursing |
Tapestry Telehealth | Medical Services |
THE NURSE CONNECTION STAFFING | Contracted Nursing |
Trusted Nurse Staffing, LLC | Contracted Nursing |
UKG, Inc. | Administrative Services |
United Medical Associates | Contracted Nursing |
Upstate Niagara Cooperative, Inc | Food Service |
US Foods | Food Service |
Vasco Brands Inc. | Housekeeping Supplies |
White Glove Placement, Inc. | Contracted Nursing |