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