N.H. Admin. Code § Ve-H 306.06

Current through Register No. 50, December 12, 2024

Section Ve-H 306.06 - Effect of Signature on Page 8 of the Application

(a) The signature on page 8 of the application shall, when combined with the first set of initials, have the effect of:

(1) Authorizing the home and those involved in the provision of services on its behalf to:

a. Examine the applicant;

b. Secure appropriate information about the applicant; and

c. Perform routine appropriate treatment;

(2) Confirming the applicant's understanding that a responsible person will explain the benefits and risks of any particular treatment; and

(3) Confirming the applicant's understanding that he or she will have the right to refuse any proposed treatment.

(b) The signature on page 8 of the application shall, when combined with the second set of initials, have the effect of:

(1) Confirming the applicant understands that:

a. The home will use his or her healthcare information for purposes of treatment and other lawful functions, including securing payment and other usual healthcare operations;

b. Such information may be available to persons working on behalf of the home, who will be subject to the same duty of confidentiality with respect to the information as is the home; and

c. His or her specific authorization shall be required for the home, if it holds such information, to disclose to others certain sensitive information related to his or her health care, such as:

1. Records covered by federal law governing confidentiality of alcohol or drug abuse treatment programs;

2. Records covered by state rules governing the rights of recipients of mental health services; and

3. Records concerning the diagnosis or treatment for HIV infections;

(2) Consenting to the home's use of the information described in (b)(1)c. above for the purpose of his or her evaluation and treatment; and

(3) Confirming the applicant's understanding that he or she may refuse the sharing by the home of such information, but refusal may result in improper diagnosis or treatment or other adverse consequences.

(c) The signature on page 8 of the application shall, when combined with the third set of initials, have the effect of:

(1) Acknowledging receipt of the notice of privacy practice for protected health information; and

(2) Confirming the applicant's understanding that the notice contains important information about how his or her medical information may be used, disclosed, and accessed by the applicant.

N.H. Admin. Code § Ve-H 306.06

#8953, eff 7-21-07

Amended by Volume XXXIX Number 06, Filed February 7, 2019, Proposed by #12711, Effective 1/15/2019, Expires 1/15/2029.