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.
Your
health information is personal, and we are committed to protecting it. Your health information is also very
important to our ability to provide you with quality care, and to comply with
certain laws. This Notice applies to
all records about your care that occurs at our facility, whether the records
are made by hospital personnel or by your physician. (Your physician may have a different policies and a different
notice regarding your health information that is created in the physician's
office.)
I. We Are Legally Required to Safeguard Your Protected Health
Information. We are required by law to:
A.
maintain
the privacy of your health information, also known as "protected health
information" or "PHI;"
provide
you with this Notice, and
comply
with this Notice.
II. Future Changes to Our Practices and This
Notice. We reserve the right to
change our privacy practices and to make any such change applicable to the PHI
we obtained about you before the change.
If a change in our practices is material, we will revise this Notice to
reflect the change. You may obtain a
copy of any revised Notice by contacting the Privacy Officer at 564-2315. We will also make any revised Notice
available in our Admitting Department.
III. How We May Use and Disclose Your Protected
Health Information. The law requires us to have
your consent to some uses and disclosures.
In other circumstances, the law allows us to use or disclose PHI without
your consent. This Section III gives
examples of each of these circumstances.
A.
Uses and Disclosures for Treatment, Payment and Health Care Operations. We may use or disclose your PHI to provide treatment to
you. For example, we may disclose your
PHI to physicians, nurses, and other health care personnel who are involved in
your care. We may also use and disclose
your PHI to contact you as a reminder that you have an appointment for
treatment at our facility, to tell you about or recommend possible treatment
options or alternatives, or about health-related benefits or services that may
interest you.
We
may also use or disclose your PHI to your insurance carrier in order to get paid for
treatment provided to you. For
example, we may use your PHI to create the bills that we submit to the
insurance company, or we may disclose certain portions of your PHI to our
business associates who perform billing and claims processing services to
us.
We
may also use or disclose your PHI in order to
operate this facility. For example,
we may use your PHI to evaluate the quality of care you received from us, or to
evaluate the performance of those involved with your care. We may also provide your PHI to our
attorneys, accountants and other consultants to make sure we are complying with
the laws that affect us. We may also
provide your contact information (such as name, address and phone number) and
the dates you received services from us, to a foundation that helps us with our
fundraising efforts.
B.
Uses and Disclosures That Require Us to Give You the Opportunity to
Object. If you do not object, we may include your
name, location in our facility and general condition in the patient directory that we use when
responding to requests by those who ask for you by name. If you do not object, we also disclose
information from the directory and your religious affiliation to clergy who visit
the facility. Unless you object, we may
provide relevant portions of your PHI to
a family member, friend or other person you indicate is involved in your
health care or in helping you get payment for your health care. In an emergency or when you are not capable
of agreeing or objecting to these disclosures, we will disclose PHI as we
determine is in your best interest, but will tell you about it later, after the
emergency, and give you the opportunity to object to future disclosures to
family and friends. Unless you object,
we may also disclose your PHI to persons performing disaster relief
notification activities.
C.
Certain Uses and Disclosures Do Not Require Your Written Authorization
Other than Treatment, Payment and Health Care Operations. The law allows us to disclose PHI without your written
authorization in the following circumstances:
(1) When Required by Law. We
disclose PHI when we are required to do so by federal, state or local law.
(2) For Public Health Activities. For example, we disclose PHI when
we report suspected child abuse, the occurrence of certain diseases, or adverse
reactions to a drug or medical device.
(3) For Reports About Victims of Abuse, Neglect or Domestic
Violence. We will disclose your PHI in
these reports only if we are required or authorized by law to do so, or if you
otherwise agree.
(4) To Health Oversight Agencies.
We will provide PHI as requested to government agencies who have
authority to audit or investigate our operations.
(5) For Lawsuits and Disputes.
If you are involved in a lawsuit or dispute, we may disclose your PHI in
response to a subpoena or other lawful request, but only if efforts have been
made to tell you about the request or to obtain a court order that will protect
the PHI requested.
(6) To Law Enforcement. We
may release PHI if asked to do so by a law enforcement official, in the
following circumstances: (a) in response
to a court order, subpoena, warrant, summons or similar process; (b) to
identify or locate a suspect, fugitive, material witness or missing person; (c)
about the victim of a crime if, under certain limited circumstances, we are
unable to obtain the person's agreement; (d) about a death we believe may be
due to criminal conduct; (e) about criminal conduct at our facility; and (f) in
emergency circumstances, to report a crime, its location or victims, or the
identity, description or location of the person who committed the crime.
(7) To Coroners, Medical Examiners and Funeral Directors. We may disclose PHI to facilitate the duties
of these individuals.
(8) To Organ Procurement Organizations. We may disclose PHI to facilitate organ donation and
transplantation.
(9) For Medical Research. We
may disclose your PHI without your written authorization to medical researchers
who request it for approved medical research projects; however, with very
limited exceptions such disclosures must be cleared through a special approval
process before any PHI is disclosed to the researchers, who will be required to
safeguard the PHI they receive.
(10) To Avert a Serious Threat to
Health or Safety. We may disclose your
PHI to someone who can help prevent a serious threat to your health and safety
or the health and safety of another person or the public.
(11) For Specialized Government
Functions. For example, we may disclose
your PHI to authorized federal officials for intelligence and national security
activities that are authorized by law, or so that they may provide protective
services to the President or foreign heads of state or conduct special
investigations authorized by law.
(12) To Workers' Compensation or
Similar Programs. We may provide your
PHI to these programs in order for you to obtain benefits for work-related
injuries or illness.
For some types of PHI, there
may be stricter restrictions on our use or disclosure of PHI. For example, drug and alcohol abuse patient
treatment information, HIV test results, mental health information, and genetic
testing results may be subject to greater protection of your privacy.
In
general, we may disclose a minor patient’s PHI to a parent or guardian, but we
may deny the parent’s access to the minor patient’s PHI in some situations.
IV. Other Uses and Disclosures of Your Protected
Health Information. Other uses and disclosures of
your PHI that are not covered by this Notice or the laws that apply to us will
be made only with your written authorization.
If you give us written authorization for a use or disclosure of your
PHI, you may revoke that authorization, in writing, at any time. If you revoke your authorization we will no
longer use or disclosure your PHI for the purposes specified in the written
authorization, except that we are unable to take back any disclosures we have
already made with your permission, and are required to retain certain records
of the uses and disclosures made when the authorization was in effect.
V. Your Rights Related to Your Protected Health Information. You have the following rights:
A.
The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask us to limit how we use and disclose
your PHI, as long as you are not asking us to limit uses and disclosures that
we are required or authorized to make to the Secretary of the federal Department
of Health Services, related to our facility's patient directory, or any of the
disclosures described in Section III, above.
Any such request must be submitted in writing to our Privacy Officer. We are not required to agree to your
request. If we do agree, we will put it
in writing and will abide by the agreement except when you require emergency
treatment.
B.
The Right to Choose How We Communicate With You. You have the right to ask that we send information to you at a
specific address (for example, at work rather than at home) or in a specific
manner (for example, by e-mail rather than by regular mail, or never by
telephone). We must agree to your
request as long as it would not be disruptive to our operations to do so. You must make any such request in writing,
addressed to our Privacy Officer.
C.
The Right to See and Copy Your PHI.
Except for limited circumstances, you may look at and copy your PHI if
you ask in writing to do so. Any such
request must be addressed to our Medical Records Department, which will respond
to your request within 30 days (or 60 days if the extra time is needed). In certain situations we may deny your
request, but if we do, we will tell you in writing of the reasons for the
denial and explain your right to have the denial reviewed.
If
you ask us to copy your PHI, we will charge you $14.00 for the first ten pages,
and $.50 for each page thereafter.
Alternatively, we may provide you with a summary or explanation of your
PHI, as long as you agree to that and to the cost, in advance.
D.
The Right to Correct or Update Your PHI. If you believe that the PHI we have about you is incomplete or
incorrect, you may ask us to amend it.
Any such request must be made in writing and must be addressed to our Medical
Records Department, and must tell us why you think the amendment is
appropriate. We will not process your
request if it is not in writing or does not tell us why you think the amendment
is appropriate. We will act on your
request within 60 days (or 90 days if the extra time is needed), and will
inform you in writing as to whether the amendment will be made or denied. If we agree to make the amendment, we will
ask you who else you would like us to notify of the amendment.
We
may deny your request if you ask us to amend information that:
(1) was not created by us, unless
the person who created the information is no longer available to make the
amendment;
(2) is not part of the PHI we keep
about you;
(3) is not part of the PHI that you
would be allowed to see or copy; or
(4) is determined by us to be
accurate and complete.
If
we deny the requested amendment, we will tell you in writing how to submit a
statement of disagreement or complaint, or to request inclusion of your
original amendment request in your PHI.
E.
The Right to Get a List of the Disclosures We Have Made. You have the right to get a list of instances in which we have
disclosed your PHI. The list will not
include disclosures we have made for our treatment, payment and health care
operations purposes, those made directly to you or your family or friends or
through our facility directory, or for disaster notification purposes. Neither will the list include disclosures we
have made with your written authorization, for national security purposes or to
law enforcement personnel, disclosure of limited data set, or disclosures made
before April 14, 2003.
Your
request for a list of disclosures must be made in writing and be addressed to
our Medical Records Department. We will
respond to your request within 60 days (or 90 days if the extra time is
needed). The list we provide will
include disclosures made within the last six years unless you specify a shorter
period. The first list you request
within a 12-month period will be free.
You will be charged our costs for providing any additional lists within
the 12-month period.
F.
The Right to Get a Paper Copy of This Notice. Even if you have agreed to receive the Notice by e-mail, you have
the right to request a paper copy as well.
You may obtain a paper copy of this Notice by contacting the Privacy
Officer at 564-2315. The Notice is also
available in our Admitting Department.
VI. Complaints. If
you believe your privacy rights have been violated, you may file a complaint
with us or with the Secretary of the federal Department of Health and Human
Services. To file a complaint with us,
put your compliant in writing and address it to our Privacy Officer at
564-2315. We will not retaliate against you for filing a complaint. You may also contact our Privacy Officer if
you have questions or comments about our privacy practices.