Your Right to Privacy
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 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.