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.
OUR COMMITMENT TO PROTECT
YOUR HEALTH INFORMATION
We are required by law to
follow the privacy practices described in this Notice, though we reserve the
right to change our privacy practices and the terms of this Notice at any time
and to apply those changes to all PHI in our possession. If we change our privacy practices and the
terms of this Notice, we will post a copy in our office in a prominent
location, have copies of the revised Notice available at our offices, and
provide you with a copy of the revised Notice upon your request.
Who
Will Follow This Notice
This Notice describes
HOW WE MAY USE AND DISCLOSE
YOUR PHI
1. Treatment, Payment and Health Care Operations. As described below, we will use or disclose your
protected health information for treatment, payment, or health care
operations. The examples below do not
list every possible use or disclosure in a category.
Treatment: We may use and disclose PHI about you to
provide, coordinate or manage your health care and related services. We may consult with other health care
providers regarding your treatment and coordinate and manage your health care
with others. For example, we may use and
disclose PHI when you need a prescription, lab work, x-ray or other health care
services. We may also use and disclose
PHI about you when referring you to another health care provider. For example, if you are referred to a
physician for treatment after your discharge, we may disclose PHI to your new
physician regarding whether you are allergic to any medications. We may also disclose PHI about you for the
treatment activities of another health care provider. For example, we may send a report about your
care from us to an outside physician so that the other physician may treat you.
Payment: We may use and disclose PHI so that we can
bill and collect payment for the treatment and services provided to you. For example, we may send your insurance
company a bill for services or release certain medical information to your
health insurance company so that it can determine whether your treatment is
covered under the terms of your health insurance policy. We also may use and disclose PHI for billing,
claims management, and collection activities.
We may also disclose PHI to another health care provider or to a company
or health plan required to comply with the HIPAA Privacy Rule for the payment
activities of that health care provider, company, or health plan. For example, we may allow a health insurance
company to review PHI relating to their enrollees to determine the insurance
benefits to be paid for their enrollees’ care.
Health Care
Operations: We may use and disclose PHI in performing
certain business activities which are called health care operations. Some examples of these operations include our
business, accounting and management activities.
These health care operations also may include quality assurance,
utilization review, and internal auditing, such as reviewing and evaluating the
skills, qualifications, and performance of health care providers taking care of
you and our other patients and providing training programs to help students
develop or improve their skills. If
another health care provider, company, or health plan that is required to
comply with the HIPAA Privacy Rule has or once had a relationship with you, we
may disclose PHI about you for certain health care operations of that health
care provider or company. For example,
such health care operations may include assisting with legal compliance
activities of that health care provider or company.
2. Communications To You From Our Office. We may use or disclose medical information in
order to contact you as a reminder that you have an appointment for treatment
or medical care, to tell you about or recommend possible treatment options or
alternatives that may be of interest to you, or to inform you about
health-related benefits or services that may be of interest to you.
3. Communications To Others If You Agree Or Do Not Object. We may also use or disclose your PHI in the following
circumstances. However, except in emergency situations, we will inform you of
our intended action prior to making any such uses and disclosures and will, at
that time, offer you the opportunity to object.
Directories: We
may maintain a directory of patients that includes your name and location
within the facility, your religious designation, and information about your
condition in general terms that will not communicate specific medical
information about you (e.g., fair, stable, etc.). The directory information,
except for your religious affiliation, may also be released to people who ask
for you by name. Your religious affiliation may be given to a member of the
clergy, such as a priest or rabbi, even if they don’t ask for you by name. This
is so that your family, friends and clergy may visit you in the hospital and
know your general condition.
Notifications
to Family/Friends: We may disclose PHI to your relatives,
close friends
or any other person identified by you if the PHI is directly related to that person’s
involvement in your care or payment for your care. If you are unable to agree or object to such a
disclosure, we may disclose such information as necessary if we determine that
it is in your best interest based on our professional judgment. We may also use and disclose your health information
for the purpose of locating and notifying your relatives or close personal
friends of your location, general condition or death, and to organizations that
are involved in those tasks during disaster situations.
4. Other Uses And Disclosures Authorized By The HIPAA Privacy
Rule. We may use and disclose PHI about you in the
following circumstances, provided that we comply with certain legal conditions
set forth in the HIPAA Privacy Rule.
Required By
Law. We may use or disclose PHI as required by
federal, state, or local law if the disclosure complies with the law and is
limited to the requirements of the law.
Public Health Activities. We may disclose PHI to public health
authorities or other authorized persons to carry out certain activities related
to public health, including to:
•
Prevent or control disease, injury, or disability or report disease,
injury, birth, or death;
•
Report child abuse or neglect;
•
Report information regarding the quality, safety, or effectiveness of
products or activities regulated by the federal Food and Drug Administration;
•
Notify a person who may have been exposed to a communicable disease in
order to control who may be at risk of contracting or spreading the disease; or
•
Report to employers, under limited circumstances, information related
primarily to workplace injuries or illness or workplace medical surveillance.
Abuse,
Neglect, or Domestic Violence. We may
disclose PHI to proper government authorities if we reasonably believe that a
patient has been a victim of domestic violence, abuse, or neglect.
Health
Oversight. We may disclose PHI to a health oversight
agency for oversight activities including, for example, audits, investigations,
inspections, licensure and disciplinary activities and other activities
conducted by health oversight agencies to monitor the health care system,
government health care programs, and compliance with certain laws.
Legal
Proceedings. We may disclose PHI as expressly required by
a court or administrative tribunal order or in compliance with state law in
response to subpoenas, discovery requests or other legal process when we
receive satisfactory assurances that efforts have been made to advise you of
the request or to obtain an order protecting the information requested.
Law Enforcement. We may disclose PHI to law enforcement
officials under certain specific conditions where the disclosure is:
•
About a suspected crime victim if the person agrees or, under limited
circumstances, we are unable to obtain the person’s agreement because of
incapacity or emergency;
•
To alert law enforcement of a death that we suspect was the result of
criminal conduct;
•
In response to authorized legal process or required by law;
•
To identify or locate a suspect, fugitive, material witness, or missing
person;
•
About a crime or suspected crime committed on our premises; or
•
In response to a medical emergency not occurring on our premises, if
necessary to report a crime.
Coroners,
Medical Examiners or Funeral Directors. We
may disclose PHI regarding a deceased patient to a coroner, medical examiner or
funeral director so that they may carry out their jobs. We also may disclose such information to a
funeral director in reasonable anticipation of a patient’s death.
Organ
Donation. We may disclose PHI to organizations that
help procure, locate, and transplant organs in order to facilitate organ, eye,
or tissue donation and transplantation.
Threat to
Health or Safety. In limited circumstances, we
may disclose PHI when we have a good faith belief that the disclosure is
necessary to prevent a serious and imminent threat to the health or safety of a
person or to the public.
Specialized
Government Functions. We may disclose PHI for
certain specialized government functions, such as military and veteran
activities, national security and intelligence activities, protective services
for the president and others, medical suitability determinations, and for
certain correctional institutions or in other law enforcement custodial
purposes.
Compliance
Review. We are required to disclose PHI to the
Secretary of the United States Department of Health and Human Services when
requested by the Secretary to review our compliance with the HIPAA Privacy
Rule.
Workers’
Compensation. We may disclose PHI in order to comply with
laws relating to workers’ compensation or other similar programs.
Research. We may disclose PHI for research purposes
under certain limited circumstances for research projects that have been evaluated and
approved through an approval process that takes into account patients’ need for
privacy. We must obtain a written authorization to use
and disclose PHI about you for research purposes except in situations where a
research project meets specific, detailed criteria established by the HIPAA
Privacy Rule to ensure the privacy of PHI.
5. Emergencies. We
may use or disclose your PHI in an emergency treatment situation in compliance
with applicable laws and regulations.
6. With Your Written Authorization. All other uses and disclosures of your PHI will be
made with only with your written authorization.
If you have authorized us to use or disclose PHI about you, you may
revoke your authorization at any time, except to the extent we have taken action
based on the authorization.
YOUR RIGHTS REGARDING YOUR
PROTECTED HEALTH INFORMATION
The HIPAA Privacy Rule gives
you several rights with regard to your PHI.
These rights include:
1. Right to Request Restrictions: You have the right to request a restriction or
limitation on the PHI we use or disclose about you for treatment, payment or
health care operations, or that we disclose to those who may be involved in
your care or payment for your care. While we will consider your
request, we are not required to agree to it. If we do agree to your request, we will
comply with your request except as
required by law or for emergency treatment. To request
restrictions, you must make your request in writing to our Privacy Officer at
the address listed on the last page of this Notice and state the specific
restriction requested and to whom you want the restriction to apply.
2. Right to Receive Confidential Communications: You have the right to request that you
receive communications regarding PHI in a certain manner or at a certain
location. For example, you may request
that we contact you at home, rather than at work. You must make your request in writing to our
Privacy Officer and specify how you would like to be contacted (for example, by
regular mail to your post office box and not your home). We will accommodate all reasonable requests.
3. Right to Inspect and
Copy: You have the right to inspect and receive a
copy of your PHI contained in records we maintain that may be used to make
decisions about your care. These records
usually include your medical and billing records but do not include
psychotherapy notes; information gathered or prepared for a civil, criminal, or
administrative proceeding; or PHI that is subject to
law that prohibits access. To
inspect and copy your PHI, please contact our Health Information Services
Department. If you request a copy of PHI
about you, we may charge you a reasonable fee for the copying, postage, labor
and supplies used in meeting your request.
We may deny your request to inspect and copy PHI only under limited
circumstances, and in some cases, a denial of access
may be reviewable.
4. Right to Amend: If you feel that medical information we have
about you is incorrect or incomplete, you may ask us to amend the information
for as long as such information is kept by or for us. You must submit your request to amend in
writing to our Health Information Services Department and give us a reason for
your request. We may deny your request
in certain cases. If your request is denied,
you may submit a written statement disagreeing with the denial, which we will
keep on file and distribute with all future disclosures of the information to
which it relates.
5. Right to Receive an
Accounting of Disclosures: You have the right to request a
list of certain disclosures of PHI made by us during a specified period of up
to six years prior to the request, except disclosures for treatment, payment or health
care operations; made to you; for our facility directory; to persons involved
in your care or for the purpose of notifying your family or friends of your
whereabouts; for national security or intelligence purposes; made pursuant to
your written authorization; incidental to another permissible use or
disclosure; for
certain notification purposes (including national security, intelligence,
correctional, and law enforcement purposes); or made before April 14,
2003. If you wish to make such a
request, please contact our Health Information Services Department. The first accounting that you request in a
12-month period will be free, but we may charge you for our reasonable costs of
providing additional lists in the same 12-month period. We will tell you about these costs, and you
may choose to cancel your request at any time before costs are incurred.
6. Right to a Paper Copy of this Notice: You have a right to receive a paper copy of this
Notice at any time. You are entitled to
a paper copy of this Notice even if you have previously agreed to receive this
Notice electronically. To obtain a paper
copy of this Notice, please contact our Privacy Officer.
COMPLAINTS
If you believe your privacy
rights have been violated, you may file a complaint with us, or the Secretary
of the
QUESTIONS
If you have any questions or
need additional information about this Notice, please contact our Privacy
Officer.
PRIVACY OFFICER
You may contact our Privacy Officer at the following
address and phone number:
Privacy Officer
5985 Hospital Drive
573-406-5800
EFFECTIVE
DATE: This Notice was published and first became
effective on