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NOTICE
OF PRIVACY PRACTICES
Effective Date: April 1, 2003
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 CAREFULLLY.
If you have any questions
about this notice, please contact the Facility Privacy Official by dialing
305-674-2722
Each time you visit a
hospital, physician, or other healthcare provider, a record of your visit is
made. Typically, this record contains your symptoms, examination and test
results, diagnoses, treatment, a plan for future care or treatment, and
billing-related information. This notice applies to all of the records of your
of your care generated by the hospital, whether made by hospital personnel,
agents of the hospital, or your personal doctor. Your personal doctor may have
different policies or notices regarding the doctor's use and disclosure of our
medical information created in the doctor's office or clinic.
Our Responsibilities
We
are required by law to maintain the privacy of your health information and
provide you a description of our privacy practices. We will abide by the terms
of this notice.
Organized Health Care Arrangement: This facility and its
medical staff members have organized and are presenting you this document as a
joint notice. Information will be shared as necessary to carry out treatment,
payment and healthcare operations. Physicians and caregivers may have access to
protected health information in their offices to assist in reviewing past
treatment as it may affect treatment at the time.
Uses and
Disclosures
How we may use and disclose Medical Information about you.
The
following categories describe examples of the way we use and disclose medical
information:
For Treatment: We may use medical information about you to
provide you treatment or services. We may disclose medical information about you
to doctors, nurses, technicians, medical students, or other hospital personnel
who are involved in taking care of you at the hospital. For example: a doctor
treating you for a broken leg may need to know if you have diabetes because
diabetes may slow the healing process. Different departments of the hospital
also may share medical information about you in order to coordinate the
different things you may need, such as prescriptions, lab work, meals, and
x-rays.
We may also provide your
physician or a subsequent healthcare provider with copies of various reports
that should assist him or her in treating you once you're discharged from this
hospital.
For Payment: We may use
and disclose medical information about your treatment and services to bill and
collect payment from you, your insurance company or a third party payer. For
example, we may need to give your insurance company information about your
surgery so they will pay us or reimburse you for the treatment. We may also tell
your health plan about treatment you are going to receive to determine whether
your plan will cover it.
For Health Care
Operations: Members of the medical staff and/or quality improvement team may use
information in your health record to assess the care and outcomes in your case
and others like it. The results will then be used to continually improve the
quality of care for all patients we serve. For example, we may combine medical
information about many patients to evaluate the need for new services or
treatment. We may disclose information to doctors, nurses, and other students
for educational purposes. And we may combine medical information we have with
that of other hospitals to see where we can make improvements. We may remove
information that identifies you from this set of medical information to protect
your privacy.
We may also use and
disclose medical information:
- To business associates we have contracted
with to perform the agreed upon service and billing for it;
- To remind you
that you have an appointment for medical care;
- To assess your satisfaction
with our services;
- To tell you about possible treatment alternatives;
- To tell you about health-related benefits or services;
- To contact
you as part of fund raising efforts;
- For Population based activities
relating to improving health or reducing healthcare costs; and
- For
conducting training programs or reviewing competence of healthcare
professionals.
Business Associates: There
are some services provided in our organization through contracts with business
associates. Examples include physician services in the emergency department and
radiology, certain laboratory tests, and a copy service we use when making
copies of your health record. When these services are contracted, we may
disclose your health information to our business associate so that they can
perform the job we've asked them to do and bill you or your third-party payer
for services rendered. To protect your health information, however, we require
the business associate to appropriately safeguard your information.
Directory: We may include
certain limited information about you in the hospital directory while you are a
patient at the hospital. The information may include your name, location in the
hospital, your general condition (e.g., fair, stable, etc.) and your religious
affiliation. This information may be provided to members of the clergy and,
except for religious affiliation, to other people who ask for you by name. If
you would like to opt out of being in the facility directory please request the
Opt Out Form from the admission staff or Facility Privacy Officer.
Individuals Involved in
Your Care or Payment for Your Care: We may release medical information about you
to a friend or family member who is involved in your medical care or who helps
pay for your care. In addition, we may disclose medical information about you to
an entity assisting in a disaster relief effort so that your family can be
notified about your condition, status and location.
Research: We may disclose
information to researchers when an institutional review board that has reviewed
the research proposal and established protocols to ensure the privacy of your
health information has approved their research.
Future Communications: We
may communicate to you via newsletters, mail outs or other means regarding
treatment options, health related information, disease-management programs,
wellness programs, or other community based initiatives or activities our
facility is participating in.
Affiliated Covered Entity: Protected health
information will be made available to hospital personnel as necessary to carry
out treatment, payment and healthcare operations. Caregivers at other facilities
may have access to protected health information at their locations to assist in
reviewing past treatment information as it may affect treatment at this time.
Please contact the Facility Privacy Official for further information on the
specific sites included in this affiliated covered entity.
As required by law, we may
also use and disclose health information for the following types of entities,
including but not limited to:
- Food and Drug Administration
- Public
Health or Legal Authorities charged with preventing or controlling disease,
injury or disability
- Correctional Institutions
- Workers Compensation
Agents
- Organ and Tissue Donation Organizations
- Military Command
Authorities
- Health Oversight Agencies
- Funeral Directors, Coroners
and Medical Directors
- National Security and Intelligence Agencies
-
Protective Services for the President and Others
Law Enforcement/Legal
Proceedings: We may disclose health information for law enforcement purposes as
required by law or in response to a valid subpoena.
State-Specific
Requirements: Many states have requirements for reporting including
population-based activities relating to improving health or reducing healthcare
costs. Some states have separate privacy laws that may apply legal requirements.
If the State privacy laws are more stringent than Federal privacy laws, the
State law preempts the Federal law.
Your Health Information
Rights
Although your health record is the physical property of the healthcare
practitioner or facility that compiled it, you have the Right to:
Inspect and
Copy: You have the right to inspect and copy medical information that may be
used to make decisions about your care. Usually, this includes medical and
billing records, but does not include psychotherapy notes. We may deny your
request to inspect and copy in certain very limited circumstances. If you are
denied access to medical information, you may request that the denial be
reviewed. Another licensed healthcare professional chosen by the hospital will
review your request and the denial. The person conducting the review will not be
the person who denied your request. We will comply with the outcome of the
review. You may receive copies of your records if your request is approved and
after payment of applicable State approved charges for copies of records has
been received.
Amend: If you feel that medical information we have
about you is incorrect or incomplete, you may ask us to amend the information.
You have the right to request an amendment for as long as the information is
kept by or for the hospital.
We may deny your request for an amendment and if
this occurs, you will be notified of the reason for the denial.
An
Accounting of Disclosures: You have the right to request an accounting of
disclosures. This is a list of the disclosures we make of medical information
about you for purposes other than treatment, payment or healthcare
operations.
Request Restrictions: You have the right to request a
restriction or limitation on the medical information we use or disclose about
you for treatment, payment or healthcare operations. You also have the right to
request a limit on the medical information we disclose about you to someone who
is involved in your care or the payment for your care, like a family member or
friend. For example, you could ask that we not use or disclose information about
a surgery you had.
We are not required to agree to your request. If we do
agree, we will comply with your request unless the information is needed to
provide you emergency treatment.
Request Confidential Communications:
You have the right to request that we communicate with you about medical matters
in a certain way or at a certain location. For example, you may ask that we
contact you at work or by U.S. Mail. The facility will grant requests for
confidential communications at alternative locations and/or via alternative
means only if the request is submitted in writing and the written request
includes a mailing address where the individual will receive bills for services
rendered by the facility and related correspondence regarding payment for
services. Please realize, we reserve the right to contact you by other means and
at other locations if you fail to respond to any communication from us that
requires a response. We will notify you in accordance with your original request
prior to attempting to contact you by other means or at another location.
" A Paper Copy of This Notice: You have the right to a paper copy of
this notice. You may ask us to give you a copy of this notice at any time. Even
if you have agreed to receive this notice electronically, you are still entitled
to a paper copy of this notice.
You may obtain a copy of
this notice at our website.
To exercise any of your rights, please obtain
the required forms from the Privacy Official and submit your request in writing.
CHANGES TO THIS
NOTICE
We reserve the right to change this notice and the revised or changed
notice will be effective for information we already have about you as well as
any information we receive in the future. The current notice will be posted in
the hospital and include the effective date. In addition, each time you register
at or are admitted to the hospital for treatment or healthcare services as an
inpatient or outpatient, we will offer you a copy of the current notice in
effect.
COMPLAINTS
If you
believe your privacy rights have been violated, you may file a complaint with
the hospital by contacting the main number and asking for the Facility Privacy
Official or with the Secretary of the Department of Health and Human Services.
To file a complaint with the hospital, contact the Privacy Official. All
complaints must be submitted in writing. You will not be penalized for filing a
complaint.
OTHER USES OF MEDICAL
INFORMATION
Other uses and disclosures of medical information not covered by
this notice or the laws that apply to us will be made only with your written
permission. If you provide us permission to use or disclose medical information
about you, you may revoke that permission, in writing, at any time. If you
revoke your permission, we will no longer use or disclose medical information
about you for the reasons covered by your written authorization. You understand
that we are unable to take back any disclosures we have already made with your
permission, and that we are required to retain our records of the care that we
provided to you.
PRIVACY
OFFICIAL
Telephone Number: 305-674-2722
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