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JOINT NOTICE OF PRIVACY PRACTICES
Effective Date:
April
14, 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 CAREFULLY.
If you
have any questions about this notice, please
contact
the
Privacy Officer at 270-487-9231, Ext. 1140.
WHO
WILL FOLLOW THIS NOTICE
This
notice describes our hospital’s practices and
that of:
► Any
health care professional authorized to enter
information into your medical record.
► All
departments and units of the hospital, including
our outpatient clinics.
► Any
member of a volunteer group we allow to help you
while you are in the hospital.
► All
employees, staff and other hospital personnel.
► Members
of the medical staff and other health care
providers who deliver services jointly with
the hospital.
► Monroe
County Medical Center Home Health and Adult Day
Care Service personnel.
► Monroe
County Medical Center Ambulance Service
personnel.
All these
entities, sites and locations follow the terms
of this notice. In addition, these entities,
sites and locations may share medical
information with each other for treatment,
payment or health care operations purposes
described in this notice.
This
hospital may provide services to you in an
integrated way with our medical staff. However,
Monroe County Medical Center accepts no legal
responsibility for activities solely
attributable to these other providers.
OUR
PLEDGE REGARDING MEDICAL INFORMATION:
We
understand that medical information about you
and your health is personal. We are committed to
protecting medical information about you. We
create a record of the care and services you
receive from our organization. We need this
record to provide you with quality care and to
comply with certain legal requirements. This
notice applies to all of the records of your
care generated by our organization, whether made
by hospital personnel or your personal doctor.
Your personal doctor may have different policies
or notices regarding the doctor’s use and
disclosure of your medical information created
in the doctor’s office or clinic.
This
notice will tell you about the ways in which we
may use and disclose medical information about
you. We also describe your rights and certain
obligations we have regarding the use and
disclosure of medical information.
We are
required by law to:
¨
Maintain
the privacy of your health information.
¨
Provide
you with a notice as to our legal duties and
privacy practices with respect to information we
collect and maintain about you.
¨
Abide by
the terms in this notice.
HOW
WE MAY USE AND DISCLOSURE MEDICAL INFORMATION
ABOUT YOU.
Members of
our medical staff, appropriate hospital
employees and other participants in our patient
care system may share your medical information
as necessary for your treatment, payment for
services provided and health care operations,
without your express permission. Other uses and
disclosures require your specific authorization.
The following categories describe different ways
that we may use and disclose medical
information. For each category of uses and
disclosures we will explain what we mean and try
to give some examples. Not every use or
disclosure in a category will be listed.
However, all of the ways we are permitted to use
and disclose information will fall within one of
the categories.
¨
For
Treatment
– We may
use medical information about you to provide you
with medical treatment or services. We may
disclose medical information about you to
doctors, nurses, technicians, medical students,
or other personnel who are involved in your
care. 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.
In addition, the doctor may need to tell the
dietitian if you have diabetes so that we can
arrange for appropriate meals. Different
departments of the hospital also may share
medical information about you in order to
coordinate the different things you need, such
as prescriptions, lab work and x-rays. We also
may disclose medical information about you to
people outside the hospital who may be involved
in your medical care after you leave the
hospital, such as family members, clergy or
others we use to provide services that are part
of your care.
¨
For
Payment
– We may
use and disclose medical information about you
so that the treatment and services you receive
by our organization may be billed to and payment
may be collected from you, an insurance company
or a third party. For example, we may need to
give your health plan information about an x-ray
you have received or will receive at the
hospital so your health plan will pay us or
reimburse you for the x-ray. We may also tell
your health plan about a treatment you are going
to receive to obtain prior approval or to
determine whether your plan will cover the
treatment.
¨
For Health
Care Operations
– We may
use and disclose medical information about you
for health care operations. These uses and
disclosures are necessary to run the hospital
and make sure that all our patients receive
quality care. For example, we may use medical
information to review our treatment and services
and to evaluate the performance of our staff in
caring for you. We may also combine medical
information about many hospital patients to
decide what additional services the hospital
should offer, what services are needed, and
whether certain new treatments are effective. We
may also disclose information to doctors,
nurses, technicians, medical students, and other
hospital personnel for review and learning
purposes. We may also combine the medical
information we have with medical information
from other hospitals to compare how we are doing
and see where we can make improvements in the
care and services we offer. We may remove
information that identifies you from this set of
medical information so others may use it to
study health care and health care delivery
without learning who the specific patients are.
¨
Appointment Reminders
– We may
use and disclose medical information to contact
you as a reminder that you have an appointment
for treatment or medical care at the hospital.
¨
Treatment
Alternatives
–
We may use
and disclose medical information to tell you
about or recommend possible treatment options or
alternatives that may be of interest to you.
¨
Health-Related Benefits and Services
– We may
use and disclose medical information to tell you
about health-related benefits or services that
may be of interest to you.
¨
Fundraising Activities
– We may use medical information about you to
contact you in an effort to raise money for the
hospital and its operations. We may disclose
medical information to a foundation related to
the hospital so that the foundation may contact
you in raising money for our organization. We
would only release contact information, such as
your name, address and phone number and the
dates you received treatment or services within
our organization. If you do not want our
organization to contact you for fundraising
efforts, you must notify Betty London, Privacy
Officer in writing.
¨
Hospital
Directory
– We may
include certain limited information about you in
the hospital directory while you are a patient
at the hospital. This information may include
your name, location in the hospital, your
general condition (e.g., fail, stable, etc.),
your gender, and your religious affiliation. 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 your family, friends,
and clergy can visit you in the hospital and
generally know how you are doing. You have the
right to object to the disclosure of some or all
of this information. If you do object, we will
honor your objection. However, if we cannot
practicably offer you the opportunity to object
because you entered our facility in a situation
requiring emergency treatment, we may exercise
professional judgment to decide whether such
disclosures would be in your best interest.
¨
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. We may also give the information
to someone who helps pay for your care. We may
also tell your family or friends your condition
and that you are in our 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
– Under
certain circumstances, we may use and disclose
medical information about you for research
purposes. For example, a research project may
involve comparing the health and recovery of all
patients who received one medication to those
who received another, for the same condition.
All research projects, however, are subject to a
special approval process. This process evaluates
a proposed research project and its use of
medical information, trying to balance the
research needs with patients’ need for privacy
of their medical information. Before we use or
disclose medical information for research, the
project will have been approved through this
research approval process, but we may, however,
disclose medical information about you to people
preparing to conduct a research project, for
example, to help them look for patients with
specific medical needs, so long as the medical
information they review does not leave the
hospital.
¨
As
Required by Law
– We will
disclose medical information about you when
required to do so by federal, state or local
law.
¨
To Avert
Serious Threat to Health or Safety
– We may
use and disclose medical information about you
when necessary to prevent a serious threat to
your health and safety or the health and safety
of the public or another person. Any disclosure,
however, would only be to someone able to help
lessen the threat.
¨
To
Business Associates
– We may disclose medical information to an
organization that performs services necessary
for us to provide health care services to you,
such as accountants or companies providing data
processing services, if they need medical
information in order to provide these services
to us. These “Business Associates” have agreed
in writing to protect the privacy of any medical
information they receive.
SPECIAL SITUATIONS
¨
Organ and
Tissue Donation
– We may
release medical information to organizations
that handle organ procurement or organ, eye or
tissue transplantation or to an organ donation
bank, as necessary, to facilitate organ or
tissue donation and transportation.
¨
Military
and Veterans
– If you
are member of the armed forces, we may release
medical information about you as required by
military command authorities. We may also
release medical information about foreign
military personnel to the appropriate foreign
military authority.
¨
Workers’
Compensation
– We may
release medical information about you for
workers’ compensation or similar programs. These
programs provide benefits for work-related
injuries or illness.
¨
Public
Health Risks
– We may
disclose medical information about you for
public health activities. These activities
generally include the following:
-
to prevent
or control disease, injury or disability;
-
to report
births or deaths;
-
to report
child abuse or neglect;
-
to report
reactions to medications or problems with
products;
-
to notify
people of recalls of products they may be using;
-
to notify
a person who may have been exposed to a disease
or may be at risk for contracting or spreading a
disease or condition;
-
to notify
your employer if, for example, we provide health
care to you at the request of your employer for
medical surveillance for purposes or to evaluate
whether you have a work-related illness or
injury and your employer needs the findings to
comply with state or federal law;
-
to notify
the appropriate government authority if we
believe a patient has been the victim of abuse,
neglect or domestic violence. We will only make
this disclosure if you agree or when required or
authorized by law.
¨
Health
Oversight Activities
– We may
disclose medical information to a health
oversight agency for activities authorized by
law. These oversight activities include, for
example, audits, investigations, inspections,
and licensure actions. These activities are
necessary for the government to monitor the
health care system, government programs, and
compliance with civil rights laws.
¨
Lawsuits
and Disputes
– If you
are involved in a lawsuit or dispute, we may
disclose medical information about you in
response to a court or administrative order. We
may also disclose medical information about you
in response to a subpoena, discovery request, or
other lawful process by someone else involved in
the dispute, but only if efforts have been made
to tell you about the request or to obtain an
order protecting the information requested.
¨
Law
Enforcement
– We may
release medical information if asked to do so by
a law enforcement official:
-
In
response to a court order, subpoena, warrant,
summons or similar process;
-
To
identify or locate a suspect, fugitive, material
witness, or missing person;
-
About the
victim of a crime if, under certain limited
circumstance, we are unable to obtain the
person’s agreement;
-
About a
death we believe may be the result of criminal
conduct;
-
About
criminal conduct at the hospital; and
-
In
emergency circumstances to report a crime; the
location of the crime or victims; or the
identity description or location of the person
who committed the crime.
¨
Coroners,
Medical Examiners and Funeral Directors
– We
may release medical information to a coroner or
medical examiner. This may be necessary, for
example, to identify a deceased person or
determine the cause of death. We may release
medical information about patients of the
hospital to funeral directors as necessary to
carry out their duties.
¨
National
Security and Intelligence Activities
– We may
release medical information about you to
authorized federal officials for intelligence,
counterintelligence, and other national security
activities authorized by law.
¨
Protective
Services for the President and Others
– We
may disclose medical information about you to
authorized federal officials so they may provide
protection to the President, other authorized
persons or foreign heads of state or conduct
special investigations.
¨
Inmates
– If you
are an inmate of a correctional institution or
under the custody of a law enforcement official,
we may release medical information about you to
the correctional institution or law enforcement
official. This release would be necessary (1)
for the institution to provide you with health
care; (2) to protect your health and safety or
the health and safety of others; (3) for the
safety and security of the correctional
institution.
YOUR
RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You have
the following rights regarding medical
information we maintain about you:
¨
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.
To
inspect and copy medical information that
may be used to make decisions about you, you
must submit your request in writing to the
Privacy Officer. If you request a copy of
the information, we may charge a fee for the
costs of copying, mailing or other supplies
associated with your request, or for
creating a summary of your information at
your request.
We may
deny your request to inspect or copy in
certain very limited circumstances. If you
are denied access to medical information,
you may request that the denial be reviewed.
Another licensed health care 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
outcome of the review.
¨
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. You have the right to
request an amendment as long as the information
is kept by or for the hospital.
To
request an amendment, your request must be
made in writing and submitted to the Privacy
Officer. In addition, you must provide a
reason that supports your request.
We may
deny your request for an amendment if it is
not in writing or does not include a reason
to support the request. In addition, we may
deny your request if you ask to amend
information that:
- Was
not created by us, unless the person or
entity that created the information is no
longer available to make the amendment;
-
Is not
part of the medical information kept by or for
the hospital;
-
Is not
part of the information which you would be
permitted to inspect and copy; or
-
Is
accurate and complete.
¨
Right to
an Accounting of Disclosures
– You have
the right to request an “accounting of
disclosures”. This is a list of the disclosures
we made of medical information about you. To
request this list or accounting of disclosures,
you must submit your request in writing to the
Privacy Officer. Your request must state a time
period which may not be longer than six years
and may not include dates before April 14, 2003.
The first list within a 12 month period will be
free. For additional lists, we may charge you
for the costs of providing the lists. We will
notify you of the cost involved and you may
choose to withdraw or modify your request at
that time before any costs are incurred.
¨
Right to
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 health care
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 an
x-ray 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.
To
request restrictions, you must make your
request in writing to the Privacy Officer.
In your request, you must tell us (1) what
information you want to limit; (2) whether
you want to limit our use, disclosure or
both; (3) to whom you want the limits to
apply, for example, disclosure to your
spouse.
¨
Right to
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 can ask
that we contact you only at work or by mail.
To
request confidential communications, you
must make your request in writing to the
Privacy Officer. We will not ask you the
reason for your request. We will accommodate
all reasonable requests. Your request must
specify how or where you wish to be
contacted.
¨
Right to 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:
www.mcmccares.com.
To obtain
a paper copy of this notice, contact the Privacy
Officer.
CHANGES TO THE NOTICE
We reserve
the right to change this notice. We reserve the
right to make the revised or changed notice
effective for medical information we already
have about you as well as any information we
receive in the future. We will post a copy of
the current notice in the hospital. The notice
will contain on the first page, in the top
right-hand corner, the effective date. In
addition, each time you register at or are
admitted for treatment or health care 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 or
with the Secretary of the Department of Health
and Human Services. To file a complaint with the
hospital, contact Mrs. Betty London, Privacy
Officer, at 270-487-9231, ext. 140. All
complaints must be submitted in writing.
You
will not be retaliated against 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 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.
ORGANIZED HEALTH CARE ARRANGEMENT
Monroe
County Medical Center and medical staff members
of the hospital are participants in an organized
health care arrangement. These entities will
share protected health information with each
other, as necessary to carry out treatment,
payment and health care operations relating to
the organized health care arrangement. The
hospital and members of the medical staff agree
to abide by the terms of this privacy notice as
part of their participation, with respect to
created or received protected health
information. This joint notice by separate
covered entities covers the hospital and active
medical staff members, including but not limited
to, the consulting, courtesy and telemedicine
physicians practicing at Monroe County Medical
Center and other health care providers who
deliver services jointly with the hospital.
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