|
|
DICKENSON COMMUNITY HOSPITAL, INC.
NOTICE OF PRIVACY PRACTICES
THIS
NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU
MAY BE USED
AND DISCLOSED
AND HOW YOU CAN OBTAIN
ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
Effective Date:
November 10, 2003
WHO WILL
FOLLOW THIS NOTICE:
This notice describes our hospitals
practices and that of:
Ø
Any
health care professional authorized to enter information into your hospital chart.
Ø
All
departments and units of the hospital.
Ø
Any
member of a volunteer group we allow to help you while you are in the hospital.
Ø
All
employees, staff and other hospital personnel
OUR PLEDGE REGARDING MEDICAL INFORMATION
We understand that medical information about
you and your health is personal. Dickenson
Community Hospital is committed to protecting medical information about you. We create a record of the care and services you
receive at the hospital in order 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 the hospital, whether made by
hospital personnel or your personal doctor. Your
personal doctor may have different policies or notices regarding the doctors use and
disclosure of your medical information created in the doctors office or clinic.
This notice will discuss 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:
·
Ensure that medical
information that identifies you is kept private;
·
Give you this notice of your legal duties and privacy practices
with respect to medical information about you; and
·
Follow the terms of the notice that is currently in effect.
HOW
WE
MAY USE
AND DISCLOSE MEDICAL
INFORMATION ABOUT YOU.
The following categories describe different
ways that we use and disclose medical information. Explanations
and examples will be provided for each category of uses or disclosures. 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 into one of the categories:
Ø
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 hospital 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.
Ø
For Payment: We may use and disclose medical information about
you so that treatment and services you receive at the hospital 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 surgery you received at the hospital so your health plan will pay us or
reimburse you for the surgery. 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.
Ø
For Health Care Operations. We may use and disclose medical information about
you for hospital operations. These uses and
disclosures are necessary to run the hospital and make sure that all of 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 not 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.
Ø
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.
Ø
Treatment Alternatives: We may tell you about or recommend possible
treatment options or alternatives that may be of interest to you.
Ø
Health Related Benefits and Services: We may tell you about health-related benefits or
services that may be of interest to you.
Ø
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 the hospital. We only would release
contact information, such as your name, address, and phone number and the dates you
received treatment or services at the hospital. If
you do not want the hospital to contact you for fundraising efforts, you must notify the
Privacy Officer in writing.
Ø
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., fair, stable, etc.) The directory information may also be released to
people who 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.
Ø
Individuals Involved In Your Care or Your Payment. We may release medical information about you to a
friend or family member who is involved in your medical care unless you request a
restriction to such releasing. We may also
give information to someone who helps pay for your care.
We may also tell your family or friends your condition and that you are in
the hospital. 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.
Ø
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. Before we use or disclose medical information for
research, the project will have to be approved through a 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. We will almost always ask for your specific
permission if the researcher will have access to your name, address or other information
that reveals who you are, or will be involved in your care at the hospital.
Ø
As Required By Law. We will disclose medical information about you
when required to do so by federal, state or local law.
Ø
To Avert A 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 prevent the threat.
SPECIAL
SITUATIONS:
Ø
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 transplantation.
Ø
Military and Veterans. If you are a
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.
Ø
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.
Ø
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 and 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 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.
Ø
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. These activities are necessary for the government
to monitor the health care system, government programs, and compliance with civil rights
laws.
Ø
Lawsuits and Disputes. If you are involved in a lawsuit or a 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 unless you obtain an order protecting the information requested.
Ø
Law Enforcement. We may release medical information if asked to do
so by a law enforcement official:
·
In response to a court order or subpoena;
·
To identify or locate a suspect, fugitive, material witness, or
missing person;
·
About the victim of a crime of, if under certain limited
circumstances, we are unable to obtain the persons 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.
Ø
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 also release medical information about
patients of the hospital to funeral directors as necessary to carry out their duties.
Ø
National Security and Intelligence Activities. We may release medical information about you to
authorized federal officials of intelligence, counterintelligence, and other national
security activities authorized by law.
Ø
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.
Ø
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; or (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:
Ø
Right to Inspect and Copy. You have the right to inspect and obtain a copy of
your 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
receive a copy of your medical information that may be used to make decisions about you,
you must submit your request in writing to the Health Information Management Department. 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.
We
may deny your request to inspect and obtain a copy in certain very limited circumstances. If you are denied access to medical information,
you may request that the denial be reviewed.
Ø
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 for 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 us 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 obtain a copy; or
·
Is accurate and complete.
Ø
Right To An Accounting of Disclosures. You have the right to request an accounting
of disclosures other than for treatment, payment, internal operations, hospital
directory, and certain law enforcement disclosures. This
is a list of the disclosures we made of medical information about you which did not
require you to sign an authorization for this release of medical information.
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 that may not
be longer that six years and may not include dates before
April 14, 2003. Your request should indicate in what form
you want the list (for example, on paper, electronically).
The first list you request within a 12-month period will be free. For additional lists, we may charge you for the
costs of providing the list. 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.
Ø
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. For example, you
may request that your information not be included in our facility directory if you are
admitted.
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.
Ø
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 only contact you
at work or by mail.
To
request restrictions of medical information or confidential communications, you must
submit your request at the time of registration or during your hospital stay. We are not required to fulfill all requests but
will attempt to accommodate all reasonable requests.
Ø
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. To obtain a copy of this notice,
contact the Privacy Officer or request one at your next visit to our facility.
CHANGES TO THIS 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 at our
facility. The notice will contain on the
first page, in the top right-handed corner, the effective date. In addition, each time you register at or are
treated at our facility as an inpatient or outpatient, we will offer you a copy of the
current NOTICE in effect.
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 authorization. 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 authorization, we will not 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.
COMPLAINTS
If you believe
your privacy rights have been violated, you may file a complaint with us or with the
Secretary of the Department of Health and Human Services.
To file a complaint with the facility, call the Compliance Number at 276-679-8355. You will not be penalized for filing a complaint. To file a written complaint with the
Department of Health and Human Services, you may contact our Compliance Department at (276) 679-9075 or our Privacy Officer at (276)
926-0323.
|
 |
|
|