This is a notice of our health information privacy practices. 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.
All of these people follow the terms of this notice. They may also share protected health information with each other for treatment, payment or health care operations as described in this notice.
We understand that health information about you and your health is personal. Your health information is contained in a medical record that is the physical property of this facility. We are committed to protecting health information about you. This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of health information.
For Treatment. We may use and disclose your health information to provide you with medical treatment or services. For example, a health care provider, such as a physician, nurse, or other person providing health services to you, will record information in your record that is related to your treatment. This information is necessary for health care providers to determine what treatment you should receive. Health care providers will also record actions taken by them in the course of your treatment and note how you respond to the actions.
For Payment. We may use and disclose your health information to others for purposes of receiving payment for treatment and services that you receive. For example, a bill may be sent to you or a third-party payor, such as an insurance company, HMO or health plan. The information on the bill may contain information that identiﬁes you, your diagnosis, and treatment or supplies used in the course of treatment. Or, unpaid service balances may be referred to a collection agency to obtain payment.
For Health Care Operations. We may use and disclose your health information for operational purposes. For example, your health information may be disclosed to members of the medical staff, risk or quality improvement personnel, and others to:
Facility Directory. Upon your approval, we may include you in the facility directory. This information may include your name, location in the facility, general condition (e.g., fair, stable, etc.) and religious afﬁliation. We may give your directory information, except for religious afﬁliation, to people who ask for you by name.
Clergy. Unless you inform us that we should not do so, your religious afﬁliation may be released to a member of the clergy even if they do not ask for you by name.
Appointments/Health-Related Products and Services. We may use your information to contact you to provide appointment reminders. We may also contact you to tell you about treatment alternatives or other health-related beneﬁts and services that may be of interest to you.
Others Involved In Your Care. We may release relevant health information to a family member, friend, or anyone else you designate in order for that person to be involved in your care or payment related to your care. We may also disclose health information to those assisting in disaster relief efforts so that others can be notiﬁed about your condition, status and location.
Required By Law. We may use and disclose information about you as required by law. For example, we may disclose information to report gunshot wounds, suspected abuse or neglect, or similar injuries and events.
Public Health. Your health information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities (e.g., state health department, Center for Disease Control, etc.) to prevent or control disease, injury, or disability, or for other public health activities.
Law Enforcement Purposes. Subject to certain restrictions, we may disclose information required by law enforcement ofﬁcials.
Judicial And Administrative Proceedings. We may disclose information in response to an appropriate subpoena, discovery request or court order.
Health Oversight Activities. We may disclose your health information to a health oversight agency for activities authorized by law. Examples of these activities include audits, investigations, and inspections to monitor the health care system and compliance with laws or regulations.
Decedents. Health information may be disclosed to funeral directors or coroners to enable them to carry out their lawful duties.
Organ/Tissue Donation. Your health information may be used or disclosed for cadaveric organ, eye or tissue donation purposes.
Research. We may use your health information for research purposes after a receipt of authorization from you or when an institutional review board (IRB) or privacy board has waived the authorization requirement by its review of the research proposal and has established protocols to ensure the privacy of your health information. We may also review your health information to assist in the preparation of a research study.
Health And Safety. Your health information may be disclosed to avert a serious threat to the health or safety of you or any other person pursuant to applicable law.
Government Functions. Your health information may be disclosed for specialized government functions such as protection of public ofﬁcials or reporting to various branches of the armed services.
Workers’ Compensation. Your health information may be used or disclosed in order to comply with laws and regulations related to Workers’ Compensation.
Other Uses And Disclosures. Other uses and disclosures will be made only with your written authorization. You may revoke an authorization except to the extent that action has already been taken. State laws that offer a patient/plan member additional privacy protections may also apply.
You have the right to:
The right is reserved to change the terms of this notice and make the new terms effective for all protected health information kept by this facility.
If you believe your privacy rights have been violated, you may ﬁle a complaint with our facility or with the Secretary of the U.S. Department of Health and Human Services. To ﬁle a complaint, submit your written complaint to our Privacy Ofﬁcer. See the facility’s website for address. You will not be penalized for filing a complaint.
If you have any questions about this notice, want to exercise one of your rights that are described in this notice, or want to ﬁle a complaint, please contact the Privacy Ofﬁcer.