Notice of 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.
This agency must maintain the privacy of your personal health information and give you this notice that describes our legal duties and privacy practices concerning your personal health information. In general, when we release your health information, we must release only the information needed to achieve the purpose of the use or disclosure. However, all of your personal health information will be available for release to you, to a health care provider regarding your treatment, or due to a legal requirement. We must follow the privacy practices described in this notice. However, we reserve the right to change the privacy practices described herein, in accordance with the law. Changes to our privacy practices would apply to all health information we maintain. If we change our privacy practices, we will send you a revised copy of the privacy notice on request.
- Treatment. [For example, we may disclose medical information needed by another health care provider to better understand your condition and diagnose and care for you appropriately.]
- Payment. [In order for an insurance company, Medicare or another payor to pay for your treatment, we must submit a bill that identifies you, your diagnosis, and the treatment provided to you. As a result, we will pass such health information onto an insurer/payor in order to help receive payment for your medical bills.]
- Health Care Operations. [We may need your diagnosis, treatment and outcome information in order to improve the quality or cost of care we deliver. These quality and cost improvement activities may include evaluating the performance of your nurses and other health care professionals or examining the effectiveness of the services provided to you when compared to patients in similar situations.]
In accordance with law and regulation, we can use/disclose your health information for the following purposes:
In addition, we may want to use your health information for scheduling visits. [For example, we may look at your medical record to determine the date and time of your next visit and then call you to remind you that we are making a visit.] [Or, we may look at your medical information and decide that a new service we offer may interest you. For example, we may contact patients who might be interested in attending a health screening program or blood pressure clinic we are offering.]
In some instances, we may want to use information in your medical record, such as your name, address, phone number and treatment dates, to contact you for fund-raising purposes. [For example, certain publicly funded programs request donations from clients to help defray expenses and we may therefore contact program recipients for a donation.]
- As required or permitted by law. Sometimes health information must be reported to legal authorities, such as law enforcement or court officials or government agencies. [For example, we may have to report abuse, neglect, domestic violence or certain physical injuries, or to respond to a court order.]
- For public health activities. We may be required to report your health information to authorities to help prevent or control disease, injury, or disability. This may include using your medical record to report certain diseases, injuries, birth or death data, information of concern to the Food and Drug Administration.
- For health oversight activities. We may disclose your health information to authorities so they can monitor, investigate, inspect, discipline or license those who work in the health care system or for government benefit programs.
- For research. Under certain circumstances, and with special approval, we may use and disclose your health information to help conduct research. [For example, research to find out a certain treatment's effectiveness in curing an illness.]
- To avoid a serious threat to health or safety. As required by law and standards of ethical conduct, we may release your health information to the proper authorities if we believe, in good faith, that such release is necessary to prevent or minimize a serious and approaching threat to your or the public's health or safety.
- For military, national security, or incarceration/law enforcement custody. If you are involved with the military or national security, or you are in the custody of law enforcement officials or incarcerated, we may release your health information to the proper authorities so they may carry out their duties under the law.
- For workers' compensation. We may disclose your health information to the appropriate persons to comply with laws related to workers' compensation or other similar programs that may provide benefits for work-related injuries or illness.
- To those involved with your care or payment of your care. If family members, relatives, or close personal friends are helping care for you or helping you pay your medical bills, we may release relevant health information about you to them. You have the right to object to such disclosure, unless you are unable to function or in an emergency.
- For disaster relief so those who care for you can receive information about your location or health status. We may allow you to agree or disagree orally to such release, except in an emergency.
- We may also disclose health information to coroners, medical examiners and funeral directors so they can carry out their duties, such as identification, determining cause of death, or for funeral preparation.
Without your written authorization, we can also use your health information for the following purposes:
NOTE: Except for the situations listed above, we must obtain your specific written authorization for any other release of your health information. If you sign an authorization form, you may withdraw your authorization in writing at any time. If you wish to withdraw your authorization, please contact the agency Privacy Officer at the nearest office location for instructions.
- Inspect and copy your health information. With a few exceptions, you have the right to inspect and obtain a copy of your health information. However, this right does not apply to information gathered for judicial proceedings, for example. In addition, we may charge you a reasonable fee for a copy of your health information.
- Request to amend your health information. If you believe your health information is incorrect, you may ask us to amend it. You may be asked to make such requests in writing and to give a reason why it should be changed. If we did not create the health information you believe is incorrect, or if we believe the information is correct, we may deny your request.
- Request restrictions on certain uses and disclosures. You have the right to ask for restrictions on how your health information is used or to whom your information is disclosed, even if the restriction affects your treatment or our payment or health care operation activities. Or, you may want to limit the health information provided to family or friends involved in your care or payment of medical bills. You may also want to limit the health information provided to authorities involved with disaster relief efforts. However, we are not required to agree in all circumstances to your requested restriction.
- As applicable, receive confidential communication of health information. You have the right to ask that we communicate your health information in ways to preserve confidentiality. For example, you may wish to receive information about your health status through a letter sent to a private address. We must accommodate reasonable requests.
- Receive an accounting of disclosures of your health information. In some limited instances — not including disclosures made to you, or for purposes of treatment, payment, health care operations, national security, law enforcement/corrections, and certain health oversight activities, you have the right to ask for a list of the disclosures of your health information we have made during the previous six years (but not including dates before April 14, 2003). This list must include the date of each disclosure, who received the disclosed health information, a brief description of the information disclosed, and why the disclosure was made. We may charge you for the list if you request such list more than once per year.
- Complain. If you believe your privacy rights have been violated, you may file a complaint with this agency and with the federal Department of Health and Human Services (HHS). We will not retaliate against you for filing a complaint. To file a complaint with either entity, please contact the agency's Privacy Officer who will provide you with the necessary assistance and paperwork. Or contact HHS directly at their Voice Hotline: (800) 368-1019.
Your Health Information Rights:
For all questions about our privacy policies and requests for authorization or complaint procedures, please contact the agency's Privacy Officer at the nearest office location.
Effective date of notice: April 14, 2003