PATIENT PRIVACY NOTICE
Effective 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 OUR RECEPTIONIST.
WHO WILL FOLLOW THIS NOTICE
This notice describes our facility’s practices and that of:
• All employees, staff and other personnel
• Any health care professional authorized to enter information into your file or record
• All entities, sites and locations within Community Hospital follow the terms of this notice. In addition, these entities, sites and locations may share medical information with each other for treatment, payment or healthcare operations purposes described in this notice.
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 in our facility. 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. This notice will tell you about the ways in which we may use and disclose medical information about you. It also describes your rights and certain obligations we have regarding the use and disclosure of medical information. We are required by law to:
• Make sure that medical information that identifies you is kept private
• Follow the terms of the notice that is currently in effect
• Give you this notice of our legal duties and privacy practices with respect to protected medical information about you.
HOW WE MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION
The following categories describe different ways that we use and disclose protected medical information. For each category of uses and disclosures we will explain what we mean. Not every use or disclosure in a category will be listed. However, all of the ways are permitted to use and disclose information will fall within one of the categories.
• For Treatment: We may use protected medical information about you for medical treatment or services. We may disclose protected medical information about you to doctors, nurses, technicians, medical students, pharmacists or other personnel who are involved in your care. Different departments of our practice 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 protected medical information about you to people outside the practice who may be involved in your medical care, such as family members or others we use to provide services that are part of your care.
• For Payment: We may use and disclose protected medical information about you so that the treatment and services you receive may be billed to and payment may be collected for you, an insurance company or a third party. For example, we may need to give the information about the treatment you received to your health plan, so that your health plan will pay us or reimburse you. We may 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. We may use and disclose your information to obtain payment from third parties that may be responsible for such costs, such as family members. We may use your information to bill you directly for services and items.
• Appointment Reminders: We may use and disclose protected medical information to contact you as a reminder that you have an appointment for treatment or medical care.
• Treatment Alternatives: We may use and disclose protected medical information to tell you about or recommend possible treatment options o alternatives that may be of interest to you.
• Health-Related Benefits and Services: We may use and disclose protected medical information to tell you about health-related benefits and services that may be of interest to you.
• Individuals Involved in Your Care or Payment for Your Care: We may release protected medical information about you to a designated friend or family member who is involved in your medical care. We may give information to someone who helps pay for your care. In addition, we may disclose protected medical information about you to an entity assisting in a disaster relief effort, so that your family can be notified about your condition, status or location.
• Research: Under certain circumstances, we may use and disclose protected medical information about you for research purposes. All research projects are subject to a special approval process. The process evaluates a proposed research project and its use or your information, trying to balance the research needs with patients need for privacy of their medical information. However, we may disclose medical information about you to people preparing to conduct a research project, though we will ask for your specific permission to give a researcher your name, address or other information that reveals your identity. In rare cases, your permission may be waived as directed by federal, state and local law.
• As Required by Law: We will disclose protected medical information about you when required to do so by federal, state or local law.
• To Avert a Serious Threat to Health or Safety: We may need to use and disclose protected 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 would only be to someone able to prevent the threat.
• Organ and Tissue Donation: If you are an organ donor, we may release protected 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.
• Military and Veterans: If you are a member of the armed forces, we may release protected medical information about you as required by military command authorities. We may also release protected medical information to a foreign military authority, if you are in their service.
• Workers’ Compensation: We may release protected medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness. State and/or federal law control release of such information.
• Public Health Risks: We may disclose protected medical information about you for public health activities. These activities include the following:
-To prevent or control disease, injury or disability
-To report child abuse or neglect
-To report births and deaths
-To report a known or suspected crime
-To report vulnerable adult abuse
-To report reactions to medications or problems with products
• 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 domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
• Health Oversight Activities: We may disclose protected medical information to a health oversight agency for activities authorized by law. These oversight activities include 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.
• Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose protected 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 protected health information if asked to do so by a law enforcement official:
– In emergency circumstances to report a crime, the location of the crime or victims and/or the identity, description or location of the person who committed the crime.
− In response to a court order, subpoena, warrant, summons or similar process – About a death we believe may be the result of criminal conduct
− To identify or locate a suspect, fugitive, material witness or missing person – About criminal conduct involving our facility
About the victim of a crime, if we are unable to obtain the person’s agreement
• Medical Examiners and Funeral Directors: We may release protected medical information to a medical examiner. This may be necessary to identify a deceased person or to determine the cause of death. We may also release medical information about patients to funeral directors as necessary to carry out their duties.
• National Security, Intelligence and Federal Protective Service Activities: We may also release protected medical information about you to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law. We may release information to authorized federal officials where required to provide protection to the President of the United States, other authorized persons or foreign heads of state and/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 protected medical information about you to the correctional institution or law enforcement official. The release of this information would be necessary for this practice to provide you with healthcare, to protect your health and safety or the health and safety of others and for the security of the correctional institution.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You have the following rights regarding protected 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. This includes medical and billing records, but does not include psychotherapy notes. To inspect and/or copy your medical information you must submit your request to Release of Information in our office. If you request a copy of the information, by Oklahoma Statute, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. If your record contains any item that requires a photographic process to copy, such as a x-ray or photograph, we may charge you $5.00 per image.
• 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 our facility. To request an amendment, your request must be made in writing and submitted to the medical records office. In addition, you must provide a reason that supports your amendment 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:
− Is not part of the medical information kept by our facility
− Is not part of the information which you would be permitted to inspect or copy
− In our judgment is accurate and complete as it appears
− Was not created by us, unless the person or entity that created the information is no longer available to make the amendment.
• Right to an Accounting of Disclosures: You have the right to request an “accounting of disclosures.” This is a list of the disclosures we have made of your medical information. To request this list of disclosures, you must submit in writing to Release of Information in our office. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list. The first list you request within each 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.
• Right to Request Restrictions: You have the right to request a restriction or limitation on the protected medical information we use or disclose about you for treatment, payment or healthcare operations. We must receive your restrictions in writing before we have made such disclosures. Also, if you restrict our right to use your protected medical information for treatment, payment or healthcare operations, we reserve the right to immediately withdraw our services from you and terminate the physician-patient relationship. You have the right to request a limit on the protected medical information we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. For example, you could ask that we not use or disclose information about a surgery to your family. 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 receptionist in our facility. If you request restrictions, you must tell us what information you want to limit, whether you want to limit our use and/or disclosure and to whom you want the limits to apply.
• 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 only contact you at work, or at home, or by mail, or by phone or by e-mail. To request confidential communications, you must make your request in writing to the receptionist in our office. 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 Copy of this Notice: You have the right to a copy of this notice. You may ask us to give you a copy of this notice at any time.
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 protected 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 our office. The notice will contain the effective date.
If you believe your privacy rights have been violated, you may file a complaint with our office or with the Secretary of the Department of Health and Human Services. To file a privacy complaint with our facility, please contact the Privacy Officer at (405) 602-8163 or to the Oklahoma State Department of Health, complaint line at (405) 271-6576 or write to 1000 NE 10, Oklahoma City, OK 73117-1299. All complaints should be submitted in writing. You will not be penalized for filing a complaint.
OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of protected 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 protected 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 protected 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.
Personal information submitted by you to the Community Hospital web site, or collected by Community Hospital as a result of your visit to our web site, will be considered private and held in confidence. We will take reasonable steps to protect your personal data from misuse, unauthorized access and alteration. In addition, we will not sell, rent, trade or give away personal information to any third party for use in selling products or services without your consent.
WHAT INFORMATION WE COLLECT
You may elect to provide such personal information as your name, address, date of birth, phone number, e-mail address and resume information. We may also collect and track certain non-personal information such as your IP address.
WHY WE COLLECT INFORMATION
Community Hospital may use the personal information you provide for the purpose of providing personalized services, for class registrations, for communicating separately with you (e.g., answering questions which you have submitted to us), for reviewing in connection with current job openings, and for our internal mailing list. This personal information is not shared with any third party outside of Community Hospital. We may also use non-personal, general demographic information about users of the site for internal marketing and planning purposes. We may also share such non-personal information with our vendors and other business partners. We may use your IP address to diagnose problems with our server, and to administer our system, and to enforce our terms and conditions of use. We also may use your IP address to gather broad demographic information concerning the use of the site.
HOW WE COLLECT INFORMATION
We do not rent or sell email addresses to third parties for unsolicited communications.
By using this web site, you agree that you will not utilize any email addresses available to you through this web site to transmit unsolicited messages.
If you have any other questions or concerns regarding this privacy statement, or any other aspect of our web site, or if you wish to have any of your information removed from our databases, please contact us at email@example.com.