NOTICE OF PRIVACY PRACTICES
Effective Date: April 14, 2003
THIS NOTICE DESCRIBES HOW HEALTH 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 Facility Privacy
Official by dialing the main hospital number (850-769-8341).
Each
time you visit a hospital, physician, or other healthcare provider, a record of
your visit is made. Typically, this record contains your symptoms, examination
and test results, diagnoses, treatment, a plan for future care or treatment,
and billing-related information. This
notice applies to all of the records of your care generated by the hospital,
whether made by hospital personnel, agents of the hospital, or your personal
doctor. Your personal doctor may have
different policies or notices regarding the doctor’s use and disclosure of your
health information created in the doctor’s office or clinic.
Our Responsibilities
We
are required by law to maintain the privacy of your health information and
provide you a description of our privacy practices. We will abide by the terms of this notice.
Uses and Disclosures
How we may use and disclose
Health Information about you.
The
following categories describe examples of the way we use and disclose health
information:
For Treatment: We may use health information about you to provide
you treatment or services. We may
disclose health information about you to doctors, nurses, technicians, medical
students, or other hospital personnel who are involved in taking care of you at
the hospital. 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.
Different departments of the hospital also may share health information
about you in order to coordinate the different things you may need, such as
prescriptions, lab work, meals, and x-rays.
We
may also provide your physician or a subsequent healthcare provider with copies
of various reports that should assist him or her in treating you once you’re
discharged from this hospital.
For Payment: We
may use and disclose health information about your treatment and services to
bill and collect payment from you, your insurance company or a third party
payer. For example, we may need to give
your insurance company information about your surgery so they will pay us or
reimburse you for the treatment. We may
also tell your health plan about treatment you are going to receive to
determine whether your plan will cover it.
For Health Care Operations:
Members of the medical staff and/or quality improvement team may use
information in your health record to assess the care and outcomes in your case
and others like it. The results will
then be used to continually improve the quality of care for all patients we
serve. For example, we may combine
health information about many patients to evaluate the need for new services or
treatment. We may disclose information
to doctors, nurses, and other students for educational purposes. And we may combine health information we have
with that of other hospitals to see where we can make improvements. We may remove information that identifies you
from this set of health information to protect your privacy.
We
may also use and disclose health information:
¨ To business associates we
have contracted with to perform the agreed upon service and billing for it;
¨ To remind you that you have
an appointment for medical care;
¨ To assess your satisfaction
with our services;
¨ To tell you about possible
treatment alternatives;
¨ To tell you about
health–related benefits or services;
¨ To contact you as part of
fundraising efforts;
¨ To inform Funeral Directors
consistent with applicable law;
¨ For population based
activities relating to improving health or reducing health care costs; and
¨ For conducting training
programs or reviewing competence of health care professionals.
When
disclosing information, primarily appointment reminders and billing/collections
efforts, we may leave messages on your answering machine/voice mail.
Business Associates: There
are some services provided in our organization through contracts with business
associates. Examples include physician
services in the emergency department and radiology, certain laboratory tests,
and a copy service we use when making copies of your health record. When these services are contracted, we may
disclose your health information to our business associates so that they can
perform the job we’ve asked them to do and bill you or your third-party payer
for services rendered. To protect your
health information, however, we require the business associate to appropriately
safeguard your information.
Directory: We may include certain limited information
about you in the hospital directory while you are a patient at the
hospital. The information may include
your name, location in the hospital, your general condition (e.g., good, fair) and your religious affiliation. This information may be provided to members
of the clergy and, except for religious affiliation, to other people who ask
for you by name.
If you would
like to opt out of being in the facility directory please request the Opt Out
Form from the admission staff or Facility Privacy Official.
Individuals Involved in Your
Care or Payment for Your Care: We may release health information about you
to a friend or family member who is involved in your medical care or who helps
pay for your care. In addition, we may
disclose health 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: We may
disclose information to researchers when an institutional review board that has
reviewed the research proposal and established protocols to ensure the privacy
of your health information has approved their research and granted a waiver of
the authorization requirement.
Future
Communications: We may communicate to you
via newsletters, mail outs or other means regarding treatment options, health
related information, disease-management programs, wellness programs, or other
community based initiatives or activities our facility is participating in.
Organized
Health Care Arrangement: This facility and its medical
staff members have organized and are presenting you this document as a joint
notice. Information will be shared as
necessary to carry out treatment, payment and health care operations. Physicians and caregivers may have access to
protected health information in their offices to assist in reviewing past
treatment as it may affect treatment at the time.
Affiliated
Covered Entity: Protected health information
will be made available to hospital personnel at local affiliated hospitals as
necessary to carry out treatment, payment and health care operations. Caregivers at other facilities may have
access to protected health information at their locations to assist in
reviewing past treatment information as it may affect treatment at this
time. Please contact the Facility
Privacy Official for further information on the specific sites included in this
affiliated covered entity.
As required by law, we may also use and
disclose health information for the following types of entities, including but
not limited to:
¨ Food and Drug Administration
¨ Public Health or Legal
Authorities charged with preventing or controlling disease, injury or
disability
¨ Correctional Institutions
¨ Workers Compensation Agents
¨ Organ and Tissue Donation
Organizations
¨ Military Command Authorities
¨ Health Oversight Agencies
¨ Funeral Directors, Coroners
and Medical Directors
¨ National Security and
Intelligence Agencies
¨ Protective Services for the
President and Others
Law Enforcement/Legal
Proceedings: We may disclose health information for law
enforcement purposes as required by law or in response to a valid subpoena.
State-Specific Requirements: Many
states have requirements for reporting including population-based activities
relating to improving health or reducing health care costs. Some states have
separate privacy laws that may apply additional legal requirements. If the state privacy laws are more stringent
than federal privacy laws, the state law preempts the federal law.
Although
your health record is the physical property of the healthcare practitioner or
facility that compiled it, you have the Right to:
¨ Inspect and Copy: You have the right to inspect and obtain a
copy of the health information that may be used to make decisions about your
care. Usually, this includes medical and
billing records, but does not include psychotherapy notes. We may deny your request to inspect and copy
in certain very limited circumstances.
If you are denied access to health 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 the outcome of the
review.
¨ Amend: If you feel
that health 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.
We may deny your request for an amendment and if
this occurs, you will be notified of the reason for the denial.
¨ An Accounting of Disclosures: You have the right to request an accounting of
disclosures. This is a list of certain
disclosures we make of your health information for purposes other than
treatment, payment or health care operations where an authorization was not
required.
¨ Request Restrictions: You have the right to request a restriction
or limitation on the health 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 health 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 a surgery
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.
¨ 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
may ask that we contact you at work instead of your home. The facility will grant reasonable requests
for confidential communications at alternative locations and/or via alternative
means only if the request is submitted in writing and the written request
includes a mailing address where the individual will receive bills for services
rendered by the facility and related correspondence regarding payment for
services. Please realize, we reserve the
right to contact you by other means and at other locations if you fail to
respond to any communication from us that requires a response. We will notify you in accordance with your
original request prior to attempting to contact you by other means or at
another location.
¨ 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.
If the facility has a website you may print or view
a copy of the notice by clicking on the Notice of Privacy Practices link.
To
exercise any of your rights, please obtain the required forms from the Privacy
Official and submit your request in writing.
We
reserve the right to change this notice and the revised or changed notice will
be effective for information we already have about you as well as any
information we receive in the future.
The current notice will be posted in the hospital and include the
effective date. In addition, each time
you register at or are admitted to the hospital for treatment or health care
services as an inpatient or outpatient, we will offer you a copy of the current
notice in effect.
If you believe your privacy
rights have been violated, you may file a complaint with the facility by
following the process outlined in the facility's Patient Rights
documentation. You may also file a
complaint with the Secretary of the Department of Health and Human
Services. All complaints must be
submitted in writing.
You will not be penalized
for filing a complaint.
Other
uses and disclosures of health 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 health 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 health 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.
Deborah Robitaille
(850)
747-7909