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 at the hospital.   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 generated by the hospital, whether made by hospital personnel or your personal doctor.   Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of  your medical information created in the doctor’s office or clinic.  

This notice will tell you about 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 medial information. 

We are required by law to:

·          make sure that medical information that identifies you is kept private;

·          give you this notice of our 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.   For each category of uses or disclosures we will explain what we mean and try to give some examples.   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 within one of the categories. 

·          For Treatment.   We may use medical information about you to provide you with medical treatment or services.   We may disclose or give medical information about you to doctors, nurses, therapists, technicians, medical students, students in training or other hospital personnel who are involved in taking care of you at the hospital.   Different departments of the hospital 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, support groups or others we use to provide services that are part of your care.

·          For Payment.   We may use and disclose your health information to bill and collect payment for the treatment and services provided to you.  For example, we may provide portions of your medical information to our billing department and your health plan to get paid for the health care services we provided to you.   We may also provide your information to our business associates, such as billing companies, claims processing companies, and others that process our health care claims.

·          For Health Care Operations.   We may use and disclose medical information about you in order to operate this hospital.   For example, we may use your medical information to evaluate the quality of heath care services that you received, to assess your satisfaction with our services or to evaluate the performance of the health care professionals who provided health care services to you.  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.   We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific patients are.

·          Appointment Reminders/Schedule Changes.  We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at the hospital.

·          Treatment Alternatives.  We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

·          Health-Related Benefits and Services.  We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.

·          Marketing and Fundraising Activities.  From time to time, the Hospital sends out mailings, newsletters or brochures about services and programs available at the Hospital.   These mailings may also include information about how to support the work of the hospital through charitable gifts.  

·          Hospital Directory/Census.    We may include your name, location in this facility, general condition, and religious affiliation, in our patient directory/census for use by clergy and visitors 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.

·          Individuals Involved in Your Care or Payment for Your Care.   We may release medical information about you to a friend or family member or other person that you indicate is involved in your care or the payment for your health care.  IN ORDER FOR YOUR FAMILY MEMBER, FRIEND OR OTHER PERSON TO RECEIVE INFORMATION ABOUT YOUR CONDITION, THEY MUST USE THE PRIVACY ID NUMBER GIVEN TO YOU AT ADMISSION.

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. 
 

·          Business Associates.   There are some services provided in our organization through contracts with business associates.   Examples include physician services, radiology, certain laboratory test, transcription service we use for typing medical documents.   When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve asked them to do and to bill you or your third-party payer or services rendered.   To protect your health information, we require the business associate to appropriately safeguard your information. 

·          Customer Service.  As a part of our customer service program, we may use health information about you to contact you by mail or phone after discharge to discuss your opinion of the services provided during your stay at our facility.

·          Follow-up Contact.  We may use health information about you to contact you by mail or phone following treatment if it is determined you may require additional follow-up.   We may also contact you or your personal physician on how you are doing following treatment at Siskin Hospital.  

·          Research.    Under certain circumstances, we may use and disclose medical information about you for research purposes.   All research projects are subject to a special approval process.

·          As Required by Law.   (Federal, state or local law, judicial or administrative proceedings, or law enforcement)  For example,   we make disclosures when a law requires that we report information to government agencies and law enforcement personnel about victims of abuse, neglect, or domestic violence; when dealing with gunshot and other wounds; or when ordered in a judicial or administrative proceeding.

·          To Avoid Harm.   In order to avoid a serious threat to the health or safety of a person or the public, we may provide medical information to law enforcement personnel or persons able to prevent or lessen such harm. 

SPECIAL SITUATIONS

·          Organ and Tissue Donation.   We may notify organ procurement organizations to assist them in organ, eye, or tissue donation and transplants, if you are an organ donor.

·          Specific Government Functions.   We may disclose the medical information of military personnel and veterans in certain situations.  We may also disclose medical information for national security purposes.

·          Workers’ Compensation.  We may provide your medical information to comply with workers’ compensation laws.

·          Public Health Activities.   We may disclose medical information about you for these activities that generally include the following:  to prevent or control disease, injury or disability; to report births and deaths; to report abuse/neglect (we will only make this disclosure if you agree or when required or authorized by law); 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.

·          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. 

·          Lawsuits and Disputes.   If you are involved in a lawsuit or 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, 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 medical information if asked to do so by a law enforcement official.

·          Coroners, Medical Examiners, and Funeral Directors.   This may be necessary to 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.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU

You have the following rights regarding 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.   Usually, this includes medical and billing records, but does not include psychotherapy notes. 

To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the Medical Records Department.   If you request a copy of the information, we will charge a fee for the costs of copying, mailing or other supplies associated with your request. 

We may deny your request to inspect and copy in certain very limited circumstances.   If you are denied access to medical information, you may request that the denial be reviewed.   Another licensed health care worker chosen in 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.

·          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 Director of Health Information Services.   In addition, you must provide a reason that supports your request.   We will respond within 60 days of receiving 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, 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 or copy, or is accurate and complete.

·          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.  You also have the right to request a limit on the medical 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. 

To request restrictions, you must make your request in writing to Medical Records.  In your request you must tell us (1) what information you want to limit;  (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse. 

·          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 by mail.  

To request confidential communications, you must make request in writing to Medical Records Department.   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 an Accounting of Disclosures.   You have the right to request an “accounting of disclosures.”  This is a list of  disclosures we made of medical information about you.   The list will not include uses or disclosures that you have already consented to, such as those made for treatment, payment, or health care operations, directly to you or your family. 

To request this list or accounting of disclosures, you must submit your request in writing to Medical Records Department.  Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003.     The first list you request 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. 

·          The Right to Get This Notice by E-Mail.   You may obtain a copy of this notice on our website, www.siskinrehab.org.