Our Pledge Regarding
Medical Information
The privacy of your medical information is important to us. We
understand that your medical information is personal and we are
committed to protecting it. We create a record of the care and
services you receive at our organization. We need this record to
provide you with quality care and to comply with certain legal
requirements. This notice will tell you about the ways we may use
and share medical information about you. We also describe your
rights and certain duties we have regarding the use and disclosure
of medical information.
Our Legal
Duty
Law Requires Us to:
Keep your medical information private.
Give you this notice describing our legal
duties privacy practices, and your rights regarding your medical
information.
Follow the terms of the current notice.
We Have the Right to:
Change our privacy practices and the terms of
this notice at any time, provided that the changes are permitted by
law.
Make the changes in our privacy practices and
the new terms of our notice effective for all medical information
that we keep, including information previously created or received
before the changes.
Notice of Change to Privacy
Practices:
Use and Disclosure of
Your Medical Information
The following section describes different ways that
we use and disclose medical information. Not every use or
disclosure will be listed. However, we have listed all of the
different ways we are permitted to use and disclose medical
information. We will not use or disclose your medical information
for any purpose not listed below, without your specific written
authorization. Any specific written authorization you provide may
be revoked at any time by writing to us.
For Treatment:
We may use medical information about you to provide you with
medical treatment or services. We may disclose medical information
about you to doctors, nurses, technicians, medical students, or
other people who are taking care of you. We may also share medical
information about you to your other health care providers to assist
them in treating you.
For Payment:
We may use and disclose your medical information for payment
purposes. A bill may be sent to your or a third-party payer. The
information on or accompanying the bill may include your medical
information.
For Health Care Operations:
We may use and disclose your medical information for any health
care operations. This might including measuring and improving
quality, evaluating the performance of employees conducting
training programs, and getting the accreditation certificates,
licenses, and credentials we need to serve you.
Additional Uses and
Disclosures:
In addition to using and disclosing your medical information for
treatment, payment, and health care operations, we may use and
disclose medical information for the following purposes:
Facility Directory:
Unless you notify us that you object, the following medical
information about you will be placed in our facility directories:
your name, your location in our facility, your condition described
in general terms, your religious affiliation, if any. We may
disclose this information to members of the clergy or, except for
your religious affiliation, to others who contact us and ask for
information about you by name.
Notification:
We may use and disclose medical information to notify or help
notify a family member, your personal representative, or another
person responsible for your care. We will share information about
your location, general condition, or death. If you are present, we
will get your permission if possible before we share, or give you
the opportunity to refuse permission. In case of emergency, and if
you are not able to give or refuse permission, we will share only
the health information that is directly necessary for your health
care according to our professional judgment. We will also use our
professional judgment to make decisions in your best interest about
allowing someone to pick up medicine, medical supplies, x-ray or
medical information for you.
Disaster Relief:
We may share medical information with a public or private
organization or person who can legally assist in disaster relief
efforts.
Fundraising:
We may provide medical information to one of our affiliated
fundraising foundations to contact you for fundraising purposes. We
will limit our use and sharing to information that describes you in
general, not personal, terms and the dates of your health care. In
any fundraising materials, we will provide you a description of how
you may choose not to receive future fundraising communications.
Research in Limited Circumstances:
We may use medical information for research purposes in limited
circumstances where the research has been approved by a review
board that has reviewed the research proposal and established
protocols to ensure the privacy of medical information.
Funeral Director, Coroner, Medical
Examiner:
To help them carry out their duties, we may share the medical
information of a person who has died with a coroner, medical
examiner, funeral director, or an organ procurement organization.
Specialized Government
Functions:
Subject to certain requirements, we may disclose or use health
information for military personnel and veterans, for national
security and intelligence activities, for protective services for
the President and others, for medical suitability determinations
for the Department of State, for correctional institutions and
other law enforcement custodial situations, and for government
programs providing public benefits.
Court Orders and Judicial and
Administrative Proceedings:
We may disclose medical information in response to a court or
administrative order, subpoena, discovery request, or other lawful
process, under certain circumstances. Under limited circumstances,
such as a court order, warrant, or grand jury subpoena, we may
share your medical information with law enforcement officials. We
may share limited information with a law enforcement official
concerning the medical information of a suspect, fugitive, material
witness, crime victim, or missing person. We may share the medical
information of an inmate or other person in lawful custody with a
law enforcement official or correctional institute under certain
circumstances.
Public Health Activities:
As required by law, we may disclose your medical information to
public health or legal authorities charged with preventing or
controlling disease, injury or disability including child abuse or
neglect. We may also disclose your medical information to persons
subject to jurisdiction of the Food and Drug Administration for
purposes of reporting adverse events associated with product
defects or problems, to enable product recalls, repairs or
replacements, to track products, or to conduct activities required
by the Food and Drug Administration. We may also, when we are
authorized by law to do so, notify a person who may have been
exposed to a communicable disease or otherwise be at risk of
contracting or spreading a disease or condition.
Victims of Abuse, Neglect, or Domestic
Violence:
We may use and disclose medical information to appropriate
authorities if we reasonably believe that you are a possible victim
of abuse, neglect, or domestic violence or the possible victim of
other crimes. We may share your medical information if it is
necessary to prevent a serious threat to your health or safety or
the health or safety of others. We may share medical information
when necessary to help law enforcement officials capture a person
who has admitted to being a part of a crime or has escaped from
legal custody.
Workers Compensation:
We may disclose health information when authorized or necessary to
comply with laws relating to workers compensation or other similar
programs.
Health Oversight
Activities:
We may disclose medical information to an agency providing health
oversight for oversight activities authorized by law, including
audits, civil, administrative, or criminal investigations or
proceedings, inspections, licensure, or disciplinary actions, or
other authorized activities.
Law Enforcement:
Under certain circumstances, we may disclose health information to
law enforcement officials. These circumstances include reporting
required by certain laws (such as the reporting of certain types of
wounds), pursuant to certain subpoenas or court orders, reporting
limited information concerning identification and location at the
request of law enforcement official reports regarding suspected
victims of crimes at the request of a law enforcement official,
reporting death crimes on our premises, and crimes in emergencies.
Appointment Reminder:
We may use and disclose medical information for purposes of sending
you appointment postcards or otherwise reminding you of your
appointments.
Alternative and Additional Medical Services:
We may use and disclose medical information to furnish you with
information about health related benefits and services that may be
of interest to you, and to describe or recommend treatment
alternatives.
Your Individual
Rights
You Have the Right to:
Look at or get copies of certain parts or your
medical information. You may request that we provide copies in a
format other than photo copies. We will use the format you request
unless it is not practical for us to do so. You must make your
request in writing. You may ask the receptionist for the form
needed to request access. There may be charges for copying and for
postage if you want the copies mailed to you. Ask the receptionist
about our fee structure.
Receive a list of all the times we or our
business associates shared your medical information for purposes
other than treatment, payment, and health care operations and other
specified exceptions.
Request that we place additional restrictions
on our use or disclose of your medical information. We are not
required to agree to these additional restrictions, but if we do,
we will abide by our agreement (except in the case of an
emergency).
Request that we communicate with you about our
medical information by different means or to different locations.
Your request that we communicate your medical information to you by
different means or at different locations must be made in writing
to our Privacy Officer.
Request that we change certain parts of your
medical information. We may deny your request if we did not create
the information you want changed or for certain other reasons. If
we deny your request, we will provide you with a written
explanation. You may respond with a statement of disagreement that
will be added to the information you wanted changed. If we accept
your request to change the information, we will make reasonable
efforts to tell others, including people you name, of the
change, and to include the changes in any future sharing of that
information.
If you wish to receive a paper copy of this
privacy notice, then you have the right to obtain a paper copy by
making a request in writing to our Privacy Officer.
Questions &
Complaints
If you have any questions about this notice, please ask the
receptionist to speak to our Privacy Officer. If you think that we
may have violated your privacy rights, you may speak to our Privacy
Officer and submit a written complaint. To take either action,
please inform the receptionist that you wish to contact the Privacy
Officer or request a complaint form. You may submit a written
complaint to the U.S. Department of health and Human Services: we
will provide you with the address to file your complaint. We will
not retaliate in any way if you choose to file a complaint.
*These privacy practices are
currently in effect and will remain in effect until further
notice.
