Fayette County Memorial Hospital
Effective Date: January 2003
Revised: October 2014
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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, please contact the Compliance Officer at 740.333.2950.
WHO WILL FOLLOW THIS NOTICE
This notice describes our hospital’s practices and that of:
• Any health care professional, physicians or therapists authorized to enter information into your chart.
• All departments and units of the hospital.
• Any member of a volunteer group we allow to help you while you are in the hospital.
• All employees, staff and other hospital personnel.
• All these entities, sites and locations follow the terms of this notice. In addition, these entities, sites and locations may share medical information with each other for treatment, payment or hospital 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 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 health care personnel or your personal doctor.
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 medical 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;
• Notify you promptly if a breach occurs that may compromise the privacy and security of your medical information; 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 medical information about you to doctors, nurses, technicians, medical students or other health care 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. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments of the hospital 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 medical information about you to people outside the hospital such as family members, clergy or others we use to provide services that are part of your care.
For Payment: We may use and disclose medical information about you so that the treatment and services you receive at the hospital may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan information about surgery you received at the hospital so your health plan will pay us or reimburse you for the surgery. We may also 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.
For Health Care Operations: We may use and disclose medical information about you for hospital operations: These uses and disclosures are necessary to run the hospital and make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical information about many hospital patients to decide what additional services the hospital should offer, what services are not needed and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, medical students and other hospital personnel for review and learning purposes. 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.
USES OR DISCLOSURES PROVIDING AN OPPORTUNITY FOR YOU TO AGREE OR TO OBJECT
Hospital Directory: We may include certain limited information about you in the hospital directory while you are a patient at the hospital. This information may include your name, location in the hospital, your general condition (e.g., fair, stable, etc.) and your religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they don’t 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. You will be given the opportunity to limit part or all of the information given in the directory.
Individuals Involved in Your Care or Payment for Your Care: We may release medical information about you to a friend or family member who is involved in your medical care, if you are unavailable, incapacitated or facing an emergency medical situation, and we determine that a limited disclosure may be in your best interest, we may share personal health information to individuals without your approval. We may also give information to someone who helps pay for your care unless you object in writing and ask us not to provide this information to a specific individual. We may also tell your family or friends your condition and that you are in the hospital unless you object in writing and ask us not to provide this information to a specific individual. We may disclose medical information to a family member or other individual who is involved in the care or payment for health care prior to an individual’s death. This information will not be disclosed if doing so is inconsistent with any prior expressed preference.
Fundraising Activities: We may use your medical information to raise money for the hospital. We may disclose this information to a related foundation. You have the right to opt-out of receiving these communications. If you do not want to be contacted for fundraising efforts, please notify the Compliance Officer. A request to opt-out of fundraising communications will have no impact on the health care services provided to you.
Disaster Relief Efforts: We may use or disclose your medical information to a public or private entity authorized by law or by its charter to assist in disaster relief efforts, for the purpose of coordinating with such entity in the notification of family members, personal representatives or another person responsible for your care.
USES OR DISCLOSURES FOR WHICH AN AUTHORIZATION OR OPPORTUNITY TO AGREE OR OBJECT IS NOT REQUIRED.
As Required by Law: We will discuss medical information about you when required to do so by federal, state or local law.
Public Health Risks: We will disclose medical information about you for public health activities. These activities generally include the following:
• To prevent or control disease, injury or disability;
• To report births and deaths;
• To report child abuse or neglect;
• 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;
• To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence as required by law; or
• To conduct public health surveillance, public health investigations or public health interventions at the direction of a public health authority or government agency.
Employers: We may release to your employer medical information about you when we have provided health care to you at the request of your employer.
Workers’ Compensation: We may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.
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 and services that may be of interest to you.
Emergencies: We may use or disclose your medical information if you need emergency treatment or if we are required by law to treat you but are unable to obtain your consent. If this happens, we will try to obtain your consent as soon as we reasonably can after we treat you.
Business Associates: We may disclose your medical information to third party associates called Business Associates that perform various activities for us (e.g., administrative, legal, actuarial or consulting services). Whenever any arrangement between the hospital and a Business Associate would involve the use or disclosure of your information, we will have a written contract that contains terms that will protect your privacy.
To Avert a Serious Threat to Health or Safety: We may use and disclose 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, however, would only be to someone able to help prevent the threat.
Organ and Tissue Donation: If you are an organ donor, we may release 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 medical information about you as required by military command authorities.
We may also release medical information about foreign military personnel to the appropriate foreign military authority.
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 a 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:
• In response to a court order, subpoena, warrant, summons or similar process;
• To identify or locate a suspect, fugitive, material witness or missing person;
• About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
• About a death we believe may be the result of criminal conduct;
• About criminal conduct at the hospital; and
• About certain wounds or other physician injuries;
• In emergency circumstances to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.
Coroners, Medical Examiners and Funeral Directors: We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or 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.
National Security and Intelligence Activities: We may release medical information about you to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law.
Protective Services for the President and Others: We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized person’s or heads of state 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 medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
Immunization Records: We may disclose medical information about your child’s immunization records if the school is required by law to have proof of immunization.
Appointment Reminders: 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.
Research: We may release your medical information for certain research purposes when approved by a review board with established rules to protect privacy.
USES AND DISCLOSURES FOR WHICH AUTHORIZATION IS REQUIRED
Psychotherapy Notes: We are required by law to obtain an authorization for any use or disclosure of psychotherapy notes, except:
• To carry out the following treatment, payment or health care operations;
• For use by originator of the psychotherapy notes for treatment;
• For use or disclosure by hospital in training programs in which students, trainees, or practitioners in mental health learn under supervision to practice or improve their skills in group, joint, family or individual counseling; or
• For use or disclosure by the hospital to defend a legal action or other proceeding brought by the individual.
Marketing Activities: Your authorization is required for the use of you medical information by our Marketing Department except in a face to face communication made by the hospital to you or for a promotional item of nominal value provided by the hospital. Authorization is required for communications about health related products or services (whether a part of treatment or health care operations) if financial remunerations received on behalf of a third party whose product or service is being described. The sale of your medical information is also prohibited.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You have the following rights regarding medical information we maintain about you:
Right to Access, Inspect and Copy: You have the right to access, inspect and copy medical information that may be used to make decisions about your care, with a few exceptions. To access, inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the Director of Medical Records. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. You may also request that the medical information be made in electronic format to you or a designated third party.
We may deny your request to access, 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 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.
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 Medical Records. In addition, you must provide a reason that supports 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, unless the person or entity that created the information is no longer available to make the amendment;
• 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 and copy; or
• Is accurate and complete.
Right to an Accounting of Disclosures: You have the right to request an “accounting of disclosures”. This is a list of the disclosures we made of medical information which does not include disclosures for payment, treatment or health care operations or others as permitted by law. Your request must state a time period which may not be longer than six years and not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 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. You must submit your written request to the Director of Medical Records.
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. We are required to honor your request to restrict disclosures to a health plan where you have paid out of pocket or in full for the health care item or service you received. Otherwise, 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. You must submit your written request to the Director of Medical Records.
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 email. We will not ask you the reason for your request. We will accommodate all reasonable requests. You must submit your written request to the Director of Medical Records. Your request must specify how or where you wish to be contacted.
Right to 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. You may obtain a copy of this notice at our website, www.fcmh.org or at any of our patient registration areas.
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 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 the hospital. The notice will contain on the first page, in the top right-hand corner, the effective date. In addition, each time you register at or are admitted to the hospital for treatment or health care services, we will offer you a copy of the current notice in effect.
If you believe your privacy rights have been violated, then you may submit a complaint to us. Complaints are to be made in writing to the Compliance Officer, Fayette County Memorial Hospital, 1430 Columbus Avenue, Washington CH, Ohio 43160 or call (740) 333-2950. You may file a complaint with the Secretary of the U.S. Department of Health and Human Services, 200 Independence Avenue SW, Washington D.C. 20201 or call (877)696-6775. You may also file a complaint with the Region V, Office of Civil Rights, U.S. Department of Health and Human Services, 233 N Michigan Avenue, Suite 240, Chicago, Il 60601 or call (312)886-1807. You will not be retaliated against or penalized in any way for filing a complaint.
OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of 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 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 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.