Clay
County Memorial Hospital
NOTICE
OF PRIVACY PRACTICES
Effective
Date: 04/14/2003
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.
WHO
WILL FOLLOW THIS NOTICE.
This notice describes Clay
County Memorial Hospital’s
practices and that of:
· Any
health care professional authorized to enter information into your
chart.
· All
departments and units of Clay
County Memorial Hospital.
· Any
member of a volunteer group we allow to help you while you are in the
care of Clay
County Memorial Hospital.
· All
employees, staff and other Clay
County Memorial 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 Clay
County Memorial Hospital
operations purposes described in this notice.
OUR
PLEDGE REGARDING MEDICAL INFORMATION:
Law to requires us 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.
Ø 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
hospital personnel who are involved in taking care of you service.
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 who may be
involved in your medical care after you leave the hospital, such as
family members, clergy or others we use to provide services that are
part of your care.
Ø For
Payment.
We may use and disclose medical information about you so that the
treatment and services you receive at Clay
County Memorial 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 care information about treatment you received at the Clay
County Memorial Hospital
so your health plan will pay us or reimburse you for the care.
We may also tell your health plan about a treatment or service you are
going to receive to obtain prior approval or to determine whether your
plan will cover the treatment.
Ø For
Health Care Operations.
We may use and disclose medical information about you for Clay
County Memorial Hospital
operations. These uses and disclosures are necessary to run Clay
County Memorial 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 patients
to decide what additional services the Clay
County Memorial 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 Clay
County Memorial Hospital
personnel for review and learning purposes. We may also combine
the medical information we have with medical information from other
health providers 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.
Ø Appointment
Reminders.
We may use and disclose medical information to contact you as a
reminder that you have an appointment for medical care.
Ø 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.
Ø 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.
Ø Fundraising
Activities.
We may use medical information about you to contact you in an effort
to raise money for Clay
County Memorial Hospital
and its operations. We may disclose medical information to a
foundation related to the Clay
County Memorial Hospital
so that the foundation may contact you in raising money for Clay
County Memorial Hospital.
We only would release contact information; such as your name, address
and phone number and the dates you received treatment or services at Clay
County Memorial Hospital.
If you do not want the Clay
County Memorial Hospital
to contact you for fundraising efforts, you must notify CCMH Privacy
Officer in writing.
Ø 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. We may also give
information to someone who helps pay for your care. 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.
Ø Research.
Under certain circumstances, we may use and disclose medical
information about you for research purposes. For Example, a
research project may involve comparing the health and recovery of all
patients who received one medication to those who received another,
for the same condition. All research projects, however, are subject to
a special approval process. This process evaluates a proposed
research project and its use of medical information, trying to balance
the research needs with patients' need for privacy of their medical
information. Before we use or disclose medical information for
research, the project will have been approved through this research
approval process, but we may, however, disclose medical information
about you to people preparing to conduct a research project, for
example, to help them look for patients with specific medical needs,
so long as the medical information they review does not leave the Clay
County Memorial Hospital.
We will almost always ask for your specific permission if the
researcher will have access to your name, address or other information
that reveals who you are, or will be involved in your care with Clay
County Memorial Hospital.
Ø As
Required By Law.
We will disclose medical information about you when required to do so
by federal, state or local law.
Ø 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.
SPECIAL
SITUATIONS
Ø 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.
Ø Workers'
Compensation.
We may release medical information about you for workers' compensation
or similar programs. These programs provide benefits for
work-related injuries or illness.
Ø Public
Health Risks.
We may 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. We
will only make this disclosure if you agree or when required or
authorized by law.
Ø 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.
Ø 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.
Ø
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 Clay
County Memorial Hospital;
and
· 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.
Ø 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 Clay
County Memorial Hospital
to funeral directors as necessary to carry out their duties.
Ø 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.
Ø 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 persons or foreign heads of state or conduct special
investigations.
Ø 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.
YOUR
RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU.
You
have the following rights regarding medical information we maintain
about you:
Ø 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 CCMH
Privacy Officer. 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.
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 professional chosen by Clay
County Memorial 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.
Ø 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 Clay
County Memorial Hospital.
To
request an amendment, your request must be made in writing and
submitted to CCMH Privacy Officer. 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 Clay
County Memorial Hospital;
· Is
not part of the information which you would be permitted to inspect
and copy; or
· Is
accurate and complete.
Ø 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 about you.
To
request this list or accounting of disclosures, you must submit your
request in writing to CCMH Privacy Officer. Your request must
state a time period, which may not be longer than six years and may
not include dates before February 26, 2003 (or the actual
implementation date of this act). 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.
Ø 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 care 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 CCMH
Privacy Officer. 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.
Ø 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 your request in
writing to CCMH Privacy Officer. 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.
Ø 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.
CHANGES
TO THIS NOTICE
Ø 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 waiting
room. The notice will contain on the first page, in the top
right-hand corner, the effective date. In addition, each time
you register at the front desk for treatment or health care services
as an inpatient or outpatient, we will offer you a copy of the current
notice in effect.
COMPLAINTS
If
you believe your privacy rights have been violated, you may file a
complaint with the Clay
County Memorial Hospital
or with the Secretary of the Department of Health and Human Services.
To file a complaint with the Clay
County Memorial Hospital,
contact CCMH Privacy Officer, 310 W. South Street, Henrietta, Tx
76365 (940.538.2204). All complaints must be submitted in
writing. You
will not be penalized for filing a complaint.
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.
Ø The
final HIPPA privacy rules prohibit the notice and consent from being
combined into a single document.
CCMH
