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NOTICE OF PRIVACY PRACTICES
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.
This notice takes effect on April 29, 2003 and remains in effect until we
replace it.
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1. OUR PLEDGE REGARDING MEDICAL INFORMATION
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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.
Law Requires Us to:
1. Keep your medical information private.
2. Give you this notice describing our legal duties, privacy practices and
your rights regarding your medical information.
3. Follow the terms of the notice that is now in effect.
We Have the
Right to:
1. Change our privacy practices and terms of this notice at any time,
provided that the changes are permitted by law.
2. 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
of Privacy Practices:
1. Before we make an important change in our privacy practices, we will
change this notice and make the new notice available upon request.
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3. USE AND DISCLOSURE OF YOUR MEDICAL INFORMATION
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The following section describes different ways that we use and disclose
medical information. Not every use of 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.
FOR HEALTH CARE OPERATIONS: We may use and disclose your medical
information for our health care operations. This might include 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.
NOTICE OF
PRIVACY PRACTICES
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 facilities'
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: 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: Medical information with 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: 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 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 institution 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 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 or 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
part of a crime or has escaped from legal custody.
Workers Compensation: We may disclose health information when
authorized and 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 a certain types
of wounds), pursuant to certain subpoenas or court orders, reporting limited
information concerning identification and location at the request of a 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.
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4. YOUR INDIVIDUAL RIGHTS |
You Have a Right
to:
1. Look at or get copies of your medical information. You may request that
we provide copies in a format other than photocopies. 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 get the form to request access by using the
contact information listed at the end of this notice. If you request copies,
we will charge you $1.00 for each page, and postage if you want the copies
mailed to you. Contact us using the information listed at the end of this
notice for a full explanation of our fee structure.
2. 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.
3. Request that we place additional restrictions on our use or disclosure 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).
4. Request that we communicate with you about your 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 the contact person listed at the end of this
notice.
5. Request that we change 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 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.
6. If you have received this notice electronically, and wish to receive a
paper copy, you have the right to obtain a paper copy by making a request in
writing to the Privacy Officer at your office.
If you have any questions about this notice or if you think that we may have
violated your privacy rights, please contact us. You may also 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 with the U.S.
Department of Health and Human Services. We will not retaliate in any way if
you choose to file a complaint. |