Notice of privacy practices
Effective 04/14/03
THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT YOU MAY
BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
PRIVACY notice
This Notice of Privacy Practices describes how we may use and disclose
your protected health information to carry out treatment, payment or health
care operations and for other purposes that are permitted or required
by law. It goes on to describe the types of information we gather about
you, with whom that information may be shared and the safeguards we have
in place to protect it. This notice also describes your rights to access
and control your protected health information. You have the right to the
confidentiality of your protected health information and the right to
approve or refuse the release of specific information except when the
release is required by law. If the practices described in this brochure
meet your expectations, there is nothing you need to do. If you prefer
that we not share information, we may honor your written request in certain
circumstances described below. If you have any questions about this notice,
please contact our Privacy Officer at the address at the end.
Who Will Follow This Notice
This notice describes the privacy practices of Jay County Hospital, an
Organized Health Care Arrangement (OHCA), and that of:
- Physicians and health care professionals credentialed by the hospital
and affiliated entities of the hospital.
- Any health care professional authorized to document protected health
information.
- All departments and units of the hospitals, clinics or doctor’s
offices, and affiliated entities you may visit or receive care or services
from.
- Any member of a volunteer group we allow to help you while you are
receiving care or services.
- All employees, staff, residents or student trainees and other personnel
who may need access to your information.
Our Pledge Regarding Protected Health Information:
We understand that protected health information about you and your health
is personal. We are committed to protecting health information about you.
We create a record of the care and services you receive. 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 Jay County Hospital, whether made by health care professionals or you
personal doctor.
This notice will tell you about the ways in which we may use and disclose
protected health information about you. We also describe your rights and
certain obligations we have regarding the use and disclosure of protected
health information.
We are required by law to:
- maintain the privacy of the protected health information that identifies
you;
- give you this notice of our legal duties and privacy practices with
respect to protected health information about you; and
- follow the terms of the notice that is currently in effect.
How We May Use and Disclose Protected Health Information About You
The following categories describe different ways that we may use and disclose
protected health information. We will explain what we mean and try to
give examples for each category of uses and disclosures. Not every use
or disclosure in a category will be listed.
For Treatment
We may use and disclose your protected health information to provide you
with medical treatment or services. We may disclose protected health information
about you to doctors, nurses, technicians, training doctors, medical students
or other health care professionals who are involved in taking care of
you. We may also share your protected health information with participants
in the hospital’s OHCA for treatment of you by them. 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 health care professionals also may share
protected health information about you in order to coordinate the different
things you need, such as prescriptions, lab work and x-rays. We also may
disclose protected health information about you to people such as family
members or others who may be involved in your medical care or provide
services that are part of your care.
For Payment
We may use and disclose your protected health information so we can be
paid for the services we provide to you. This can include billing you,
your insurance company or a third party. For example, your insurance may
need to know about surgery you received so they will pay us or reimburse
you for the surgery. We may also use and disclose protected health information
about you to obtain prior approval or to determine whether your insurance
will cover the treatment. We may also disclose your PHI to other providers
or health plans for their payment activities as they relate to your treatment.
For Health Care Operations
We may use or disclose protected health information about you for Jay
County Hospital operations. These uses and disclosures are necessary in
order for us to run our system business and make sure that all of our
patients receive quality health care. For example, we may use protected
health information to review our treatment and services and to evaluate
our staff in caring for you. We may also combine the protected health
information we have with information from other health care providers
to compare how we are doing and see where we can make improvements in
the care and services that we offer. We may also disclose information
to doctors, nurses, technicians, training doctors, medical students, and
other personnel for review and learning purposes. We may remove information
that identifies you specifically so that others may use the information
to study health care without learning who the specific patients are.
Incidental Uses and Disclosures
We may occasionally inadvertently use or disclose your protected health
information when such use of disclosure is incidental to another use or
disclosure permitted by law. For example, while we have safeguards in
place to protect against others overhearing our conversations that take
place between doctors, nurses, and other personnel, there may be times
that such conversations are overheard by others. Please be assured that
we will avoid such situations as much as possible.
Appointment Reminders
We may use and disclose protected health information to contact you as
a reminder that you have an appointment for treatment or medical care.
Treatment Alternatives
We may use and disclose protected health 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 protected health information to tell you about
health-related benefits or services that may be of interest to you.
Facility Directory
We may include certain limited information about you in the facility directory
or patient census information while you are receiving health care and
services. This information may include your name, location in the facility,
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 have the right to object to being included in the facility
directory.
Individuals Involved in Your Care or Payment for Your Care
We may release protected health 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. We may also tell your family or
friends your condition and that you are in the hospital. In addition,
we may disclose protected health 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. If you are unable to agree or object
to such a disclosure, we may disclose such information as necessary if
we determine that it is in your best interest based on our professional
judgment.
Suspected Abuse or Neglect
We may disclose your protected health information to a public health authority
that is authorized by law to receive reports of child abuse or neglect.
In addition, we may disclose your protected health information if we believe
that you have been a victim of abuse, neglect or domestic violence to
the governmental entity or agency authorized to receive such information.
In this case, the disclosure will be made consistent with the requirements
of applicable federal and state laws.As Required By Law
We will disclose protected health information about you when required
to do so by federal, state or local law.
To Avert a Serious Threat to Health or Safety
We may use and disclose protected health 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.
Fundraising Activities
We may use protected health information about you in an effort to raise
money for Jay County Hospital and its operations. We may disclose protected
health information to a foundation related to the hospital so that the
foundation may raise money for the hospital. We would only release demographic
information, such as your name, address, phone number and the dates you
received treatment or services from Jay County Hospital. If you do not
want Jay County Hospital to contact you for fundraising efforts, you must
notify our Privacy Officer in writing at the address below.
Special Situations
Organ and Tissue Donation
If you are an organ donor, we may release protected health 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 protected health
information about you as required by military command authorities.
Workers' Compensation
We may release protected health information about you for workers' compensation
or similar programs. These programs provide benefits for work-related
injuries or illness.
Public Health Risks
We may disclose protected health 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.
Health Oversight Activities
We may disclose protected health 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 and privacy
laws.
Lawsuits and Disputes
We may disclose protected health information about you in response to
a subpoena, discovery request, or other lawful order from a court.
Law Enforcement
We may release protected health information if asked to do so by a law
enforcement official as part of law enforcement activities; in investigations
of criminal conduct or of victims of crime; in response to court orders;
in emergency circumstances; or when required to do so by law.
Coroners, Medical Examiners and Funeral Directors
We may release protected health 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 protected health information about
patients of the hospital to funeral directors as necessary to carry out
their duties.
National Security and Intelligence Activities
We may release protected health 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, or
for intelligence, counterintelligence, and other national security activities
authorized by law.
Inmates
If you are an inmate of a correctional institution or under the custody
of a law enforcement official, we may release protected health 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 Protected Health Information About You
You have the following rights regarding protected health information we
maintain about you:
Right to Inspect and Copy
You have the right to inspect and copy protected health information about
you that is contained in a designated record set for as long as we maintain
the protected health information. A “designated record set”
contains records 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 protected health information that may be used
to make decisions about you, you must sign an authorization, show picture
identification, and submit your request in writing to the Health Information
Management Department in the hospital or to the Medical Record designee
in your physician office or health care facility. We may deny your request
to inspect and copy in certain very limited circumstances. If you are
denied access to protected health information, you may request that the
denial be reviewed. Another licensed health care professional chosen by
Jay County 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 protected health 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 of protected health information about you in a
designated record set for as long as we maintain the information. To request
an amendment, your request must be made in writing and submitted to our
Privacy Officer in the hospital. 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 protected health information kept by Jay County
Hospital;
- Is not part of the information which you would be permitted to inspect
and copy; or
- Is accurate and complete.
If we deny your request for amendment, you have the right to file a statement
of disagreement with us and we may prepare a rebuttal to your statement
and will provide you with a copy of any such rebuttal.
Right to an Accounting of Disclosures
You have the right to request an accounting of certain disclosures. This
is a list of the disclosures we made of protected health information about
you for reasons other than treatment, payment, or healthcare operations
as described in the Notice of Privacy Practices. It also excludes disclosures
we may have made to you, for a facility directory, to family members or
friends involved in your care, or for notification purposes. To request
this list or accounting of disclosures, you must submit your request in
writing to our Privacy Officer in the hospital or to the practice manager
in your physician office or health care facility. Your request must state
a time period that may not be longer than six years and may not include
dates before April 14, 2003. Your request should indicate in what form
you want the list (for example, on paper, electronically).
Right to Request Restrictions
You have the right to request a restriction or limitation on the protected
health 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 protected health 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, as described in this Notice of Privacy Practices. 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 or if your physician believes it is in your best interest to
permit the use and disclosure of protected health information. To request
restrictions, you must make your request in writing to our Privacy Officer
in the hospital. 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.
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 should contact a nurse or other health care professional
involved in your care, our patient representative, our 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.
Right to a Paper Copy of This Notice
You have the right to a paper 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. To obtain a paper copy of this notice,
please request one at the time of admission or in writing from our Privacy
Officer at the address below or you may view and print a copy by visiting
our website at www.jaycountyhospital.com.
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 protected health 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. The notice will contain
on the first page, at the top of the page, the effective date.
Complaints
If you believe your privacy rights have been violated, you may file a
complaint with Jay County Hospital or with the Secretary of the Department
of Health and Human Services. To file a complaint with Jay County Hospital,
contact our Privacy Officer at the address and phone number below. All
complaints must be submitted in writing. You will not be penalized for
filing a complaint.
Other Uses of Protected Health Information
Other uses and disclosures of protected health 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 protected
health information about you, you may revoke that permission, in writing,
at any time. If you revoke your permission, thereafter we will no longer
use or disclose protected health 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.
Privacy Officer:
Irene Heare, RHIT
Director, Health Information Management
500 West Votaw Street
Portland, IN 47371
Department # 260-726-1819 |
