PRIVACY PRACTICES

Effective Date: April 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 CAREFULLY.

The Hospital is required by law to maintain the privacy of your medical information and to provide you with notice of its legal duties and privacy practices with respect to this information.  The purpose of this notice is to provide you with that information.  

Any information that is about your health, the health care you receive, or payment for that care is considered confidential and protected by the Hospital.  The Hospital is required to abide by the terms of the notice that is currently in effect at the time your medical information is used or disclosed. 

We may use your medical information for purposes of treatment, payment and health care operations.

The following is a description and example of the ways in which we may use and disclose your medical information.

For Treatment:  We may provide medical information about you to doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you.  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.  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 facility - such as family members, or others providing services that are part of your care.

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.

For Payment:  We may disclose your medical information so that the treatment and services you receive or are going to receive may be approved and billed so payment may be collected from you or a third party payer.  For example, we may need to give your health plan information about care you received so your health plan will pay for the care.

For Health Care Operations:   We may disclose your medical information for hospital and corporation 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 performances of our staff in caring for you.

Fundraising Activities:   We may use information about you to contact you in an effort to raise money for the hospital and foundation operations.  We may need to disclose your medical information in the sale or transfer of our practice.

We may use or disclose your medical information without your written consent or authorization.

The following is a description of ways in which we may use and disclose your information for which consent, an authorization or an opportunity to agree or object, is not required:

Research:  If a researcher has obtained the required waiver and has demonstrated that the information is necessary to the research and posses a minimal risk of inappropriate use or disclosure, we may use and disclose medical information about you for research purposes.  If a researcher has not obtained the required waiver, we will not disclose the information without your written authorization.

As Required By Law:   We may use or disclose your medical information to the extent required by law, provided that the use or disclosure complies with and is limited to the relevant requirements of such law.

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. 

Victim of Abuse, Neglect or Domestic Violence:  If we believe you have been a victim of abuse, neglect or domestic violence, we may disclose your medical information to a government authority.  We will make this disclosure if it is necessary to prevent  serious harm to you or other potential victims, you are unable to agree due to your incapacity, you agree to the disclosure, or when required by law. 

Organ and Tissue Donation:   For the purpose of  facilitating organ, eye or tissue donation and transplantation, we may use or disclose medical information to organizations that handle organ procurement, banking, or organ, eye or tissue transplantation.

Workers’ Compensation:   We may release medical information about you for workers’ compensation or similar programs that are established by the law to provide benefits for work-related injuries or illness without regard to fault.

Public Health Activities:   To the extent authorized or required by law, we may disclose your medical information to a public health authority to report a birth, death, disease, or injury, as part of a public health investigation, and to report child or adult abuse, or domestic violence.  To the extent authorized or required by the Food and Drug Administration we may disclose your medical information to persons authorized to report adverse events, track products, enable product recalls, repairs or replacement, and/or conduct post marketing surveillance.

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.

Law Suits and Disputes:   We may disclose medical information about you as required by a court or administrative order or under certain circumstances in response to a subpoena, discovery request or other legal process.

Law Enforcement:   We may release medical information to law enforcement officials as required by law.  Under limited circumstances we may release your medical information to report a crime or in   response to a court order, grand jury subpoena,  warrant, or administrative request. 

Coroners, Medical Examiners & Funeral Directors:  Consistent with applicable law, we may release medical information to a coroner, medical examiner, or funeral director.

Specialized Government Functions:   Medical information may be disclosed for military and veterans affairs, national security and intelligence, or for correctional activities.

The following is a description of ways in which we may use and disclose your information without   written consent or authorization.  We will attempt to obtain your permission prior to making a disclosure for these purposes.  This permission may be oral.  If we are unable, due to your incapacity or unavailability, we may use or disclose some or all of this information, if based on our professional judgment that this is in your best interest.

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 do not 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.

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 tell your family or friends your condition and that you are in the hospital.  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.

We may use or disclose your medical information for other purposes, once we have obtained your written authorization.

Other uses and disclosure of medical information not covered by this notice or the laws that apply to us will be made only with your written authorization.  You may revoke this authorization, in writing, at any time.  However, this revocation will not apply to the extent we have taken action in reliance on that authorization.  In addition, if the authorization was obtained as a condition of obtaining insurance coverage, the insurer will have a right to contest a claim under the policy.

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