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I-70
Community Hospital's Patient Privacy
Statement
NOTICE OF PRIVACY PRACTICES FOR I-70
COMMUNITY HOSPITAL
Effective date: November 15th, 2005
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.
I-70
Community Hospital creates a
record of the care and services you receive in the facility. Your
medical records and billing information are created and retained on
I-70 Community Hospital's computer system. That system is accessible to
I-70 Community Hospital personnel and members of the medical staff. Proper
safeguards are in place to discourage improper use or access. We are
required by law to protect your privacy and the confidentiality of
your personal and protected health information and records. This
notice describes your rights and our legal duties regarding your
protected health information.
Definitions: you, at times, may see or hear new terms in
relation to this notice. Some of the terms you may hear and their
definitions are:
1. Protected Health Information
(PHI) is your personal and
protected health information that we use to render care to you and
bill for services provided
2. Privacy Officer – is the individual in the has
responsibility for developing and implementing all polices and
procedures your PHI and receiving and investigating any complaints you
may have about the use and disclosure of your PHI
3. Business Associate – is an individual or business outside of
I-70 Community Hospital that works with I-70 Community Hospital to help
provide you with services in I-70 Community Hospital.
4. Authorization- we will obtain an authorization from you
giving us permission to use or disclose your protected health
information for purposes other than for your treatment, to obtain
payment of your bills and for health care operations of I-70 Community
Hospital.
I-70
Community Hospital may use and
disclose your protected health information for the following:
1. Treatment–We
may use protected health information about you to provide medical
treatment or services. We may disclose protected health information
about you to doctors, nurses, technicians, medical, nursing and other
students in care of you at I-70 Community 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 so that we can arrange for
appropriate meals. Different departments of I-70 Community Hospital 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 individuals such as family members, clergy or others we
use to provide services that are part of your care.
2. Payment- We may use and disclose protected health
information about you so that treatment and services you receive at
I-70 Community 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
I-70 Community Hospital so your health plan will pay us or reimburse your
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.
3. Health Care Options- We may use and disclose protected
health information about you for I-70 Community Hospital operations. These
uses and disclosures are necessary to run I-70 Community Hospital and make
sure that all of our patients receive quality care. For example, we
may use protected health information about your high blood pressure to
review our treatment and services and to evaluate the performance of
our staff in caring for you. We may also combine protected health
information about many I-70 Community Hospital patients to decide what
additional services I-70 Community Hospital should offer, what services
are not needed, and whether certain new treatments are effective. We
may also combine protected health information we have with protected
health information from other facilities to compare how we are doing
and see where we can make improvements in the care and services we
offer.
4. Business Associates- We may disclose your protected health
information to Business Associates outside I-70 Community Hospital with
whom we contract to provide services on our behalf. However, we will
only make these disclosures if we have received satisfactory assurance
that the Business Associate will properly safeguard your privacy and
the confidentiality of your protected health information. For example,
we may contract with a company outside of I-70 Community Hospital to
provide medical transcription services for I-70 Community Hospital.
5. Appointment Reminders. We may use and disclose your protected
health information to contact you to remind you of an appointment for
treatment or medical care at I-70 Community Hospital.
6. Health Related Benefits and Services. We may use and disclose your
protected health information to tell you about health-related benefits
or services or recommend possible treatment options or alternatives
that may interest you.
7. Fundraising Activities of I-70 Community Hospital- We may use or
disclose your protected health information to contact you in an effort
to raise money for I-70 Community Hospital and its operations. We would
only release contact information, such as your name, address and phone
number and the dates you received treatment or services at I-70
Community Hospital. If you do not want I-70 Community Hospital to contact you
for fundraising efforts, please notify the Privacy Officer.
8. I-70 Community Hospital Directory- We may include certain
limited information about you in the I-70 Community Hospital directory
while you are a patient at I-70 Community Hospital. This information may
include your name, location in I-70 Community Hospital and your general
condition (e.g., fair, stable, etc.) which may 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 I-70 Community Hospital and generally know how you are doing.
9. Individuals Involved in Your Care or Payment for Your Care-
We may disclose protected health information to a friend or family
member who is involved in your medical care. We may also give your
protected health information to someone who helps pay for your care.
We may also disclose protected health information about you to any
entity assisting in a disaster relief effort so that your family can
be notified about your condition, status and location.
10. Research- Under certain circumstances, we may use and
disclose protected health 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 protected health
information, trying to balance the research needs with patients’ need
for privacy of their protected health 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 protected health 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 protected health
information they review does not leave I-70 Community 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 at I-70 Community
Hospital.
11. As Required by Law- We will disclose protected health
information about you when required to do so by federal, state or
local law.
12. 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.
13. Organ and Tissue Donations. 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 or transplantation.
14. Military- If you are a member of the armed forces, we may
release protected health information about you as required by military
command authorities. We may also release protected health information
about foreign military personnel to the appropriate foreign military
authority.
15. Workers Compensation- We may release protected health
information about you for workers’ compensation or similar programs as
authorized by state laws. These programs provide benefits for
work-related injuries or illness.
16. Public Health Risks- We may disclose protected health
information about you for public health activities, to, for example:
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prevent or
control disease, injury or disability;
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report births
and deaths;
-
report child
abuse or neglect;
-
report
reactions to medications or problems with products;
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notify people
of recalls of products they may be using;
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notify a
person who may have been exposed to a disease or may be at risk for
contracting or spreading a disease or condition as ordered by public
health authorities;
-
notify the
appropriate government authority if we believe a patient has been
the victim of abuse, neglect or domestic violence, if you agree or
when required by law.
17. Health Oversight Activities-
We may disclose your protected health information to a health
oversight agency for activities necessary for the government to
monitor the health care system, government programs, and compliance
with applicable laws. These oversight activities include, for example,
audits, investigations, inspections, medical device reporting and
licensure.
18. Lawsuits and Disputes- If you are involved in a lawsuit or
a dispute, we may disclose protected health information about you in
response to a court or administrative order. We may also disclose
protected health 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.
19. Law Enforcement- We may release protected health
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;
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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 I-70 Community Hospital; and in emergency circumstances
to report a crime;
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the location
of the crime or victims; or the identity, description or location of
the person who committed the crime.
20. 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 cause of death. We may also release protected
health information about patients of I-70 Community Hospital to funeral
directors as necessary to carry out their duties.
21. National Security and Intelligence Activities- We may
release protected health information about you to authorized federal
officials for intelligence, counterintelligence, and other national
security activities authorized by law.
22. Protective Services for the President and Others- We may
disclose 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.
23. 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 correctional 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:
1. Right to Inspect and Copy- You have the right to inspect and
request a copy of your protected health information, except as
prohibited by law.
To inspect and/or request a copy of your protected health information
that may be used to make decisions about you, you must submit your
request in writing. If you request a copy of the information, we may
charge a fee of 25 cents a page to offset the costs associated with
the request.
We may deny your request to inspect and copy in certain 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 I-70 Community Hospital will review your request
and the denial. The person conduction the review will not be the
person who denied your request. We will comply with the outcome of the
review.
2. 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 for as long as the information is kept by or for I-70
Community Hospital. To request an amendment, your request must be made in
a writing that states the reason for the 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 or for I-70
Community Hospital;
is not part of the information which you would be permitted to inspect
and copy; or
is accurate and complete
3. Right to an Accounting of Disclosures- You have the right to
request one free accounting every 12 months of the disclosures we made
of protected health information about you. To request this list, you
must submit your request in writing. Your request must state the time
period during which disclosures should be counted. The time period may
not be longer than six years and may not include dates before November
15, 2005. Your request should indicate in what form you want the list
(for example, on paper, electronically). 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.
4. 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 of the payment for your care, like a family
member or friend. For example, you could ask that we not use or
disclose information about a surgery 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. 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.
5. 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. 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.
6. 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 web site,
www.i70medcenter.com
To obtain a paper copy of this notice, contact:
Julie
Davenport, Director
of Patient Services
I-70 Community Hospital
105 Hospital Drive
Sweet Springs, Missouri 65351
Phone: 660-335-7409
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 in
I-70 Community Hospital. The notice will contain on the first page, near
the top, the effective date. In addition, each time you register at
I-70 Community Hospital for treatment or health care services we will make
available to you, if you request, a copy of the current notice in
effect.
AUTHORIZATION FOR 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 authorization. If you provide us authorization to use or
disclose protected health information about you, you may revoke that
authorization, in writing, at any time. If you revoke your
authorization, 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 authorization, and that we
are required to retain our records of the care that we provided to
you.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a
written complaint with I-70 Community Hospital or with the Secretary of
the Department of Health and Human Services. To file a complaint with
the I-70 Community Hospital, write:
Julie
Davenport, Director
of Patient Services
I-70 Community Hospital
105 Hospital Drive
Sweet Springs, Missouri 65351
Phone: 660-335-7409
To file a complaint with the
Secretary of the Department of Health and Human Services, contact:
The U.S. Department
of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201
HHS.Mail@hhs.gov
The complaint
to the Secretary must be filed within 180 days of when the complainant
knew or should have known that the act or omission complained of
occurred. The complaint must be in writing, either on paper or
electronically, name the entity that is the subject of the complaint
and describe the acts or omissions believed to be in violation of the
standards.
You will not be penalized for filing a complaint.
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