HIPPA NOTICE OF PRIVACY PRACTICES
Platte Health Center/ Avera Health
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.
If you have any questions about this notice, please
contact Nancy Nachtigal at nancy.nachtigal@phcavera.org.
WHO WILL FOLLOW THIS NOTICE?
This notice describes our
hospital’s practices and that of:
v
Any health
professional authorized to enter information into your hospital chart.
v
All departments
and units of the hospital.
v
Any member of a
volunteer group we allow to help you while you are in the hospital.
v
All employees,
staff and other hospital personnel.
OUR PLEDGE REGARDING MEDICAL INFORMATION:
We understand that medical
information about you and your health is personal. We are committed to
protecting medical information about you. We created a record of the care and
services you receive at the hospital. We need this record to provide you with
quality care and to comply with certain legal requirements. This notice applies
to al of the records of your care generated by the hospital, whether made by
hospital personnel or your personal doctor. Your personal doctor may have
different policies or notices regarding doctor’s use and disclosure of your
medical information created in the doctor’s office or clinic.
This notice will tell you
about the ways in which we may use and disclose medical information about you.
We also describe your rights and certain obligations we have regarding the use
and disclosure of medical information.
We are required by law to:
v
make sure that medical
information that identifies you is kept private;
v
give you this
notice of our legal duties and privacy practices with respect to medical
information about you; and
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follow the terms
of the notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT
YOU.
The following categories
describe different ways that we use and disclose medical information. For each
category of uses or disclosures we will explain what we mean and try to give
some examples. Not every use or disclosure in a category will be listed.
However, all of the ways we are permitted to use and disclose information will
fall within one of the categories.
v
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 in
the hospital. For example, a doctor treating you for a broken leg may need to
know if you have diabetes because diabetes may slow down 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.
v
For Payment: We may use and disclose medical information about you so that the
treatment and services you receive at the 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
the hospital so you health plan will pay us or reimburse you 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 you plan will cover the
treatment.
v
For Health Care Operations: We may use and
disclose medical information about you for hospital 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 performance of our staff
in caring for you. We may also combine medical information about many hospital
patients to decide what additional services the 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 hospital personnel for review and learning purposes. We may
also combine the medical information we have with medical information from
other hospitals 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.
v
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.
v
Treatment Alternatives: 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.
v
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.
v
Fundraising Activities: We may use medical information about you to contact
you in an effort to raise money for the hospital and its operations. We may
disclose medical information to a foundation related to the hospital so that
the foundation may contact you in raising money for the hospital. We only would
release contact information, such as your name, address and phone number and
the dates you received treatment or services at the hospital. If you do not
want the hospital to contact you for fundraising efforts, you must notify
Platte Health Center
in writing.
v
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 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.
v
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.
v
Research:
Under certain circumstances, we may use and disclose medical information about
you for research purposes. For example, a research project may involve
comparing 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 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 the hospital.
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As Required By Law: We will disclose medical information about you when
required to do so by federal, state or local law.
v
To Avert a Serious Threat to Health or Safety: We may use and disclose medical information about you
hen necessary to prevent a serious threat to your 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:
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Organ and Tissue Donation: If you are an organ donor, we may release medical
information about you as required by military command authorities. We may also
release medical information about foreign military personnel to the appropriate
foreign military authority.
v
Military and Veterans: If you are a member of the armed forces, we may
release medical information about you as required by military command
authorities. We may also release medical information about foreign military
personnel to the appropriate foreign military authority.
A
hospital that is a component of the Department of Defense or Transportation
should also include the following. “If you are a member of the Armed Forces, we
may disclose medical information about you to the Department of Veterans’
Affairs upon your separation or discharge from military services. This
disclosure is necessary for the Department of Veterans’ Affairs to determine if
you are eligible for certain benefits.
v
Worker’s Compensation: We may release
medical information about you for worker’s compensation or similar programs.
These programs provide benefits for work-related injuries or illness.
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Public Health Risks: We may disclose medical information about you for
public health activities. These activities generally include the following:
Ø
to prevent or
control disease, injury or disability;
Ø
to report child
abuse or neglect;
Ø
to report
reactions to medications or problems with products;
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to notify people
of recalls of products they may be using;
Ø
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;
Ø
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.
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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.
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Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may
disclose medical information about you in a 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.
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Law Enforcement: We may release medical information if asked to do so by a law
enforcement official:
Ø
In response to a
court order, subpoena, warrant, summons or similar process;
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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;
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About a death we
believe may be the result of criminal conduct;
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About criminal
conduct at the hospital; and
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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.
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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 the hospital to funeral directors as necessary to carry out
their duties.
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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.
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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.
Hospitals
which are components of the Department of State should also include the
following: “Security Clearances:
We may use medical information about you to make decisions regarding your
medically suitability for a security clearance or service aboard. We may also
release your medical suitability determination to the officials in the
Department of State who need access to that information for these purposes.”
v
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 other; 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:
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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
Platte Health Center % Medical Records. 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 the hospital will review your request 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.
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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
hospital.
To
request an amendment, your request must be made in writing and submitted to
Platte Health Center % Medical Records. 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:
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Was not created
by us, unless the person or entity that created the information is no longer
available to make the amendment;
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Is not part of
the medical information kept by or for the hospital;
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Is not part of
the information which you would be permitted to inspect and copy; or
Ø
Is accurate and
complete.
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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 Platte Health Center % Medical
Records. Your request must state a time period which may not be
longer than six years and may not include dates before February 26, 2003. 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.
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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, 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 to
Platte Health Center % Medical Records. 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.
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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
Platte Health Center % Medical Records. We will 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.
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Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice.
You might 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.
To
obtain a paper copy of this notice, Platte Health Center.
CHANGES TO THIS NOTICE
We
reserve the right to change this notice. We reserve the right to make the
revised or change effective for medical information we already have about you
as we; as well as any information we receive in the future. We will post a copy
of the current notice in the hospital. The notice will contain on the first
page, I the top right-hand corner, the effective date. In addition, each time
you register at or are admitted to the hospital 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 hospital or with the Secretary of the Department of Health and Human Services.
To file a complaint with the hospital, contact
Nancy Nachtigal. All complaints must be
submitted in writing.
You
will not be penalized for filing a complaint.
OTHER USES OF MEDICAL INFORMATION
Other
uses and disclosures of medical information not covered by this notice or they
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 anytime. 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.