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This notice describes how medical information about you mya 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 the Hospital’s Privacy Officer at 219.886.4763. Who Will Follow this Notice
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at the Hospital and/or Hospital owned facilities. This record is called a “medical record” and is needed 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 the Hospital, whether made by Hospital personnel or your personal doctor. Your personal doctor may have different policies or Notices regarding the 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:
How We May Use and Disclose Medical Information About You In some circumstances, we are permitted or required to use or disclose your medical information without obtaining your consent, prior authorization, or without offering you the opportunity to object. 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 give some examples. However, not every use or disclosure in a category will be listed. For Treatment. We may use and disclose your medical information for the purpose of providing or allowing others, such as doctors, nurses, technicians, family practice residents, nursing students, or other Hospital personnel involved in your care, to provide you with medical treatment or services. For example, your attending doctor may disclose information about your health to another doctor to provide a consultation. If your doctor is treating you for a broken leg, he or she may need to know if you have diabetes because diabetes may slow the healing process. Your doctor may ask another doctor to consult, request diabetic education classes, and discuss your case with the Hospital dietitian to 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. For Payment. We may use and disclose your medical information for the purpose of allowing us, as well as other health care providers, to obtain payment from you, Medicare or Medicaid, an insurance company, or a third party for the health services provided to you. For example, your doctor or another doctor, who provides a consult, may use your financial information to submit a bill for your care. We may need to give your health plan information about your diagnosis and treatment so your health plan will pay us or reimburse you for medical care. 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. For Health Care Operations. We may use and disclose medical information about you for the purposes of our day-to-day functions that 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 disclose your information to another covered entity/health care provider to allow it to perform its day-to-day functions, but only to the extent that we both have a relationship with 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 the identity of individual patients. We may also disclose medical information about you to accreditation agencies, such as the Joint Commission on Accreditation of Healthcare Organizations or other certifying organizations, as part of their review and accreditation processes. In addition to the above, The Methodist Hospitals, Inc. may use or disclose your medical information for the following reasons:
Other Uses and Disclosures That May Bed Made with Your Knowledge or Opportunity to Object For the following items, you have the opportunity to agree or object to the use or disclosure of your medical information. If you are not able to agree or object to the use or disclosure of your medical information, we would use our professional judgment to determine whether the disclosure is appropriate and in your best interest. For each category of uses or disclosures we will explain what we mean and give some examples. However, not every use or disclosure in a category will be listed. 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. Individuals Involved in Your Care or Payment for Your Care. We may release medical information about your current condition to a family member or friend 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. We may reasonably infer from the circumstances that you would not object to the use and disclosure of your medical information (example—your family or friend is in the examination room and you do not ask them to leave when your condition is being discussed). 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. Fundraising Activities. We may use medical information about you in an effort to raise money for the Hospital and its operations. We may disclose medical information to a business associate or foundation related to the Hospital so that the foundation may contact you in raising money for the Hospital. We would only release contact information, such as your name, address and phone number and the dates you received treatment or services at the Hospital. We would not use any information about your illness or treatment provided to you. Additionally, all fundraising communications would include information about how you can “opt out” of any future fundraising communications. Emergencies. If you are unable to make medical decisions or in an emergency situation, we would decide if disclosing your medical information is in your best interests. Other Uses and Disclosures That May Bed Made Without Your Authorization or Opportunity to Object In the following situations we will use or disclose your medical information as required by federal, state or local 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. Any disclosure, however, would only be to someone able to help prevent the threat. Organ and Tissue Donation. If you are an organ donor, we may release medical 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 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. Workers’ Compensation. We may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness. Public Health Activities. We may disclose medical information about you for public health activities. These activities generally include the following:
Research. Under certain circumstances, we may use and disclose medical information about you for research purposes. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information with the patient’s need for privacy of his/her medical information. 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. 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. Judicial and Administrative Proceedings. If you are involved in a lawsuit or a dispute, we may disclose medical information about you in 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. Law Enforcement. We may release medical information if asked to do so by a law enforcement official:
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. 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. 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 to conduct special investigations. 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:
Your Rights Regarding Medical Information About You The following sections list your rights regarding the medical information we maintain about you, subject to certain conditions. Also, please note that some “rights” listed below are a right to make a request. The Hospital may grant or deny the request depending on the individual circumstances. Right to Inspect and Request a Copy. You have the right to inspect and request a copy of medical information that may be used to make decisions about your care. Usually, this includes your medical record and billing summary and/or an itemized bill, but does not include psychotherapy notes. To inspect and request a copy of medical information that may be used to make decisions about you, you must submit your request in writing to the Medical Records Department or the Central Business Office. If you request a copy of the information, we may charge a reasonable 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 limited circumstances. If you are denied access to medical information, you may request to the Privacy Officer that the denial be reviewed. Another licensed health care professional chosen by the 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 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 the Medical Records Department or Central Business Office. In addition, you must provide a reason that supports your request. We will act on your request within sixty (60) days of receipt of the request. We may extend the time for such action by up to thirty (30) days if we provide you with a written explanation of the reasons for the delay and the date by which we will complete the action on 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:
If we deny your request for amendment, you will receive a timely, written denial in plain language that explains the basis for the denial, your rights to submit a statement disagreeing with the denial and an explanation of how to submit the statement. Right to an Accounting of Disclosures. You have the right to request an accounting of disclosures made by us for up to six (6) years prior to the date on which the accounting is requested for any reason other than for treatment, payment or health care operations and other applicable exceptions. To request this list of accounting of disclosures, you must submit your request in writing to the Medical Records Department or the Central Business Office. Your request must state a time period which may not be longer than six years and may not include dates before April 14th, 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. 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 or 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 attempt to 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 the Hospital’s Privacy Officer. In your request, you must tell us:
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. We will ask you during the admitting and registration process if you have any requests for confidential communications. We will not ask you the reason for your request. We will attempt to accommodate reasonable requests. However, if we are unclear about your request or if we need further information before we can reply to you, we may ask that you submit your request in writing to the Hospital’s Privacy Officer. In your request, must specify how or where you wish to be contacted. If you have questions concerning this process or confidential communications, please contact the Hospital’s Privacy Officer. 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 also obtain a copy of this Notice at our website, www.methodisthospitals.org. If you have any questions about this matter, please contact the Hospital’s Privacy Officer. Changes to this Notice For More Information or to Report a Problem or Concern If you would like more information about this Notice, or to report a problem or concern, please ask your caregiver or the Privacy Officer to assist you. All problems or concerns must be submitted in writing and state the specific incident (s) in terms of subject, date and other relevant matters. 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. You will not be penalized for filing a complaint. The complaint needs to be filed in writing, either on paper or electronically. The complaint needs to be filed within 180 days of the incident to the following: Secretary of Health and Human Services (HHS) |
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