NOTICE OF PRIVACY PRACTICES
YOUR INFORMATION. YOUR RIGHTS.
When it comes to your health information, you have certain rights. 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.
Your health information rights:
You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you.
We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
You can ask us to correct health information that you think is incorrect or incomplete. We may say “no” to your request, but we will tell you why in writing within 60 days.
You can ask us to contact you in a specific way (for example, home or office phone) or send email to a different address. We will say “yes” to all reasonable requests.
You can ask us not to share certain health information for treatment, payment or our operations. We may say “no” if it would affect your care.
You can ask for a list of the times we’ve shared your health information for 6 years prior to the date you ask, who we shared it to and why. We’ll provide one list a year for free but will charge a reasonable, cost-based fee if you ask for additional requests within a 12-month period.
You can ask for a paper copy of this notice at any time.
Your medical power of attorney or legal guardian can exercise your rights and make choices about your health information if they have the appropriate authority.
You can complain if you feel your rights have been violated to Hospital Leadership or file a complaint with the U.S. Dept. of Health and Human Services Office for Civil rights by sending a letter to 200 Independence Ave. S.W., Washington, DC 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/
- You have both the right and choice to tell us to:
Share information with family, friends, and others involved in your care;
Share information in a disaster relief situation;
Include your information in a hospital directory;
Contact you for fundraising efforts. We may share your information when needed to lessen a serious and imminent threat to health and safety.
- We never share your information unless you give us written permission for:
Sale of your information;
Sharing of psychotherapy notes.
In the case of fundraising we may contact you, but you can tell us not to contact you again.
Our uses and disclosures:
We can use your health information and share it with other professionals who are treating you.
We can use and share your health information to manage your treatment and services.
We can give information about you to your health insurance plan so it will pay for your services.
We can share your health information for certain situations such as: preventing disease, helping with product recalls, reporting adverse reactions to medications, reporting suspected abuse, neglect, or domestic violence, preventing or reducing serious threat to anyone’s health or safety.
We can use or share your information for health research.
We will share information about you if state or federal laws require it.
We can share health information about your with organ procurement organizations.
We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
We can use or share your health information for: worker’s compensation claims, law enforcement purposes or with a law enforcement official, with health oversight agencies for activities authorized by law, and/or for special government functions such as military national security, and presidential protective services.
We can share health information about you in response to court or administrative order, or in response to a subpoena.
We are required by law to maintain the privacy and security of your protected health information.
We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
We must follow the duties and privacy practices described in this notice and give you a copy of it.
We will not use or share your information other than is described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time by telling us in writing.
We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office and on our website.
Effective Date of Notice: Jan. 1, 2021