THIS NOTICE DESCRIBES HOW
HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN
GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
When this Notice refers to
"we", "us" or "Organization" it is referring
to Camden-Clark Memorial Hospital Corporation, the members of its Medical
Staff (including your physician(s), other health care providers affiliated
with the Hospital, and Camden-Clark Ambulance Service, Inc. This Notice
applies only to protected health information created or obtained in
connection with medical care provided to you in the Hospital or by
Camden-Clark Ambulance Service, Inc. It does not apply to care provided to
you in your physicians office or in the office of any other health care
provider. If you have not previously visited your physicians office,
upon your next visit you should receive that physicians Notice of
Privacy Practices as it relates to his or her own office practice.
This Notice describes how
we will use and disclose your health information. The
policies outlined in this Notice apply to all of your health information
generated by this Organization, whether recorded in your medical record,
invoices, payment forms, videotapes or other ways. Similarly, these
policies apply to the health information gathered from other organizations
by any health care professional, employee or volunteer who participates in
your care.
USES AND DISCLOSURES OF
YOUR HEALTH INFORMATION
In some circumstances
we are permitted or required to use or disclose your health
information without obtaining your prior authorization and without
offering you the opportunity to object. These circumstances include:
Uses or
disclosures for purposes relating to treatment, payment and health
care operations:
Treatment.
We may use or disclose your health information for the purpose of
providing, or allowing others to provide, treatment to you. An
example would be if your primary care physician discloses your
health information to another doctor for the purposes of a
consultation. Also, we may contact you with appointment reminders
or information about treatment alternatives or other
health-related benefits and services that may be of interest to
you.
Payment.
We may use and/or disclose your health information for the purpose
of allowing us, as well as other entities, to secure payment for
the health care services provided to you. For example, we may
inform your health insurance company of your diagnosis and
treatment in order to assist the insurer in processing our claim
for the health care services provided to you.
Health Care
Operations. We may use and/or disclose your information for
the purposes of our day-to-day operations and functions. We may
also disclose your information to another covered entity to allow
it to perform its day-to-day functions, but only to the extent
that we both have a relationship with you. For example, we may
compile your health information, along with that of other
patients, in order to allow a team of our health care
professionals to review that information and make suggestions
concerning how to improve the quality of care provided at this
facility. Also, we may contact you as part of our efforts to raise
funds for the Organization. All fundraising communications will
include information about how you may opt out of future
fundraising communications.
We have agreed, as
permitted by law, to share protected health information among ourselves
for purposes of treatment, payment or health care operations. This
enables us to better address your health care needs.
To
a Business Associate with whom we contract to provide services on
our behalf. To protect your health information, we require our
Business Associates to appropriately safeguard the health
information of our patients.
To
create material(s) that originally had any identifying information
concerning you deleted from the final material(s);
When
required by law;
For
public health purposes, such as reporting information to public
health authorities for the purpose of controlling disease, injury,
or disability;
To
disclose information about victims of abuse, neglect, or domestic
violence;
For
health oversight activities, such as audits or civil, administrative
or criminal investigations;
For
judicial or administrative proceedings;
For
law enforcement purposes;
To
assist coroners, medical examiners or funeral directors with their
official duties;
To
facilitate organ, eye or tissue donation;
For
certain research projects that have been evaluated and approved
through a research approval process that takes into account
patients' need for privacy;
To
contact you in order to ascertain your opinion about hospital
services;
To
avert a serious threat to health or safety;
For
specialized governmental functions, such as military, national
security, criminal corrections, or public benefit purposes; and
For
workers' compensation purposes, as permitted by law.
We
may also use or disclose your health information in the following
circumstances. However, except in emergency situations, we will inform
you of our intended action prior to making any such uses and
disclosures and will, at that time, offer you the opportunity to
object.
Directories
.
In the Hospital, we may maintain a directory of patients that
includes your name and location within the facility, your
religious designation, and information about your condition in
general terms that will not communicate specific medical
information about you. Except for your religion, we may disclose
this information to any person who asks for you by name. We may
disclose all directory information to members of the clergy.
Notifications
.
We may disclose to your relatives or close personal friends any
health information that is directly related to that person's
involvement in the provision of, or payment for, your care. We may
also use and disclose your health information for the purpose of
locating and notifying your relatives or close personal friends of
your location and general condition or death, and to organizations
that are involved in those tasks during disaster situations.
Except as described
above, disclosures of your health information will be made only with
your written authorization. You may revoke your authorization at any
time, in writing, unless we have taken action in reliance upon your
prior authorization, or if you signed the authorization as a condition
of obtaining insurance coverage.
YOUR RIGHTS
To
Request Restrictions. You have the right to request restrictions
on the use and disclosure of your health information for treatment,
payment or health care operations purposes or notification purposes.
We are not required to agree to your request. If we do agree to a
restriction, we will abide by that restriction unless you are in need
of emergency treatment and the restricted information is needed to
provide that emergency treatment. To request a restriction, submit a
written request to the Contact listed on the final page of this
Notice.
To
Limit Communications. You have the right to receive confidential
communications about your own health information by alternative means
or at alternative locations. This means that you may, for example,
designate that we contact you only via e-mail, or at work rather than
home. To request communications via alternative means or at
alternative locations, you must submit a written request to the
Contact listed on the final page of this Notice. All reasonable
requests will be granted.
To Access and Copy
Health Information. You have the right to inspect and copy any
health information about you other than psychotherapy notes,
information compiled in anticipation of or for use in civil, criminal
or administrative proceedings, or certain information that is governed
by the Clinical Laboratory Improvement Act. To arrange for access to
your records, or to receive a copy of your records, you should submit
a written request to the Contact listed on the last page of this
Notice. If you request copies, you will be charged our regular fee for
copying and mailing the requested information.
Despite your general
right to access your Protected Health Information, access may be denied
in some limited circumstances. For example, access may be denied if you
are an inmate at a correctional institution or if you are a participant
in a research program that is still in progress. Access may be denied if
the federal Privacy Act applies. Access to information that was obtained
from someone other than a health care provider under a promise of
confidentiality can be denied if allowing you access would reasonably be
likely to reveal the source of the information. The decision to deny
access under these circumstances is final and not subject to review.
In addition, access may
be denied if (i) access to the information in question is reasonably
likely to endanger the life and physical safety of you or anyone else,
(ii) the information makes reference to another person and your access
would reasonably be likely to cause harm to that person, or (iii) you
are the personal representative of another individual and a licensed
health care professional determines that your access to the information
would cause substantial harm to the patient or another individual. If
access is denied for these reasons, you have the right to have the
decision reviewed by a health care professional who did not participate
in the original decision. If access is ultimately denied, the reasons
for that denial will be provided to you in writing.
To
Request Amendment. You may request that your health information be
amended. Your request may be denied if the information in question:
was not created by us, is not
part of our records, is not the type of information that would be
available to you for inspection or copying (for example, psychotherapy
notes), or is accurate and complete. If your request to amend your
health information is denied, you may submit a written statement
disagreeing with the denial, which we will keep on file and distribute
with all future disclosures of the information to which it relates.
Requests to amend health information must be submitted in writing to
the Contact listed on the final page of this Notice.
To
an Accounting of Disclosures. You have the right to an accounting
of any disclosures of your health information made during the six-year
period preceding the date of your request. However, the following
disclosures will not be accounted for: (i) disclosures made for the
purpose of carrying out treatment, payment or health care operations,
(ii) disclosures made to you, (iii) disclosures of
information maintained in our patient directory, or disclosures made
to persons involved in your care, or for the purpose of notifying your
family or friends about your whereabouts, (iv) disclosures for
national security or intelligence purposes, (v) disclosures to
correctional institutions or law enforcement officials who had you in
custody at the time of disclosure, (vi) disclosures that occurred
prior to April 14, 2003, (vii) disclosures made pursuant to an
authorization signed by you, (viii) disclosures that are part of a
limited data set, (ix) disclosures that are incidental to another
permissible use or disclosure, or (x) disclosures made to a
health oversight agency or law enforcement official, but only if the
agency or official asks us not to account to you for such disclosures
and only for the limited period of time covered by that request. The
accounting will include the date of each disclosure, the name of the
entity or person who received the information and that person's
address (if known), and a brief description of the information
disclosed and the purpose of the disclosure. To request an accounting
of disclosures, submit a written request to the Contact listed on the
final page of this Notice.
To a Paper Copy of
this Notice. You have the right to obtain a paper copy of this
Notice upon request.
OUR DUTIES
We
are required by law to maintain the privacy of your health information
and to provide you with this Notice of our legal duties and privacy
practices.
We
are required to abide by the terms of this Notice. We reserve the
right to change the terms of this Notice and to make those changes
applicable to all health information that we maintain, including any
information created or received prior to issuing the new notice. Any
changes to this Notice will be posted on our internet site at www.ccmh.org
and at our facilities, and will be available from us upon request.
COMPLAINTS
You can complain to us and
to the Secretary of the federal Department of Health and Human Services if
you believe your privacy rights have been violated. To lodge a complaint
with us, please file a written complaint with the Contact set forth below.
This Contact will also provide you with further information about our
privacy policies upon request. No action will be taken against you for
filing a complaint.
