Notice
of Privacy Practices
This notice describes how medical information about you may be used and disclosed and how you can get access to this information.
PLEASE
READ CAREFULLY
ABOUT THIS NOTICE
Each time you register at or are admitted to the Hospital
for treatment or health care services as an inpatient or outpatient, we will
make available copies of the current Notice.
We reserve the right to make
changes to this notice. Any revisions to our Notice will be
posted on the Interfaith Medical
Center website at www.interfaithmedical.com.
USES AND DISCLOSURES OF PHI
PHI includes demographic and medical
information that concerns the past, present, or future physical or mental
health of an individual. Demographic information could include your name,
address, telephone number, social security number and any other means of identifying
you as a specific person. PHI contains specific information that identifies a
person or can be used to identify a person.
PHI is health
information created or received by a health care provider, health plan,
employer, or health care clearinghouse. This medical information is used by IMC
in many ways while performing normal business activities.
Your PHI may be used or disclosed by for
purposes of treatment, payment, and health care operations. Exceptions to this rule are found in
the subsection of this form labeled EXCEPTIONS.
For Treatment: We may use medical
information about you to provide you with medical treatment or services you require. 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. An example would be
if your physician discloses your health information to another doctor for the
purposes of a consultation. 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. 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.
For 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. We may also tell your health plan
about a treatment you are going to receive in order to obtain prior approval or
to determine whether your plan will cover the treatment. We may also disclose
information about you to other healthcare facilities for purposes of payment as
permitted by law.
You may request us to withhold medical information from
your health plan if the information relates to services you paid for yourself
in full.
For
Health Care Operations: We may use and/or
disclose your information for the purposes of our day-to-day operations and
functions. For example, we may compile your health information, along with that
of other patients, in order to allow us to review that information and make
suggestions concerning how to improve the quality of care. We have agreed, to
the extent permitted by law, to share your PHI among ourselves for purposes of
treatment, payment or health care operations. This enables us to better address
your health care needs. Also, we may contact you as part of our efforts to
raise funds for IMC. All fundraising communications will include information
about how you may “opt out” of future fundraising communications.
OTHER
USES OF PHI
We may also use or disclose health information in
connection with your care in the following circumstances.
Inpatient
Directory: We may include
certain limited information about you in our directory while you are a patient
at the Hospital, so that your family, friends and clergy can visit you and
generally know how you are doing. This information may include 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, 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, general condition or death, and to organizations that are involved in
those tasks during disaster situations.
The following categories can also be
disclosed without your written authorization as allowed by law. Those
circumstances include but are not limited to:
Ø Reporting abuse and neglect of children,
adults, or disabled person, or domestic violence;
Ø Public health purposes including vital
statistics, disease reporting, public health surveillance, investigations,
interventions and regulation of health professionals;
Ø For health oversight activities, such as audits or civil, administrative
or criminal investigations;
Ø Court orders, warrants, or subpoenas;
Ø Research approved by the Hospital;
Ø Law
enforcement purposes, administrative
investigations, and judicial and administrative proceedings;
Ø To assist coroners, medical examiners or funeral directors with their
official duties;
Ø To facilitate organ, eye or tissue donation;
Ø To avert a serious threat to health or safety;
Ø For specialized governmental functions, such as military, national
security, criminal corrections, or public benefit purposes; and
Ø For workers' compensation purposes, as permitted by law.
EXCEPTIONS:
The following categories of information receive special
protection under state law, and will be used and disclosed only as allowed by
state law:
Ø HIV-related information;
Ø Records of mental health treatment;
Ø Substance abuse records.
If you are under 18 years of age, your parent or guardian will control
access to, and disclosure of, your health information, subject to the
provisions of this Notice, with the following exceptions:
1. Communicable
Diseases. If you are being diagnosed or treated for a sexually
transmitted disease or any other disease or condition that we are required by
law to report to the government or health authorities, you (the minor) will
control access to, and disclosure of, your health information that is related
to that diagnosis or treatment.
2. Mental Health. If you are over
14 years of age, and you are able to understand the nature of your mental
health records and the purpose of releasing them, you will control access to,
and disclosure of, the health information related to your mental health
treatment.
Other uses and
disclosures of your PHI not covered by this Notice or the laws that apply to us
will require your written authorization. This authorization will have an
expiration date that can be revoked by you in writing. These uses and
disclosures may be for marketing, fundraising and for research purposes. Certain
uses and disclosure of psychotherapist notes will also require your written
authorization.
INDIVIDUAL
RIGHTS
You have the right to make certain requests of us related to your PHI.
For example you have the right:
- To inspect and copy your medical records
- To request that we amend health information that you believe is
incorrect
- To request that we communicate with you in a particular way (ex. via
e-mail)
- To an accounting of disclosures
- To request that we restrict the uses and disclosures of your health
information
- To request confidential communication
Right to Access 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. This right does not include psychotherapy notes, information
compiled for use in a legal proceeding, or certain information maintained by
laboratories.
In order to inspect and copy medical information that may
be used to make decisions about you, you must submit your request in writing to
the Hospital’s Health Information Management Department. 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 limited circumstances. If you are denied access to
medical information, you may request that the denial be reviewed. A licensed
healthcare professional will conduct the review. The reviewer will not be the
person who denied your original request. We will comply with the outcome of the
review.
You also have the right to obtain access to your PHI in an
electronic format, when requested.
You are also permitted to designate another person or entity to be the
recipient of the transmittal of such electronic PHI.
Right to
Amend: If you think 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 Hospital’s Health Information Management Department. You
must give 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:
Ø was not created by us, unless the person or entity that created the
information is no longer available to make the amendment;
Ø is not part of the medical information kept by or for the Hospital;
Ø is not part of the information that you would be permitted to inspect and
copy; or
Ø is accurate and complete.
We will provide you with written notice of action we take
in response to your request for amendment.
Right to an Accounting of Disclosures: You have the right to request an “accounting of
disclosures.” This is a list of certain disclosures we made of medical
information about you. If your PHI is disclosed through an electronic health
record (EHR), we are required to provide you with an accounting, when requested, for up
to three years prior to the request. Uses and disclosures of PHI through an
electronic health record include treatment, payment and healthcare operations.
To request an accounting of disclosures, you must submit
your request in writing to Health Information Management Department. Your
request must state a time period. We will attempt to honor your request. If you
request more than one accounting in any 12-month period, we may charge you for
our reasonable retrieval, list preparation and mailing costs for the second and
subsequent requests. We will notify you of the costs 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 PHI we use or disclose about you for treatment, payment or
health care operations. You also have the right to request a limit on the PHI
we disclose about you to someone who is involved in your care or the payment
for your care, such as a family member or friend. We are not required to
agree to your request. If we agree, we will comply with your request unless the
information is needed to provide you emergency treatment. We are required to
agree with requested restrictions if:
Ø The disclosure is made to a health plan for purposes other
than treatments
Ø If you or someone else pays in full for the care that is
the subject of the PHI
Right
to Request Confidential 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 Health Information Management
Department. All reasonable requests will be granted.
Right
to a Paper Copy of This Notice: You have the
right to a paper copy of this Notice at your first treatment encounter at the
Hospital. You may get an additional copy of this Notice at any time by
contacting the Admitting Department. You may also obtain a copy of this notice
at our website, http://www.interfaithmedical.com
COMPLAINTS
If you believe your
privacy rights have been violated, you may file a complaint with the Hospital. The complaint must be
in writing, describing the acts or omissions that you believe violate your
privacy rights. IMC will not retaliate against you for filing a complaint.
All complaints must be submitted in writing to:
Corporate Compliance Officer
Interfaith
AMENDMENTS/ACCOUNTING
& DISCLOSURES: If you wish to request an amendment or accounting of disclosures please
submit your request in writing to:
Health Information Management Department
Interfaith
Effective and Revised Date This Notice of Privacy Practices is effective
beginning April 1, 2003, and has been revised on February 3, 2010. This notice is effective as of April 1,
2003. The notice has been revised February 3, 2010