NOTICE OF PRIVACY PRACTICES

                                   Effective Date     April 14, 2003

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:

This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment, or healthcare operations and for other purposes that are permitted or required by law.  It also describes your rights to access and control your protected health information.  “Protected health information” is any information about you, including demographic information, that identifies you and is related to your health.  This information may be spoken, electronic, or written.

In addition to the departments, employees, staff, and other personnel associated with the Hospital (Bates County Memorial Hospital, Bates County Memorial Hospital Home Care, and Nursery Street Family Care Clinic), the following will also follow the practices described in this Notice of Privacy Practices: 

·        Any health care professional who is authorized to enter information in your medical record

·        Any member of a volunteer group that we allow to help you

·        Contracted employees responsible for providing care or performing tests for you

·        Any student who is receiving clinical experience or job shadowing at the Hospital

OUR PLEDGE REGARDING MEDICAL INFORMATION

We understand that health information about you is confidential, and we are committed to protecting this information.  We create a record of the care and services you receive at the Hospital in order to provide you with quality care and comply with certain legal requirements.  This notice applies to all of the records of your care generated by the Hospital.

 HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

The following categories describe different ways that we may use and disclose health information:

 Ø      For Treatment.  Doctors, nurses, technicians, medical students, and other Hospital personnel may use or disclose your health information in order to care for you while a patient 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 the healing process.  In addition, the doctor may need to tell the dietician if you have diabetes so that arrangements can be make for appropriate meals.  Different departments of the Hospital also may share medical information about you in order to coordinate services.  Upon your discharge from the Hospital, your health information will be provided to your physician/healthcare provider to assist with your aftercare. 

Ø      For Payment.  We may use and disclose health 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 your 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 your plan will cover the treatment.

Ø      For Health Care Operations.  We may use and disclose health 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 health information to review our treatment and services and to evaluate the performance of our staff in caring for you.  We may also combine health 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 remove information that identifies you from this set of health information so others may use it to study health care and health care delivery without learning who the specific patients are. 

Ø      Business Associates.  There are some services provided in our organization through contacts with business associates.  Examples include physician services in the emergency department and radiology, and the performance of certain laboratory tests.  When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we’ve asked them to do and bill you or your third-party payer for services rendered.  We require the business associate to appropriately safeguard your health information. 

Ø      Directory.  Unless you notify us of your objection, we may disclose your name, location in the facility, general condition, and religious affiliation to those people who ask for you by name and to the clergy.

Ø      Notification.  We may use or disclose your medical information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition.

 Ø      Communication With Family.  Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care.

 Ø      Research.  We may disclose your health information to researchers when their research has been approved by an institution review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.

Ø      Coroner, Medical Examiner, or Funeral Director.  We may disclose your health information to a coroner, medical examiner, or funeral director consistent with applicable laws to carry out their duties. 

Ø      Organ Procurement Organizations.  Consistent with applicable law, we may disclose your health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant. 

Ø      Marketing.  We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Ø      Fundraising.  We may use your contact information (name, address, phone number, date of service) in an effort to raise money for the Hospital and its Foundation.  If you don’t want the Hospital to contact you, you must notify the Hospital in writing. 

Ø      Food and Drug Administration (FDA).  We may disclose your health information to the FDA relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, and replacement. 

Ø      Workers Compensation.  We may disclose your health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

Ø      Public Health.   As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability. 

Ø      Correctional Institutions.  Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals. 

Ø      Law Enforcement.  We may disclose your health information for law enforcement purposes as required by law or in response to a valid subpoena.  

Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients.

 YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU

Although your record of health information is the physical property of the Hospital, the information belongs to you.  You have the right to:

 ·        Request a restriction on certain uses and disclosures of your health information as provided by 45 CFR 164.22

·        Obtain a paper copy of the notice of information practices upon request or on our web page at www.bcmhospital.com

·        Inspect and copy your record of health information as provided for in 45 CFR 164.524

·        Amend your record of health information as provided in 45 CFR 164.528

·        Obtain an accounting of disclosures of your health information as provided in 45 CFR 164.528

·        Request communications of your health information by alternative means or at alternative locations

·        Revoke an authorization to use or disclose health information except to the extent that action has already been taken

OUR RESPONSIBILITIES TO YOU

The Hospital is required to:

·        Maintain the privacy of your health information

·        Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you

·        Abide by the terms of this notice

·        Notify you if we are unable to agree to a requested restriction

·        Accommodate reasonable requests to communicate health information by alternative means or locations

CHANGES TO THIS NOTICE

We reserve the right to change this notice.  We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future.                                            

FOR MORE INFORMATION OR TO REPORT A PROBLEM

If you have questions and would like additional information, you may contact the Director of Medical Records at 660-200-7028.  If you believe your privacy rights have been violated, you can file a complaint with the Chief Executive Officer at 660-200-7001 or with the Secretary of Health and Human Services.  There will be no retaliation for filing a complaint.

 OTHER USES OF HEALTH INFORMATION

Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written permission.  If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time.  If you revoke your permission, we will no longer use or disclose health 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.