NOTICE OF PRIVACY PRACTICES
Effective Date April 14, 2003
DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED
AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT
you have any questions about this notice, please contact:
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
Any member of a volunteer group that we allow to help you
Contracted employees responsible for providing care or performing tests
Any student who is receiving clinical experience or job shadowing at the
OUR PLEDGE REGARDING
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
WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU
The following categories describe different ways that we may use and
disclose health information:
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
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.
For Health Care
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.
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
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.
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.
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.
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.
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
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.
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.
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
Food and Drug
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.
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.
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.
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.
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.
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
a restriction on certain uses and disclosures of your health information
as provided by 45 CFR 164.22
a paper copy of the notice of information practices upon request or on
our web page at
and copy your record of health information as provided for in 45 CFR
Amend your record of health information as provided in 45 CFR 164.528
an accounting of disclosures of your health information as provided in
45 CFR 164.528
communications of your health information by alternative means or at
an authorization to use or disclose health information except to the
extent that action has already been taken
The Hospital is required to:
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
by the terms of this notice
you if we are unable to agree to a requested restriction
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
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.
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.