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Alabama - English (2018)
Effective 4/14/03

Effective 7/31/2018


St. Vincent's Health System | Ascension

Organized Healthcare Arrangement

JOINT NOTICE OF HEALTH INFORMATION 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 REVIEW IT CAREFULLY.



UNDERSTANDING YOUR HEALTH RECORD/INFORMATION

St. Vincent’s Health System and its affiliates (STVHS) create a record of the care and services you receive at the hospital. We understand that medical information about you and your health is personal. We are committed to protecting the confidentiality of medical information we maintain about you.

This notice describes the way that STVHS employees and contracted workers, as well as the physician members of the medical staff and allied health professionals who practice at STVHS will treat your health information created while you are a patient at one of the following St. Vincent’s entities, sites, and locations. All these entities, sites, and locations follow the terms of this Notice.


St. Vincent’s Birmingham

St. Vincent’s East

St. Vincent’s One Nineteen

St. Vincent’s Blount

St. Vincent’s St. Clair

St. Vincent’s Physician Alliance

St. Vincent’s Chilton

St. Vincent’s Trussville

Vincentian Ventures of North Alabama

This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.


YOUR HEALTH INFORMATION RIGHTS

Although your health record is the physical property of STVHS, the information contained within it belongs to you. You have the following legal rights with respect to your health information:

  • You have the right to request a restriction on certain uses and disclosures of your information for treatment, payment, health care operations and as to disclosures permitted to persons, including family members involved with your care. However, we are not required by law to agree to a requested restriction, except for when you request that we not disclose information to your health plan about services for which you paid out-of-pocket in full. In those cases, we will honor your request, unless the disclosure is necessary for your treatment or is required by law. Requests for restrictions must be made in writing to: Privacy Officer, St. Vincent’s Health System, 810 St. Vincent’s Drive, Birmingham, AL 35205.


  • You have the right to obtain a paper copy of this notice of information practices upon request. Please contact the STVHS Privacy Officer at 1-866-742-4922 to request a copy of this Notice. A copy of this notice may also be obtained from St. Vincent’s website at www.stvhs.com.


  • Except under certain limited circumstances, you have the right to inspect and request a copy of your health record. You do not have the right to free copies of your records. We will charge you a reasonable fee for copying your records.


  • If you believe that information in your records is incorrect or incomplete, you have the right to request that we amend your health record. However, we are not required by law to agree to a request to amend your health record. We will notify you if we are unable to grant your request.


  • You have the right to ask for a list of instances when we have disclosed your health information for any reasons other than treatment, payment, healthcare operations or upon your written authorization. If you ask for this information more than once in a twelve month period, we may charge you a fee for responding to your request.


  • You have the right to request communications of your health information by alternative means or at alternative locations. For example, you may ask that we contact you only at home or through a post office box. We will accommodate reasonable requests. To request confidential communications, you must make your request in writing to: Privacy Officer, St. Vincent’s Health System, 810 St. Vincent’s Drive, Birmingham, AL 35205.


  • You have the right to revoke your authorization to use or disclose health information except to the extent that action has already been taken.

    You may exercise your rights set forth in this notice, by providing a written request to the Health Information Management department of STVHS unless otherwise specified above.

    OUR RESPONSIBILITIES


    In addition to the responsibilities set forth above, we are also 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 maintain about you;

  • Abide by the terms of this notice as it may be revised from time to time;

  • Notify you if we are unable to agree to a requested restriction on certain uses and disclosures.


We must obtain your written authorization before we may use or disclose your psychotherapy notes, except for: use by the originator of the psychotherapy notes for treatment; use or disclosure by STVHS for its own mental health training programs; or use or disclosure by Covered Entity to defend itself in a legal action or other proceeding brought by the individual.


We must obtain your written authorization before we may sell your PHI.


We are required to notify you in the event of a breach of your unsecured PHI.


STVHS reserves the right to change our practices and to make the new provisions effective for all protected health information we maintain, including information created or received before the change. Should our information practices change we are not required to notify you, but we will have the revised notice available for you to request at each of the facilities within STVHS and on St. Vincent’s website, http://www.stvhs.com.


STVHS is required to abide by the terms of this Notice as currently in effect. We will not use or disclose your health information without your written authorization, except as described in this notice or permitted by law.


EXAMPLES OF DISCLOSURES FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS AND AS OTHERWISE ALLOWED BY LAW

The following categories describe different ways that we use and disclose medical information.

For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information should fall within one of the categories.

FOR TREATMENT:

For example: We may disclose medical information about you to doctors, nurses, technicians, medical students, or other personnel who are involved in taking care of you within the facility. We may share medical information about you in order to coordinate different treatments, such as prescriptions, lab work and x-rays. We may also provide your other health-care providers with copies of various reports to assist in treating you after you are discharged from the facility. In some cases the sharing of your PHI with other health care providers, health plans and hospitals may be done electronically through an electronic health information exchange (‘HIE’) operated by STVHS or a business associate. By using an HIE, we may be able to make your PHI available to those who care for you in a more timely and effective manner, and thus help to improve the coordination of your care. Contact the Corporate Privacy Officer at 1-866-742-4922 with any questions or concerns.

FOR PAYMENT:

For example: A bill may be sent to you or a third-party payer such as an insurance company or an HMO. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, the medical procedures performed on you, and supplies used in taking care of you.

FOR HEALTH CARE OPERATIONS:

For example: We may use the information in your health record to assess the care and outcome in your case and others like it.

This information will then be used in an effort to continually improve the quality and effectiveness of the health care and services we provide.

ORGANIZED HEALTH CARE ARRANGEMENTS: Each of the hospitals in the STVHS has a medical staff, which includes physicians and other professionals who are not employees of the hospital. In addition, St. Vincent’s Physician Alliance is an arrangement between STVHS and a number of physicians from each medical staff (including physicians employed by STVHS Medical Group). These parties are participants in an organized health care arrangement, which permits protected health information to be shared for purposes of treatment, payment and/or health care operations (described above) relating to such organized health care arrangement. STVHS may participate in organized health care arrangements in addition to those listed immediately above and may share protected health information with the other participants in such organized health care arrangements.


WE WILL USE YOUR HEALTH INFORMATION TO COMMUNICATE WITH FAMILY AND FRIENDS INVOLVED IN YOUR CARE.

We may release health information about you to a friend or family member who is involved in your medical care. We may also give information to a family member or friend who helps pay for your care. Unless you object to being included in our patient information system (hospital directory), we may also tell your family members or friends about your general medical condition and that you are in the facility.

WE WILL USE YOUR HEALTH INFORMATION TO COMMUNICATE WITH YOU.

We may use and disclose medical information to contact you by telephone, cell phone, texting, e-mail, patient portal or mail. We will do this in order to remind you that you have an appointment for treatment, medical care, or other services at the facility.


WE WILL USE YOUR HEALTH INFORMATION AS OTHERWISE ALLOWED BY LAW.

The following are some examples of how we may use and disclose medical information about you.


BUSINESS ASSOCIATES: There are some services provided in our organization through contracts with business associates. Examples include certain laboratory tests, and copy services. To protect your health information, however, we require business associates to take the appropriate measures to safeguard your information.

DIRECTORY: Unless you notify us that you object, we will use your name, your room number or other location within in the facility, your general medical condition (such as serious, good, fair, etc.), and your religious affiliation as part of our hospital patient information system. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name.

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

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

FUNERAL DIRECTORS: We may disclose health information to funeral directors consistent with applicable law to carry out their duties.

ORGAN PROCUREMENT ORGANIZATIONS: Consistent with applicable law, we may disclose 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.

MARKETING: We may contact you to provide information about treatment alternatives or other health-related benefits, goods, and services provided by the facility that may be of interest to you. We must obtain your written authorization before we may use or disclose your PHI for marketing purposes, except for face-to-face communications made by us to you or a promotional gift of nominal value provided by us to you.

FUNDRAISING: We may contact you to raise money for the Health System. We would use only contact information, such as your name, address and phone number, and the dates you were here. We may communicate with you as part of our fundraising activities, but you have the right to opt out of receiving such communications. If you do not want the Health System to contact you for fundraising efforts, you must notify us in writing. Your notification must be sent to: St. Vincent’s Foundation, One Medical Park East Drive, Birmingham, AL 35235.

UNITED STATES FOOD AND DRUG ADMINISTRATION (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, medications, devices, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

HEALTH OVERSIGHT ACTIVITIES: We may disclose your health information to a health oversight agency for activities authorized by law. These oversight activities might include audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government benefit programs, and compliance with civil rights laws.

WORKER’S CO MPE NSATIO N: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs established by law.

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.

ABUSE, NEGLECT OR DOMESTIC VIOLENCE: As required by law, we may disclose health information to a governmental authority authorized by law to receive reports of abuse, neglect, or domestic violence.

JUDICIAL, ADMINISTRATIVE AND LAW ENFORCEMENT PURPOSES: Consistent with applicable law, we may disclose health information about you for judicial, administrative and law enforcement purposes. This may include disclosures in response to subpoenas or court orders.

TO AVERT A SERIOUS THREAT TO HEALTH OR SAFETY: We may use and disclose your health information when we believe it is necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent or lessen the threat or to law enforcement authorities in particular circumstances.

NATIONAL SECURITY AND INTELLIGENCE ACTIVITIES: We may release your health information to authorized federal officials for lawful intelligence, counterintelligence, and other national security activities authorized by law.

PROTECTIVE SERVICES FOR THE PRESIDENT AND OTHERS: We may disclose your health information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or for the conduct of special investigations.

CUSTODIAL SITUATIONS: If you are an inmate in a correctional institution and if the correctional institution or law enforcement authority makes certain representations to us, we may disclose your health information to a correctional institution or law enforcement official.

REQUIRED OR ALLOWED BY LAW: We will disclose medical information about you when required or allowed to do so by federal, state or local law.

FOR MORE INFORMATION OR TO REPORT A PROBLEM

If you have questions and would like additional information, you may contact the St. Vincent’s Health System Privacy Office at

1-866-742-4922.


If you believe your privacy rights have been violated, you can file a complaint with STVHS or with the Secretary of the Federal Department of Health and Human Services. To file a complaint with STVHS, call 1-866-742-4922. To file a complaint with the Secretary of Health and Human Services, call 404-562-7886. There will be no retaliation for filing a complaint.


St. Vincent’s Birmingham

810 St. Vincent’s Drive, Birmingham, Alabama 35205


St. Vincent’s East

50 Medical Park Drive East, Birmingham, Alabama 35235


St. Vincent’s St. Clair

7063 Veterans Parkway, Pell City, Alabama 35125


St. Vincent’s Blount

150 Gilbreath Drive, Oneonta, Alabama 35121


St. Vincent’s Chilton

2030 Lay Dam Road, Clanton, Alabama 35045


St. Vincent’s One Nineteen

7191 Cahaba Valley Road, Hoover, Alabama 3542


St. Vincent’s Trussville

7201 Happy Hollow Road, Trussville Alabama 35173

Florida - English (2014)
FL_english_2014


St. Vincent's HealthCare | Ascension

NOTICE OF PRIVACY PRACTICES

Effective Date: July 23, 2014


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:

St. Vincent’s HealthCare Privacy Office

P.O. Box 2982, Jacksonville, Florida 32203


(904) 308-3983


OUR PLEDGE REGARDING HEALTH INFORMATION.


St. Vincent’s HealthCare (“SVHC”) is committed to protecting the privacy of health information. “Protected Health Information,” or “PHI,” includes information that SVHC has created or received about your past, present, or future health or condition, the provision of health care to you, or payment for health care services that may be used to identify you. This Notice applies to all the records of your care generated or maintained at SVHC. SVHC is required by law to maintain that privacy and to provide you this Notice. This Notice is provided to inform you about: (i) the ways SVHC may use and disclose PHI; (ii) your rights regarding PHI; and (iii) certain obligations SVHC has regarding the use and disclosure of PHI. SVHC is required to abide by the terms of the Notice currently in effect. However, SVHC reserves the right to change the terms of this Notice and its privacy policies at any time. Any changes will apply to the PHI SVHC already has. SVHC will promptly post any new or amended versions of this Notice. This Notice will always contain an effective date on the top of the first page.


WHO WILL FOLLOW THIS NOTICE.


This Notice applies to SVHC and its wholly owned or controlled affiliates and subsidiaries that are covered entities, including but not limited to those listed below, which are referred to collectively for purposes of this Notice as SVHC:


St. Vincent’s Medical Center, Inc. St. Vincent’s Ambulatory Care, Inc. St. Luke’s-St. Vincent’s HealthCare, Inc. St. Catherine Labouré Manor, Inc. St. Vincent’s Medical Center-Clay County, Inc. Seton Pharmacy, Inc.

Consolidated Pharmacy Services, Inc.


This Notice also applies to independent health care providers, including doctors and their employees, who participate in your care at SVHC. These independent health care providers are not agents or employees of SVHC, and they are solely responsible for the health care services they provide and for their compliance with privacy laws. They are included in this Notice so SVHC and they may share PHI with each other as allowed by law, as necessary to carry out treatment, payment, and health care operations, and to simplify the process of informing you about your rights with respect to PHI. They may use and disclose PHI in accordance with the terms of this Notice to the same extent as SVHC. These independent health care providers may have different policies or notices regarding their use and disclosure of your medical information generated or maintained at their own offices or clinics.


HOW SVHC MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU.


Following are some descriptions and examples of different ways SVHC may use and disclose PHI. Not every use or disclosure of PHI is listed below. However, all the ways SVHC is permitted to use and disclose information will fall within one of these categories. For purposes of this Notice, PHI includes information about mental health, sexually-transmissible diseases (including HIV and AIDS), alcohol and substance abuse, and other information that may be subject to additional

confidentiality provisions of federal or state law. Any use or disclosure of PHI other than those permitted by the laws, rules, and regulations regarding patient privacy will be made only with your authorization, including most uses and disclosures of psychotherapy notes, uses and disclosures of PHI for marketing purposes, and disclosures that constitute a sale of PHI.


Treatment. SVHC may use PHI to provide you with medical treatment or services. SVHC may disclose PHI to, and obtain information from, doctors, nurses, medical technicians, students, and other health care personnel who are involved in taking care of you at SVHC or at other facilities. 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 a dietitian if you have diabetes so you can receive appropriate meals. Different departments of SVHC also may share PHI in order to coordinate the tests, care, and treatment you need, such as prescriptions, lab work, and x-rays. SVHC also may disclose health information about you to people outside SVHC who may be involved in your medical care, such as family members, clergy, or others used to provide services that are part of your care.


Payment. SVHC may use and disclose PHI so the treatment and services you receive at SVHC may be billed to and payment may be collected from you, an insurance company, or a third party. For example, SVHC may need to give your health plan information about surgery you received so your health plan will pay SVHC or reimburse you for the surgery. SVHC 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.


Health Care Operations. SVHC may use and disclose PHI for SVHC operations. These uses and disclosures are necessary to run SVHC and make sure patients receive quality care. For example, SVHC may use and disclose PHI to: (i) review treatment and services and to evaluate the performance of staff in caring for you; (ii) compile data to decide what additional services SVHC should offer, what services are not needed, and whether certain new treatments are effective; (iii) educate doctors, nurses, medical technicians, students, and SVHC personnel; and (iv) compare SVHC statistics to other local, state, and national healthcare facilities to see how SVHC is doing and where SVHC can make improvements in care and services. SVHC may remove information that identifies you so others may use PHI to study health care and health care delivery without learning patient specific information.


Appointment Reminders, Treatment Alternatives, and Services. SVHC may use and disclose PHI to contact you as a reminder that you have an appointment for treatment or medical care or to tell you about possible treatment options, treatment alternatives, or health-related benefits or services that may be of interest to you. If you do not want SVHC to contact you for these purposes, you must notify the Privacy Office in writing.


Fundraising Activities. SVHC may use PHI to contact you in an effort to raise money for SVHC and its operations. SVHC may disclose PHI to a foundation related to SVHC so the foundation may contact you in raising money for SVHC. SVHC would only release information as permitted by law, which might include contact information such as your name, address, and phone number, the dates you received health care, the general department in which you received treatment, the name of your physician, the outcome of your health care, and whether or not you have insurance. If you do not want SVHC to contact you for fundraising efforts, you must notify the Privacy Office in writing.


Facility Directory. SVHC may include certain limited information about you in the SVHC facility directory while you are a patient at SVHC. This information may include your name, location in SVHC, your general condition (e.g., good, fair, etc.), and your religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they do not ask for you by name. This directory information may be given so your family, friends, and clergy can visit you and generally know how you are doing. If you would like to opt-out of the facility directory, please complete the opt-out form available from the admissions staff.


Family and Friends. SVHC may release PHI to a friend or family member who is involved in your medical care. SVHC may also give PHI to someone who helps pay for your care. SVHC may also disclose your PHI to your family or friends when, in exercising professional judgment, SVHC believes the disclosure is in your best interest. In addition, SVHC may disclose PHI to an entity assisting in a disaster relief effort so your family can be notified about your condition, status, and location.


Research. Under certain circumstances, SVHC may use and disclose PHI for research purposes, if the purpose is to study morbidity and mortality of patients. Before SVHC uses or discloses PHI for research, the project must be approved through a special process that evaluates the project, its use of PHI, and its balance of research needs with patient needs for PHI privacy. SVHC may disclose PHI to people preparing to conduct a research project to help them look for patients with specific

medical needs that are the subject of their research, so long as the PHI they review does not leave SVHC. Lastly, if certain criteria are met, SVHC may disclose PHI to researchers after your death when it is necessary for research purposes.


As Required By Law. SVHC will disclose PHI when required to do so by federal, state, or local law.


To Avert a Serious Threat to Health or Safety. SVHC may use and disclose PHI when necessary to prevent or lessen a serious threat to your health or safety or the health or safety of the public or another person.


Organ and Tissue Donation. SVHC may disclose PHI to organizations that handle organ procurement or organ, eye, or tissue transplantation, or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.


Military and Veterans. If you are a member of the armed forces, SVHC may release PHI as required by military command authorities based upon a subpoena or court order. SVHC may also release PHI about foreign military personnel to the appropriate foreign military authority based upon a subpoena or court order.


Workers' Compensation. SVHC may release PHI for workers' compensation or similar programs upon your consent or as authorized by applicable law.


Public Health Purposes. SVHC may disclose PHI for public health activities, including: (i) preventing or controlling disease, injury, or disability; (ii) reporting births and deaths; (iii) reporting reactions to medications or problems with products; (iv) notifying people of recalls of products they may be using; or (v) notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading an infectious disease or condition of public health significance, subject to applicable law.


Victims of Abuse. SVHC may disclose PHI to notify the appropriate government authority if SVHC believes an individual has been the victim of abuse, neglect, or domestic violence. SVHC will only make this disclosure if you agree or when required or authorized by law.


Health Oversight Activities. SVHC may disclose PHI to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. SVHC may also disclose PHI to federal and state agencies that regulate licenses of nurses and other health care professionals.


Business Associates. SVHC may disclose information to SVHC Business Associates, who are independent vendors that SVHC has contracted with to provide services for, or on behalf of, SVHC. Examples of Business Associates include companies that provide billing services, transcription of medical records, and computer maintenance.


Health Information Networks, Organizations, and Exchanges. SVHC may disclose PHI to, or obtain PHI from, regional health information organizations and similar networks, which are sometimes called RHIOs, for the purpose of treatment, payment, and health care operations. RHIOs are electronic health information systems that SVHC and other health care providers may participate in to facilitate providing care for you. Information contained in RHIOs may also be analyzed to improve the health care operations of SVHC and other participating facilities.


Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, SVHC may disclose PHI in response to a court or administrative order, subpoena, discovery request, or other lawful process by someone else involved in the dispute. The disclosure will be made after SVHC receives satisfactory assurance that a reasonable effort has been made either to give you notice of the request or to secure a qualified protective order.


Law Enforcement. SVHC may release PHI to law enforcement: (i) in response to a court or administrative order, subpoena, warrant, summons, or similar process; (ii) to report certain types of wounds or other physical injuries; (iii) to identify or locate a suspect, fugitive, material witness, or missing person; (iv) about the victim of a crime if, under certain limited circumstances, SVHC is unable to obtain the person's agreement; (v) about a death SVHC believes may be the result of criminal conduct; (vi) about criminal conduct at SVHC; or (vii) in emergency circumstances to report a crime; the location of the crime or victims; or the identity, description, or location of the person who committed the crime.


Coroners, Medical Examiners, and Funeral Directors. SVHC may release PHI to a coroner or medical examiner for the purposes of identifying a deceased person or determining the cause of death. SVHC may also release PHI to funeral directors as necessary to carry out their duties.

National Security and Intelligence Activities. SVHC may release PHI to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.


Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, SVHC may release certain PHI to the correctional institution or law enforcement official in accordance with law. This release would be necessary: (i) for the institution to provide you with health care; (ii) to protect your health and safety or the health and safety of others; or (iii) for the safety and security of the correctional institution.


OTHER USES OF HEALTH INFORMATION.


Other uses and disclosures of PHI not covered by this Notice or the laws that apply to SVHC will be made only with your written authorization. You may revoke your written authorization at any time by delivering a written revocation to the Privacy Office. If you revoke your authorization, SVHC will no longer use or disclose PHI about you for the reasons covered by your written authorization. You understand that SVHC is unable to take back any disclosures SVHC has already made and that SVHC is required to retain records of the care provided to you.


YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU.


You may exercise the following rights by submitting a written request to the SVHC Privacy Officer. Please be aware, however, that SVHC may deny your request, when legally permitted to do so.

Right to Inspect and Copy. In most circumstances, you have the right to inspect and copy PHI that may be used to make decisions about your care, including the right to access your PHI in an electronic format if it is readily producible in that format. SVHC may deny your request to inspect and copy PHI in certain circumstances. If denied, you may request that the denial be reviewed. Another licensed health care professional chosen by SVHC will review your request and the denial.

SVHC will comply with the outcome of the review. In certain instances, in lieu of providing copies, SVHC may choose to provide you with a summary or explanation of the requested records. Charges for the costs of labor, copying, mailing or other supplies with your request may apply.


Right to Amend. If you feel that PHI SVHC has about you is incorrect or incomplete, you have the right to ask SVHC to amend the PHI for as long as the PHI is maintained by or for SVHC. SVHC 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, SVHC may deny your request if you ask SVHC to amend information that: (i) was not created by SVHC, unless the person or entity that created the information is no longer available to make the amendment; (ii) is not part of the PHI kept by or for SVHC; (iii) is not part of the information which you would be permitted to inspect and copy; or (iv) is accurate and complete.


Right to an Accounting of Disclosures. You have the right to request an accounting of disclosures. This is a list of the disclosures SVHC made of PHI about you. The list will not include any of the uses and disclosures for treatment, payment, and health care operations or for certain other limited reasons. Your request must state a time period that is not longer than six years prior to the date of your request and that does not include dates before April 14, 2003. Your request should indicate whether you want the list on paper or electronically. The first list you request within a 12-month period will be free. SVHC may charge you for the cost of providing additional lists. SVHC will notify you of the cost involved, and you may withdraw or modify your request at that time before any costs are incurred.


Right to Notification of Breach of Unsecured PHI. You have the right to be notified when there has been unauthorized acquisition, access, use, or disclosure of your PHI which compromises the security or privacy of such information.


Right to Request Restrictions. You have the right to request a restriction or limitation on PHI SVHC uses or discloses about you. You also have the right to request a limit on PHI SVHC discloses about you to someone who is involved in your care or the payment for your care, like a family member or a friend.


SVHC is not required to agree to your request. If SVHC does agree, SVHC will comply with your request unless the PHI is needed to provide you emergency treatment. In your request, you must tell SVHC: (i) what information you want to limit;

(ii) whether you want to limit SVHC use, disclosure, or both; and (iii) to whom you want the limits to apply. You may not limit the uses and disclosures that SVHC is legally required or allowed to make.

SVHC will comply with any request for restriction on disclosures of PHI to a health plan for the purpose of carrying out payment or health care operations and if the restriction applies to PHI that pertains solely to a health care item or service for which the provider has been paid out of pocket in full


Right to Request Confidential Communications. You have the right to request that SVHC communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that SVHC only contact you at work or by mail. SVHC will not ask you the reason for your request. SVHC will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.


Right to a Paper Copy of This Notice. You have the right to ask SVHC to give you a copy of this Notice at any time by contacting the Privacy Officer. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice. You may also obtain a copy of this Notice at the SVHC website, www.jaxhealth.com.


COMPLAINTS.

If you believe your privacy rights have been violated, you may file a complaint by contacting the SVHC Privacy Office, P.O. Box 2982, Jacksonville, FL 32203, (904) 308-3983. You may also contact the Secretary of the U.S. Department of Health and Human Services. All complaints must be submitted in writing. You will not be retaliated against for filing a complaint.

Indiana - English (2018)
IN_english_2018

Joint Notice of Privacy Practices

Effective October 2018

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.


Our responsibilities

St. Vincent takes the privacy of your health information seriously. We understand the importance and sensitivity of your health information. We are required by law to maintain your privacy and to provide you with this Notice of Privacy Practices (“Notice”). We are required to abide by the terms of the Notice that are currently in effect.

How we may use and disclose your health information

We protect the privacy of your health information because it is the right thing to do. We use your health information (and allow others to have it) only as permitted by federal and state laws. When we care for you, we gather and create some of your health information. This Notice includes examples of how we will use and share your information. Not every use or disclosure is listed below; however, all permissible uses and disclosures will fall within one of the categories.


For treatment: We use information about you to understand your health condition and to treat you when you are sick. We may share your health information with doctors, nurses, aides, technicians or other employees who are involved in taking care of you. We might use your health information to manage or coordinate your treatment, healthcare or other related services. We might share your medical information with your physician or other healthcare provider who is providing treatment to you, whether or not we are involved with your treatment at the time. For example, a doctor treating you for a broken leg may need to know if you have diabetes because if you do, this may affect your recovery. We may receive and share prescription

information to help you avoid harmful drug interactions. Different departments of the facility may also share health information about you to coordinate care you might need such as medications, X-rays, laboratory work, etc.


For payment: To receive payment for our services, we may send your health information to an insurance company or other third-party payor. We may also disclose your medical information to another healthcare provider for their own payment activities. For example, your insurance company may request information about your surgery and we must provide that information to obtain payment. The physician who reads your x-ray may need to bill you or your insurance company for reading your X-ray; therefore, your billing information may be shared with that physician.


For healthcare operations: We may use and disclose your health information to enable St. Vincent to make sure you receive competent, quality healthcare, and to maintain and improve the quality of healthcare we provide. We may assess the care and outcomes in your case and others like it and then use the results to continually improve the quality of care for all patients we serve. We may also provide your health information to renew our governmental licenses or other accreditations. For example, we may combine health information about many patients to evaluate the need for new services or treatment. We may combine health information we have with that of other facilities to see where we can improve our quality of care.

The law sometimes requires us to share information for specific purposes, including reporting to:


  • The Indiana Department of Health to report communicable diseases, traumatic injuries, birth defects, or for vital statistics such as a baby’s birth.

  • A funeral director or an organ-donation agency, when a patient dies, or to a medical examiner when appropriate to investigate a suspicious death.

  • The appropriate governmental agency, if an injury or unexpected death occurs at our facility.

  • Public health authorities, to report child or elderly abuse, or suspected child or elderly abuse, if authorized or otherwise required to report by law.

  • Law enforcement official, if required to do so by law, for example, to identify or locate a suspect, fugitive, material witness, missing person, or to report a crime or criminal conduct at the facility.

  • Governmental inspectors, who, for example, make sure our facilities are safe.

  • Military command authorities or the Department of Veterans Affairs, for patients who are in the military or veterans.

  • A correctional institution or law enforcement official, if you are an inmate in a correctional institution and if the correctional institution or law enforcement authority makes certain requests to us.

  • The Secret Service or National Security Agency, if required, to protect the country or the president.

  • A medical device manufacturer, as required by the Food and Drug Administration, to monitor the safety of a medical device.

  • Court officers, as required by law, in response to a court order or a valid subpoena.

  • Governmental authorities, to prevent serious threats to the public’s health or safety.

  • Governmental agencies and other affected parties, to report a breach of health information privacy, or in the case of a compliance review to determine whether we are complying with privacy laws.

  • A worker’s compensation program, if a person is injured at work and claims benefits under that program.

    • Business associates or third parties, that we have contracted with to perform agreed-upon services.

    • Indiana Health Information Exchange (IHIE) that permits computer-based transfer of health information directly between healthcare providers at different location and institutions to facilitate your care and treatment. If you do not want your information to be shared in this way, you can opt-out by contacting the Privacy Official.

      Additional information

      Facility directory: We may include certain limited information about you in our directory while you are a patient. This information may include your

      name, location in our facility, your general condition (e.g., fair, stable, etc.) and your religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest or minister, even if they do not ask for you by name. If you do not wish to be included in the facility directory, you will be given an opportunity to object at the time of admission.

      Individuals involved in your care or payment for your care: We may release health information about you to a family member, or any other person identified by you who is involved in your healthcare or helps pay for your care. We may also disclose health information about you to notify your family or an emergency contact that you are at St. Vincent or to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location. We will not share this information with these individuals if we are aware of your desire to not have this information shared. If you are unable to object, our healthcare providers will use their best judgment in communicating with your family and others.

      Disclosures to you: Upon a request by you, we may use or disclose your medical information in accordance with your request. We may contact you to remind you about appointments and tell you about possible treatment alternatives or health-related benefits or services.

      Fundraising: We may contact you for fundraising purposes to raise money to support our mission. You may opt out of receiving such communications by following the opt-out instructions on the communication you receive or by contacting the St. Vincent Foundation.

      Incidental uses and disclosures: While we have safeguards in place, your medical information may inadvertently be disclosed. For example, while we have safeguards in place to protect against others overhearing our conversations that take place between doctors, nurses or other St. Vincent personnel, there may be times that conversations are in fact overheard.

      Disclosures by members of our workforce: Members of our workforce, including employees, volunteers, trainees or independent contractors, may disclose your medical information to a health oversight agency, public health authority, healthcare accreditation organization or attorney hired by the workforce member, to report the workforce member’s belief that we have engaged in unlawful conduct or that our care or services could endanger a patient, worker or the public. In addition, if a workforce member is a crime victim whom you are involved with, the member may disclose your personal information to a law enforcement official to report the crime.

      Research: Under certain circumstances, we may use and disclose health information about you for research purposes. All research projects are subject to a special approval process and information released is done so only with your consent or with appropriate authority as permitted by law. We may share medical information about you with people preparing to conduct a research project. For example, we may share information to help them look for patients with specific medical needs.

      Disclosures of records containing drug or alcohol abuse information: Due to federal law, we will not release your medical information if it contains information about drug or alcohol abuse without your written permission except in very limited situations.

      Psychotherapy notes: If applicable, we must obtain your written authorization before we may use or disclose your psychotherapy notes, except for: use by the originator of the psychotherapy notes for treatment; use or disclosure by St. Vincent to its own mental health training programs; or use or disclosure by St. Vincent to defend itself in a legal action or other proceeding brought by the individual to whom the notes apply.

      Marketing: We must obtain your written authorization before we may use or disclose your health information for marketing purposes, except for face-to-face communications made by us to you or a promotional gift of nominal value provided by us to you. You may opt out of receiving such communications by following the opt-out instructions on the communication you receive.

      Breach notification: We are required to notify you in the event of a breach of your unsecured protected health information, and will do so.

      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 authorization. If you provide us authorization to use or disclose your health information, you may revoke that authorization, in writing, at any time.

      If you revoke your authorization, 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 under the authorization, and that we are required to retain our records of the care that we provided to you.

      Your rights regarding your health information

      You have the following rights regarding health information we maintain about you:

      Right to request restrictions: You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or healthcare operations. You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care. You have the right to restrict disclosures of your health information to your health plan for payment and healthcare operations purposes (and not for treatment) if the disclosure pertains to a healthcare item or service for which you paid out-of-pocket in full. If requesting a restriction for a healthcare item or service for which you paid out-of-pocket in full, we will honor your request, unless the disclosure is necessary for your treatment or is required by law.

      For all other restriction requests, we are not required to agree to your request. If we do agree, we will comply with your request unless the information is

      needed to provide you emergency treatment.

      Any request for restrictions must be sent in writing to the Privacy Official.

      Right to request confidential communications: You have the right to request that we communicate with you or your personal representative about your healthcare in an alternative way or at a certain location. To request confidential communications, you must make your request in writing to the Privacy Official. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

      Right to access, inspect and copy: You have the right to inspect and obtain a paper or electronic copy of your medical information that we use to make decisions about your care, when you submit a written request. 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.

      Right to amend: You have the right to ask us to amend your health and/or billing information for as long as the information is kept by us. We may deny your request for an amendment and, if this occurs, you will be notified of the reason for the denial and provided an opportunity to appeal the denial.

      Right to an accounting of disclosures: You have the right to request a list of certain disclosures that we have made of your health information that were for purposes other than treatment, payment or healthcare operations or were authorized by you.

      Right to a paper copy of this Notice: You have the right to a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time.

      Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice. You may obtain a copy of this Notice at our web site at www.stvincent.org/legal or contact the Privacy Official.


      To whom this Notice applies

      This Notice describes St. Vincent practices and those of:

      • Any healthcare professional authorized to enter information into or consult your medical record or who provides treatment to you while you are at or in the facility, including but not limited to, attending physicians, radiologists, pathologists, anesthesiologists, surgeons, internal medicine physicians, emergency department physicians, staff members of such physicians, and any other physician or healthcare provider that is involved in your care at the facility.

      • St. Vincent Hospitals, St. Vincent System subsidiaries and St. Vincent subsidiary organizations, including, but not limited to, hospitals, ambulatory surgery centers, imaging and oncology centers, physician practices and shared services centers.

      • Any member of a volunteer group serving St. Vincent.

      • All employees, staff and other St. Vincent personnel, and any resident, student or trainee who trains at the facility.


        All of these entities, sites and locations follow the terms of this Notice while providing services at our facility. In addition, these entities, sites and locations may share health information with each other for treatment, payment or operations purposes described in this Notice.

        Changes to this Notice: We reserve the right to change this Notice. We reserve the right to make the revised Notice effective for health information we already have about you, as well as any information we receive in the future. The Notice will be posted in our facility and on our website, and include the effective date. The Notice is also available to you upon request. In addition, if we revise the Notice, you may request a copy of the Notice currently

        in effect.

        Complaints: If you believe your privacy rights have been violated, you may file a complaint with St. Vincent or with the Secretary of the Department of Health and Human Services. To file a complaint with us, contact the Privacy Official. All complaints must be submitted in writing. You will not be penalized, discriminated against, retaliated against, or intimidated for filing a complaint. If you have any questions about this Notice, please contact

        our Privacy Official at 888-395-9888, or St. Vincent, Parkwood West, 250 W. 96th Street, Suite 425, Indianapolis, IN 46260.

        If you have any questions about this Notice , please contact our Privacy Official at 888-395-9888.


        To learn more, visit www.stvincent.org

        Discrimination is Against the Law!


        St. Vincent complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.


        St. Vincent does not exclude people or treat them differently because of race, color, national origin, age, disability or sex.


        St. Vincent provides free aids and services to people with disabilities to communicate effectively with us, such as:

    • Qualified sign language interpreters; and

    • Written information in other formats (large print, audio, accessible electronic formats and other formats). St. Vincent provides free language services to people whose primary language is not English, such as:

    • Qualified interpreters; and

    • Information written in other languages.

If you need these services, contact the St. Vincent Care Line at 317-338-CARE (2273).


If you believe that St. Vincent has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability or sex, you can file a grievance with:

Adam Oatess

Regional Compliance Officer St. Vincent Parkwood West 250 W. 96th St.

Indianapolis, IN 46260

t 317-583-3237

f 317-583-4503

AMOatess@ascension.org


You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, Adam Oatess , Regional Compliance Officer, is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil

Rights, electronically through the Office for Civil Rights Complain Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by

mail or phone at:


U.S. Department of Health and Human Services 200 Independence Avenue SW

Room 509F, HHH Building Washington, DC 20201

1-800-368-1019, 800-537-7697 (TDD)

Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

Language Assistance Services


ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-317-338-2273 (TTY: 711).


注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1-317-338-2273 (TTY: 711).


ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-317-338-2273 (TTY: 711).


Wann du Deitsch (Pennsylvania German) schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englisch Schprooch. Ruf selli Nummer uff: Call 1-317-338-2273 (TTY: 711).

注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1-317-338-2273 (TTY:711)

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-317-338-2273 (TYY:711)

번으로 전화해 주십시오.


CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-317-338-2273 (TTY: 711).


ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le

1-317-338-2273 (TTY: 711).

AANDACHT: Als u Nederlands spreekt, zijn er gratis taalondersteuningsdiensten beschik-baar. Bel:

1-317-338-2273 (TTY: 711).


PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-317-338-2273 (TTY: 711).


ВНИМАНИЕ: если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-317-338-2273 (TTY: 711).


1-317-338-2273 (TTY: .(711مﻗرﺑ لﺻﺗا .كﻟ ةرﻓوﺗﻣ ﺔﯾﻧﺎﺟﻣ ﺔﯾوﻐﻟ ةدﻋﺎﺳﻣ تﺎﻣدﺧ كﺎﻧﮭﻓ ،ﺔﯾﺑرﻌﻟا ﺔﻐﻠﻟا ثدﺣﺗﺗ تﻧﻛ اذإ :ﮫﯾﺑﻧﺗ

Indiana - Espanol (2018)
IN_espanol_2018

Notificación Conjunta de Prácticas de Privacidad

Vigente a partir de octubre de 2018

En esta Notificación se describe cómo se puede usar y divulgar su información médica, y cómo usted puede obtener acceso a esa información. Revísela detenidamente.

Nuestras responsabilidades

St. Vincent toma muy en serio la privacidad de su información de salud. Comprendemos la importancia y la confidencialidad de su información de salud.

Estamos obligados por ley a mantener su privacidad y a proporcionarle la presente Notificación de Prácticas de Privacidad (“Notificación”). Estamos obligados a cumplir con los términos de la Notificación en vigencia actualmente.

Cómo podemos usar y divulgar su información de salud

Protegemos la privacidad de su información de salud porque es lo correcto. Usamos su información de salud (y permitimos que otras personas la

tengan) únicamente de acuerdo con lo permitido por las leyes federales y estatales. Al preocupamos por usted, reunimos y creamos parte de su información de salud. La presente Notificación incluye ejemplos de cómo usaremos y compartiremos su información. Aunque a continuación no se detalla cada uno de los usos o divulgaciones, todos los usos y divulgaciones permitidos quedan comprendidos en alguna de las categorías.


Para el tratamiento: Usamos su información para comprender su estado de salud y brindarle tratamiento cuando está enfermo. Podemos compartir su información de salud con médicos, personal de enfermería, auxiliares, técnicos u otros empleados involucrados en su atención. Podríamos usar su información de salud para gestionar o coordinar su tratamiento, atención médica u otros servicios relacionados. Podríamos compartir su información médica con su médico u otro proveedor de atención médica que le brinde tratamiento, ya sea que estemos o no involucrados con su tratamiento en ese momento. Por ejemplo, es posible que un médico que lo está tratando por una fractura de pierna necesite saber si usted tiene diabetes porque si es así, esto podría afectar su recuperación. Podemos recibir y compartir información sobre las recetas para ayudarlo a evitar la peligrosa interacción

farmacológica. Los diferentes departamentos del centro también pueden compartir su información de salud para coordinar la atención que usted podría necesitar, por ejemplo, medicamentos, radiografías, análisis de laboratorio, etc.

Para el pago: Para recibir el pago de nuestros servicios, podemos enviar su información de salud a una compañía de seguros u otro tercero que realice el pago. También podemos divulgar su información médica a otro proveedor de atención médica para sus propias actividades de pago. Por ejemplo,

su compañía de seguros puede solicitar información sobre su cirugía y debemos proporcionar esa información para obtener el pago. El médico que interpreta su radiografía puede tener que facturarle a usted o a su compañía de seguros por interpretar su radiografía; por lo tanto, su información de facturación puede compartirse con ese médico.

Para las operaciones de atención médica: Podemos usar y divulgar su información de salud para permitir que St. Vincent se asegure de que usted reciba atención médica competente y de calidad, y para mantener y mejorar la calidad de la atención médica que proporcionamos. Podemos evaluar la atención y los resultados correspondientes a su caso y otros similares, y luego usar la información obtenida para mejorar de forma continua la calidad de la atención de todos los pacientes a quienes brindamos servicios. También podemos proporcionar su información de salud para renovar nuestros permisos gubernamentales u otras habilitaciones. Por ejemplo, podemos combinar la información de salud de varios pacientes a fin de evaluar la necesidad de nuevos servicios o tratamientos. También podemos combinar la información de salud que tenemos con la de otros centros para ver dónde podemos mejorar la calidad de nuestra atención.

En ocasiones, estamos obligados por ley a compartir información con fines específicos, que incluyen las notificaciones a los siguientes:

  • El Departamento de Salud de Indiana (Indiana Department of Health), para informar sobre enfermedades contagiosas, lesiones traumáticas, defectos congénitos o estadísticas demográficas, como el nacimiento de un bebé.

  • El responsable de una funeraria o una agencia de donación de órganos, cuando muere un paciente, o a un médico forense cuando es apropiado investigar sobre una muerte sospechosa.

  • La agencia gubernamental apropiada, si ocurre una lesión o una muerte inesperada en nuestro centro.

  • Las autoridades de salud pública, para notificar abuso de menores o mayores, o la sospecha de abuso de menores o mayores, si se autoriza o exige de otra forma la notificación por ley.

  • Las autoridades policiales, si así lo exige la ley, por ejemplo, para identificar o ubicar a un sospechoso, un fugitivo, un testigo material, una persona perdida o para denunciar un delito o una conducta delictiva en el centro.

  • Los inspectores gubernamentales que, por ejemplo, garantizan la seguridad de nuestro centro.

  • Las autoridades del comando militar o el Departamento de Asuntos de Veteranos (Department of Veterans Affairs), para pacientes que están en el ejército o son veteranos.

  • Un establecimiento penitenciario o una autoridad policial, si usted está preso en un establecimiento penitenciario y si el establecimiento penitenciario o una autoridad policial nos hace solicitudes específicas.

  • El Servicio Secreto (Secret Service) o la Agencia de Seguridad Nacional (National Security Agency), si se requiere, para proteger al país o al presidente.

  • Un fabricante de dispositivos médicos, según lo requiera la Administración de Alimentos y Medicamentos (Food and Drug Administration), para supervisar la seguridad de un dispositivo médico.

  • Los funcionarios judiciales, según lo establecido por ley, en respuesta a una orden judicial o una citación válida.

  • Las autoridades gubernamentales, para evitar amenazas graves a la salud o la seguridad pública.

  • Las agencias gubernamentales y otras partes afectadas, para denunciar un incumplimiento en la privacidad de la información de salud o en el caso de una revisión de cumplimiento, para determinar si estamos cumpliendo con las leyes de privacidad.

  • Un programa de indemnización por accidente laboral, si una persona se lesiona en el trabajo y reclama beneficios conforme a dicho programa.

  • Los asociados comerciales o terceros que fueron contratados para llevar a cabo servicios acordados.

  • El Intercambio de Información Médica de Indiana (Indiana Health Information Exchange, IHIE), que permite la transferencia informática de la información de salud directamente entre los proveedores de atención médica en diferentes ubicaciones y las instituciones para facilitar su atención y tratamiento. Si no quiere que se comparta su información de esta manera, puede excluirse voluntariamente al ponerse en contacto con el funcionario de Privacidad.

Información adicional

Directorio del centro: Podemos incluir cierta información limitada sobre usted en nuestro directorio mientras sea paciente. Esta información puede

incluir su nombre, ubicación en nuestro centro, estado general (p. ej., satisfactorio, estable, etc.) y su afiliación religiosa. La información del directorio,

excepto por su afiliación religiosa, también puede divulgarse a las personas que pregunten por usted dando su nombre. Su afiliación religiosa puede brindarse a un miembro del clero, como un sacerdote o ministro, incluso si ellos no preguntan por usted dando su nombre. Si no desea ser incluido en el directorio del centro, se le dará la oportunidad de presentar una objeción al momento del ingreso.

Personas involucradas en su atención o el pago de su atención: Podemos divulgar su información de salud a un familiar o a cualquier otra persona que usted identifique como involucrada en su atención médica o que ayude a pagar por su atención. También podemos divulgar su información de salud para notificar a su familia o a un contacto de emergencia que usted se encuentra en St. Vincent, o a una entidad que lo asiste en caso de una catástrofe para que se pueda notificar a su familia sobre su afección, estado y ubicación. No compartiremos esta información con esas personas si sabemos que usted no desea que se comparta dicha información. Si no puede presentar una objeción, nuestros proveedores de atención médica usarán su mejor criterio para comunicarse con su familia y demás personas.

Divulgaciones a usted: Si usted lo solicita, podemos usar o divulgar su información médica de acuerdo con su solicitud. Podemos comunicarnos con usted para recordarle sobre sus citas e informarle acerca de posibles alternativas de tratamientos, beneficios o servicios relacionados con la salud.

Recaudación de fondos: Podemos comunicarnos con usted con fines de recaudación de fondos para apoyar nuestra misión. Puede excluirse voluntariamente para no recibir dichas comunicaciones; para ello, siga las instrucciones de exclusión detalladas en la comunicación que reciba o comuníquese con la fundación St. Vincent Foundation.

Usos y divulgaciones imprevistos: Si bien contamos con medidas de protección vigentes, su información médica puede divulgarse de forma involuntaria. Por ejemplo, si bien contamos con medidas de protección vigentes contra otras personas que puedan oír por casualidad nuestras conversaciones que tienen lugar entre médicos, personal de enfermería u otros empleados de St. Vincent, existen momentos en que esas conversaciones en efecto se escuchan por parte de terceros.

Divulgaciones por parte de miembros de nuestro personal: Los miembros de nuestro personal, incluidos los empleados, voluntarios, residentes o contratistas independientes, pueden divulgar su información médica a un organismo de vigilancia médica, autoridad de salud pública, organización de habilitación sanitaria o abogado contratado por un miembro del personal para notificar si este cree que hemos incurrido en una conducta ilícita, o que nuestra atención o nuestros servicios podrían poner el peligro a un paciente, trabajador o al público. Asimismo, si un miembro del personal es víctima de un delito en el que usted está involucrado, el miembro puede divulgar su información personal a una autoridad policial para denunciar el delito.

Investigación: Bajo ciertas circunstancias, podemos usar y divulgar su información de salud con fines de investigación. Todos los proyectos de investigación están sujetos a un proceso de aprobación especial y la divulgación de la información se realiza únicamente con su consentimiento o el de una autoridad pertinente según lo permita la ley. Podemos compartir su información médica con las personas que se preparan para llevar a cabo un proyecto de investigación. Por ejemplo, podemos compartir información para ayudarlas a localizar a los pacientes que tienen necesidades médicas específicas.

Divulgaciones de registros que contienen información sobre abuso de drogas o alcohol: Conforme a la ley federal, no divulgaremos su información médica si esta contiene información sobre abuso de drogas o alcohol sin su permiso por escrito, excepto en situaciones muy limitadas.

Notas de psicoterapia: Si corresponde, debemos obtener su autorización por escrito para poder usar o divulgar sus notas de psicoterapia, excepto por los siguientes: uso por quien dio origen a las notas de psicoterapia para tratamiento; uso o divulgación por parte de St. Vincent para sus propios programas de capacitación sobre salud mental; o uso o divulgación por parte de St. Vincent para defenderse en una acción judicial u otro litigio presentado por la persona a quien se aplican las notas.

Comercialización: Debemos obtener su autorización por escrito antes de poder usar o divulgar su información de salud con fines de comercialización, excepto por las comunicaciones en persona que mantengamos con usted o un obsequio promocional de valor nominal que usted nos proporcione.

Puede excluirse voluntariamente para no recibir dichas comunicaciones; para ello, siga las instrucciones de exclusión detalladas en la comunicación que reciba.

Notificación sobre incumplimiento: Estamos obligados a notificarle en caso de que ocurra un incumplimiento de su información de salud protegida poco segura y lo haremos.


Otros usos de la información de salud

Otros usos y divulgaciones de la información de salud, no contemplados en esta Notificación ni en las leyes que nos rigen, solo se realizarán con su

autorización por escrito. Si nos brinda su autorización para usar o divulgar su información de salud, puede revocar dicha autorización, por escrito, en cualquier momento. Si revoca su autorización, ya no usaremos ni divulgaremos su información de salud por los motivos contemplados en su

autorización por escrito. Usted comprende que no podemos retirar ninguna divulgación que ya hayamos realizado conforme a su autorización y que se nos exige que conservemos nuestros registros acerca de la atención que le brindamos.

Sus derechos acerca de su información de salud

Tiene los siguientes derechos en relación con su información de salud que conservamos:

Derecho a solicitar restricciones: Tiene derecho a solicitar una restricción o limitación sobre su información de salud que usamos o divulgamos con fines de tratamiento, pago u operaciones de atención médica. También tiene derecho a solicitar un límite en la información de salud sobre usted que divulgamos a alguna persona involucrada en su atención o el pago de su atención. Tiene derecho a restringir las divulgaciones de su información de salud a su plan de salud con fines de pagos y operaciones de atención médica (y no de tratamiento) si la divulgación corresponde a un producto o servicio de atención médica por el cual usted pagó por completo en efectivo. Si usted solicita una restricción por un producto o servicio de atención médica por el cual pagó por completo en efectivo, cumpliremos con su solicitud excepto que la divulgación sea necesaria para su tratamiento o esté exigida por ley.

En el caso de cualquier otra restricción, no estamos obligados a aceptar su solicitud. Si aceptamos su solicitud, cumpliremos con esta excepto que la información sea necesaria para brindarle tratamiento de emergencia.

Cualquier solicitud de restricción debe enviarse por escrito al funcionario de Privacidad.

Derecho a solicitar comunicaciones confidenciales: Tiene derecho a solicitar que nos comuniquemos con usted o su representante personal acerca de su atención médica de un modo alternativo o en una ubicación específica. Para solicitar comunicaciones confidenciales, debe realizar su solicitud por escrito al funcionario de Privacidad. No le preguntaremos el motivo de su solicitud. Atenderemos todas las solicitudes razonables. Su solicitud debe especificar cómo o dónde desea que se lo contacte.

Derecho al acceso, a inspección y copia: Tiene derecho a inspeccionar y obtener una copia impresa o electrónica de su información médica que usamos para tomar decisiones sobre su atención cuando envía una solicitud por escrito. Si solicita una copia de la información, podemos cobrarle un arancel para cubrir los costos de las copias, el envío por correo u otros suministros relacionados con su solicitud.

Derecho a modificación: Tiene derecho a solicitarnos que modifiquemos su información de salud o facturación siempre que conservemos la información. Podemos denegar su solicitud de modificación y, si eso ocurre, recibirá una notificación sobre el motivo de la denegación y se le brindará la oportunidad de apelar la denegación.

Derecho a una contabilización de las divulgaciones: Tiene derecho a solicitar una lista de determinadas divulgaciones que hayamos realizado sobre su información de salud con fines que no sean para tratamiento, pago ni operaciones de atención médica o que usted haya autorizado.

Derecho a una copia impresa de la presente Notificación: Tiene derecho a recibir una copia impresa de la presente Notificación. Puede solicitarnos que le proporcionemos una copia de la presente Notificación en cualquier momento.

Incluso si usted aceptó recibir la presente Notificación en forma electrónica, aún tiene derecho a recibir una copia impresa de esta Notificación. Puede obtener una copia de la presente Notificación en nuestro sitio web en www.stvincent.org/legal o puede comunicarse con el funcionario de Privacidad.

A quién se aplica la presente Notificación

En esta Notificación se describen las prácticas de St. Vincent y aquellas de:

  • Cualquier profesional de atención médica autorizado para introducir información en su historia clínica o consultarla, o que le brinde tratamiento mientras usted se encuentra en el centro, que incluye, entre otros, médicos a cargo de su atención, radiólogos, patólogos, anestesistas, cirujanos, médicos especializados en medicina interna, médicos del departamento de emergencias, miembros del personal de dichos médicos, y cualquier otro médico o proveedor de atención médica que esté involucrado en su atención en el centro.

  • St. Vincent Hospitals, las subsidiarias de St. Vincent System y las organizaciones subsidiarias de St. Vincent, que incluyen, entre otros, hospitales, centros de cirugía ambulatoria, centros de diagnóstico por imágenes y oncología, centros de prácticas médicas y servicios compartidos.

  • Cualquier miembro de un grupo de voluntarios que brinde servicios en St. Vincent.

  • Todos los empleados, el personal y demás trabajadores de St. Vincent, y cualquier residente, estudiante o médico en prácticas que realice prácticas en el centro.


    Todas estas entidades, sitios y ubicaciones cumplen con los términos de la presente Notificación mientras brindan servicios en nuestro centro. Asimismo, estas entidades, sitios y ubicaciones pueden compartir entre ellos la información de salud por motivos de tratamiento, pago u operaciones que se describan en la presente Notificación.

    Cambios en la presente Notificación Nos reservamos el derecho de hacer cambios en la presente Notificación. Nos reservamos el derecho de hacer regir la Notificación revisada para su información de salud que ya tenemos, así como cualquier información que recibamos en el futuro. La Notificación se publicará en nuestro centro y en nuestro sitio web e incluirá la fecha de entrada en vigencia. La Notificación también estará a su disposición si lo solicita. Además, si revisamos la Notificación, usted puede solicitar una copia de la Notificación que actualmente está

    en vigencia.

    Reclamos: Si considera que se violaron sus derechos de privacidad, puede presentar un reclamo ante St. Vincent o el secretario del Departamento de Salud y Servicios Sociales (Department of Health and Human Services). Para presentar un reclamo ante nosotros, póngase en contacto con el funcionario de Privacidad. Todos los reclamos deben presentarse por escrito. No sufrirá sanciones, discriminación, represalias ni amenazas por

    presentar un reclamo. Si tiene alguna pregunta sobre la presente Notificación, comuníquese connuestro funcionario de Privacidad al 888-395-9888 o

    en St. Vincent, Parkwood West, 250 W. 96th Street, Suite 425, Indianapolis, IN 46260.

    Si tiene alguna pregunta sobre la presente Notificación, comuníquese con nuestro funcionario de Privacidad al 888-395-9888.


    Para obtener más información, visite www.stvincent.org

    ¡La discriminación está legalmente prohibida!


    St. Vincent cumple con las leyes federales sobre derechos civiles aplicables y no discrimina por motivos de raza, color, nacionalidad, edad, discapacidad ni género.

    St. Vincent no excluye a las personas ni las trata diferente por motivos de raza, color, nacionalidad, edad, discapacidad ni género.

    St. Vincent proporciona asistencia y servicios gratuitos a las personas con discapacidades a fin de que puedan comunicarse de forma eficaz con nosotros, como por ejemplo:

    • intérpretes de lenguaje de señas calificados e

    • información escrita en otros formatos (impresión en letra grande, audio, formatos electrónicos accesibles y otros formatos).


      St. Vincent proporciona servicios lingüísticos gratuitos a las personas cuyo idioma principal no es el inglés, como por ejemplo:

    • intérpretes calificados e

    • información escrita en otros idiomas.

Si necesita esos servicios, comuníquese con la línea de atención de St. Vincent al 317-338-CARE (2273).

Si considera que St. Vincent ha incumplido en el suministro de esos servicios o ha discriminado de alguna otra forma por motivos de raza, color, nacionalidad, edad, discapacidad o género, puede presentar una queja ante el funcionario de Cumplimiento Regional:

Adam Oatess

Regional Compliance Officer St. Vincent Parkwood West 250 W. 96th St.

Indianapolis, IN 46260

t 317-583-3237

f 317-583-4503

AMOatess@ascension.org

Puede presentar una queja en persona o por correo postal, fax o correo electrónico. Si necesita ayuda para presentar la queja, el funcionario de Cumplimiento Regional, Adam Oatess, está a su disposición para ayudarlo. También puede presentar una queja sobre derechos civiles ante la Oficina de Derechos Civiles (Oficina de Derechos Civiles) del Departamento de Salud y Servicios Humanos de Estados Unidos (U. S. Department of Health and Human Services) por vía electrónica a través del Portal de Reclamos de la Oficina de Derechos Civiles, disponible en https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, o por correo postal o teléfono en:

U. S. Department of Health and Human Services 200 Independence Avenue SW

Room 509F, HHH Building Washington, DC 20201

1-800-368-1019, 800-537-7697 (TDD)

Puede encontrar formularios para quejas disponibles en http://www.hhs.gov/ocr/office/file/index.html.

.

Servicios de asistencia lingüística


ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-317-338-2273 (TTY: 711).


注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電

1-317-338-2273 (TTY: 711).


ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-317-338-2273 (TTY: 711).


Wann du Deitsch (Pennsylvania German) schwetzscht, kannscht du mitaus Koschte ebber gricke, ass dihr helft mit die englisch Schprooch. Ruf selli Nummer uff: Call 1-317-338-2273 (TTY: 711).


注意:如果您使用繁體中文,您可以免費獲得語言援助服務。請致電 1-317-338-2273 (TTY:711)

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-317-338-2273 (TYY:711)

번으로 전화해 주십시오.


CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-317-338-2273 (TTY: 711).


ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le 1-317-338-2273 (TTY: 711).


AANDACHT: Als u Nederlands spreekt, zijn er gratis taalondersteuningsdiensten beschik-baar. Bel: 1-317-338-2273 (TTY: 711).


PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-317-338-2273 (TTY: 711).


ВНИМАНИЕ: если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-317-338-2273 (TTY: 711).


1-317-338-2273 (TTY:7111)مﻗرﺑ لﺻﺗا .كﻟ ةرﻓوﺗﻣ ﺔﯾﻧﺎﺟﻣ ﺔﯾوﻐﻟ ةدﻋﺎﺳﻣ تﺎﻣدﺧ كﺎﻧﮭﻓ ،ﺔﯾﺑرﻌﻟا ﺔﻐﻠﻟا ثدﺣﺗﺗ تﻧﻛ اذإ :ﮫﯾﺑﻧﺗ

Kansas - English (2019)
KS_english_2019

JOINT NOTICE OF PRIVACY PRACTICES

Effective Date: February 5, 2003 Revised: April 1, 2019

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVEW IT CAREFULLY.

WHAT IS THIS DOCUMENT?

Ascension Via Christi, which is comprised of physicians, hospitals, clinics and other health care providers who work together to deliver a broad range of health care services, is committed to protecting your health information (“protected health information” or “PHI”). We create and maintain a record of your care and services you receive on a variety of media, including paper, film and electronic. This information is available to workforce members, such as medical staff members, business associates and volunteers, who need this information to provide treatment to you, obtain payment for services provided or to support various operational functions necessary to provide health care. We are required by law to:

  • Have reasonable safeguards in place to discourage improper use or access to your PHI;

  • Maintain and protect your privacy and the confidentiality of your PHI and records;

  • Provide you with this Joint Notice describing your rights and our legal duties regarding your PHI; and,

  • Notify affected individuals in the event of a breach of unsecured PHI.

    HOW DO WE USE OR DISCLOSE YOUR PHI?

    We May Use and Disclose Your PHI for the Following Reasons Without Your Written Authorization.

    Treatment: We may use and disclose your PHI to provide you medical treatment and services. Your PHI may be used by or disclosed to physicians, nurses, technicians, medical students and others who are involved in your care.

    Example:

  • We may tell your primary care physician, nursing home or other health care provider about your hospital stay so they can provide appropriate follow-up care.

    Payment: We may use and disclose your PHI to bill for the treatment and services you receive and to collect payments from you, your insurance company or a third party.

    Examples:

  • We may tell your health plan about a proposed treatment for you to obtain prior approval or to determine if your plan will cover the treatment.

  • We may disclose your PHI to physicians or their billing agents, so they can send their claims to your insurance company or to you.

    Health Care Operations: We may use or disclose your PHI for health care operations. These uses, and disclosures are necessary to run our organizations and make sure patients receive quality care.

    Examples:

  • We may use PHI to review our treatment and services, evaluate staff performance and train health care professionals.

  • We may use the PHI of many patients to decide if additional services should be offered if services are needed or if new treatments or processes are effective.

    Business Associates: We may disclose your PHI to business associates with whom we contract to provide services on our behalf. We require business associates to take appropriate measures to safeguard your information.

    Example:

  • We may contract with a company outside the organization to provide medical transcription services or to provide collection services for past due accounts.

    The Following Categories Describe Additional Ways that We May Use and Disclose Your PHI Without Your Written Authorization. Not Every Use or Disclosure is Listed.

    Disclosures Required by Law: We may use or disclose your PHI when required to do so by federal, state or local law.

    Victims of Abuse: We may disclose your PHI to notify the appropriate government authority if we believe that you have been

    the victim or abuse or neglect. We will only make this disclosure if you agree or when required or authorized by law.

    Electronic Health Information Exchanges: We may access or disclose your PHI to other health care organizations, health plans or the government through health information exchange organizations. These organizations are committed to securing the information and allowing your PHI to be available when needed for the purposes of treatment, payment or health care operations. You have the right to opt out of participating in a health information exchange.

    Appointment Reminders and Health-Related Benefits or Services: We may use and disclose your PHI to contact you by telephone, cell phone, text, email, patient portal or mail, as a reminder that you have an appointment for treatment or medical care or to give you information about treatment alternatives or other health care services or benefits we offer. This may be done through an automated system or by one of our associates. If you do not answer, we may leave this information on your voice mail or in a message left with the person answering the phone.

    Research: We may disclose information to researchers when the research project has been approved by an Institutional Review Board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.

    Workers’ Compensation: We may disclose your PHI for workers’ compensation or similar programs as authorized by state law. These programs provide benefits for work related injuries or illnesses.

    Coroners, Medical Examiners and Funeral Directors: We may disclose PHI to a coroner, medical examiner or funeral director.

    Examples:

    • To identify a deceased person or determine the cause of death.

    • To assist the funeral director in completing the death certificate.

      Organ and Tissue Procurement Organizations: We may disclose your PHI to organizations that handle organ, eye, or tissue procurement or transplantation, or to a donation bank as necessary to facilitate donation and transplantation.

      Military: If you are a member of the Armed Forces, we may disclose PHI as required by military command authorities. We may also disclose PHI about foreign military personnel to the appropriate foreign military authority. In addition, we may disclose PHI of military veterans to Department of Veterans Affairs in certain situations.

      Judicial, Administrative and Law Enforcement Purposes: We may disclose PHI about you for judicial, administrative and law enforcement purposes. This may include disclosures in response to subpoenas or court orders.

      To Advert a Serious Threat to Health or Safety: We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. This disclosure would only be made to someone able to help prevent the threat.

      Health Oversight Agencies: We may disclose PHI to a health oversight agency for activities authorized by law, including audits, investigations, inspections, and licensure or disciplinary actions, that are necessary for the government to monitor the health care system, government programs, and compliance with applicable laws.

      Public Health: We may disclose your PHI to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

      National Security and Intelligence Activities: We may disclose your PHI to federal officials for intelligence, counterintelligence or other national security activities authorized by law.

      Protective Services for the President and Others: We may disclose your PHI to federal officials, so they may provide protection for the

      President, other authorized persons or foreign heads of state, or to conduct special investigations.

      Custodial Situation: If you are an inmate of a correctional institution or in the custody of a law enforcement official, we may disclose your PHI to the correctional facility or law enforcement official.

      Following are Uses and Disclosures to Which You Have an Opportunity to Object.

      Facility Directory: Unless you notify us that you object, we will use your name, your room number or other location within the facility, your general medical condition (critical, serious, good, fair, etc.), and your religious affiliation as part of our patient information system. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name.

      Individuals Involved in Your Care or Payment of Your Care: We may release PHI to a friend or family member who is involved in your medical care and those who help pay for your care. If you are unable to object, our health care professionals will use their best judgment in communicating with your family and others. We may disclose PHI about you to an entity assisting in disaster relief efforts so that your family can be notified about your condition, status and location.

      Fundraising: We may contact you as part of our fundraising activities, including through a foundation owned by or affiliated with Ascension Via Christi, but you have the right to opt out of receiving such communications. If you do not want to be contacted about our fundraising efforts, you must notify us in writing.

      All Other Uses and Disclosures Require Your Prior Written Authorization.

      Marketing: We must obtain your written authorization before we may use or disclose your PHI for marketing purposes, except for face-to-face communications made by us to you or a promotional gift of nominal value provided by us to you.

      Any other uses or disclosures not covered by this notice or the laws that apply to us will be made only with your written authorization. If you choose to sign an authorization to disclose your PHI, you can later revoke that authorization, in writing, at any time. Your revocation will stop any future uses and disclosures to the extent that we have not taken any action relying on the authorization.

      WHAT ARE MY RIGHTS REGARDING MY PHI?

      You have the following rights regarding your PHI. You are required to submit in writing requests to exercise any of these rights for records that the facility creates and maintains.

      Right to Inspect and Copy: You have the right to inspect and request a copy of your health record, except as prohibited by law. If you request a copy in either paper or electronic format, you may be charged a fee in accordance with federal and state law. In certain circumstances, we may deny your request to inspect a copy. If you are denied access, you may request that the denial be reviewed.

      Right to Amend: If you believe the information in your records is incorrect or incomplete, you have the right to request that we amend your health record. We are not required by law to agree to a request to amend your health record. We will notify you in writing within 60 days if we are unable to grant your request.

      Right to Accounting of Disclosures: You have the right to get a list of instances in which we have disclosed your PHI in the last six years unless you request a shorter time. The list will not include any disclosures for treatment, payment or health care operations or certain other disclosures not required to be accounted for under applicable law. We will respond within 60 days of receiving your request. We will provide the list to you at no charge, but if you make more than one request in the same 12-month period, we may charge you a reasonable, cost-based fee for each additional request.

      Right to Request a Paper Copy of this Notice: You have the right to a paper copy of this notice even if you agreed to receive this notice electronically.

      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 healthcare operations or disclose about you to a family member or friend involved in your care. We are not required by law to agree to a requested restriction, except when you request that we not disclose information to your health plan about services for which you paid out-of-pocket in full. For all other restriction requests, if we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment or the use or disclosure is required by law.

      Right to Request Confidential Communications: You have the right to request that we communicate with you about your PHI via a certain method or certain location. We will accommodate all reasonable requests.

      Example:

  • You may request that we only contact you via mail or at your work phone number.


CAN ASCENSION VIA CHRISTI CHANGE THIS NOTICE?

We reserve the right to change this notice and to make the revised or changed notice effective for PHI we already have about you as well as for any PHI we create or receive in the future. Each notice has an effective date. Copies of the current notice are posted in our facilities and on our website. Additionally, the current notice is available to you upon request. We are required to follow the terms of the notice currently in effect.

WHAT IF YOU HAVE QUESTIONS OR NEED TO FILE A COMPLAINT?

If you have questions or would like to file a complaint, you may contact our Privacy Officer. If you believe your privacy rights have been violated, you may file a complaint with us or the Secretary of the Department of Health and Human Services. We will not retaliate against you for filing a complaint.

Ascension Via Christi U.S. Department of Health and Human Services

Attention: Privacy Officer Office for Civil Rights

8200 E. Thorn 200 Independence Avenue, S.W.

Wichita, KS 67226 Washington, D.C. 20201

1-800-707-2198 1-877-696-6775

PrivacyProgram@ascension.org www.hhs.gov/ocr/privacy/hipaa/complaints/

WHO WILL FOLLOW THIS JOINT NOTICE OF PRIVACY PRACTICES?

Ascension Via Christi, its medical staff and other health providers are part of a clinically integrated care setting that creates an organized health care arrangement (OHCA) under HIPAA. This allows sharing of information among these legally separate entities to enhance the delivery of quality care to our patients; however, no entity is responsible for the medical judgement or patient care provided by other entities in the arrangement. Medical staff and other independent health care providers may have different privacy practices for medical records they create or maintain in their offices.

These entities are designated as an Affiliated Covered Entity and follow the terms of this Joint Notice:

Ascension Via Christi Hospitals Wichita, Inc. Ascension Via Christi Hospital Pittsburg, Inc. Ascension Via Christi Hospital Manhattan, Inc. Ascension Via Christi Hospital St. Teresa, Inc. Wamego Health Center

Ascension Medical Group Via Christi, P.A.

Ascension Via Christi Rehabilitation Hospital, Inc. Ascension Via Christi Imaging Wichita, LLC Ascension Via Christi Health Partners, Inc.

Ascension Via Christi Home Medical Wichita, LLC Affiliated Medical Services Laboratory, Inc.

Maryland - English (2018)
MD_english_2018

ASCENSION HEALTHCARE SAINT AGNES

SAINT AGNES HEALTHCARE, INC. JOINT NOTICE OF PRIVACY PRACTICES


  1. THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.


  2. WE HAVE A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION (PHI)


    We are legally required to protect the privacy of your health information. We call this information "protected health information" or "PHI" for short. PHI is information that can be used to identify you, which has been created or received about your past, present, or future health or condition, the provision of healthcare to you, or the payment for this health care. We are required to provide you with this notice about our privacy practices that explains how, when, and why we use and disclose your PHI. We are required to notify you in the event of a breach of your unsecured PHI. With some exceptions, we may not use or disclose any more of your PHI than is necessary to accomplish the purpose of the use or disclosure. We are legally required to follow the privacy practices that are described in this notice. However, we reserve the right to change the terms of this notice and our privacy policies at any time. Any changes will apply to the PHI we already have. Before we make an important change to our policies, we will promptly change this notice and post a new notice in a location clearly visible and accessible to all individuals who receive treatment or services at any Saint Agnes Health Care, Inc. facility. You can also request a copy of this notice from the Saint Agnes Health Care, Inc. HIPAA Privacy Office listed in Section 5 at any time and can view a copy of the notice on our website at www.stagnes.org.


  3. HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION


    We use and disclose health information for many different reasons. For some of these uses or disclosures, we must obtain your written authorization. Below, we describe the different categories of our uses and disclosures and give you some examples of each.

    1. Uses and Disclosures Relating to Treatment, Payment or Health Care Operations.


      1. For treatment. We may disclose your PHI to physicians, nurses, medical students and other health care personnel who provide you with health care services or are involved in your care. For example, if you're being treated for a knee injury, we may disclose your PHI to the physical therapy department to coordinate your care.


      2. To obtain payment for treatment. We may use and disclose your PHI to bill and collect payment for the treatment and services provided to you. For example, we may provide portions of your PHI to our billing department and your health plan to get paid for the health care services we provided to you. We may also provide your PHI to our business associates, such as billing companies, claims processing companies, and others that process our health claims.


      3. For health care operations. We may disclose your PHI to operate our hospital, clinics, and other health care service locations. For example, we may use your PHI to evaluate the quality of health care services that you received or evaluate the performance of the health care professionals who provided health care services to you. We may also provide your PHI to our accountants, attorneys, consultants, and others to make sure we are complying with the laws that affect us.


      4. For education/training. On occasion, we participate in the education and training of health care professionals. We may use and disclose your medical information to current and prospective students, residents, and/or observers as part of the training and educational process. For example, your physician may allow a student or observer to monitor your treatment as a part of a learning experience.


    2. Certain Other Uses and Disclosures That Do Not Require Your Consent


      1. When disclosure is required by federal, state, or local law, judicial or administrative proceedings, or law enforcement. For example, we make disclosures when a law requires that we report information to government agencies and law enforcement personnel about victims of abuse, neglect, or domestic violence; when dealing with gunshot and other wounds, or when ordered in a judicial or administrative proceeding.

      2. For public health activities. For example, we report information about births, deaths, and various diseases to government officials in charge of collecting that information, and we provide coroners, medical examiners, and funeral directors necessary information relating to an individual's death.


      3. For health oversight activities. For example, we will provide information to assist the government when it conducts an investigation or inspection of a health care provider or organization.


      4. For purposes of organ donation. We may notify organ procurement organizations to assist them in organ, eye, or tissue donation or transplants.


      5. For research purposes. In certain circumstances, we may provide PHI to conduct research.


      6. To avoid harm. To avoid a serious threat to the health or safety of a person or the public, we may provide PHI to law enforcement personnel or persons able to prevent or lessen such harm.


      7. For specific government functions. We may disclose PHI of military personnel and veterans in certain situations. We may also disclose PHI for national security purposes, such as protecting the President of the United States or conducting intelligence operations.


      8. For workers' compensation purposes. We may provide PHI to comply with workers' compensation laws.


      9. Appointment reminders and health-related benefits or services. We may use PHI to provide appointment reminders or give you information about treatment alternatives, or other health care services or benefits we offer.


      10. Fundraising activities. We may use PHI to raise funds for our organization. The money raised through these activities is used to expand and support the health care services and educational programs we provide to the community. If you do not wish to be contacted as part of our fundraising efforts, you can opt out by notifying the Saint Agnes Health Care, Inc. Privacy Coordinator or the Foundation Office listed in Section 5.


      11. Marketing. We must obtain your written authorization before we can use or disclose your PHI for marketing purposes, except for face to face communications made by us to you or a promotional gift of nominal value provided by us to you. We must also obtain your written authorization before we sell your PHI.

    3. Uses and Disclosures to Which You Have an Opportunity to Object


      1. Patient directories. We may include your name, location in this facility, general condition, and religious affiliation (if any) in our patient directory for use by clergy and visitors who ask for you by name, unless you object in whole or in part.


      2. Disclosure to family, friends, or others. We may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment of your health care, unless you object in whole or in part.


      3. Health Information Exchange

        In an effort to provide the best care to you, St. Agnes Healthcare participates in arrangements between health care organizations that facilitate access to health care information that may be relevant to your care. For example, if you have an emergency and you cannot provide important information about your health, these arrangements will allow us to obtain information to treat you.

        Some St. Agnes Healthcare facilities participate in health information exchange organizations (“HIE”) that permit computer-based transfer of health information directly between healthcare providers at different locations and institutions to facilitate your care and treatment. Some facilities store information in a shared electronic medical record with other health care providers who participate in this regional arrangement. The participants may share your medical information with each other through the shared electronic medical record. You may opt out of the health exchanges St. Agnes participates in by letting your St. Agnes staff know. They can provide you instruction upon your request if you wish to opt out at this time or at any time in the future. Even if you opt-out of the health exchanges, public health reporting and Controlled Dangerous Substances information, as part of the Maryland Prescription Drug Monitoring Program (PDMP), will still be available to providers as permitted by law.


    4. All Other Uses and Disclosures Require Your Prior Written Authorization. In any other situation not described in this section, we will ask for your written authorization before using or disclosing any of your PHI. If you choose to sign an authorization to disclose your PHI, you can later revoke that authorization in writing to stop any future uses and disclosures (to the extent that we haven't taken any action relying on the authorization).

  4. WHAT RIGHTS YOU HAVE REGARDING YOUR PHI


    1. The Right to be Notified in the Event of a Breach of Your Unsecured PHI.


    2. The Right to Request Restrictions on Uses and Disclosures of Your PHI. You have the right to ask that we restrict how we use and disclose your PHI. We are not required to agree to these requests, except for when you request that we not disclose information to your health plan about services for which you paid out-of-pocket in full. In those cases, we will honor your request, unless the disclosure is necessary for your treatment or is required by law.


    3. The Right to Choose How We Send PHI to You. You have the right to ask that we send information to you at an alternate address (for example, to your work address rather than your home address) or by alternate means. We must agree to your request so long as we can easily provide it as you requested.


    4. The Right to See and Get Copies of Your PHI. In most cases, you have the right to look at or get copies of your PHI that we have, but you must make the request in writing. If we don't have your PHI but we know who does, we will tell you how to get it. We will respond to you within 21 days after receiving your written request. In certain situations, we may deny your request. If we do, we will tell you, in writing, our reasons for the denial and explain your right to have the denial reviewed. If you request copies of your PHI, we will charge you a reasonable cost-based fee. We do not charge a fee for sending copies of your PHI to another health care facility or provider where you are or will be receiving health care services.


    5. The Right to Get a List of the Disclosures We Have Made. You have the right to get a list of instances in which we have disclosed your PHI. The list will not include any of the uses or disclosures listed in section 3.1, 3.3, and 3.4. The list also won't include any uses or disclosures made before April 14, 2003. We will respond within 60 days of receiving your request. The list we will give you will include disclosures made in the last six years unless you request a shorter time. The list will include the date of the disclosure, to whom PHI was disclosed (including their address, if known), a description of the information disclosed, and the reason for the disclosure. We will provide the list to you at no charge, but if you make more than one request in the same year, we will charge you for the cost to provide you each additional request.

    6. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI or that a piece of important information is missing, you have the right to request that we correct the existing information or add the missing information. You must provide the request and your reason for the request in writing. We will respond within 60 days of receiving your request. We may deny your request in writing if the PHI is (i) correct and complete, (ii) not created by us, (iii) not allowed to be disclosed, or (iv) not part of our records. Our written denial will state the reasons for the denial and explain your right to file a written statement of disagreement with the denial. If you don't file one, you have the right to request that your request and our denial be attached to all future disclosures of your PHI. If we approve your request, we will make the change to your PHI, tell you that we have done it, and tell others that need to know about the change to your PHI.


    7. The Right to Get This Notice electronically. You have the right to get a copy of this notice electronically. Even if you have agreed to receive notice electronically, you also have the right to request a paper copy of this notice.


    8. The Right to Keep Your Mental Health Providers' Private Notes Secure. We must obtain your written authorization before we may use or disclose your psychotherapy notes, except for: use by the originator of the psychotherapy notes for treatment; use or disclosure by the hospital for mental health training programs; or, use or disclosure by Saint Agnes Health Care, Inc. to defend itself in a legal action or other proceeding brought by you.

  5. PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR TO COMPLAIN ABOUT OUR PRIVACY PRACTICES.


    If you have questions about this notice or think that we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, please contact our Privacy Officer:


    Saint Agnes Health Care, Inc. Privacy Officer

    900 Caton Ave.

    Baltimore, MD 21229

    Phone: 667-234-2491


    For clarifications about fundraising:


    Saint Agnes Health Care, Inc. Fundraising Office, President 900 Caton Ave.

    Baltimore, MD 21229


    You also may send a written complaint to:


    Secretary of the Department of Health and Human Services 200 Independence Avenue, SW

    Washington, DC 20201


    We will not take actions against you if you file a complaint about our privacy practices.

  6. WHO WILL FOLLOW THIS NOTICE OF PRIVACY PRACTICES


    This notice describes the practices of the employees, affiliates, staff, volunteers, departments and units of Saint Agnes Health Care, Inc.


    Saint Agnes Health Care, Inc. contracts with certain independent physicians and groups of healthcare providers (for example, radiologists, anesthesiologists, pathologists, emergency room physicians etc.) who may provide services at some of our sites and locations even though Saint Agnes Health Care, Inc. does not directly employ them.

    Unless one of these contracted groups provides you with its own Notice of Privacy Practices, this Notice applies to their uses and disclosures of PHI and they have agreed to abide by the terms of this Notice.


    All Saint Agnes Health Care, Inc. entities, sites, and locations follow the terms of this Notice. In addition, these Saint Agnes Health Care, Inc. entities, sites, and locations may share PHI with each other for purposes of treatment, payment, or hospital operations as described in this Notice.


  7. EFFECTIVE DATE OF THIS NOTICE


The initial notice was effective on April 14, 2003 Revised October 11, 2011

Revised September 23, 2013

Revised August 7, 2015

Revised March 31, 2017

Revised February 27, 2018

ASCENSION HEALTHCARE SAINT AGNES


DISCRIMINATION IS AGAINST THE LAW!


Saint Agnes complies with applicable Federal civil rights laws and does not discriminate based on race, color, national origin, age, disability or sex; including discrimination based on sexual orientation, gender identity and transgender status.


Saint Agnes does not exclude people or treat them differently because of race, color, national origin, age, disability or sex.


Saint Agnes provides free aids and services to people with disabilities to communicate effectively with us, such as:


  • Qualified sign language interpreters; and

  • Written information in other formats (large print, audio, accessible electronic formats and other formats).

    Saint Agnes provides free language services to people whose primary language is not English, such as:

  • Qualified interpreters; and

  • Information written in other languages.

If you need these services, contact the nursing office at 667-234-2900 between 6:30 a.m.

- 12:00 a.m. Between the hours of 12:00 a.m. - 6:30 a.m., please contact the nursing supervisor at 667-234-2814.


If you believe that Saint Agnes has failed to provide these services or discriminated in another way based on race, color, national origin, age, disability or sex, you can file a grievance with:


Patient Relations Coordinator 900 Caton Avenue

Baltimore, MD 21229

Phone: 667-234-2146

Fax: 667-234-3518

Email: Patient.Relations@stagnes.org

You can file a grievance in person or by mail, fax or email. If you need help filing a grievance, the Patient Relations Coordinator is available to help you. You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/cp/complaint_frontpage.jsf, or by mail or phone at:


U.S. Department of Health and Human Services 200 Independence Avenue SW

Room 509F, HHH Building Washington, DC 20201

1-800-868-1019, 800-537-7697 (TDD)


Complaint forms are available at:

https://www.hhs.gov/civil-rights/filing-a-complaint/complaint-process/index.html

ATTENTION

Language Assistance Services Available


ENGLISH

ATTENTION: If you speak English, language assistance services,

free of charge, are available to you. Call 1-667-234-2146 (TTY: 1-410-368-2001)


ESPAÑOL / SPANISH

ATENCIÓN: si habla español, tiene a su disposición servicios

gratuitos de asistencia lingüística. Llame al 1-667-234-2146 (TTY: 1-410-368-2001)


POLSKI / POLISH

UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej

pomocy językowej. Zadzwoń pod numer 1-667-234-2146 (TTY: 1-410-368-2001)


PORTUGUÊS / PORTUGUESE

ATENÇÃO: Se fala português, encontram-se disponíveis

serviços linguísticos, grátis. Ligue para 1-667-234-2146 (TTY: 1-410-368-2001)


ITALIANO / ITALIAN

ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti. Chiamare il numero 1-667-234-2146 (TTY: 1-410-368-2001)


FRANÇAIS / FRENCH

ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le

1-667-234-2146 (TTY: 1-410-368-2001)


繁體中文 / CHINESE 注意:如果您使用繁體中文,您可以免費獲得語言援助服務。 請致電 1-667-234-2146 (TTY: 1-410-368-2001)


KREYÒL AYISYEN / FRENCH CREOLE

ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-667-234-2146 (TTY: 1-410-368-2001)


िंदी / HINDI

यान द:यद आप हदी बोलते ह तो आपके ि लए म त म भाषा सहायता सेवाए उपल ध ह। 1-667-234-2146 (TTY: 1-410-368-2001)

Русский / RUSSIAN

ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните

1-667-234-2146 (TTY: 1-410-368-2001)


لاعربية / ARABIC

ملحوظة: إذا كنت تتحدث اذكر لالغة، فإن خدمات لامساعدة لالغو ة تتوافر لك بلامجان. اتصل برقم رقم اتف لاصم ولابكم:

1-667-234-2146 (TTY: 1-410-368-2001)


λληνικά / GREEK

ΠΡΟΣΟΧΗ: Αν μιλάτε ελληνικά, στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης, οι οποίες παρέχονται δωρεάν. Καλέστε 1-667-234-2146 (TTY: 1-410-368-2001)


FILIPINO / TAGALOG

PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-667-234-2146 (TTY: 1-410-368-2001)


Tiếng Việt / VIETNAMESE

CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-667-234-2146 (TTY: 1-410-368-2001)


SHQIP / ALBANIAN

KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të

asistencës gjuhësore, pa pagesë. Telefononi në 1-667-234-2146 (TTY: 1-410-368-2001)


한국어 / KOREAN

주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이 용하실 수 있습니다. 1-667-234-2146 (TTY: 1-410-368-2001)

Maryland - Espanol (2018)
MD_Spanish_2018


ASCENSION HEALTHCARE SAINT AGNES

SAINT AGNES HEALTHCARE, INC. NOTIFICACIÓN DE PRÁCTICAS DE PRIVACIDAD

  1. ESTA NOTIFICACIÓN DESCRIBE CÓMO PUEDE UTILIZARSE Y DIVULGAR SU INFORMACIÓN MÉDICA, Y CÓMO PUEDE ACCEDER USTED A ESTA INFORMACIÓN. POR FAVOR REVÍSELA CON CUIDADO.


  2. TENEMOS LA RESPONSABILIDAD LEGAL DE SALVAGUARDAR SU INFORMACIÓN DE SALUD PROTEGIDA (PHI)


    Es requerido por ley proteger la privacidad de su información de salud. Esto se llama “información de salud protegida” o “PHI” como abreviación. PHI es la información que se usa para identificarlo, la cual ha sido creada acerca de su condición de salud pasada, presente o futura, y provisión de salud otorgada, o el pago por el su cuidado de salud. Requerimos la obligación de proveer a usted con esta notificación acerca de su práctica de privacidad la cual explica cómo, cuando y porque usamos y divulgamos su PHI. Requerimos notificar a usted en el caso de un incumplimiento que pueda haber comprometido su PHI. Con algunas excepciones, no divulgaremos más de lo necesario de su PHI para lograr el próposito de uso y divulgación. Por ley debemos seguir las pólizas de prácticas de privacidad describidas en este documento. Sin embargo, nos reservamos el derecho de cambiar los términos de este documento y nuestras pólizas de privacidad en cualquier momento. Cualquier cambio será aplicado a PHI existente.

    Antes de realizar un cambio importante a nuestas pólizas, haremos inmediatamente los cambios en este documento y pondremos el documento con los nuevos cambios en un lugar visible y accessible a todos los individuos que reciben tratamiento o servicios en cualquier instalación de Saint Agnes Healthcare, Inc. Usted también puede solicitar una copia de este documento de Saint Agnes Healthcare, Inc. oficina de Prácticas de Privacidad HIPAA mencionada en la sección 5 y en cualquier momento usted puede ir a nuestra página de internet www.stagnes.org. y revisar el documento


  3. COMO PODEMOS USAR Y DIVULGAR SU INFORMACIÓN DE SALUD PROTEGIDA.

    Nosotros usamos y divulgamos su información de salud por diferentes razones. Por algunos de esos usos

    o divulgaciones debemos obtener autorización por escrito. Debajo, describimos las diferentes categorias de usos y divulgaciones y le damos algunos ejemplos de los mismos.


    1. Usos y divulgaciones relacionadas con el tratamiento, pago u operaciones de cuidado médico


      1. Para tratamientos. Podemos divulgar su PHI a médicos, enfermeras, estudiantes de medicina y otros empleados de salud que le dan servicios de salud o son parte de su cuidado médico. Por ejemplo, si se le da tratamiento por una lesión en la rodilla, podemos divulgar su PHI al departmento de terapía física para cordinar su cuidado


      2. Para obtener pago por tratamiento. Podemos usar y divulgar su PHI para cobrar y collectar pagos por tratamientos y servicios prestados. Por ejemplo, podemos proporcionar partes de su PHI al departmento de facturación y a su seguro médico para recibir pagos por su cuidado y servicios prestados. Podemos también proporcionar su PHI a nuestros socios de negocios como compañias de cobro, compañias de reclamos y otro que procesan nuestros reclamos.


      3. Para operaciones de atención médica. Podemos divulgar su PHI para el funcionamiento del hospital, clínicas y otras ubicaciones que prestan servicio de salud. Por ejemplo, podemos usar su PHI para evaluar la calidad del servicio de salud recibido o evaluar el desempeño de los profesionales de la salud, los cuales le dieron cuidado. También podemos proveer su PHI a nuestros contadores, abogados, asesores, y otros para asegurarnos que estamos cumpliendo con las leyes en efecto.


      4. Para educación y entrenamiento. Ocasionalmente, participamos en la educación y entrenamiento de los profesionales de la salud. Podriamos usar y divulgar su infromación médica a estudiantes actuales y futuros estudiantes, residentes, y/o personas que observan como parte del proceso de entrenamiento y educación. Por ejemplo, su médico puede permitir a un estudiante u observante a monitorear su tratamiento como parte del proceso de aprendizaje


    2. Ciertos usos y divulgaciones que no requieren su consentimiento


      1. Cuando la divulgación es requerida por la ley federal, estatal o local, procedimientos. judiciales o administrativos, o por personal de agencias del orden público. Por ejemplo, hacemos divulgaciones cuando la ley requiere que información sea reportada a agencias del gobierno y personal del orden público acerca de victimas de abuso, negligencia o violencia domestica, cuando se trata de una herida por arma de fuego u otras heridas o cuando es ordenado por un procedimiento judicial o administrativo


      2. Para actividades de salud pública. Por ejemplo, reportamos información acerca de nacimientos, fallecimientos y varias enfermedades a oficiales del gobierno a cargo de la recolección de información, y proporcionamos información relacionada a el fallecimiento de un individuo a forenses, médicos forenses y directores funerarios.

      3. Para la supervición de actividades de salud. Por ejemplo, reportamos información para asistir al gobierno cuando realiza una investigación o inspección de un provedor de salud u organización.


      4. Para la donación de órganos. Notificamos a organizaciones de obtención de organos para asistirlos con la donación de organos, ojos, tejido o transplantes.


      5. Por motivos de investigación médica. En ciertas circunstancias, podemos divulgar su PHI para realizar una investigación médica.


      6. Para prevenir la causa de daños. En orden de prevenir amenazas serias hacia la salud o seguridad de una persona o el público podemos divulgar su PHI a personal del orden público o personas que puedan aminorar dicho daño.


      7. Para funciones guberrnamentales especificas. Podriamos divulgar la PHI de personal militar y veteranos en ciertas situaciones. También podriamos divulgar su PHI para propósitos de seguridad nacional, como para proteger al presidente de los Estados Unidos o realizar operaciones de inteligencia.


      8. Para propósitos de compensación al trabajador. Podriamos divulagar su PHI para cumplir las leyes de compensación al trabajador.


      9. Recordatorios de citas y beneficios relacionados con la salud o servicios. Podriamos usar su PHI para proporcionar recordatorios de citas o dar información acerca de tratamientos alternativos, u otros servicios o beneficios de cuidado de salud que ofrecemos


      10. Actividades de recaudación de fondos. Podriamos usar su PHI para recaudar fondos para nuestra organización. El dinero recaudado mediante esas actividades es usado para expander y apoyar los servicios de salud y programas educacionales otorgados a la comunidad. Si usted prefiere no ser contactado para las actividades de recaudación de fondos, usted puede optar por no, notificando a Saint Agnes Health Care, Inc. Cordinador de Privacidad o la oficina de la fundación enumerada en la Sección 5.


      11. Márketing. Nosotros debemos obtener su autorización por escritro antes de usar o divulgar su PHI para propósitos de márketing, excepto con comunicaciones cara a cara hechas por nosotros o regalos promocionales de ciertas cantidades proporcionados por nosotros hacia usted. También debemos obtener su autorización por escrito antes de vender su PHI.

    3. Usos y divulgaciones las cuales usted tiene la oprtunidad de oponerse


      1. Directorio de pacientes . Podriamos incluir su nombre, ubicación en esta instalacion, condición general y afiliación religiosa ( si existe) en el directorio de pacientes para el uso del clero y visitantes que preguntan por su nombre, al menos que usted tenga objeción complete o parcial.


      2. Divulgación a familiares, amigos u otros. Podriamos proporcionar su PHI a un familiar, amigo u otra persona que usted indique que es parte de su cuidado médico o responsable de pagos, al menos que usted tenga alguna objeción total o parcial.


      3. Intercambio de la información


        En esfuerzo para otorgar el mejor cuidado, St. Agnes Healthcare participa en un convenio entre organizaciones de salud que facilitan el acceso a información de salud que puede ser pertinente para su cuidado. Por ejemplo, si usted tiene una emergencia y no puede dar información importante acerca de su salud, estos convenios nos permitirán obtener información para darle tratamiento. Algunas de las instalaciones de St. Agnes Healthcare participant en la organización de intercambio de información de salud (“HIE”) la cual permite transferir informción computarizada de salud directamente entre provedores de salud localizados en diferentes lugares e instituciones para facilitar su cuidado y tratamiento. Algunas instalaciones almacenan información en un registro médico electrónico que comparten con provedores de salud participantes de este arreglo regional. Los participantes pueden compartir su información médica con otros por medio del registro electrónico de salud. Usted puede optar por no compartir su información de salud en forma electrónica dejandole saber al personal de St. Agnes. Ellos le pueden proporcionar las instrucciones si usted decide optar por no compartir su infromación en el presente o en el future. Aunque usted opte por no compartir su información de salud, reportes de información de salud pública y Substancias Peligrosas Controladas, que forman parte de el Programa de Monitoreo de Medicamentos con Recetas de Maryland (PDMP), se encontrarán disponibles a provedores de salud como se permite por ley.


    4. Cualquier otro uso o divulgación requiere su autorización previa por escrito. En cualquier otra situación


      no mencionada en esta sección, le pediremos su autorización por escrito antes de usar o divulgar cualquier porción de su PHI. Si usted firma un permiso para divulgar su PHI, más tarde puede revocar ese permiso por escrito para anular usos y divulgaciones futuras ( a la extensión que no se haya tomado ninguna acción dependiendo de esa autorización)

  4. CUALES SON SUS DERECHOS ACERCA DE SU PHI


    1. El derecho de ser notificado en el caso de incumplimiento de su PHI no salvaguardada.


    2. El derecho a pedir restrinciones en el uso y divulgación de su PHI. Usted tiene el derecho de pedir que su PHI sea usada y divulgada con restrinciones. Nosotros no estamos obligados a estar de acuerdo con estas peticiones, excepto para cuando usted solicite que no se divulgue información a su seguro médico por servicios que usted ha pagado de su bolsillo. En este caso nosotros le haremos honor a su pedido, al menos que su divulgación sea necesaria para su tratamiento o es requirido por ley.


    3. El derecho de elegir como le enviamos su PHI. Usted tiene el derecho de solicitar que su informción sea enviada a una dirección alternativa (por ejemplo a la dirección de su trabajo en vez de su domicilio). Nosotros debemos estar de acuerdo a su pedido siempre y cuando le podamos proveer facilmente lo solicitado.


    4. El derecho de visualizar y obtener las copias de su PHI. En la mayoria de los casos usted tiene el derecho de ver u obtener copies de su PHI, pero tiene que hacer el pedido por escrito. Si nosotros no tenemos su PHI pero sabemos quien tiene su PHI, le informaremos como obtenerla. Después de recibir su pedido por escrito le responderemos dentro de 21 días. En ciertas circunstancias podriamos negar su pedido. Si lo hacemos, le dejaremos saber por escrito, las razones de la negación y su derecho de apelar a la negación. Si usted solicita copias de su PHI, le cobraremos un arancel razonable de costo base. Nosotros no cobramos aranceles por enviar copias de su PHI a una entidad médica o provedor de salud donde usted está o recibirá cuidados de salud.


    5. El derecho de recibir una lista con las divulgaciones hechas. Usted tiene el derecho de obtener una lista de ejemplos en donde nosotros hemos divulgado su PHI. La lista no incluirá ningún uso o divulgación numeradas en la sección 3.1, 3.3 y 3.4. La lista también no incluirá ningún uso o divulgación hecha antes del 14 de abril del 2003. Le responderemos dentro de los 60 dias de recibir su pedido. La lista que se le entregará tendrá divulgaciones hechas en los ultimos seis años al menos que su solicitud haya sido por un periodo más corto. La lista incluirá la fecha de la divulgación, a quién su PHI fué enviada (incluyendo la dirección, si está disponible), una descripción de la información divulgada, y la razón por la divulgación. Le proporcionaremos la lista sin cargos, pero si usted solicita más de una copia en el mismos año, se le cobrará por cada copia adicional.


    6. El derecho de corregir y actualizar su PHI. Si usted cree que existe un error en su PHI o que falta información importante, usted tiene el derecho de pedir la corrección o agregar la información faltante. Usted debe proporcionar el pedido y la razón del mismo por escrito. Nosotros le responderemos dentro de los 60 días de recibir su pedido. Podemos negar su pedido por escrito si su PHI es (i) correcta y completada, (ii) no ha sido creado por nosotros (iii) la divulgación no es permitida o (iv) no es parte de nuestros expedientes. Nuestra negación tendrá las razones de la negación y explicará su derecho a presenter un reclamo por escrito con el desacuerdo por la negación. Si usted no presenta un reclamo, usted tiene el derecho de solicitar que su pedido y negación sean adjuntados a sus divulgaciones futuras de su PHI. Si aprovamos su pedido, haremos los cambios de su PHI, le dejaremos saber que los cambios se han hecho, y dejar saber a quien sea necesario de dichos cambios en su PHI


    7. El derecho de recibir esta notificación por correo electrónico. Usted tiene el derecho de recibir una copia de esta notificación por correo electrónico. Aunque usted estuvo de acuerdo a recibir notificaciones por correo electrónico, usted también tiene el derecho de solicitar una copia por escrito de esta notificación


    8. El derecho de mantener privadas y seguras las copias de sus provedores de salud mental. Nosotros debemos obtener su autorización por escrito antes de poder usar o divulgar sus notas de psicoterapia, excepto para el uso del originador de las notas de psicoterapia para tratamiento, uso o divulgación por el hospital con el propósito de programas de educación mental o uso o divulgación para Saint Agnes Health Care, Inc. con el propósito de defenderse en una acción legal u otra acción legal iniciada por usted.

  5. Persona para comunicarse para obtener información acerca de esta notificación o con quejas acerca de nuestras practicas de privacidad.


    Si usted tiene alguna pregunta acerca de esta notificación o piensa que sus derechos de privacidad han sido violados, o no está de acuerdo con una desición hecha acerca del acceso a su PHI, por favor contactar al cordinador de privacidad:


    Saint Agnes Health Care, Inc. Privacy Officer

    900 Caton Ave.

    Baltimore, MD 21229

    Teléfono: 667-234-2491


    Para clarificaciones acerca de recaudación de fondos:


    Saint Agnes Health Care, Inc. Fundraising Office, President 900 Caton Ave.

    Baltimore, MD 21229


    Usted puede también enviar una queja por escrito a:


    Secretary of the Department of Health and Human Services 200 Independence Avenue, SW

    Washington, DC 20201


    Nosotros no tomaremos ninguna acción en su contra si usted presenta una queja acerca de nuestras practicas de privacidad.

  6. QUIÉN SEGUIRÁ ESTA NOTIFICACIÓN DE PRACTICAS DE PRIVACIDAD


    Esta notificación describe la practica de sus empleados, afiliados, personal, voluntarios, departamentos y unidades de Saint Agnes Health Care, Inc.


    Saint Agnes Health Care, Inc.tiene contratos con ciertos médicos y grupos de provedores de salud independientes (por ejemplo radiólogos, anestesiólogos, patólogos, médicos en la sala de emergencia etc.) que puedan trabajar en algunos de nuestros sitios y oficinas aunque Saint Agnes Health Care, Inc. no les da empleo en forma directa. Al menos que uno de estos grupos contratados le proporciona con su propia notificación de la practica de privacidad, esta notificación se aplica a sus usos y divulgaciones de PHI y ellos han acordado cumplir con los términos de esta notificación.


    Saint Agnes Health Care, Inc. entidades, sitios y localidades, todos, se avalan por los terminos de esta notificación. También Saint Agnes Health Care, Inc. entidades, sitios y localidades, todos, pueden compartir entre ellos su PHI con el próposito de tratamiento, pago u operaciones del hospital describidas en esta Notificación.


  7. . FECHA DE VIGENCIA DE ESTA NOTIFICACIÓN


La notificación inicial fué efectiva en abril 14 del 2003. Versión revisada el 11 de octubre del 2011

Versión revisada el 23 de septiembre del 2013 Versión revisada el 7 de Agosto del 2015 Versión revisada el 31 de marzo del 2017 Versión revisada el 27 de febrero del 2018

ASCENSION HEALTHCARE

SAINT AGNES


LA DISCRIMINACIÓN ES CONTRA LA LEY!


Saint Agnes cumple con las leyes federales de derechos civiles y no discrimina en base a la raza, color, nacionalidad de origen, edad, discapacidad o sexo; incluyendo la discriminación basada en orientación sexual, identidad de género y estado transgénero.


Saint Agnes no excluye a la gente o la trata diferente por la raza, color, nacionalidad de origen, edad, discapicidad o sexo.


Saint Agnes proporciona ayuda gratuita y ayuda a personas con discapacidades para comunicarse efectivamente con nosotros, como:


  • Intérpretes de idioma de señas calificados e

  • Información en distintos formatos (impresiones con letras grandes, audio, acceso a formatos electrónicos y otros formatos)


    Saint Agnes proporciona servicios gratuitos de interpretación para las personas que el inglés no es su primer idioma, como:


  • Intérpretes calificados, e

  • Información en otros lenguajes.


Si usted necesita de esos servicios, llamar a Nursing Office al 667-234-2900 entre las 6:30 am y 12:00 am. Entre las 12:00 am y las 6:30 am, por favor llamar al supervisor al 667-234-2814.


Si usted cree que Saint Agnes ha fallado en proporcionar estos servicios o ha discriminado de alguna manera por su raza, color, nacionalidad, edad, discapacidad o sexo, usted puede presenter una queja con:


Patient Ralations Coordinator 900 Caton Avenue

Baltimore, MD 21229 Teléfono:667-234-2146 Fax: 667-234-3518

Correo: Patient.Relations@stagnes.org

Usted puede presentar una queja en persona o por correo, fax o correo electrónico. Si usted necesita ayuda para completar una queja, el cordinador de relación al paciente (Patient Relation Coordinator) está disponible para ayudarlo. . Usted también puede presentar una queja de derechos civiles con el Departamento de Salud y Servicios Humanos, Oficina de Derechos Civiles en forma electrónica o en la página de Quejas de Derechos Civiles, disponible https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, o por correo o por teléfono a:



U.S. Department of Health and Human Services 200 Independence Avenue SW

Room 509F, HHH Building Washington, DC 20201

1–800–868–1019, 800–537–7697 (TDD)


Los formularios de quejas se encuentran disponibles en:


http://www.hhs.gov/ocr/office/file/index.html.

ATENCIÓN

SERVICIOS DE ASISTENCIA DE LENGUAJE DISPONIBLES


INGLÉS


ATTENTION: If you speak English, Language assistance services, free of charge are available to you. Call 1- 667-234-2146 (TTY:1-410-368-2001)


ESPAÑOL/SPANISH


Atención: Si usted habla español, servicio de asistencia de lenguaje gratis se encuentra disponible. Llame al 1- 667-234-2146 (TTY:1-410-368-2001)


POLSKI / POLISH


UWAGA: Jeżeli mówisz po polsku, możesz skorzystać z bezpłatnej pomocy językowej. Zadzwoń pod numer 1-667- 234-2146 (TTY: 1-410-368-2001)


PORTUGUÊS / PORTUGUESE


ATENÇÃO: Se fala português, encontram-se disponíveis serviços linguísticos, grátis. Ligue para 1-667-234-2146 (TTY: 1-410-368-2001)


ITALIANO / ITALIAN


ATTENZIONE: In caso la lingua parlata sia l’italiano, sono disponibili servizi di assistenza linguistica gratuiti.

Chiamare il numero 1-667-234-2146 (TTY: 1-410-368-2001)


FRANÇAIS / FRENCH


ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le 1- 667-234-2146 (TTY: 1-410-368-2001)


繁體中文 / CHINESE


注意:如果您使用繁體中文,您可以免費獲得語言援助服務 請致電 1-667-234-2146 (TTY: 1-410-368-2001)


KREYÒL AYISYEN / FRENCH CREOLE


ATANSYON: Si w pale Kreyòl Ayisyen, gen sèvis èd pou lang ki disponib gratis pou ou. Rele 1-667-234-2146 (TTY: 1- 410-368-2001)


ह द

/ HINDI


यान द:यद आप हदी बोलते ह तो आपके ि लए म त म भाषा सहायता सेवाएं उपल ध ह। 1-667-234-

2146 (TTY: 1-410-368-2001)

Русский / RUSSIAN


ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-667-234-2146 (TTY: 1-410-368-2001)

لاعربية / ARABIC


بلامجان. اتصلبرقمرقماتفلاصمولابكم ملحوظة: إذاكنتتتحدثاذكرلالغة،فإنخدماتلامساعدةلالغوةتتوافرلك: 1-667-234-2146 (TTY: 1-410-368-2001)

λληνικά / GREEK


ΠΡΟΣΟΧΗ: Αν μιλάτε ελληνικά, στη διάθεσή σας βρίσκονται υπηρεσίες γλωσσικής υποστήριξης, οι οποίες παρέχονται δωρεάν. Καλέστε 1-667-234-2146 (TTY: 1-410-368-2001)


FILIPINO / TAGALOG


PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-667-234-2146 (TTY: 1-410-368-2001)


Tiếng Việt / VIETNAMESE


CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-667-234-2146 (TTY: 1-410-368-2001)


SHQIP / ALBANIAN


KUJDES: Nëse flitni shqip, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë. Telefononi në 1- 667-234-2146 (TTY: 1-410-368-2001)


한국어 / KOREAN


주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이 용하실 수 있습니다. 1-667-234-2146 (TTY: 1-410-368-2001)



.

Michigan - English (2018)
MI_english_2018

Ascension Michigan


Ascension Michigan Notice of Privacy Practices


  1. 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.

  2. WE HAVE A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION (PHI)

    We are legally required to protect the privacy of your health information. We call this information “protected health information” or “PHI” for short, and it includes information that can be used to identify you that we have created or received about your past, present, or future health or condition, the provision of healthcare to you, or the payment for this health care. We must provide you with this notice about our privacy practices that explains how, when, and why we use and disclose your PHI. With some exceptions, we may not use or disclose any more of your PHI than is necessary to accomplish the purpose of the use or disclosure. We are legally required to follow the privacy practices that are described in this notice.

    However, we reserve the right to change the terms of this notice and our privacy policies at any time. Any changes will apply to the PHI we already have. Before we make an important change to our policies, we will promptly change this notice and post a new notice near the main entrance to each Ascension Michigan facility. You can also request a copy of this notice from the contact person listed in Section 7 below at any time and can view a copy of the notice on our website at www.ascension.org/michigan

  3. HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION.

    We use and disclose health information for many different reasons. For some of these uses or disclosures, we need your prior specific authorization. Below, we describe the different categories of our uses and disclosures and give you some examples of each.

    1. Uses and Disclosures Relating to Treatment, Payment or Health Care Operations.

      We may use and disclose your PHI for the following reasons:

      1. For treatment. We may disclose your PHI to physicians, nurses, medical students and other health care personnel who provide you with health care services or are involved in your care. For example, if you’re being treated for a knee injury, we may disclose your PHI to the physical therapy department in order to coordinate your care.

      2. To obtain payment for treatment. We may use and disclose your PHI in order to bill and collect payment for the treatment and services provided to you. For example, we may provide portions of your PHI to our billing department and your health plan to get paid for the health care services we provided to you. We may also provide your PHI to our business associates, such as billing companies, claims processing companies and others that process our health care claims.

      3. For health care operations. We may disclose your PHI in order to operate our hospitals, clinics, urgent care centers and other health care service locations. For example, we may use your PHI in order to evaluate the quality of health care services that you received or evaluate the performance of the health care professionals who provided health care services to you. We may also provide your PHI to our accountants, attorneys, and consultants who perform services on our behalf.

    2. Other Uses and Disclosures That Do Not Require Your Authorization

      1. When disclosure is required by federal, state or local law, judicial or administrative proceedings, or law enforcement. For example, we make disclosures when a law requires that we report information to government agencies and law enforcement personnel about victims of abuse, neglect or domestic violence; when dealing with gunshot and other wounds, or when ordered in a judicial or administrative proceeding.

      2. For public health activities. For example, we report information about births, deaths and various diseases to government officials in charge of collecting that information, and we provide coroners, medical examiners and funeral directors necessary information relating to an individual’s death.

      3. For health oversight activities. For example, we will provide information to assist the government when it conducts an investigation or inspection of a health care provider or organization.

      4. For purposes of organ donation. We may notify organ procurement organizations to assist them in organ, eye or tissue donation and transplants.

      5. For research purposes. In certain circumstances, we may provide PHI in order to conduct research.

      6. To avoid harm. In order to avoid a serious threat to the health or safety of a person or the public, we may provide PHI to law enforcement personnel or persons able to prevent or lessen such harm.

      7. For specific government functions. We may disclose PHI of military personnel and veterans in certain situations. And we may disclose PHI for national security purposes, such as protecting the president of the United States or conducting intelligence operations.

      8. For workers’ compensation purposes. We may provide PHI in order to comply with workers’ compensation laws.

      9. Appointment reminders and health-related benefits or services. We may use PHI to provide appointment reminders through the mail, telephone, email or by text or give you information about treatment alternatives, or other health care services or benefits we offer.

      10. Fundraising activities. We may use PHI to raise funds for our organization. The money raised through these activities is used to expand and support the health care services and educational programs we provide to the community. If you do not wish to be contacted as part of our fundraising efforts, please contact the person listed at the end of this notice.

    3. Uses and Disclosures to Which You Have an Opportunity to Object

      1. Patient directories. We may include your name, location in this facility, general condition in our patient directory and disclose it to visitors who ask for you by name, unless you object in whole or in part. We also may include your religious affiliation (if any) in the facility directory and disclose facility directory information to clergy members, unless you object in whole or part.

      2. Disclosure to family, friends, or others. We may provide your PHI to a family member, friend or other person to the extent that person is involved in your care or the payment for your health care, unless you object in whole or in part.

      3. Special Legal Restrictions Frequently, Michigan law and/or Federal Regulations require explicit authorization for the disclosure of PHI of patients treated for mental health, substance abuse and HIV/AIDS conditions.

    4. All Other Uses and Disclosures Require Your Prior Written Authorization

      In any other situation not described in this section, we will ask for your written authorization before using or disclosing any of your PHI. If you choose to sign an authorization to disclose your PHI, you can later revoke that authorization in writing to stop any future uses and disclosures (to the extent that we have not taken any action relying on the authorization).


      34028-67250-002 REVISED 6/28/18

  4. WHAT RIGHTS YOU HAVE REGARDING YOUR PHI

    You have the following rights with respect to your PHI:

    1. The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask that we limit how we use and disclose your PHI. We will consider your request but are not legally required to accept it. However, if you pay in full out-of-pocket and you request that we not disclose any information to your health plan about that service, we must grant that request. If we accept your request, we will put any limits in writing and abide by them except in emergency situations. You may not limit the uses and disclosures that we are legally required or allowed to make related to your treatment.

    2. The Right to Choose How We Send PHI to You. You have the right to ask that we send information to you at an alternate address (for example, to your work address rather than your home address) or by alternate means (for example, e-mail instead of regular mail). We must agree to your request so long as we can easily provide it in the format you requested.

    3. The Right to See and Get Copies of Your PHI. In most cases you have the right to look at or get copies of your PHI that we have, but you must make the request in writing. If we don’t have your PHI but we know who does, we will tell you how to get it. We will respond to you within 30 days after receiving your written request. In certain situations, we may deny your request. If we do, we will tell you, in writing, our reasons for the denial and explain your right to have the denial reviewed.

      If you request copies of your PHI, we will charge you a reasonable copying fee.

    4. The Right to Get a List of the Disclosures We Have Made. You have the right to get a list of instances in which we have disclosed your PHI. The list will not include any of the uses or disclosures for treatment, payment and health care operation and some other purposes per the law. The list also will not include any uses or disclosures made before April 14, 2003.

      We will respond within 60 days of receiving your request. The list we will give you will include disclosures made in the last six years unless you request a shorter time. The list will include the date of the disclosure, to whom PHI was disclosed (including their address, if known), a description of the information disclosed, and the reason for the disclosure. We will provide the list to you at no charge, but if you make more than one request in the same year, we will charge you $25 for each additional request.

    5. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI or that a piece of important information is missing, you have the right to request that we correct the existing information or add the missing information. You must provide the request and your reason for the request in writing. We will respond within 60 days of receiving your request. We may deny your request in writing if the PHI is (i) correct and complete, (ii) not created by us, (iii) not required to be disclosed to you, or (iv) not part of your medical record. Our written denial will state the reasons for the denial and explain your right to file a written statement of disagreement with the denial. If you don’t file one, you have the right to request that your request and our denial be attached to all future disclosures of your PHI. If we approve your request, we will make the change to your PHI, tell you that we have done it, and tell others that need to know about the change to your PHI.

    6. Notice by E-Mail. If you agree to receive this notice via e-mail, you still have the right to request a paper copy of this notice.

    7. Psychotherapy Notes. We must obtain your written authorization before we may use or disclose your psychotherapy notes, except for:

      use by the originator of the psychotherapy notes for treatment; use or disclosure by Covered Entity for its own mental health training programs; or use or disclosure by Covered Entity to defend itself in a legal action or other proceeding brought by the individual.

    8. Marketing. We must obtain your written authorization before we may use or disclose your PHI for marketing purposes, except for face-to face communications made by us to you or a promotional gift of nominal value provided by us to you.

    9. Sale of PHI. We must obtain your written authorization before we sell your PHI.

    10. Breach of PHI. We are required to notify you in the event of a breach of your unsecured PHI.

  5. HOW TO COMPLAIN ABOUT OUR PRIVACY PRACTICES

    If you think that we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a complaint with: Ascension Michigan HIPAA Privacy Office - (See section 7 of this Notice.)

    You also may send a written complaint to: Secretary of the Department of Health and Human Services We will take no retaliatory action against you if you file a complaint.

  6. WHO WILL FOLLOW THIS NOTICE OF PRIVACY PRACTICES

    This notice describes the practices of the employees, medical staff, volunteers, departments, units, contracted providers who provide services at our locations and joint ventures of the following entities:

    Ascension Michigan

    Ascension Brighton Center for Recovery Ascension Crittenton Hospital Ascension Eastwood Behavioral Health Ascension Medical Group

    Ascension Providence Hospital Ascension St. John Hospital Ascension Macomb-Oakland Hospital Ascension River District Hospital

    Ascension Providence Foundation Ascension St. John Foundation

    Ascension Michigan Occupational Health Partners Ascension SE Michigan Community Health

    St. John Providence Partners in Care Affiliated Health Services, Inc Ascension Physician Services

    Bone & Joint Surgery Center of Novi Ascension Michigan Open MRI


    Also, these entities, sites and locations may share medical information with physicians and other healthcare professionals within Ascension Michigan and as a Member of a Regional Health Information Organization (“RHIO”) or other Health Information Exchange

    (“HIE”). If you want to “opt out” of the RHIO or HIE, please notify the Privacy Officer listed under Section 7.

  7. PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR TO COMPLAIN ABOUT OUR PRIVACY PRACTICES. If you have questions about this notice or any complaints about our privacy practices, or would like to know how to file a complaint with the Secretary of the Department of Health and Human Services, please contact the HIPAA Privacy Officer at 248-849-5302. All complaints must be submitted in writing to:

    Ascension Michigan - HIPAA Privacy Officer 28000 Dequindre Road

    Warren, MI 48092

  8. EFFECTIVE DATE OF THIS NOTICE: April 14, 2003. REVISED: December 1, 2016

NY - Amsterdam - English (2017)
NY_Amsterdam_english_2017

St. Mary’s Healthcare

HIPAA NOTICE OF PRIVACY PRACTICES

Effective Date: August 1, 2017


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.


WHO THIS NOTICE APPLIES TO

This Notice applies to St. Mary’s Healthcare (SMH):

  • Service locations, including: _446a, 427, 425, 380, 76 Guy Park Avenue, 4988, 4950 State Highway 30, 48 Erie Blvd., CANAJOHARIE, 7 Timmerman Ave ST. JOHNSVILLE, 700 S. Perry St. JOHNSTOWN, 84 E. State St., 73 N. Main St. 57 E. Fulton St., GLOVERSVILLE, 331 Bridge St. NORTHVILLE

  • Medical staff members, employees and other St. Mary’s Healthcare workforce members.


    OUR RESPONSIBILITIES

    SMH takes the privacy of the health information entrusted to us seriously, as both an ethical and a legal obligation. We call this health information “protected health information.” Protected health information is any information in a medical record that can be used to identify an individual; and that was created, used, or disclosed in the course of providing a health care service, such as a diagnosis or treatment. It also includes information about payment for health care services, such as a claims record. Disclosures of your protected health information for purposes described in this Notice may be in writing, orally, electronically, or by facsimile.

    We are required by law to:

    • Maintain the privacy of health information.

    • Provide you with this Notice of Privacy Practices ("Notice"), which tells you about our duties and practices with respect to protecting health information.

    • Abide by the terms of the Notice that is currently in effect.

    • Notify you following a breach of unsecured health information that affects you.


      HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION

      The following categories describe different ways SMH may use and disclose your health information without your written authorization. Health information is most often used and disclosed to provide treatment, to obtain payment for treatment, or for health care operations. We will provide an example of the types of uses covered by these categories. Not every use or disclosure in a category will be listed. References to "you" and "your" information include your child's information, when appropriate.

  • For Treatment. SMH may use and disclose health information to provide treatment, health care or other related services. Health information may be used by or disclosed to doctors, nurses, aides, or other healthcare providers who are involved in taking care of you. Additionally, SMH may use or disclose health information to manage or coordinate treatment, health care or other related services. For example, we may use or disclose health information about you for treatment purposes such as when you are referred to a specialist for care or when we send a prescription to a pharmacy to be filled for you.


  • For Payment. SMH may use and disclose health information to bill and collect for the treatment and services we provide to you. We may send health information to your insurance company or other third party payer for payment purposes. For example, we may use and disclose health information about you for payment purposes such as when we send claims to your HMO for payment or to find out whether proposed treatment is covered.

  • For Health Care Operations. SMH may use and disclose health information for health care operations. These uses and disclosures are necessary to run SMH and to maintain and improve the quality of health care we provide. For example, we may use and disclose health information about you for health care operations purposes such as accreditation renewals, quality improvement activities, and teaching purposes.

  • Hospital Directory. SMH may include limited information about you in the hospital directory while you are a patient at SMH. This information includes your name, location and/or discharge status in the hospital, your general condition (e.g., fair, stable, etc.) and your religious affiliation. The directory information may be disclosed to people who ask for you by name, except for your religious affiliation, which may only be disclosed to clergy members. You have the right to not have your information included in the hospital directory ("opt-out"). To opt-out of the hospital directory, we ask that you make this request during patient registration.

  • Individuals Involved in Your Care or Payment for Your Care. SMH may disclose to your family member, relative, close personal friend or other person identified by you, health information that is directly relevant to that person’s involvement with your care or payment for your care. SMH will not share this information with these individuals if we are aware of your desire not to have this information shared.

  • Fundraising. We may contact you for the purpose of raising funds to help support the SMH mission.

    You have the right to opt-out of receiving fundraising communications.

  • Research. Under certain circumstances, SMH may use and disclose health information for research purposes. For example, a research project may involve comparing the health and recovery of all individuals who receive one medication to those who receive another. All research projects are subject to a special approval process.

  • Immunization Records. SMH may disclose immunization records to a school where you are or will be a student, if the school is required by law to have proof of immunizations for admission purposes. SMH will first obtain your verbal or written permission to make this disclosure.

  • For Public Health Purposes. SMH may disclose health information for public health activities. For example, public health activities include: preventing and controlling disease, injury or disability; reporting births and deaths; and reporting defective medical devices or problems with medications.

  • About Victims of Abuse. SMH may disclose your health information to notify the appropriate government authority if we believe you have been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree, or when required or authorized by law.

  • Health Oversight Activities. SMH may disclose health information to a health oversight agency for health oversight activities authorized by law. These activities include audits, investigations, licensure and disciplinary actions, and related activities to monitor the health care system, governmental benefit programs, and compliance with civil rights laws.

    • Judicial and Administrative Proceedings. SMH may disclose health information in response to a subpoena, court order, or administrative order, if certain requirements are met.

    • Law Enforcement. SMH may release health information to law enforcement if the disclosure is required by law, necessary to identify or locate a suspect or missing person, about criminal conduct at SMH, about a victim of crime under certain circumstances, and in certain emergency situations.

    • To Avert a Serious Threat to Health or Safety. SMH may use and disclose health information when SMH believes it is necessary to prevent a serious threat to the individual's health and safety or the health and safety of the public or another person. Any disclosure would only be to someone able to help prevent or lessen the threat, or to law enforcement authorities.

    • Coroner, Medical Examiners, and Funeral Directors. SMH may disclose health information to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death, or other duties authorized by law. SMH may disclose health information to a funeral director, consistent with law, to permit the funeral director to carry out his/her duties.

    • Organ Donation Purposes. SMH may disclose health information to organ procurement organizations and others engaged in procurement, banking or transplantation of cadaveric organs, eyes, or tissue, for the purposes of facilitating organ donation and transplantation.

    • Military and Veterans. If you are a member of the armed forces, we may release your health information as required by military command authorities. We may also release health information about foreign military personnel to the appropriate foreign military authority.

    • National Security and Intelligence Activities. SMH may release health information to authorized federal officials for intelligence, counterintelligence and other national security activities as authorized by law.

    • Protective Services for the President and Others. SMH may disclose health information to authorized federal officials so they may provide protection to the President or other authorized persons, or for the conduct of special investigations authorized by law.

    • Inmates. If you are an inmate or in the custody of a correctional institution or law enforcement, SMH may disclose health information to the correctional institution or law enforcement official for treatment and safety purposes.

    • Worker’s Compensation . SMH may disclose health information as authorized by and to the extent

      necessary to comply with worker’s compensation laws or laws relating to similar programs.

    • As Required by Law. SMH will disclose health information when required to do so by federal, state or local law.


      ALLIANCE AND IHANY

      We participate in (i) the Alliance for Better Health Care, LLC, (Alliance), which is a Performing Provider System (PPS) and (ii) Innovative Health Care Alliance of NY (IHANY), which is an Accountable Care Organization (AC). These are NYS regulated organizations created to coordinate your care and to reduce unnecessary or duplicate medical procedures or tests. We will share your health information with these organizations and with other health care providers who are participating in these organizations, in order to coordinate your care. Such information may include alcohol and drug treatment information, HIV/AIDS information, mental health conditions, and/or information about sexually transmitted diseases. Such disclosures are permitted based on the treatment, payment or health care operations exceptions or based on your consent. The use and disclosure of such information will be carried out in accordance with each of the applicable Federal or State laws. A list of those participating providers and further information can be found at ihany.org and

      allianceforbetterhealthcare.com.


      HEALTH INFORMATION EXCHANGE

      SMH participates in a health information exchange organization (“HIXNY”) that permits computer-based transfer of health information directly between healthcare providers at different locations and institutions to facilitate your care and treatment. If you do not want your information to be

      shared in this way, you can opt-out by refusing to sign the authorization to do so at the time of registration.


      CONFIDENTIALITY OF SUBSTANCE USE DISORDER RECORDS

      The confidentiality of substance use disorder patient records maintained by substance use treatment programs at SMH (“SU Programs”) is protected by federal law and regulations. Generally, if you receive substance use treatment services from SU Programs, we may not acknowledge to a person outside a SU Program that you attend a substance use program, or disclose any information identifying you as having or having had a substance use disorder unless:

    • You consent in writing;

    • The disclosure is allowed by court order; or

    • Disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit or program evaluation.


      Federal law and regulations do not protect any information about a crime committed by you either at SMH or against any person who works for SMH or about any threat to commit such a crime. Federal law and regulations do not protect any information about suspected child abuse or neglect from being reported under State law to appropriate State or local authorities.


      Violation of the Federal law and regulations by a program is a crime. Suspected violations may be reported to the United States Attorney for the Northern District of New York at:


      U.S. Attorney's Office 445 Broadway, Room 218 Albany, NY 12207-2924 Telephone: (518) 431-0247


      Specifically for opioid treatment programs, suspected violations may be reported to Substance Abuse and Mental Health Services Administration Region II Opioid Treatment Program Compliance Office at (240)276- 2547.

      (See 42 U.S.C. 290dd–3 and 42 U.S.C. 290ee–3 for federal laws and 42 CFR part 2 for federal regulations.)


      OTHER SPECIAL RESTRICTIONS UNDER STATE AND OTHER FEDERAL LAWS

      We will also comply with all other applicable state and federal laws. For example, under state law, there are more limits on when HIV and AID, genetic testing, or mental health information may be disclosed. We abide by all applicable state and federal laws.


      OTHER USES AND DISCLOSURES

      Any 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 Authorization.


      DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION

      An Authorization is a special written permission from you that grants authority to SMH to use or disclose your health information.

    • We must obtain your Authorization to use or disclose psychotherapy notes. Psychotherapy notes may only be used for limited purposes, such by the treating professional. Disclosures are permitted only as required by law, for certain health oversight activities, or to avert a serious threat to health or safety.

    • We must obtain your Authorization to use or disclose health information for marketing purposes, or for disclosures that constitute the sale of medical information.

    • If you provide us an Authorization to use or disclose your health information, you may revoke that Authorization, in writing, at any time. If you revoke your Authorization, we will no longer use or disclose health information about you for the reasons covered by your Authorization.


      YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION

      You have the following rights regarding health information we maintain about you:

    • Right to Request Restrictions. You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment or health care operations. However, we are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.

    • Right to Restrict Disclosure for Services Paid by You in Full. You have the right to restrict the disclosure of health information if you have paid for the care out-of-pocket, in-full and you are asking us not to submit information about that care to your health plan.

    • Right to Request Confidential Communications. Typically, we communicate with you regarding your health care either by calling your home phone or sending mail to your home address. You have the right to request that we communicate with you in an alternative way or at a certain location. To request confidential communications, we ask that you make your request in writing to the Privacy Officer at the addressed listed at the end of this Notice. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

    • Right to Access. In most cases, you have the right to access your health information by requesting to inspect and/or obtain a copy of your health information, with limited exceptions. We ask that your request be made in writing to the Privacy Officer at the addressed listed at the end of this Notice. You may request the copy of your health information be provided in a summary format. You may also request the copy be provided on paper ("hard copy") or in an electronic form or format. SMH will also transmit a copy of your health information to another person designated by you in writing. SMH may charge reasonable fees for copies.

    • Right to Request Amendments. You have the right to ask us to amend your health information. To request an amendment, we ask that your request be made in writing to the Privacy Officer at the addressed listed at the end of this Notice. In addition, you must provide a reason that supports your request. We may deny your request in certain circumstances; such as if the information was not created by us, or we believe the information is already accurate and complete. If we deny your request, you may appeal the denial.

    • Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures that we have made of your health information. Your request must state a time period which may not be

      longer than six years. The first list you request within a twelve-month period will be free. For additional lists during such twelve-month period, SMH may charge you a reasonable fee.

    • Right to a Paper Copy of this Notice. You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice. You may also obtain a copy of this Notice at our web site at www.smha.org


CHANGES TO THIS NOTICE

We reserve the right to make changes to this Notice. We reserve the right to make the revised Notice effective for health information we already have, as well as any health information we receive or create in the future. The Notice will contain the current effective date. We will post a copy of the current Notice in our locations and on our website. Any revised Notice is also available to you upon request.


COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with SMH or with the Secretary of the Department of Health and Human Services at www.hhs.gov/ocr/privacy/hipaa/complaints/ or call (800) 368-1019. To file a complaint with SMH, contact our Privacy Officer. You will not be penalized for filing a complaint. To ensure we have sufficient information, we ask that complaints be submitted in writing.


If you have any questions about this Notice, please contact:

St. Mary’s Healthcare Attn: Privacy Officer


427 Guy Park Avenue Amsterdam, NY 12010

518-841-7102

518-770-7528

NY - Amsterdam - Espanol (2017)
NY_Amsterdam_spanish_2017

St. Mary’s Healthcare

AVISO DE PRÁCTICAS DE PRIVACIDAD DE LA LEY DE PORTABILIDAD Y RESPONSABILIDAD DE SEGUROS MÉDICOS (HIPAA)


ESTE AVISO DESCRIBE CÓMO SU INFORMACIÓN MÉDICA PUEDE SER UTILIZADA Y DIVULGADA, Y CÓMO USTED PUEDE OBTENER ACCESO A ESTA INFORMACIÓN. LÉALO CON ATENCIÓN.


Fecha de entrada en vigencia: 1 de agosto de 2017


ESTE AVISO ES PARA LOS SIGUIENTES DESTINATARIOS:

Este aviso está destinado a St. Mary’s Healthcare (SMH):

  • Los centros de servicios son los siguientes: 446a, 427, 425, 380, 76 Guy Park Avenue, 4988, 4950 State Highway 30, 48 Erie Blvd., CANAJOHARIE, 7 Timmerman Ave ST. JOHNSVILLE, 700 S. Perry St. JOHNSTOWN, 84 E. State St., 73 N. Main St. 57 E. Fulton St., GLOVERSVILLE, 331 Bridge St. NORTHVILLE.

  • Miembros del personal médico, empleados y otros miembros de St. Mary’s que proveen atención

    médica.


    NUESTRAS RESPONSABILIDADES

    SMH toma muy en serio la privacidad de la información de salud que nos confía y la considera tanto una

    obligación legal como ética. Denominamos a esta información de salud “información de salud protegida”.

    La información de salud protegida es toda información que consta en un registro médico, que puede utilizarse para identificar a una persona, y que se crea, utiliza y divulga durante el suministro de los servicios de atención médica, como el diagnóstico o el tratamiento. También incluye información acerca del pago por los servicios de atención médica, como los registros de reclamaciones. Las divulgaciones de su información de salud protegida para los propósitos descritos en este Aviso pueden realizarse por escrito, de forma oral, electrónica o por fax.

    De conformidad con la ley, tenemos las siguientes obligaciones:

    • Mantener la privacidad de la información de salud.

    • Enviarle este Aviso de Prácticas de Privacidad (“Aviso”), que le informa nuestras obligaciones

      y prácticas con respecto a la protección de la información de salud.

    • Cumplir los términos del Aviso vigente en la actualidad.

    • Informarle luego de una violación a la información de salud no protegida que pueda afectarlo.


CÓMO PODEMOS UTILIZAR Y DIVULGAR SU INFORMACIÓN DE SALUD

Las siguientes categorías describen las diferentes maneras en que SMH puede utilizar y divulgar su información de salud sin su autorización por escrito. Por lo general, la información de salud se utiliza y divulga para proporcionar tratamiento, obtener pagos por los tratamientos o por las operaciones de

atención médica. Le mostraremos un ejemplo de los tipos de usos cubiertos por estas categorías. No se enumerarán todos los usos o divulgaciones de cada categoría. “Usted” y “su” información incluyen la información de su hijo, según corresponda.

  • Para el tratamiento: SMH puede utilizar y divulgar la información de salud para proporcionar tratamiento, atención médica u otros servicios relacionados. Se podrá divulgar la información

    de salud a los médicos, profesionales de enfermería, asistentes u otros proveedores médicos que participan de su cuidado, quienes también podrán utilizarla. Además, SMH puede utilizar o divulgar la información de salud para gestionar o coordinar el tratamiento, la atención médica u otros servicios relacionados. Por ejemplo, podemos utilizar o divulgar su información de salud para los fines del tratamiento, como cuando se lo deriva a un especialista para que le proporcione atención o cuando enviamos una receta a una farmacia para que le surtan los medicamentos.

  • Para el pago: SMH puede utilizar y divulgar la información de salud para facturar y cobrar el tratamiento y los servicios que le proporcionamos. A fin de tramitar su pago, es posible que le enviemos la información de salud a su compañía aseguradora o a otros terceros que realicen los pagos. Por ejemplo, podemos utilizar y divulgar su información de salud a los fines del pago, como cuando enviamos las reclamaciones a su HMO (Organización de Mantenimiento de la Salud) para que realice el pago o para saber si el tratamiento propuesto está cubierto.

  • Para operaciones de atención médica: SMH puede utilizar y divulgar la información de salud para las operaciones de atención médica. Estos usos y divulgaciones son necesarios para la gestión de SMH,

    y para mantener y mejorar la calidad de la atención médica que ofrecemos. Por ejemplo, podemos utilizar y divulgar su información de salud para realizar operaciones de atención médica, como las renovaciones de autorizaciones, las actividades de mejora de la calidad y los objetivos de enseñanza.

  • Directorio del hospital: SMH puede incorporar información limitada acerca de usted en el directorio del hospital, mientras sea paciente de SMH. Esta información incluye su nombre, ubicación o estado de alta en el hospital, su estado de salud general (por ejemplo, bueno, estable, etc.) y su religión.

    Es posible que la información del directorio se divulgue a las personas que pregunten por usted utilizando su nombre, a excepción de su religión, que solo puede divulgarse a miembros del clero. Usted tiene derecho a que su información no se incorpore en el directorio del hospital (“exclusión”). Para solicitar la exclusión de su información en el directorio del hospital, le pedimos que realice la solicitud durante su registro como paciente.

  • Personas que participan en su atención o en el pago de su atención: SMH puede divulgar a los miembros de su familia, familiares, amigos íntimos u otras personas identificadas por usted,

    la información de salud que sea directamente relevante para la participación de dichas personas en su cuidado o en el pago de su cuidado. SMH no compartirá esta información con dichas personas si conocemos su deseo de mantenerla en privado.

  • Recaudación de fondos: podemos comunicarnos con usted con el propósito de recaudar fondos para financiar la misión de SMH. Usted tiene derecho a solicitar que no se comuniquen con usted con el propósito de recaudar fondos.

  • Investigación: en determinadas circunstancias, SMH puede utilizar y divulgar información de salud para realizar investigaciones. Por ejemplo, un proyecto de investigación puede consistir en comparar el estado de salud y la recuperación de todas las personas que reciben un medicamento con las personas que reciben un medicamento diferente. Todos los proyectos de investigación están sujetos a un proceso especial de aprobación.


  • Registros de vacunación: SMH puede divulgar los registros de vacunación a una escuela en la que usted es o será alumno, si la escuela está obligada por ley a contar con una constancia de vacunación para fines de admisión. Antes de esta divulgación, SMH solicitará su permiso escrito u oral.

  • Para propósitos relacionados con la salud pública: SMH puede divulgar información de salud para la realización de actividades relacionadas con la salud pública. Estos son algunos ejemplos de actividades relacionadas con la salud pública: prevenir y controlar enfermedades, lesiones o discapacidades; declarar nacimientos y defunciones; informar acerca de dispositivos médicos defectuosos o problemas con los medicamentos.

  • En relación con las víctimas de abuso: SMH puede divulgar su información de salud para informarle a la autoridad competente del gobierno si pensamos que usted ha sido víctima de abuso, negligencia o violencia doméstica. Solo divulgaremos esta información si usted está de acuerdo, o si la ley lo requiere o autoriza.

  • Actividades de supervisión de la salud: SMH puede divulgar información de salud a una agencia de supervisión de salud para realizar actividades de supervisión de salud autorizadas por la ley.

    Estas actividades comprenden auditorías, investigaciones, certificaciones, medidas disciplinarias

    y actividades relacionadas para controlar el sistema de atención médica, los programas de beneficios gubernamentales y el cumplimiento de las leyes de derechos civiles.

  • Procedimientos judiciales y administrativos: si se cumplen determinados requisitos, SMH puede divulgar información de salud en respuesta a una citación, orden judicial o administrativa.

  • Orden público: SMH puede divulgar información de salud a las agencias del orden público si dicha divulgación es requerida por ley, es necesaria para identificar o localizar a un sospechoso o a una persona desaparecida, está relacionada con una conducta criminal en SMH o con una víctima de delito en determinadas circunstancias y en determinadas situaciones de emergencia.

  • Para evitar una amenaza grave a la salud o la seguridad: SMH puede utilizar y divulgar información de salud, cuando lo considere necesario, para evitar una amenaza grave a la salud y la seguridad de la persona, del público o de otra persona. Toda divulgación se realizará ante una persona capaz de ayudar a evitar o reducir la amenaza, o a las autoridades del orden público.

  • Médicos forenses, examinadores médicos y directores fúnebres: SMH puede divulgar información de salud a un médico forense o a un examinador médico para identificar a una persona fallecida, determinar la causa de muerte o para otras funciones autorizadas por ley. SMH puede divulgar información de salud a un director de funeraria, de acuerdo con la ley, para permitir que este cumpla con sus obligaciones.

  • Donación de órganos: SMH puede divulgar información de salud a las organizaciones de obtención de órganos y otras organizaciones que participan en la obtención, conservación o trasplante de órganos, ojos o tejidos cadavéricos, para facilitar la donación y el trasplante de órganos.

  • Militares y veteranos: si usted es miembro de las fuerzas armadas, es posible que divulguemos su información de salud según lo requieran las autoridades de mando militar. También podemos

    divulgar información de salud acerca del personal militar extranjero a la autoridad militar extranjera competente.

  • Actividades de inteligencia y seguridad nacional: SMH puede divulgar información de salud a los funcionarios federales autorizados a cargo de las actividades de inteligencia, contrainteligencia

    y otras actividades de seguridad nacional autorizadas por ley.


  • Servicios de protección para el presidente y otras personas: SMH puede divulgar información de salud a los funcionarios federales autorizados para que puedan proteger al presidente o a otras personas autorizadas, o para la realización de investigaciones especiales autorizadas por ley.

    • Reclusos: si usted es un recluso o está bajo la custodia de una institución correccional o del orden público, SMH puede divulgar información de salud a los funcionarios de la institución correccional o del orden público para proporcionar tratamiento y garantizar la seguridad.

    • Indemnización de los trabajadores: SMH puede divulgar información de salud si cuenta con la autorización de las leyes de indemnización de los trabajadores o de las leyes relativas a programas similares, y en la medida necesaria para cumplir con estas.

    • De conformidad con lo establecido por la ley: SMH divulgará información de salud cuando así lo requieran las leyes locales, estatales o federales.


      ALLIANCE IHANY

      Participamos en (i) Alliance for Better Health Care, LLC, (Alliance), que es un Sistema de proveedores de servicios (Performing Provider System, PPS) y en (ii) Innovative Health Care Alliance of NY (IHANY), que es una Organización de atención médica (Accountable Care Organization, AC). Son organizaciones reguladas por el NYS (estado de Nueva York) creadas para coordinar su atención y para reducir los procedimientos o las pruebas médicas innecesarios o duplicados. Compartiremos su información de salud con estas organizaciones y con otros proveedores de atención médica que participan en ellas para coordinar su

      atención médica. Es posible que esta incluya información sobre los tratamientos contra el abuso de drogas

      o alcohol, información sobre el VIH/SIDA, afecciones de salud mental o información acerca de enfermedades de transmisión sexual. Dichas divulgaciones están permitidas según las excepciones de operaciones de atención médica, de tratamiento o de pago o conforme con su consentimiento. El uso y la divulgación de dicha información se llevarán a cabo de acuerdo con cada una de las leyes estatales o federales aplicables.

      Puede acceder a una lista de los proveedores participantes y obtener más información en ihany.org

      y allianceforbetterhealthcare.com.


      INTERCAMBIO DE INFORMACIÓN DE SALUD

      SMH participa en una organización de intercambio de información de salud (“HIXNY”, por sus siglas en inglés) que permite la transferencia directa de información de salud por computadora entre los proveedores de atención médica de diferentes lugares e instituciones para facilitar su atención y tratamiento. Si no desea que su información se comparta de esta manera, puede excluirse negándose a firmar la autorización correspondiente en el momento del registro.


      CONFIDENCIALIDAD DE LOS REGISTROS DE TRASTORNOS POR ABUSO DE SUSTANCIAS

      Las leyes y regulaciones federales protegen la confidencialidad de los registros de los pacientes con trastornos por abuso de sustancias conservados por los programas de tratamientos para el consumo de sustancias en SMH (“Programas SU”). Por lo general, si usted recibe servicios de tratamiento para el abuso de sustancias de los Programas SU, no estamos autorizados a reconocer ante una persona externa al Programa SU que usted asiste al programa de abuso de sustancias ni a divulgar información que lo identifique como paciente que sufre o sufrió un trastorno por abuso de sustancias, a menos que suceda lo siguiente:


    • Usted proporciona su consentimiento por escrito.

    • Una orden judicial autoriza la divulgación.

    • Se divulga información al personal médico ante una emergencia médica o al personal calificado para realizar investigaciones, auditorías o evaluaciones de programas.

      Las leyes y regulaciones federales no protegen la información con respecto a un delito cometido por usted, ya sea en las instalaciones de SMH o en contra de una persona que trabaja para SMH, o con respecto

      a una amenaza de cometer tal delito. Las leyes y regulaciones federales no impiden que la información con respecto a la sospecha de abuso infantil o negligencia sea denunciada, de acuerdo con la ley estatal, a las autoridades locales o estatales competentes.


      La violación de las leyes y regulaciones federales por parte de un programa constituye un delito. Las presuntas violaciones deben denunciarse ante el procurador de los Estados Unidos del Distrito del Norte de Nueva York a la siguiente dirección:


      U.S. Attorney's Office 445 Broadway, Room 218 Albany, NY 12207-2924 Teléfono: (518) 431-0247


      En el caso específico de los programas de tratamientos para el abuso de opioides, las presuntas violaciones pueden denunciarse ante la Oficina de Cumplimiento de los Programas de Tratamiento para el Abuso

      de Opioides (Opioid Treatment Program Compliance Office), región II, de la Administración de Servicios de Salud Mental y Abuso de Sustancias (Substance Abuse and Mental Health Services Administration), al (240) 276-2547.

      (Consulte las leyes federales en los artículos 290dd-3 y 290ee-3 del título 42 del U.S.C. [Código de los Estados Unidos], y las regulaciones federales en la parte 2 del título 42 del CFR [Código de Regulaciones Federales]).


      RESTRICCIONES ESPECIALES ADICIONALES SEGÚN LAS LEYES ESTATALES Y OTRAS LEYES FEDERALES

      También cumpliremos con todas las demás leyes estatales y federales aplicables. Por ejemplo, de acuerdo con la ley estatal, existen más límites con respecto a cuándo se puede divulgar la información relacionada con el VIH y el SIDA, las pruebas genéticas o la salud mental. Respetamos todas las leyes estatales y federales aplicables.


      OTROS USOS Y DIVULGACIONES

      Los demás usos y divulgaciones de información de salud no especificados en este Aviso ni en las leyes aplicables se realizarán, únicamente, con su Autorización.


      DIVULGACIONES QUE REQUIEREN SU AUTORIZACIÓN

      Una Autorización es un permiso especial por escrito proporcionado por usted que autoriza a SMH a utilizar o divulgar su información de salud.

    • Es necesario que obtengamos su Autorización para utilizar o divulgar las notas de psicoterapia.

      Las notas de psicoterapia solo pueden utilizarse con fines limitados, como el uso por parte del profesional a cargo del tratamiento. Las divulgaciones están permitidas únicamente según lo requiera la ley, para determinadas actividades de supervisión de la salud o para evitar una amenaza grave a la salud o la seguridad.

    • Es necesario que obtengamos su Autorización para utilizar o divulgar información de salud para fines publicitarios o para divulgaciones que constituyen la venta de información médica.

    • Si usted nos proporciona una Autorización para utilizar o divulgar su información de salud,

      puede revocarla por escrito en cualquier momento. Si revoca su Autorización, ya no utilizaremos ni divulgaremos su información de salud por los motivos especificados en su Autorización.


      SUS DERECHOS CON RESPECTO A SU INFORMACIÓN DE SALUD

      Usted goza de los siguientes derechos con respecto a la información de salud que conservamos acerca de usted:

    • Derecho a solicitar restricciones: tiene derecho a solicitar una restricción o limitación de la información de salud acerca de usted que utilizamos o divulgamos para las operaciones de atención médica, tratamiento o pago. Sin embargo, no estamos obligados a aceptar su solicitud. Si la aceptamos, cumpliremos con su solicitud, a menos que la información sea necesaria para proporcionarle tratamiento de emergencia.

    • Derecho a restringir la divulgación de los servicios que usted pagó en su totalidad: tiene derecho

      a restringir la divulgación de información de salud si ha pagado el monto total de la atención médica con fondos de su bolsillo y si nos solicita que no presentemos información con respecto a tal servicio ante su plan de cobertura médica.

    • Derecho a solicitar comunicaciones confidenciales: por lo general, nos comunicamos con usted en relación con su atención médica llamándolo al teléfono de su hogar o enviando correo postal a su hogar. Tiene derecho a solicitar que nos comuniquemos con usted de otra manera o en un lugar determinado. Para solicitar comunicaciones de índole confidencial, debe hacerlo por escrito ante el funcionario de privacidad a la dirección especificada al final de este Aviso. No le preguntaremos cuál es el motivo de su solicitud. Nos adaptaremos a todas las solicitudes razonables. Su solicitud debe especificar cómo o dónde desea ser contactado.

    • Derecho al acceso: en la mayoría de los casos, tiene derecho a acceder a su información de salud si solicita inspeccionarla o si pide una copia de dicha información, con excepciones limitadas. Debe

      realizar su solicitud por escrito ante el funcionario de privacidad a la dirección especificada al final de este Aviso. Puede solicitar una copia de su información de salud resumida. También puede solicitar una copia en papel (impresa) o en formato electrónico. SMH también enviará una copia de su información de salud a otra persona designada por usted por escrito. SMH puede cobrar cargos razonables por las copias.

    • Derecho a solicitar enmiendas: tiene derecho a solicitarnos que realicemos enmiendas en su información de salud. Para solicitar una enmienda, debe realizar su solicitud por escrito ante el funcionario de privacidad a la dirección especificada al final de este Aviso. Además, debe explicar el motivo de su solicitud. Es posible que, en determinadas circunstancias, rechacemos su solicitud; por ejemplo, si la información no fue creada por nosotros o si creemos que la información es precisa

      y está completa. Si rechazamos su solicitud, puede apelar la denegación.

    • Derecho a recibir una lista de las divulgaciones: tiene derecho a solicitar una lista de determinadas divulgaciones que hemos realizado de su información de salud. Su solicitud debe especificar un período no mayor a seis años. La primera lista que solicite dentro de un período de doce meses será gratuita. Si desea listas adicionales durante dicho período de doce meses, es posible que SMH le cobre un cargo razonable.

    • Derecho a recibir una copia impresa de este Aviso: puede solicitar que le proporcionemos una copia de este Aviso en cualquier momento. Aun si acordó recibir este Aviso de forma electrónica, tiene derecho a recibir una copia impresa. También puede obtener una copia de este Aviso en nuestro sitio web en www.smha.org.


CAMBIOS EN ESTE AVISO

Nos reservamos el derecho a modificar este Aviso. Nos reservamos el derecho de hacer efectivo el Aviso revisado para la información de salud que ya poseemos, así como para la información de salud que recibamos o creemos en el futuro. El Aviso especificará la fecha de entrada en vigencia actual. Publicaremos una copia del Aviso actual en nuestros centros y en nuestro sitio web. Todo Aviso revisado estará a su disponibilidad tras su solicitud.


QUEJAS

Si cree que sus derechos de privacidad han sido violados, puede presentar una queja ante SMH o ante el secretario del Departamento de Salud y Servicios Humanos (Department of Health and Human Services), en www.hhs.gov/ocr/privacy/hipaa/complaints/, o puede llamar al (800) 368-1019. Para presentar una

queja ante SMH, comuníquese con nuestro funcionario de privacidad. No será sancionado por presentar una queja. Para garantizar que contamos con suficiente información, solicitamos que las quejas se realicen por escrito.


Si tiene preguntas con respecto a este Aviso, comuníquese a:

St. Mary’s Healthcare Attn: Privacy Officer


427 Guy Park Avenue, Amsterdam, NY 12010


518-841-7102

518-770-7528

NY - Binghamton - English (2013)
NY_Binghamton_english_2013


Joint Notice of Privacy Practices


Effective Date:

September 23, 2013


Lourdes

169 Riverside Drive

Binghamton, NY 13905

(607) 798-5111

www.lourdes.com

Notice of Privacy Practices ("Notice")

This Notice describes how your health information (HI):

  • May be used,

  • May be disclosed (“shared”), and How you can access it.


Please read this carefully.


Who follows this Notice

Lourdes and the providers who work here agree to follow the same privacy practices. We are jointly giving you this Notice.

The notice applies to:

All non-employed doctors and other health care providers (HCPs) who take care of you while you are at Lourdes:

  • Hospital,

  • Mobile Vans,

  • Walk-In Clinics,

  • Primary Care Sites and

  • Any other Lourdes location.

    All of Lourdes:

  • Departments,

  • Units,

  • Employees,

  • Volunteers, and

  • All other staff.


    Our Responsibilities

    Lourdes is committed to keeping all HI private. We are required by law to: Keep your HI private.

    Give you this Notice. It tells you what we do to protect your HI. Abide by the terms of the Notice that is currently in effect.

    Inform you if we did not protect your HI.


    How We May Use and Share Your HI

    This list describes the ways Lourdes may use and share your HI without your written permission. Most of the time HI is used and shared to:

    Provide treatment, Obtain payment, or

    For health care reasons


    Here are examples. Not every type of use or sharing is listed. References to "you" and "your" HI include your child's HI, when appropriate:

    For Treatment - Your HI may be used by or shared with doctors, nurses, aides, or other HCPs who take care of you. We may use or share your HI when we:

  • Send you to a specialist or

  • Send a script to your pharmacy.

For Payment - We may send your HI to your insurance company, other companies, or people for payment. We send claims to your insurance company:

  • For payment or

  • To find out if proposed treatment is covered.

    For Other Health Care Reasons - Uses and sharing of HI are needed to:

  • Run Lourdes,

  • Support quality of care, and

  • Improve the quality of care we provide.

    We may use and share HI for:

  • Certification renewals,

  • Quality improvement activities, and

  • Teaching purposes.

    Inpatient Directory - The Directory has:

  • Your name,

  • The unit you are on,

  • Your general health (fair, stable, etc.) and

  • Your religion.

    The directory may be shared with people who ask for you by name. Your religion will only be shared with clergy. You have the right to "opt-out". This means that you are not listed in the directory. To opt- out: just tell us when you are admitted.

    Persons Involved in Your Care or Payment For It - If you say so, Lourdes may share your HI with:

  • Family member(s)

  • Relative(s), or

  • Personal friend(s).

    We will only share the HI that is needed to care for you or to pay for it. Lourdes will not share HI when you tell us you do not want it shared.

    Reminders, Services, and Benefits - We may use HI to give you:

  • Appointment reminders,

  • Information about health care options, or

  • Other services and benefits we offer.

    Fundraising - We may use or share HI for fundraising. We use these funds to support Lourdes’ Mission. You have the right to "opt-out". If you do not want to receive fundraising information, please call the Lourdes Foundation. The phone number is 607-798-5684.

    Research - Lourdes may use and share HI for research.

  • A research project may involve comparing the health and recovery of all patients who take one type

    of medicine to those who take another. There is a special approval process for all research projects. Vaccine Records - Some schools are required by law to have proof of vaccines for admission purposes. Lourdes may share vaccine records with a school where you:

  • Are a student, or

  • Will be.

    In some cases, Lourdes first will obtain your verbal or written permission to share your vaccine records.

    For Public Health Purposes - Public health activities include:

  • Preventing and controlling:

    • Disease,

    • Injury, and

    • Disability;

  • Reporting:

    • Births and deaths,

    • Defective medical devices,

    • Problems with medications.

      About Victims of Abuse - If we believe that you have been the victim of abuse, neglect or domestic violence, Lourdes may share your HI with the appropriate government office.

      We will only share this if:

  • You agree, or

  • When required or allowed by law.

    Health Supervision Activities Allowed by Law - Lourdes may share HI with a Health Supervision Agency for:

  • Audits,

  • Investigations,

  • Licensure,

  • Disciplinary actions,

  • Monitoring of the health care system,

  • Governmental benefit programs, and

  • Compliance with civil rights laws.

    Judicial and Administrative Proceedings - If certain requirements are met, Lourdes may share HI in response to a:

  • Subpoena,

  • Court order, or

  • Administrative order.

    Law Enforcement - Lourdes may share HI with law enforcement if:

  • Required by law,

  • Needed to identify or locate a:

    • Suspect or

    • Missing person,

  • Criminal acts happen at Lourdes,

  • About a victim of crime under certain conditions, or

  • In certain emergency situations.

    To Stop a Serious Threat to Health or Safety - When it is needed to stop a serious threat to:

  • Health and safety of the patient,

  • Public, or

  • Another person.

    Any sharing of HI would only be to someone who is:

  • Able to help stop or lessen the threat, or

  • Law enforcement.

    Coroner, Medical Examiners, and Funeral Directors - Lourdes may share HI with a coroner or medical examiner to:

  • Identify a dead body,

  • Determine a cause of death, or

  • Other duties allowed by law.

    The law allows Lourdes to share HI with funeral directors so they can carry out their duties.

    Organ Donation - Lourdes may share HI with organ donation centers and others who:

  • Gather,

  • Bank, or

  • Transplant human organs, eyes, or tissue.

    Military and Veterans - If you are or were a member of the armed forces, Lourdes may share your HI. This may be required by military command authorities. Lourdes also may share the HI of foreign military personnel to the appropriate foreign military authority.

    National Security and Intelligence Activities – As allowed by law, Lourdes may share HI with authorized federal officials for:

  • Intelligence,

  • Counterintelligence, and

  • Other national security activities

Protective Services for the President and Others - As allowed by law, Lourdes may share HI with authorized federal officials:

  • To provide protection to the:

    • President or

    • Other persons

  • For the conduct of special investigations.

    Inmates - If you are an inmate or in the custody of a correctional institution or law enforcement, Lourdes may share your HI with the correctional institution or law enforcement officials for:

  • Treatment and

  • Safety purposes.

    Worker’s Compensation - Lourdes may share HI to comply with:

  • Worker’s compensation laws or

  • Laws relating to similar programs.

    As Required by Law - Lourdes will share HI when required to do so by federal, state or local law.


    Shared Medical Record/HI Exchange

    Lourdes has agreed to work with other HCPs to share access to HI that may be needed to care for you. We store HI about our patients in a joint electronic medical record that is shared with other HCPs. Example:

    You are admitted to another hospital. It is an emergency. You cannot give them important information about your health condition. These agreements allow us to share your HI with those who need it to treat you. Ready access to your HI means better care for you.

    You do not have to have your HI added to the joint electronic medical record. Please contact Lourdes’ Privacy Officer if you have any questions.


    Special restrictions under State and other Federal Laws

    Lourdes follows and complies with all other applicable state and federal laws. Example:

    Under state law, there are limits on when HIV and AIDS information may be shared.

    Under federal law, there are limits on when drug or alcohol abuse treatment information may be shared.


    Other Uses and Sharing of HI

    Any other uses and sharing of HI not covered by this Notice or laws that apply to us will be made only with your permission.


    Sharing of HI that Requires Your Permission

    ”Permission” is a special written approval from you that allows Lourdes to use or share your HI.

    We must obtain your permission to use or share psychotherapy notes. Psychotherapy notes may only be used for limited purposes. Sharing of these notes is permitted only as required by law for:

  • Certain health supervision activities, or

  • To stop a serious threat to health or safety.

    We must obtain your permission to use or share HI for:

  • Marketing purposes, or

  • For reasons that involve the sale of HI.

    You may cancel that permission at any time. You must cancel permission in writing. If you do that, we will no longer use or share HI about you for the reasons covered by your permission.

    Your Rights and Your HI

    You have the following rights related to the HI we keep about you:

    Right to Request Restrictions - You have the right to request a restriction or limitation on the HI we use or share about you for:

  • Treatment,

  • Payment, or

  • Other health care reasons needed to run Lourdes.

    In most cases, we do not have to agree to your request.

  • If we do agree, we will comply with your request unless the information is needed to provide you

    emergency care.

  • We must agree to your request If you are:

    • Paying or have paid for the whole service yourself, and

    • You are asking us not to send information about that service to your health plan.

  • Unless a law requires us to share that information, we will say “yes” to your request.

    You must:

    • Identify the date of service and

    • The exact information that you want restricted.

      We ask that you make this request before you have the service. The request is to be made to the “Director, Health Information Management Systems” (HIMS [Medical Records]) at the address below. Right to Request Private Communications - Usually we communicate with you regarding your health care either by:

  • Calling your home phone or

  • Sending mail to your home address.

    You have the right to request that we communicate with you:

    • in another way or

    • at a certain location.

      To request private communications, we ask that you:

    • Make your request in writing to your HCP where you receive those services.

    • Specify how or where you wish to be contacted. We will:

    • Not ask you the reason for your request.

    • Agree to all reasonable requests.

      Right to Access - In most cases, you have the right to get your HI by asking to:

  • Look it over or

  • Get a copy of your HI

    Please note:

    • There are some exceptions.

    • Lourdes may charge for copies.

      We ask that your request be made in writing to the Director of HIMS at the address below. You may request that the copy of your HI be:

    • Summarized for you.

    • Provided:

      • On paper ("hard copy") or

      • In an electronic form or format.

    • Sent to another person that you chose. You must note this in writing.

HIMS Address: Our Lady of Lourdes Memorial Hospital, Inc.

Attn: Director, HIMS 169 Riverside Dr.

Binghamton, NY 13905

607-798-5266

Right to Request Amendments - You have the right to ask us to correct your HI. To request a correction, your request must:

  • Be In writing.

  • Be given to your HCP at the location where you received services.

  • Include a reason that supports your request.

    In certain situations, we may say no to your request:

  • When the information was not created by Lourdes, or

  • If we believe the information is accurate and complete.

    If we say no to your request, you may ask us to reconsider.

    Right to a List of How We Used or Shared Your HI - You have the right to request a list of how we used or shared your HI. Your request must:

  • Be made in writing to the Director of HIMS (address on page 5).

  • State a time period which may not be longer than six (6) years.

    We do not have to include in the list uses and sharing related to:

  • Your treatment,

  • Payment for your treatment or

  • Other health care reasons needed to run Lourdes.

    The first list you request within a 12-month period will be free. If you want more lists during the same 12-month period, we may charge you for each.

  • The cost will be reasonable.

  • We will let you of the cost.

  • Before you pay anything, you may choose to:

    • Withdraw or

    • Modify your request.

      Right to be Notified of a Breach - Lourdes must tell you if we did not protect your HI.

      Right to a Paper Copy of this Notice - You may ask us to give you a copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still allowed to have a paper copy of this Notice. You may also obtain a copy of this Notice at our web site; www.lourdes.com


      Changes to this Notice - We reserve the right to make:

  • Changes to this Notice.

  • The revised Notice effective for:

    • HI we already have,

    • Any information we:

      • Receive or

      • Create in the future.

        The Notice will contain the current effective date. We will post a copy of the current Notice in our locations and on our website. The Notice also is available to you upon ask.

        Complaints

        If you believe that your privacy rights have been violated, you may file a complaint with:

  • Lourdes or

  • Secretary of the Department of Health and Human Services.

    To file a complaint with Lourdes, contact our Privacy Officer.

  • You will not be penalized for filing a complaint.

  • To be sure that we have enough information, we ask that complaints be made in writing.

If you have any questions about this Notice, please contact Lourdes or the Office for Civil Rights:

Our Lady of Lourdes Memorial Hospital, Inc. Attn: Privacy Officer

169 Riverside Dr. Binghamton, NY. 13905

607-798-5335

Office for Civil Rights

U.S. Department of Health and Human Services Jacob Javits Federal Building

26 Federal Plaza - Suite 3312 New York, NY 10278

Oklahoma - English (2015)
2911.indd

St. John Health System

JOINT NOTICE OF PRIVACY PRACTICES

Effective Date: December 27, 2007, Revised August, 2015

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


WHAT IS THIS DOCUMENT?

St. John Health System (SJHS), comprised of doctors, hospitals and other health care providers who work together to deliver a broad range of health care services, is committed to protecting your medical information. We create and maintain a record

of the care and services you receive on a variety of media, including paper, computers and films. This information is available to all Health System associates and non-associates, such as medical staff members, who need this information to provide treatment to you, obtain payment for services rendered or to support various functions necessary for the operational aspects of your care. We are required by law to:

  • Have proper safeguards in place to discourage improper use or access to your protected health information (PHI);

  • Maintain and protect your privacy and the confidentiality of your PHI and records;

  • Provide you with this Joint Notice describing your rights and our legal duties regarding your PHI; and

  • Notify affected individuals in the event of a breach of PHI.

    WHO DOES THIS NOTICE COVER?

    This Joint Notice will be followed by the facilities and entities identified in this document including:

  • All Health System associates;

  • Any health care professional treating you within the Health System who is part of our organized health care arrangement; and

  • Volunteers and volunteer groups providing help to patients.

    WHAT DO THESE WORDS MEAN?

    Organized Health Care Arrangement

    SJHS, its medical staff and other health providers are part of a clinically integrated care setting that creates an organized health care arrangement under the Health Insurance Portability and Accountability Act (HIPAA). This allows sharing of information among these legally separate entities to enhance the delivery of quality care to our patients while in the Health System; however, no entity is responsible for the medical judgment or patient care provided by the other entities in the arrangement. Medical staff and other health care providers may have different privacy practices for medical records they create or maintain in their offices.

    Protected Health Information (PHI)

    Your personal and protected health information created and used by us to provide care to you and bill for services provided.

    Privacy Officer

    The person responsible for the policies and procedures developed to protect your PHI and for investigating complaints regarding how your PHI is used or disclosed.

    Business Associate

    An independent business or individual who contracts with the Health System for services provided to you or the Health System.

    Authorization

    A document signed by you that gives us permission to use or disclose your PHI for purposes other than your treatment, obtaining payment or health care operations.

    2911 (8/15)

    WHAT WILL YOU DO WITH MY MEDICAL AND BILLING INFORMATION?

    The following categories describe how we may use and disclose your PHI. Not every use or disclosure in a category will be listed. For those categories of use and disclosure not listed herein, disclosure will be made only with your authorization. An authorization may be revoked in writing at any time, but will not apply with respect to disclosures already made or actions taken in reliance thereon. To assure compliance with Oklahoma law, we will obtain your consent for the use and disclosure of your PHI. THE INFORMATION AUTHORIZED FOR USE OR DISCLOSURE MAY INCLUDE INFORMATION WHICH MAY INDICATE THE PRESENCE OF A COMMUNICABLE OR NON-COMMUNICABLE DISEASE. Disclosure may

    also include psychiatric and drug abuse treatment. If you do not consent, we cannot provide you treatment except in emergency situations or when we cannot communicate with you for some other reason.

    1. Treatment: We may use your PHI to provide you with medical treatment or services. We may disclose your PHI to doctors, nurses, technicians, medical students or other Health System personnel who are involved in your care. We may also participate with digital health information exchanges and their members, in which we send patient data to a network system committed to securing the information and allowing your data to be available to other members who are providing treatment to you.

      Examples:

  • The surgeon treating your broken leg may need to know if you have diabetes because diabetes may slow the healing process.

  • The surgeon will need to notify the dietitian so appropriate meals can be provided to you.

  • We may tell your primary care physician, nursing home or other health care provider about your hospital stay so they can provide appropriate follow-up care.

    1. Payment: We may use and disclose your PHI to bill for the treatment and services you receive and to collect payments from you, your insurance company or a third party.

      Examples:

  • We may provide your health plan with information about your surgery so that they will pay us or reimburse you for the surgery.

  • We may tell your health plan about a proposed treatment for you in order to obtain prior approval or to determine if your plan will cover the treatment.

  • We may disclose your PHI to physicians or their billing agents so they can send bills to your insurance company or to you.

    1. Health Care Operations: We may use or disclose your PHI for health care operations. These uses and disclosures are needed to run the Health System and make sure patients receive quality care.

      Examples:

  • We may use your blood pressure measurements to review our treatment and services, evaluate staff performance and train health care professionals.

  • We may combine PHI of many patients to decide if additional services should be offered, if services are not needed or if new treatments are effective.

  • We may combine PHI of our patients with that of other health care systems to compare how we are performing and to see where we can make improvements in the care and services we offer.

    1. Business Associates: We may disclose your PHI to Business Associates with whom we contract to provide services on our behalf. We will only make these disclosures after receiving satisfactory assurances that the Business Associate will properly safeguard your privacy and the confidentiality of your PHI.

      Examples:

  • We may contract with a company outside the Health System to provide medical transcription services or to provide collection services for past due accounts.

    1. Appointment Reminders: We may use and disclose your PHI to contact you as a reminder that you have an appointment for treatment or medical care. This may be done through an automated system or by one of our staff members. If you are not at home, we may leave this information on your voice mail or in a message left with the person answering the telephone.

    2. Health Related Benefits and Services: We may use and disclose your PHI to tell you about health-related benefits or services, recommend possible treatment options or alternatives that may be of interest to you.

    3. Marketing and Fund-raising Activities: As required by applicable law, SJHS will not disclose your PHI for marketing or fund-raising activities absent your authorization.

    4. Facility Directory: We may include certain information about you in our directory while you are receiving health care services. This information may include your name, location in the facility, your general condition, e.g. good, fair, etc., and your religious affiliation. This information, except for your religious affiliation, may be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a minister, priest or rabbi, even if they don’t ask for you by name. This is so your family, friends and clergy can contact and visit you. If you do not want to be included in this directory, notify the Health System staff during the registration process.

    5. Individuals Involved in Your Care or Payment for Your Care: We may release PHI to a friend or family member who is involved in your medical care and those who help pay for your care. We may disclose PHI about you to an entity assisting in disaster relief efforts so that your family can be notified about your condition, status and location.

    6. Research: We may use your PHI for research purposes after a receipt of authorization from you or when the SJHS Institutional Review Board (IRB) has waived the authorization requirements through its review of the research proposal and has established protocols to ensure the privacy of your PHI. We may also review your PHI to assist in the preparation of a research study.

      Examples:

  • We may conduct a research project to compare the health and recovery of all patients who received one medication against those who receive a different medication for the same illness or condition.

  • We may provide a research person with a listing of all patients admitted with diabetes over the past year.

    1. Psychotherapy Notes: We may use and disclose psychotherapy notes for treatment, payment and healthcare

    operations or in limited situations as defined by regulation. In all other instances, a release will not be made without a separate authorization.

    CAN YOU EVER USE OR DISCLOSE MY PHI WITHOUT MY CONSENT?

    Yes. The following categories describe ways we may use or disclose your PHI without your consent. Not every use or disclosure in a category will be listed.

    1. Required by Law: We will disclose your PHI when required to do so by federal, state or local law.

      Example:

  • Oklahoma law requires us to report all births that occur in our facilities to the Oklahoma State Department of Health.

    1. To Avert a Serious Threat to Health or Safety: We may use and disclose your PHI when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. This disclosure would only be made to someone able to help prevent the threat.

    2. Organ and Tissue Donations: If you are an organ donor, we may release your PHI to organizations that handle organ, eye or tissue procurement or transplantation, or to a donation bank as necessary to facilitate donation and transplantation.

    3. Military: If you are a member of the Armed Forces, we may release your PHI as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate foreign military authority.

    4. Workers’ Compensation: We may release your PHI for workers’ compensation or similar programs as authorized by state law. These programs provide benefits for work related injuries or illnesses.

    5. Public Health Reporting: We may disclose your PHI for public health activities.

      Examples:

  • For the purpose of preventing or controlling disease, injury or disability.

  • Reporting birth defects or infant eye infection.

  • Reporting cancer diagnoses and tumors.

  • Reporting reactions to medication or problems with products.

  • Notifiying patients of recalled products.

  • Notifiying the Oklahoma State Department of Health of patients who may have been exposed to a disease or at risk for contracting or spreading a disease or condition such as HIV, Syphilis or other sexually transmitted diseases.

  • Reporting abuse, neglect or violence as required by law, including children who are born with alcohol or other substances in their body.

    1. Health Oversight Agencies: We may disclose PHI to a health oversight agency for activities necessary for the government to monitor the health care system, government programs, and compliance with applicable laws; for example, audits, investigations, inspections, medical device reporting and licensure.

    2. Lawsuits and Disputes: If you are involved in a lawsuit or dispute, we may disclose your PHI in response to a court or administrative order. We may also disclose your PHI in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

    3. Law Enforcement: We may release PHI if requested by a law enforcement official.

      Examples:

  • To identify or locate a suspect, fugitive, material witness or missing person.

  • If you are the victim of a crime, under certain circumstances, where your consent cannot be obtained.

  • About a death we believe may be the result of criminal conduct.

  • In emergency circumstances to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime while on SJHS premises.

    1. Coroners, Medical Examiners and Funeral Directors: We may disclose PHI to a coroner, medical examiner or funeral director.

      Examples:

  • To identify a deceased person or determine the cause of death.

  • To assist the funeral director in completing the death certificate.

    1. National Security and Intelligence Activities: We may disclose your PHI to federal officials for intelligence, counterintelligence or other national security activities authorized by law.

    2. Protective Services for the President and Others: We may disclose your PHI to federal officials so they may provide protection for the President, other authorized persons or foreign heads of state, or to conduct special investigations.

    3. Inmates: If you are an inmate of a correctional institution or in the custody of a law enforcement official, we may disclose your PHI to the correctional facility or law enforcement official. This may be necessary: (1) for the correctional institution to provide you with health care; or (2) to protect your health and the safety of others or the correctional institution.

    WHAT ARE MY RIGHTS REGARDING MY PHI?

    You have the following rights regarding your PHI. You are required to submit a written request to the appropriate facility in the Health System to exercise any of these rights for records that the facility creates and maintains.

    1. Right to Inspect and Copy: You have the right to inspect and request a copy of your PHI, except as prohibited by law. If you request a copy in either paper or electronic format, you may be charged a fee in accordance with federal and Oklahoma law. We may deny your request to inspect and copy in certain circumstances, such as a request for mental health records. If you are denied access to certain PHI, you may request that the denial be reviewed. A licensed health care professional chosen by us, who was not involved in the denial, will review your request and the denial. We will comply with the outcome of the review.

    2. Right to Amend: If you feel that the PHI created by us is incomplete or incorrect, you may request an amendment for as long as we maintain the information. If your request is not in writing and does not include a reason to support your request for amendment, we may deny the request. We may also deny your request for amendment if you ask us to amend information that:

  • We did not create, unless the person or entity that created the information is no longer available to make the amendment;

  • Is not part of the PHI which we maintain;

  • Is not part of the information that you would be permitted to inspect or copy; or

  • Is accurate and complete.

    1. Right to an Accounting of Disclosures: You have the right to request one free ‘accounting of disclosures’ every 12 months.

      Federal regulations define the scope, timeframes and data elements, i.e., information that is to be included in an accounting. Your request must state a time period which may not be longer than six years or include dates before April 14, 2003. For additional accountings, we may charge you the costs of providing such. We will notify you of the cost involved and you may choose to withdraw or modify your request before any charges are incurred.

    2. 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 healthcare operations or disclose about you to a family member or friend.

      Example:

  • You ask us not to use or disclose information about your surgery.

    We are not required to agree with your request unless the request is to withhold information from a health plan for payment or health care operations and you have paid for your services in full, in advance, from your own personal funds. If your PHI has been withheld from your health plan, you may be requested to continue to pay in full, in advance, for future services to preserve this request. If your health plan seeks the

    information for treatment purposes, we are obligated to provide it to them. For all other requests, if we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment or the use or disclosure is required by law. Your request must include:

  • What information you want restricted;

  • The type of restriction you want; and

  • To whom you want the restriction to apply.

    1. Right to Request Confidential Communications: You have the right to request that we communicate with you about your PHI by a certain method or certain location.

      Examples:

  • You request we only contact you via mail or at your work phone number.

We will not ask you the reason for the request and will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

  1. Right to a Paper Copy of this Notice: You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy.

To obtain a paper copy, contact the Privacy Officer listed in this document. You also may obtain a copy of

this notice at our website, www.stjohnhealthsystem.com.

CAN SJHS CHANGE THIS NOTICE?

SJHS reserves the right to change this notice and to make the revised or changed notice effective for PHI we already have about you as well as for any PHI we receive in the future. Each notice will have an effective date. Copies of the current notice will be posted. Additionally, at each visit for treatment or health care services, we will make available to you a copy of the current notice.

WHAT IF YOU WANT TO USE OR DISCLOSE MY PHI FOR A PURPOSE NOT DESCRIBED IN THIS NOTICE?

Other uses and disclosures not covered by this notice or the laws that apply to us will only be made with your written authorization. In other words, the consent you already provided us will not be enough to use or disclose your PHI for any purpose not described in this notice. If you provide us authorization to use or disclose your PHI, you may revoke that authorization, in writing, at any time.

If you revoke your authorization, we will no longer use or disclose your PHI for the reasons covered by your authorization. You understand we are unable to retrieve or cancel any uses or disclosures we have already made with your authorization.

WHAT IF I HAVE QUESTIONS OR NEED TO FILE A COMPLAINT?

If you have a question or would like to file a complaint, you may contact us by mail, phone or email and it will be forwarded to the appropriate Privacy Officer affiliated with your facility as listed below. If you believe your privacy rights have been violated, you may file a written complaint with us or the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint.


St. John Health System

Attention: Privacy Officer

1924 S. Utica Avenue, Ste. 601

Tulsa, OK 74104

1-888-200-8513

SJHSPrivacyOfficer@sjmc.org


Jane Phillips Foundation (Auxiliary) Jane Phillips Memorial Medical Center Jane Phillips Nowata Health Center Regional Medical Laboratory, Inc.

St. John Health System St. John Auxiliary, Inc.

St. John Broken Arrow, Inc. St. John Home Care, LLC

St. John Medical Center, Inc.

St. John Owasso (Owasso Medical Facility, LLC) St. John Sapulpa Hospital

St. John Clinic

(St. John Clinic is a registered trademark of St. John Physicians, Inc., and has been licensed for use by St. John Physicians, St. John Urgent Care Clinics, St. John Anesthesia Services, Omni Medical Group. Inc., Physician Support Services, Inc.)


The U.S. Department of Health and Human Services

200 Independence Avenue, S.W. Washington, D.C. 20201

Toll Free: 1-877-696-6775


Office for Civil Rights, DHHS

1301 Young Street, Suite 1169

Dallas, TX 75202

Toll Free: 1-800-368-1019


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St. John Health System

AVISO CONJUNTO DE PRÁCTICAS DE PRIVACIDAD

Fecha Efectiva: Diciembre 27, 2007, Revisado Agosto 2015

ESTE AVISO DESCRIBE COMO PUEDE USARSE Y REVELARSE SU INFORMACIÓN MÉDICA Y COMO USTED PUEDE TENER ACCESO A ESTA INFORMACIÓN. POR FAVOR REVÍSELO CUIDADOSAMENTE


¿QUÉ ES ESTE DOCUMENTO?

El Sistema de Salud de St. John (SJHS, por sus siglas en inglés), integrado por doctores, hospitales y otros proveedores de cuidado de salud los cuales trabajan conjuntamente para suministrar un amplio rango de cuidado de salud, se compromete a proteger su información médica. Nosotros creamos y mantenemos un registro del cuidado y servicios que usted recibe con una variedad de medios, incluyendo papel, computadoras y películas. Esta información está disponible para todos los asociados y no asociados del Sistema de Salud, tales como miembros del personal médico, quienes necesitan dicha información para proporcionarle el tratamiento, obtener el pago por los servicios prestados o para mantener varias funciones necesarias para el aspecto operacional de su cuidado. La ley requiere que nosotros:

  • Tengamos los resguardos apropiados en un lugar donde se haga difícil el uso impropio o acceso a su información de salud protegida (PHI, por sus siglas en inglés).

  • Mantengamos y protejamos su privacidad y la confidencialidad de su PHI,y registros;

  • Proporcionemos este Aviso Conjunto en donde describe sus derechos y nuestros deberes legales en relación a su PHI; y

  • Notifiquemos a los individuos afectados en el evento de una violación de su PHI.


    ¿QUÉ CUBRE ESTE AVISO?

    Este Aviso Conjunto será cumplido por las instalaciones y entidades identificadas en este documento incluyendo:

  • Todos los asociados del Sistema de Salud;

  • Cualquier profesional de cuidado de salud que lo esté tratando dentro del Sistema de Salud el cual es parte de nuestro convenio de cuidado de salud organizado;

  • Voluntarios y grupos voluntarios que proporcionen ayuda a los pacientes.


    ¿QUÉ SIGNIFICAN ESTAS PALABRAS?

    Acuerdo Para Asistencia Médica

    SJHS, su personal médico y otros proveedores de salud son parte de un grupo de cuidado clínicamente integrado que crea un convenio de cuidado de salud organizado bajo la Ley Federal de Portabilidad y Responsabilidad de los Seguros de Salud (HIPAA, por sus siglas en inglés). Esto permite compartir información entre estas entidades legalmente separadas para reforzar la prestación de un cuidado de calidad a nuestros pacientes mientras se encuentren en el Sistema de Salud; sin embargo, ninguna entidad es responsable por el juicio

    médico o del cuidado del paciente proporcionado por otras entidades en el convenio. El personal médico y otros proveedores de cuidado de la salud pueden tener diferentes prácticas de privacidad para los registros médicos que ellos crean o mantienen en sus consultorios.

    Información de Salud Protegida (PHI por sus siglas en inglés)

    Su información de salud personal y protegida creada y usada por nosotros para proporcionarle el cuidado y cargar en cuenta los servicios suministrados.

    Oficial de Privacidad

    La persona responsable por las políticas y procedimientos desarrollados para proteger su PHI y de investigar las quejas en relación en como se usa o divulga su PHI.

    2959 (8/15)

    Socio Comercial

    Un negocio independiente o individuo que contrata con el Sistema de Salud para los servicios a usted proporcionados o para el Sistema de Salud.

    Autorización

    Un documento firmado por usted por el cual nos concede permiso para usar o divulgar su Información Protegida de Salud (PHI, según sus siglas en inglés) para fines distintos a su tratamiento, obtención del pago u operaciones de cuidado de la salud.

    ¿QUÉ HARÁN USTEDES CON MI INFORMACIÓN MÉDICA Y DE FACTURACIÓN?

    Las siguientes categorías describen como podemos usar y divulgar su PHI. No será listado cada uso o divulgación. Para aquellas categorías de uso y divulgación no listadas en el presente, la divulgación será realizada sólo con su autorización. Una autorización puede ser revocada por escrito en cualquier momento, pero no aplicará con respecto a divulgaciones ya realizadas o acciones tomadas al respecto. Para asegurar el cumplimiento con la ley de Oklahoma, nosotros obtendremos su consentimiento para el uso y divulgación de su PHI. LA INFORMACIÓN AUTORIZADA PARA EL USO O DIVULGACIÓN PUEDE INCLUIR INFORMACIÓN QUE PUEDE INDICAR LA PRESENCIA DE UNA ENFERMEDAD

    CONTAGIOSA O NO CONTAGIOSA. La divulgación también puede incluir tratamiento psiquiátrico y abuso de droga. Si usted no lo consiente, no podremos proporcionarle el tratamiento excepto en situaciones de emergencia o cuando nosotros, por alguna otra razón, no podamos comunicarnos con usted.

    1. Tratamiento: Podemos usar su PHI para proporcionarle tratamiento médico o servicios. Podemos divulgar su PHI a doctores, enfermeras, técnicos, estudiantes de medicina u otro personal del Sistema de Salud que esté involucrado en su cuidado. También podemos participar con intercambios de información de salud digital con sus miembros,

      a los que enviamos los datos de los pacientes a un sistema de red comprometido a afianzar la información y permitir que sus datos estén disponibles a otros miembros que están proporcionándole tratamiento.

      Ejemplos:

  • El cirujano que trata su pierna fracturada puede necesitar saber si usted sufre diabetes, ya que la diabetes puede retardar el proceso de curación.

  • El cirujano necesitará notificar al dietista las comidas que le son apropiadas.

  • Podemos informarle a su médico de cuidado primario, residencia de reposo u otro proveedor de cuidado de salud en relación a su estadía en el hospital para que ellos puedan proporcionarle el cuidado posterior apropiado.


    1. Pago: Podemos usar y divulgar su PHI para cargar en cuenta el tratamiento y servicios que usted recibe y para cobrar sus pagos, de la compañía de su seguro o de una tercera parte.

      Ejemplos:

  • Podemos usar sus mediciones de tensión arterial para revisar nuestro tratamiento y servicios, evaluar el desempeño del personal y la capacitación de los profesionales de cuidado de salud.

  • Podemos informar su plan de salud en relación a un tratamiento que se la ha propuesto a los fines de obtener la aprobación anterior o determinar si su plan cubrirá el tratamiento.

  • Podemos divulgar su PHI a médicos o a sus agentes de facturación para que ellos puedan enviar las facturas a su compañía de seguro o a usted.

    1. Operaciones de Cuidado de Salud: Podemos usar o divulgar su PHI para las operaciones de cuidado de salud. Se necesitan estos usos y divulgaciones para ejecutar el Sistema de Salud y asegurarse que los pacientes reciban un cuidado de calidad. Ejemplos:

  • Podemos usar las mediciones de su presión sanguínea para revisar su tratamiento y servicios, evaluar el desempeño del personal y la preparación de los profesionales de salud.

  • Podemos combinar el PHI de muchos pacientes para decidir si deben ofrecerse servicios adicionales, si no se necesitan los servicios o si los nuevos tratamientos son eficaces.

  • Podemos combinar los PHI de nuestros pacientes con otros sistemas de cuidado salud para comparar como nos estamos desempeñando y para ver donde podemos realizar mejoras en el cuidado y servicios que ofrecemos.

    1. Asociados Comerciales: Podemos divulgar su PHI a los Asociados Comerciales con quienes nosotros contratamos para proporcionar los servicios en nuestro nombre. Haremos estas divulgaciones sólo después de recibir las convicciones satisfactorias de que el Asociado Comercial salvaguardará apropiadamente su privacidad y confidencialidad de su PHI. Ejemplos:

  • Podemos contratar con una compañía fuera del Sistema de Salud para proporcionar servicios de transcripción médica o para proporcionar los servicios de cobranza de deudas de cuentas anteriores.

    1. Recordatorios de Cita: Podemos usar y divulgar su PHI para avisarle y recordarle, que tiene una cita para el tratamiento o cuidado médico. Esto puede ser realizado a través de un sistema automatizado o por uno de nuestros miembros del personal. Si usted no está en casa, podemos dejar esta información en su contestador automático o mediante un mensaje con la persona que conteste el teléfono.

    2. Beneficios y Servicios Relacionados con la Salud: Podemos usar y divulgar su PHI para informarle sobre los beneficios salud relacionados o servicios, recomendarle posibles opciones o alternativas de tratamiento que puedan serle de interés.

    3. Actividades de Marketing y para recaudar fondos: Como la ley aplicable se requiere, SJHS no revelará su PHI para el marketing ni la recaudación de fondos sin su autorización.

    4. Directorio de la Instalación: Podemos incluir cierta información suya en nuestro directorio mientras esté recibiendo los servicios de cuidado de salud. Esta información puede incluir su nombre, ubicación en la instalación, su condición general (por ejemplo: bueno, favorable, etc.) y su filiación religiosa. Esta información, salvo su filiación religiosa, podrá divulgarse a personas que le soliciten por el nombre. Su filiación religiosa puede ser dada a un miembro del clero, ministro, sacerdote o rabino, aun cuando ellos no le soliciten por el nombre. Esto es para que su familia, amigos y clero pueden contactarle y visitarle. Si no desea ser incluido en este directorio, notifíqueselo al personal del Sistema de Salud durante el proceso de registro.

    5. Individuos Involucrados en Su Cuidado o Pago por Su Cuidado: Podemos divulgar su PHI a un amigo o miembro de la familia que esté involucrado en su cuidado médico y aquellos que ayuden a pagar por su cuidado. Podemos divulgar su PHI a una entidad asistiendo en esfuerzos de alivio de desastre para que su familia pueda ser notificada de su condición, estado y situación.

    6. Investigación: Podemos usar su PHI para propósitos de investigación después de recibir una autorización suya o cuando la Junta de Revisión Institucional de SJHS (IRB, por sus siglas en inglés) haya renunciado a los requerimientos de autorización a través de su revisión del propósito de investigación y haya establecido los protocolos para asegurar la privacidad de su PHI para asistir en la preparación de un estudio de investigación. Ejemplos:

  • Podemos dirigir un proyecto de investigación para comparar la salud y recuperación de todos los pacientes que recibieron una medicación contra aquellos que reciben una medicación diferente por la misma enfermedad o condición.

  • Podemos proporcionar una persona de investigación con un listado de todos los pacientes admitidos con diabetes durante el último año.

    1. Notas Psicoterapéuticas: Podemos usar y divulgar las notas psicoterapéuticas para las operaciones de tratamiento, pago

    y cuidado de la salud o en limitadas situaciones tal y como está definido por regulación. En todas las otras instancias, la liberación no será realizada sin una autorización por separado.

    ¿PUEDEN USTEDES USAR O DIVULGAR MI PHI SIN MI

    CONSENTIMIENTO? Sí. Las siguientes categorías describen las maneras en que nosotros podemos usar o divulgar su PHI sin su consentimiento. No se listará cada uso o divulgación en una categoría.

    1. Requerido por la Ley: Divulgaremos su PHI cuando sea requerido hacerlo por ley federal, estatal o local. Ejemplo:

  • La ley de Oklahoma nos exige que informemos al Departamento de Salud del Estado de Oklahoma todos los nacimientos que ocurran en nuestras instalaciones.

    1. Para Prevenir una Amenaza Seria o a la Seguridad de la Salud: Podemos usar y divulgar su PHI cuando sea necesario

      prevenir una amenaza seria a su salud y seguridad o a la salud y seguridad del público u otra persona. Esta divulgación sólo se haría a alguien capaz de ayudar a prevenir la amenaza.

    2. Donaciones de Tejido y Órgano: Si usted es un donante de órgano, podemos divulgar su PHI a organizaciones que se ocupen del trasplante o procura de órganos, ojos o tejidos, o a un banco donante como requisito para facilitar donación y trasplante.

    3. Ejército: Si usted es miembro de las Fuerzas Armadas, podemos divulgar su PHI cuando lo requieran las autoridades del comando del ejército. También podemos divulgar el PHI del personal militar extranjero a la autoridad del ejército extranjera pertinente.

    4. Compensación de los Trabajadores: Podemos divulgar su PHI para la compensación de los trabajadores o programas

      similares tal y como lo autoriza la ley estatal. Estos programas proporcionan los beneficios para el trabajo relacionado con lesiones o enfermedades.

    5. Reportando Salud Pública: Podemos divulgar su PHI para las actividades de salud pública.

      Ejemplos:

  • Con el propósito de prevenir o controlar enfermedades, lesiones o discapacidades.

  • Reportando defectos de nacimiento o infección del ojo en el infante.

  • Reportando los diagnósticos de cáncer y tumores.

  • Reportando las reacciones a medicaciones o problemas con los productos.

  • Notificando a los pacientes con relación a productos revocados.

  • Notificando al Departamento de Salud del Estado de Oklahoma de pacientes que pueden haber sido expuestos a una enfermedad, o el riesgo de contraer o diseminar una enfermedad o condición como VIH, Sífilis u otras enfermedades transmitidas sexualmente.

  • Reportando abuso, abandono o violencia tal y como es requerido por la ley, incluyendo niños que nacen con alcohol u otra substancia en su cuerpo.

    1. Agencias de Vigilancia de Salud: Podemos divulgar su Información Protegida de Salud (PHI, según sus siglas en inglés) a una agencia de supervisión de la salud para actividades necesarias para que el gobierno supervise el sistema de cuidado de salud, los programas gubernamentales, y el cumplimiento con las leyes aplicables; por ejemplo, auditorías, investigaciones, inspecciones, informes de dispositivos médicos y licencia.

    8. Juicios y Disputas: Si usted está involucrado en un juicio o disputa, podemos divulgar su PHI a solicitud de una corte u orden administrativa. También podemos divulgar su PHI en

    respuesta a una citación, solicitud de demanda, u otro proceso legal por alguien más involucrado en la disputa, pero sólo si se

    han hecho los esfuerzos para que sea enterado en relación a la demanda o para obtener una orden protegiendo la información.

    1. Cumplimiento de la Ley: Podemos divulgar el PHI si es solicitado hacerlo por un oficial del orden público.

      Ejemplos:

  • Para identificar o localizar a un sospechoso, fugitivo, testigo material, o a una persona extraviada.

  • Si usted es víctima de un crimen, bajo ciertas circunstancias, donde su consentimiento no puede obtenerse.

  • Sobre una muerte que nosotros creamos que puede ser resultado de conducta criminal.

  • En circunstancias de emergencia para informar un crimen, la ubicación del crimen o víctimas, identidad, descripción o situación de la persona que cometió el crimen mientras estaba en las premisas de SJHS.

    1. Pesquisidores, Examinadores Médicos y Directores Fúnebres: Podemos divulgar el PHI a Pesquisidores, Examinadores Médicos y Directores Fúnebres.

      Ejemplos:

  • Para identificar a una persona fallecida o determinar la causa de su muerte.

  • Para asistir al director fúnebre a completar el certificado de defunción.

    1. Seguridad Nacional y Actividades de Inteligencia: Podemos divulgar su PHI a los oficiales federales de inteligencia, contrainteligencia u otras actividades de seguridad nacional autorizadas por la ley.

    2. Servicios de Protección al Presidente y Otros: Podemos divulgar su PHI a los oficiales federales para que ellos puedan proporcionar protección al Presidente, a otras personas autorizadas o cabezas de estado extranjeras, o para dirigir investigaciones especiales.

    3. Presos: Si usted es un preso de una institución correccional o en custodia de un oficial en cumplimiento de la ley, podemos divulgar su PHI a la instalación correccional u oficial en cumplimiento de la ley. Esto puede ser necesario: (1) para

    la institución correccional para proporcionarle el cuidado de salud; ó (2) para proteger su salud y seguridad, de otros o de la institución correccional.

    ¿CUÁLES SON MIS DERECHOS CON RESPECTO A MI PHI?

    Usted tiene los derechos siguientes con respecto a su PHI. Usted debe presentar una solicitud por escrito a la instalación apropiada en el Sistema de Salud para ejercer cualquiera

    de estos derechos para los registros que crea y mantiene la instalación.

    1. Derecho a Inspeccionar y Copiar: Usted tiene el derecho a inspeccionar y solicitar una copia de su PHI, exceptuando si ello está prohibido por la ley. Si usted solicita una copia en papel o en formato electrónico se le puede cobrar un gasto de acuerdo con la ley federal y la ley de Oklahoma. Nosotros

      podemos negarle su solicitud a inspeccionar y copiar en ciertas circunstancias, tal como una solicitud de los registros de salud mental. Si le niegan el acceso a cierto PHI, usted puede solicitar que sea revisada la negativa. Un profesional de cuidado de salud autorizado escogido por nosotros, el cual no esté involucrado

      en el rechazo, revisará su solicitud y la negativa. Nosotros obedeceremos el resultado de la revisión.

    2. Derecho a Enmienda: Si usted cree que el PHI creado por nosotros está incompleto o es incorrecto, puede solicitar una enmienda siempre y cuando mantengamos la información. Si su solicitud no es por escrito y no incluye una razón para la enmienda, podemos negar la solicitud. También podemos negar su solicitud de enmienda si usted nos solicita que corrijamos información que:

  • Nosotros no hayamos creado, a menos que la persona o entidad que crearon la información no estén más disponibles para hacer la enmienda;

  • No sea parte del PHI mantenido por nosotros;

  • No sea parte de la información que fuese permitida inspeccionar o copiar; o

  • Sea exacta y completa.

    1. Derecho a una Explicación de las Divulgaciones: Usted tiene el derecho a solicitar gratuitamente “una justificación de las divulgaciones” cada 12 meses. Las regulaciones Federales definen el alcance, calendario y elementos de datos, ejemplo, información, que es para ser incluida en una justificación. Su solicitud debe exponer un período de tiempo que no puede ser mayor a 6 años o incluir fechas antes del 14 de abril del

      2003. Por las justificaciones adicionales, podemos cobrarle los costos por proporcionarle dicha información. Le notificaremos el costo involucrado y usted puede escoger retirar o modificar su solicitud antes de que se incurra en cualquier cargo.

    2. Derecho a Solicitar Restricciones: Usted tiene el derecho a solicitar una restricción o limitación en el PHI que nosotros usamos o divulgamos en relación a su tratamiento, pago u operaciones de cuidado de la salud o a divulgar su información a un miembro familiar o amigo.

      Ejemplo:

  • Usted nos solicita no usar o divulgar la información en relación a su cirugía.

    No estamos obligados a estar de acuerdo con su solicitud a menos que la misma sea para retener información de un plan de salud para el pago u operaciones de de atención médica y haya pagado los servicios en su totalidad, por adelantado, y con

    sus propios recursos personales. Si su PHI se ha ocultado de su plan de salud, se le podrá solicitar que continúe pagando por completo, y por adelantado, por los servicios futuros para mantener esta solicitud. Si su plan de salud busca la

    información para propósitos del tratamiento, estamos obligados a proporcionarla. Para todas las otras solicitudes, si nosotros estamos de acuerdo, cumpliremos con su solicitud a menos que la información sea necesaria para proporcionarle tratamiento de emergencia o el uso o divulgación sea requerida por la ley. Su solicitud debe incluir:

  • Que información usted necesita restringir;

  • El tipo de restricción que usted desea; y

  • A quien usted quiere aplicar la restricción.

    1. Derecho a Solicitar Comunicaciones Confidenciales: Usted tiene el derecho a solicitar que nos comuniquemos con usted en relación con su PHI mediante un cierto método o una cierta ubicación.

      Ejemplos:

  • Usted solicita que sólo le avisemos vía correo o al número telefónico de su trabajo.

Nosotros no le preguntaremos la razón de la solicitud. Nosotros complaceremos todas las solicitudes razonables. Su solicitud debe especificar en que forma o donde usted desea ser notificado.

  1. Derecho a una Copia en Papel de Este Aviso: Usted tiene el derecho a una copia en papel de este aviso. Usted puede solicitarnos que le demos una copia de este aviso cuando lo desee. Aunque esté de acuerdo en recibir esta notificación electrónica, tiene también el derecho a recibir una copia impresa. Para obtener una copia en papel, contacte al Funcionario de Privacidad listado en este documento. También puede obtener una copia de este aviso a través de nuestro sitio web, www.stjohnhealthsystem.com

¿PUEDE SJHS MODIFICAR ESTE AVISO?

SJHS se reserva el derecho a modificar este aviso y que las revisiones o cambios sean efectivos para el PHI que ya tenemos sobre usted así como para cualquier PHI que recibamos en

el futuro. Cada aviso tendrá una fecha en vigor. Las copias del aviso actual serán publicadas. Adicionalmente, en cada

visita a los servicios de tratamiento o salud, le pondremos a su disposición una copia del aviso actual.

¿QUE PASA SI QUIEREN UTILIZAR O DIVULGAR MI INFORMACIÓN PROTEGIDA DE SALUD (PHI, POR SUS SIGLAS EN INGLÉS) PARA UN FIN QUE NO SE DESCRIBE EN ESTA NOTIFICACIÓN?

Otros usos y divulgaciones que no están cubiertos por esta notificación o las leyes que aplican a nosotros se harán sólo con su autorización por escrito. En otras palabras, el consentimiento que ya nos ha proporcionado no será suficiente para usar o divulgar su PHI para cualquier propósito no descrito en esta notificación. Si nos da la autorización para usar o divulgar su PHI, puede revocar esa autorización, por escrito, en cualquier momento. Si revoca su autorización, ya no podremos usar o divulgar su PHI por las razones cubiertas en su autorización. Usted entiende que no podemos recuperar o cancelar cualquier uso o revelación que ya hayamos hecho con su autorización.


¿QUÉ PASA SI TENGO PREGUNTAS O NECESITO PRESENTAR UNA QUEJA?

Si tiene alguna pregunta o desea presentar una queja, puede comunicarse con nosotros por correo, teléfono o correo electrónico y se remitirá al Oficial de Privacidad apropiado afiliado con su centro citado a continuación. Si cree que sus derechos han sido violados, puede presentarnos una queja por escrito o con el Secretario del Departamento de Salud y Servicios Humanos. Usted no será penalizado por presentar una queja.


St. John Health System

Attention: Privacy Officer

1924 S. Utica Avenue, Ste. 601

Tulsa, OK 74104

1-888-200-8513

SJHSPrivacyOfficer@sjmc.org


Jane Phillips Foundation (Auxiliary) Jane Phillips Memorial Medical Center Jane Phillips Nowata Health Center Regional Medical Laboratory, Inc.

St. John Health System St. John Auxiliary, Inc.

St. John Broken Arrow, Inc. St. John Home Care, LLC

St. John Medical Center, Inc.

St. John Owasso (Owasso Medical Facility, LLC) St. John Sapulpa Hospital

St. John Clinic

(St. John Clinic is a registered trademark of St. John Physicians, Inc., and has been licensed for use by St. John Physicians, St. John Urgent Care Clinics, St. John Anesthesia Services, Omni Medical Group. Inc., Physician Support Services, Inc.)


The U.S. Department of Health and Human Services

200 Independence Avenue, S.W. Washington, D.C. 20201

Toll Free: 1-877-696-6775


Office for Civil Rights, DHHS

1301 Young Street, Suite 1169

Dallas, TX 75202

Toll Free: 1-800-368-1019


Página 4

Tennessee - English (2016)
Microsoft Word - NPP - Physician Practices TEAR OFFS English 09-01-2016

Saint Thomas Medical Partners

NOTICE OF PRIVACY PRACTICES


Effective Date: September 1, 2016


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.


UNDERSTANDING THIS NOTICE

We understand that information about your health, health care and payment for health care is personal and confidential, and we are committed to safeguarding that information. Further, your health information is protected by state and federal laws and regulations. This notice will tell you about the ways in which we may use and disclose your protected health information (“PHI”). We also describe your rights and certain obligations we have regarding the use and disclosure of your protected health information.


This notice applies to Saint Thomas Medical Partners, its employees and other personnel, trainees, volunteers who we allow to help you while you are at Saint Thomas Medical Partners, clinically integrated health care professionals, and other participants in our organized health care arrangements. This notice applies only to your PHI created while you are a patient at Saint Thomas Medical Partners. All entities, sites, and locations follow the terms of this notice.


YOUR HEALTH INFORMATION RIGHTS

Although your health record is the physical property of Saint Thomas Medical Partners, the information belongs to you. You have the right to:

  • Request a restriction on certain uses and disclosures of your PHI for treatment, payment or health care operations. You also have the right to request restrictions on certain disclosures to persons, such as family members involved with your care or the payment for your care. However, we are not required to agree to these requests. We are required to agree to your request only if 1) except as otherwise required by law, the disclosure is to your health plan and the purpose is related to payment or health care operations (and not treatment purposes), and 2) your information pertains solely to health care items and services for which you or someone on your behalf have paid in full. For other requests, we are not required to agree. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. We will attempt to notify you if we are unable to grant your request;

  • Obtain a copy of this Notice of Privacy Practices upon request. You may request a paper copy of this notice, in person, at any of Saint Thomas Medical Partners’ sites. You may also obtain a copy of this notice from the Saint Thomas Medical Partners website at: sthealth.com.

  • Inspect and request a copy of your PHI in electronic format or hardcopy as provided by law. You may also access health information in your medical record through a portal by creating an account and providing an email address. We will respond to your request in a timely manner. We may charge a reasonable fee for labor and supplies;

  • Request that we amend your PHI as provided by law. We will attempt to notify you if we are unable to grant your request;

  • Obtain an accounting of certain disclosures of your PHI as provided by law;

  • Request communications of your PHI by alternative means or at alternative locations. We will accommodate reasonable requests; and

  • Revoke your authorization to use or disclose your PHI except to the extent that action has already been taken in reliance on your authorization.

    You may exercise your rights set forth in this notice by providing a written request to the Saint Thomas Health Corporate Privacy Officer, 2000 Church Street, Nashville, TN 37236.


    OUR RESPONSIBILITIES

    In addition to the responsibilities set forth above, we are also required to:

  • Maintain the privacy of your PHI;

  • Provide you with notification if we discover a breach of unsecured PHI unless there is a demonstration, based on a risk assessment, that there is a low probability that the PHI has been compromised;

  • Obtain your written authorization before we may use or disclose your psychotherapy notes, except for: use by the originator of the psychotherapy notes for treatment; or use or disclosure by Saint Thomas Medical Partners to defend itself in a legal action or other proceeding brought by the individual;

  • Provide you with a notice as to our legal duties and privacy practices with respect to PHI we maintain about you;

  • Abide by the terms of Saint Thomas Medical Partners’ Notice of Privacy Practices currently in effect;

  • We reserve the right to change our practices and to make changes effective for all PHI we maintain, including information created or received before the change. Should our privacy practices change, we are not required to notify you, but we may post the revised notice at each facility, and you may request copies of the revised notice in person at Saint Thomas Medical Partners or website at: sthealth.com.


HOW WE USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION

Generally, we may not use or disclose your PHI without your written authorization. However, in certain circumstances, we are permitted to use your PHI without authorization. The following categories describe different ways that we may use and disclose your PHI without your written authorization. For each category of uses or disclosures, we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed.

However, all of the ways we are permitted to use and disclose your PHI without your written authorization should fall within one of these categories.


WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION FOR TREATMENT

In order to enhance your treatment while in our care, and better coordinate your health care and related services after discharge, we may provide your PHI (including summaries of your care, prescriptions, lab work and x-rays) to your health care providers. These providers may include physicians, nurses, technicians, medical students or other medical personnel who are involved with your care. In some cases the sharing of your PHI with other health care providers and hospitals may be done electronically through an electronic health information exchange (“HIE”) operated by Saint Thomas Medical Partners or a business associate. By using electronic means, we may be able to make your PHI available to those who care for you in a more timely and effective manner, and thus help to improve the coordination of your care. Contact the Corporate Privacy Officer at 615-284-5488 with any questions or concerns.

WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION FOR PAYMENT

For example, we may share information with someone involved in paying for your care and send a bill to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures and supplies used.


WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION FOR HEALTH CARE OPERATIONS

For example, we may use your PHI to assess the care and outcome in your case and others like it. This information may then be used in an effort to continually improve the quality and effectiveness of the health care and services we provide. We may otherwise use your PHI, as needed, to facilitate the operation of our facility. Further, Saint Thomas Medical Partners and health care professionals with staff privileges may share medical information with each other and with participants in our organized health care arrangements (e.g., MissionPoint Health Partners) for treatment, payment or health care operations.


WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION AS OTHERWISE ALLOWED BY LAW

The following categories describe different ways that we may use and disclose your PHI for other than treatment, payment or health care operations without your written authorization. Under certain circumstances, we have noted when your authorization is required. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information for other than treatment, payment or health care operations without your written authorization should fall within one of these categories, with noted exceptions:

Business Associates: We provide some services through business associates. Examples include certain laboratory tests and copy services. To protect your information, however, we require business associates to take appropriate measures to safeguard your PHI.

Involvement in Care or Notification: We may use or disclose relevant information to family members or others who you have involved in your care or to notify or assist in notifying a family member, personal representative or another person responsible for your care, of your location, general condition or death. Research: We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.

Funeral Directors, Coroners and Medical Examiners: We may disclose your PHI to funeral directors, coroners and medical examiners consistent with applicable law to carry out their duties.

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

Contacting You About Appointments, Insurance and Other Matters: We may contact you by mail, phone, fax or email about appointments, registration questions, insurance updates, billing or payment matters, test results, to follow up about care received, about treatment alternatives, and health related benefits that may be of interest to you. We may leave voice messages at the telephone number you give to us. We may communicate to you via newsletters, mail outs or other means regarding health related information, disease-management programs, wellness programs, or other community based initiatives or activities our facility is participating in.

Marketing and Sale of PHI: We may communicate with you face-to-face regarding goods and services that may be of interest to you and may provide you with promotional gifts of nominal value. With very limited exceptions, we must obtain your written authorization before we may use or disclose your PHI for marketing purposes or when selling your PHI.

Fund Raising: We may communicate with you as part of our fund raising activities, but you have the right to opt out of receiving such communications. Food and Drug Administration (FDA): We may disclose to the FDA PHI relative to adverse events with respect to food medications, devices, supplements, product and product defects or post marketing surveillance information to enable product recalls, repairs or replacement.

Health Oversight Activities: We may disclose your PHI to a health oversight agency for activities authorized by law. These oversight activities might include audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the health care system; government benefits programs and compliance with civil rights laws.

Workers’ Compensation: We may disclose your PHI 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.

Public Health, Disaster Relief and Immunization Records: Consistent with applicable law, we may disclose your PHI to public health or legal authorities charged with preventing or controlling disease, injury or disability, disaster relief agencies, or with parental or guardian agreement, immunization records to schools.

Abuse, Neglect or Domestic Violence: Consistent with applicable law, we may disclose your PHI to a governmental authority authorized by law to receive reports of abuse, neglect or domestic violence.

Judicial, Administrative, Crime Victim and Law Enforcement Purposes: Consistent with applicable law, we may disclose your PHI for judicial, administrative and law enforcement purposes. This may include, for example, certain subpoenas and court orders disclosures to avert a serious threat to you or a third party’s health or safety as well as victims of crime or criminal conduct at Saint Thomas Medical Partners. This includes disclosing PHI to respond to lawsuits or legal action.

To Avert a Serious Threat to Health or Safety: Consistent with applicable law, we may use and disclose your PHI when we believe it is necessary to prevent a serious and imminent threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent or lessen the threat or to law enforcement authorities in particular circumstances.

National Security and Intelligence Activities: We may release your PHI to authorized federal officials for lawful intelligence, counterintelligence and other national security activities authorized by law. We may release your PHI to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or for the conduct of special investigations to the extent permitted by law.

Custodial Situations: If you are an inmate in a correctional institution and if the correctional institution or law enforcement authority makes certain representations to us, we may disclose your PHI to a correctional institution or law enforcement official in certain circumstances.

Required or Allowed by Law: We may use and disclose your PHI when required to do so by federal, state or local law.


FOR MORE INFORMATION OR TO REPORT A PROBLEM

If you believe your privacy rights have been violated, you can file a written complaint with the Corporate Privacy Officer at 615-284-5488 (2000 Church Street, Nashville, TN 37236) or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint. You will not be asked to waive your right to file a complaint as a condition of treatment, payment, enrollment in a health plan, or eligibility for benefits.

Tennessee - Espanol (2016)
Microsoft Word - NPP - Physician Practices TEAR OFFS Spanish 09-01-2016

Saint Thomas Medical Partners

AVISO DE PRÁCTICAS DE PRIVACIDAD


Fecha de vigencia: 1 de septiembre de 2016

ESTE AVISO DESCRIBE CÓMO INFORMACIÓN MÉDICA SOBRE UD. PUEDE SER

USADA Y DIVULGADA Y CÓMO ES QUE PUEDE ACCEDER ESTA INFORMACIÓN. POR FAVOR, REVÍSELO CON CUIDADO.


ENTENDER ESTE AVISO

Comprendemos que la información sobre su salud, cuidado de salud y pago de su cuidado médico es personal y confidencial, y nos comprometemos a resguardar dicha información. Además, la información sobre su salud está protegida por leyes y reglamentos estatales y federales. Este aviso le informará sobre cómo podemos utilizar y divulgar su información de salud protegida (“PHI”). También describimos sus derechos y ciertas obligaciones que tenemos con respecto al uso y la divulgación de su información de salud protegida.


Este aviso corresponde a Saint Thomas Medical Partners, sus empleados y otro personal, aprendices, voluntarios a quienes permitimos asistirle durante su permanencia en los establecimientos de Saint Thomas Medical Partners y a los profesionales médicos clínicamente integrados y otros participantes en nuestros acuerdos de salud organizados. Este aviso aplica solamente a su PHI que se crea durante su estadía como paciente en Saint Thomas Medical Partners. Todas las entidades, sedes y ubicaciones cumplen los términos del presente aviso.

SUS DERECHOS CON RESPECTO A LA INFORMACIÓN DE LA SALUD

Si bien su expediente de salud pertenece físicamente a Saint Thomas Health, la información que contiene le pertenece a usted. Usted tiene derecho a:

  • Solicitar la restricción de ciertos aspectos del uso y la divulgación de su PHI para efectos de tratamiento, pagos o el funcionamiento del sistema de salud. Usted también tiene el derecho a solicitar que se restrinja la divulgación de su información a determinadas personas, por ejemplo a miembros de su familia involucrados en su cuidado o en el pago del mismo. Sin embargo, no estamos obligados a acceder a su solicitud. Tenemos la obligación de acceder a su solicitud solamente si 1) la información es divulgada a su plan de salud y el motivo de la divulgación se relaciona con los pagos por su cuidado de salud o con el funcionamiento del sistema de salud (y no para fines de tratamiento), y 2) su información se refiere solamente a elementos y servicios de cuidado de salud por los que usted o una persona en su nombre ha pagado completamente. No estamos obligados a acceder a otras solicitudes. Si aprobamos su solicitud, cumpliremos con la misma a menos que se necesite la información para proporcionarle tratamiento de emergencia. Intentaremos notificarle si no podemos concederle su solicitud;

  • Obtener una copia de este Aviso de Prácticas de Privacidad al solicitarla. Ud. puede solicitar una copia de este aviso en persona en Saint Thomas Medical Partners. Ud. también puede obtener una copia de este aviso en el sitio de web de Saint Thomas Health en: sthealth.com.

  • Inspeccionar y solicitar una copia de su PHI en formato electrónico o impreso de conformidad con la ley; También puede acceder a la información de salud que está en su expediente médico a través de un portal, para ello debe crear una cuenta y proporcionar una dirección de correo electrónico. Es posible que le cobremos una tarifa razonable por mano de obra y suministros;

  • Solicitar que enmendemos su PHI de conformidad con la ley. Intentaremos notificarle si no podemos concederle su solicitud;

  • Obtener un recuento de ciertas divulgaciones de su PHI, de conformidad con la ley;

  • Solicitar la comunicación de su PHI a través de medios alternativos o en otras localidades. Consideraremos las solicitudes que sean razonables, y

  • Revocar su autorización para usar o divulgar su PHI hasta el límite en que dicha acción ya haya sido ejecutada de conformidad con su autorización.

    Usted puede ejercer sus derechos planteados en el presente aviso enviando una solicitud escrita a Saint Thomas Health Corporate Privacy Officer, 2000 Church Street, Nashville, TN 37236.

    NUESTRAS RESPONSABILIDADES

    Además de las responsabilidades descritas anteriormente, también estamos obligados a:

  • Mantener la privacidad de su PHI;

  • Notificarle si descubrimos que ha ocurrido una infracción relacionada con PHI desprotegida a menos que se demuestre, mediante una evaluación de riesgo, que hay una probabilidad muy baja de que su PHI haya sido comprometida;

  • Obtener su autorización escrita antes de usar o divulgar sus notas psicoterapéuticas, excepto: para fines de tratamiento por parte del autor de las notas psicoterapéuticas; o para uso o divulgación por parte de Saint Thomas Medical Partners para defenderse contra una acción legal u otro procedimiento interpuesto por la persona;

  • Proporcionarle un aviso que expone nuestros deberes legales y nuestras prácticas de privacidad con respecto a la PHI que mantenemos sobre usted;

  • Acatar los términos del Aviso de Prácticas de Privacidad de Saint Thomas Health que esté vigente;

  • Nos reservamos el derecho a cambiar nuestras prácticas y efectuar cambios en toda la PHI que mantenemos, incluyendo la información que fue creada o recibida antes de efectuar el cambio. No estamos obligados a notificarle de ningún cambio que hagamos a nuestras prácticas de privacidad, pero podemos exhibir el aviso enmendado en cada establecimiento y usted podrá solicitar en persona copias del aviso enmendado en Saint Thomas Health o en nuestro sitio Web: sthealth.com.


CÓMO UTILIZAMOS Y DIVULGAMOS SU INFORMACIÓN DE SALUD PROTEGIDA

Generalmente no podemos utilizar ni divulgar su PHI sin una autorización escrita de usted. Sin embargo, en ciertas circunstancias, se nos permite utilizar su PHI sin su autorización. Las siguientes categorías describen las diferentes formas en que podemos utilizar y divulgar su PHI sin su autorización. Explicaremos el significado de cada categoría de uso y divulgación y ofreceremos ejemplos. No se listará cada uso o divulgación en cada categoría. Sin embargo, todas las formas en que se nos permite utilizar y divulgar su PHI sin su autorización escrita recaen dentro de una de estas categorías.

PODEMOS UTILIZAR O DIVULGAR SU INFORMACIÓN DE SALUD PARA FINES DE TRATAMIENTO

Podríamos proporcionar su PHI (incluidos los expedientes de su cuidado, recetas médicas, resultados de laboratorio y rayos X) a sus proveedores de atención médica después de darle de alta para mejorar su tratamiento mientras esté bajo nuestro cuidado y para coordinar mejor su cuidado de salud y los servicios relacionados. Estos proveedores pueden incluir médicos, enfermeras, técnicos, estudiantes médicos u otro personal médico que participan en su cuidado mientras Ud. esté en Saint Thomas Medical Partners o posterior a su dada de alta. En algunos casos, su PHI podría compartirse con otros hospitales y proveedores de atención médica a través de un sistema de intercambio electrónico de información de salud ("HIE") que es administrado por Saint Thomas Medical Partners o un socio comercial. El sistema de intercambio electrónico de información de salud nos permite proporcionar en forma más oportuna y efectiva su PHI a quienes le proporcionan cuidado médico, y por lo tanto, nos permite coordinar mejor su cuidado. Contacte al Funcionario de Privacidad Corporativa (Corporate Privacy Officer) llamando al teléfono 615-284-5488 si tiene alguna pregunta o inquietud.

PODEMOS UTILIZAR O DIVULGAR SU INFORMACIÓN DE SALUD PARA FINES DE PAGO

Por ejemplo, podemos compartir información con una persona que participe en el pago de su cuidado y enviar una factura a usted o a terceros. La información que contiene la factura o acompaña a la factura podrá incluir datos que lo identifican o información sobre su diagnóstico, sus procedimientos y los suministros utilizados.

PODEMOS UTILIZAR O DIVULGAR SU INFORMACIÓN DE SALUD PARA FINES DE CUIDADO DE LA SALUD

Por ejemplo, podemos usar su PHI para evaluar el cuidado y los resultados en su caso y en casos similares. Esta información podría utilizarse después para mejorar continuamente la calidad y efectividad de los servicios de cuidado de salud que proveemos. Podemos utilizar su PHI de otras formas, según sea necesario, para mejorar el funcionamiento de nuestro establecimiento. Adicionalmente, Saint Thomas Health y los profesionales médicos que tienen privilegios de empleados pueden compartir información médica entre sí y con participantes en nuestros acuerdos de cuidado de salud organizados (p. ej., MissionPoint Health Partners) para fines de tratamiento, pago u otras operaciones de cuidado de la salud.

PODEMOS UTILIZAR O DIVULGAR SU INFORMACIÓN DE SALUD DE CUALQUIER OTRA FORMA PERMITIDA POR LA LEY

Las siguientes categorías describen las diferentes formas en que podemos utilizar y divulgar su PHI para fines diferentes a tratamiento, pago u operaciones de cuidado de salud sin una autorización escrita de usted. En ciertas circunstancias, hemos puesto por escrito cuándo se requiere su autorización. No se listará cada uso o divulgación en cada categoría. Sin embargo, todas las formas en que se nos permite utilizar y divulgar información para fines diferentes a tratamiento, pago u operaciones de cuidado de salud sin su autorización escrita recaen dentro de una de estas categorías, con las siguientes excepciones:

Socios comerciales: Proporcionamos algunos servicios a través de socios comerciales. Ejemplos incluyen ciertas pruebas de laboratorio y servicios de fotocopiado. Para proteger su información, sin embargo, le exigimos a los socios comerciales que tomen medidas apropiadas para resguardar su PHI.

Participación en el cuidado o la notificación: Podemos utilizar o divulgar información relevante a miembros de su familia o a otras personas que usted ha involucrado en su cuidado, o notificar o ayudar a notificar a un miembro de su familia, un representante personal o a otra persona responsable de su cuidado, sobre su paradero, condición general o fallecimiento.

Investigación: Podemos divulgar información a investigadores una vez que su investigación haya sido aprobada por un comité de evaluación institucional que ha analizado la propuesta de investigación y establecido protocolos que garantizan la privacidad de su PHI.

Directores de funerarias, médicos forenses, y auditores médicos: Podemos divulgar su PHI a directores de funerarias, médicos forenses y auditores médicos de conformidad con las leyes aplicables para permitir que realicen sus obligaciones.

Organizaciones que gestionan la donación de órganos: De conformidad con las leyes vigentes, podemos divulgar su PHI a las organizaciones que gestionan la donación de órganos o a otras entidades que participan en la obtención, el almacenamiento o el trasplante de órganos y tejidos para fines de donación y trasplante de órganos y tejidos.

Comunicaciones con usted sobre citas, seguros y otros asuntos: Podemos contactarle por correo postal, teléfono, fax o correo electrónico acerca de asuntos como citas médicas, admisión en el hospital, actualizaciones de seguros, temas de facturación o pago, resultados de pruebas, seguimiento del cuidado que ha recibido, alternativas al tratamiento y beneficios para la salud que puedan interesarle. Podemos dejarle mensajes de voz en el número telefónico proporcionado por usted. Podemos comunicarnos con usted a través de boletines informativos, por correo postal u otros medios para proporcionarle información de salud, programas de control de enfermedades, programas de bienestar y otras iniciativas o actividades comunitarias en las cuales nuestro establecimiento participa.

Comercialización y venta de PHI: Podemos comunicarnos con usted personalmente para ofrecerle bienes y servicios que podrían interesarle, así como ofrecerle obsequios promocionales de valor nominal. Con muy limitadas excepciones, tenemos que obtener una autorización de usted antes de usar o divulgar su PHI para fines de comercialización o para vender su PHI.

Recaudación de fondos: Podemos comunicarnos con usted como parte de un esfuerzo para recaudar fondos, pero usted tiene derecho a excluirse de estas comunicaciones.

La Administración de Alimentos y Medicamentos (FDA): Podemos divulgar a la FDA la PHI sobre eventos adversos relacionados con alimentos, medicamentos, dispositivos, suplementos, productos y productos defectuosos, o información recopilada sobre productos comercializados para permitir su retiro, reparación o reemplazo.

Actividades de control de la salud: Podemos divulgar su PHI a un organismo de control de salud para actividades autorizadas por la ley. Dichas actividades pueden incluir auditorías, investigaciones, inspecciones y otorgamiento de licencias. Estas actividades son necesarias para que el gobierno supervise el sistema de cuidado de la salud, los programas de beneficios gubernamentales y el cumplimiento de las leyes de derechos civiles.

Compensación a Trabajadores: Podemos divulgar su PHI en la medida que lo permita la ley y que sea necesario para cumplir con las leyes de compensación por accidentes y enfermedades laborales u otros programas similares establecidos por la ley.

Salud pública, rescate durante desastres y expedientes sobre vacunas: De conformidad con la ley, podemos divulgar su PHI a autoridades judiciales o de salud pública que se ocupan de prevenir o controlar enfermedades, lesiones o discapacidades, agencias de rescate en desastres, o mediante acuerdo mutuo con padres o custodios, los expedientes de vacunas a las escuelas.

Abuso, negligencia o violencia doméstica: De conformidad con las leyes aplicables, podemos divulgar su PHI a una autoridad gubernamental que esté facultada para procesar informes sobre abuso, negligencia o violencia doméstica.

Fines judiciales, administrativos, víctimas de crímenes y cumplimiento de la ley: De conformidad con las leyes aplicables, podemos divulgar su PHI para fines judiciales, administrativos y de cumplimiento de la ley. Esto podría incluir, por ejemplo, ciertas citaciones y órdenes judiciales divulgaciones para prevenir una amenaza grave para la salud o la seguridad de usted o de terceros, así como de víctimas de crímenes o de conducta criminal en Saint Thomas Health. Esto incluye divulgar la PHI para responder a demandas o acción legal.

Para prevenir una amenaza grave para la salud o la seguridad: De conformidad con las leyes aplicables, podemos utilizar y divulgar su PHI cuando consideremos que sea necesario para prevenir una amenaza grave e inminente para la salud y la seguridad de usted o del público general u otra persona. Sin embargo, la información se divulgaría solamente a una persona capacitada para ayudar a prevenir o aminorar la amenaza o a las autoridades judiciales en circunstancias específicas.

Actividades de seguridad e inteligencia nacional: Podemos divulgar su PHI a funcionarios federales autorizados para prestar servicios de inteligencia, contrainteligencia y otras actividades de seguridad nacional autorizadas por la ley. Podemos entregar su PHI a funcionarios federales autorizados para que proporcionen servicios de protección al Presidente, a otras personas autorizadas o a dignatarios de otros países, o para realizar investigaciones especiales en la medida que lo permita la ley.

Situaciones de custodia: Si usted está recluido en una institución penitenciaria y si dicha institución o una autoridad judicial nos comunican hechos específicos, podemos divulgar su PHI a un funcionario de una institución penitenciaria o una autoridad legal en ciertas circunstancias.

Obligación o autorización legal: Podemos utilizar y divulgar su PHI cuando las leyes federales, estatales o locales requieran hacerlo.

PARA SOLICITAR MÁS INFORMACIÓN O REPORTAR UN PROBLEMA

Si considera que sus derechos a la privacidad han sido violados, puede enviar un reclamo escrito al Funcionario de Privacidad Corporativa (Corporate Privacy Officer) llamando al 615-284-5488 (2000 Church Street, Nashville, TN 37236) o al Secretario de Salud y Servicios Humanos (Secretary of Health and Human Services). No habrá ninguna represalia por presentar una queja. A Ud. no se le pedirá renunciar su derecho de presentar una queja como condición de tratamiento, pago, inscripción en un plan de seguro o para elegibilidad de beneficios.

Texas - English (2013)
TX_english_2013

Seton Healthcare Family

JOINT NOTICE OF PRIVACY PRACTICES

FOR ORGANIZED HEALTHCARE ARRANGEMENT


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

Effective Date: 04/14/03 Revised: 06/05/13


The Seton Healthcare Family (Seton) consists of hospitals, other facilities/entities (e.g., skilled nursing facility, home health agency, community clinics), physician groups, providersi, students and volunteers. We create a record of the medical care you receive at Seton. We understand that your medical information is personal and we are committed to protecting your medical information. This Notice applies to all of your medical information received or created by Seton and describes how Seton may use and disclose your medical information. This Notice also describes your rights and Seton’s obligations when using and disclosing your medical information.

YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION.

Even though your medical record belongs to Seton, your medical information in the medical record belongs to you. You have the right to:

  • Inspect And Request A Copy Of Your Medical Information. Upon request, you have the right to inspect and request a copy of your medical information that is maintained by Seton in a designated record set whether it is in paper format or contained in an electronic record. Seton may deny access in accordance with state or federal law. Seton may charge a fee for this service. As allowed by law, Seton may deny your request to inspect and/or receive a copy of your medical information. If Seton denies your request, you may have the right to request a review of that denial.

  • Request Confidential Communications. You may request that you receive communications of your medical information in a specific manner or at other locations. Your request must specify how or where you want to be contacted. Seton will accommodate reasonable requests.

  • Request Restrictions. You have the right to request restrictions on how we use and disclose your medical information. We are not required to agree to these requests, except for when you request that we not disclose information to your health plan about services for which you paid out-of-pocket in full. In those cases, we will honor your request, unless the disclosure is necessary for your treatment or is required by law.

  • Request Amendment of your Medical Information. You may request that Seton amend your medical information maintained in a designated record set. We may deny your request if it is not properly submitted or does not include a reason to support the request. We may also deny your request if you ask us to amend information that:

    • Was not created by Seton;

    • Is not part of the medical information kept by or for Seton;

    • Is not part of the information which you would be permitted to inspect and/or copy; or

    • Is accurate and complete in the record.

      If we deny your request, we will notify you in writing and you will have the right to file a statement of disagreement with Seton.

  • An Accounting of Disclosures. You may request a list of certain disclosures Seton has made of your medical information. Your request must include the time period for the listing and cannot be more than six (6) years before the date of your request. You have the right to receive one accounting within any 12-month period at no cost to you. You will be charged a reasonable cost for any additional accounting requests made during a 12-month period.

    You may exercise your rights outlined in this Notice by providing a written request to the Health Information Management Department and/or Medical Records Department at the facility or location where you were seen.

    You may request a paper copy of this Notice from the Seton Privacy Officer at 1345 Philomena Street, Austin, TX 78723. This Notice is also available on the Seton website at www.seton.net


    SETON’S RESPONSIBILITIES

    In addition to the responsibilities set forth above, Seton will:

    • Maintain the privacy of your medical information.

    • Provide you with a notice as to our legal duties and privacy practices with respect to your medical information.

    • Abide by the terms of this Notice.

    • Notify you if we are unable to agree to a requested restriction on certain uses and disclosures.

    • Reserve the right to change our practices and to make the provisions effective for all medical information we maintain, including medical information created or received before the change. Should our information practices change we are not required to notify you, but you may obtain a copy of the revised Notice at any Seton location and on the Seton website at www.seton.net.

    • Not use or disclose your medical information without your written authorization, except as described in this Notice or as permitted by law.

    • Notify you of any breaches of your unsecured medical information.

USES AND DISCLOSURES OF MEDICAL INFORMATION WITHOUT YOUR AUTHORIZATION FOR TREATMENT, PAYMENT AND HEALTHCARE OPERATIONS.


The following categories describe different ways that we use and disclose medical information. For each category of use or disclosure we will explain what we mean and give an example. Not every use or disclosure in a category will be listed.

TREATMENT: We may disclose medical information about you to doctors, nurses, technicians, medical students or other personnel involved in your care. This may include sharing your information through regional and national health information exchanges for treatment purposes. We may share medical information about you in order to coordinate different treatments, such as prescriptions, lab work and X-rays. For example, we may provide your physician or another health care provider with copies of your medical information to assist in providing continuing treatment.

PAYMENT: We may use and disclose your medical information so that health care services and items you receive at Seton or from other entities, such as an ambulance company, may be billed to, and payment may be collected from, you, your insurance company or a third party. It may include information that identifies you, as well as your diagnosis, procedures and supplies used. For example, Seton may give your health information to your insurer in order for Seton to receive payment for health care services provided to you.

HEALTHCARE OPERATIONS: We may use and disclose your medical information to support Seton’s operations. These uses and disclosures are made for quality of care, medical staff activities, and teaching activities. Your medical information may be used or disclosed for contractual obligations, patient claims, grievances or lawsuits, legal services, financial planning, management and administration. For example, we may review medical information to find ways to improve treatment and services provided to our patients.

OTHER USES AND DISCLOSURES.

Appointment Reminders. We may contact you to remind you of appointment(s). For example, we may send you a postcard to remind you of an upcoming appointment.

Treatment Alternatives. We may contact you about treatment alternatives or other health-related benefits and services that may be of interest to you where Seton does not receive payment for contacting you. For example, we may contact you about new treatment options for a medical condition you have.

Fundraising. We may contact you as part of fund-raising activities to support Seton’s healthcare mission. For example, you may receive information from a Seton Foundation about fund-raising events. You have the right to opt out of receiving fundraising communications by contacting the Seton Foundations at 512-324-1000 extension 85916.


USES AND DISCLOSURES OF MEDICAL INFORMATION PERMITTED WITHOUT AUTHORIZATION OR OPPORTUNITY FOR THE INDIVIDUAL TO OBJECT

The privacy laws allow Seton to use or disclose your medical information without your authorization and without an opportunity for you to object in the following circumstances:

  1. REQUIRED BY LAW: We will disclose your medical information when required to do so by federal, state or local law.

  2. PUBLIC HEALTH. We may disclose your medical information for the following public health activities:

    1. Prevention or control of disease, injury or disability;

    2. Reporting of disease, injury, or vital events such as birth or death;

    3. Public health surveillance, investigations or interventions;

    4. At the direction of a public health authority to an official of a foreign government agency acting in collaboration with a public health authority.

    5. To a public health authority or other government authority authorized by law to receive reports of child abuse or neglect.

    6. To notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease or condition.

    7. Reporting of child abuse or neglect

    8. Under limited circumstances, to report to an employer information about an individual who is a member of the employer’s workforce related to a work-related illness or injury or a workplace-related medical surveillance.

  3. FOOD AND DRUG ADMINISTATION (FDA): We may disclose to the FDA medical information related to FDA regulated products or activities to collect or report adverse events, product defects or problems, or biological product deviations, to track FDA-regulated products; to enable product recalls, repairs or replacement, or conduct post marketing surveillance.

  4. ABUSE, NEGLECT OR DOMESTIC VIOLENCE: We may notify government authorities if we believe a patient is a victim of neglect or abuse. We will make this disclosure only when specifically authorized or required by law, or when the patient agrees to the disclosure.

  5. HEALTH OVERSIGHT ACTIVITIES: We may disclose your health information to a health oversight agency for activities authorized by law. These oversight activities might include audits, investigations, inspections and licensure or disciplinary actions or other government oversight activities. These activities are necessary for the government to monitor the healthcare system, government benefit programs and compliance with civil right laws.

  6. JUDICIAL AND ADMINSITRATIVE PURPOSES: Consistent with applicable law, we may disclose health information about you for judicial, administrative and law enforcement purposes. This may include disclosures to avert a serious threat to health or safety.

  7. LAW ENFORCEMENT PURPOSES: We may disclose your medical information to law enforcement officials in the following cases:

    1. As required by law to report wound or physical injury;

    2. In compliance with, and as limited by the relevant requirements of a court order or court-ordered warrant, subpoena, summons or similar process;

    3. Identification or location of a suspect, fugitive, material witness or missing person;

    4. In limited circumstances when the individual is or may be the victim of a crime;

    5. About an individual who has died to alert law enforcement that the individual’s death may have resulted from criminal conduct;

    6. Related to criminal conduct that occurred on Seton’s property; or

    7. In a medical emergency not on Seton’s property to report the nature or location of a crime, the victim(s) of such crime and the identity, description and location of the criminal.

  8. CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS: We may disclose medical information to a coroner or medical examiner to identify a deceased person, determine cause of death or other purposes as authorized by law. We may disclose medical information to funeral directors so they can carry out their duties.

  9. ORGAN PROCUREMENT ORGANIZATIONS. Consistent with applicable law, we may disclose medical information to organ procurement organizations or other entities engaged in the procurement, storage or transplantation of organs, eyes or tissue to facilitate organ, eye or tissue donation and transplant.

  10. RESEARCH: Seton conducts research activities. We may disclose information to researchers when their research has been approved by an Institutional Review Board or Privacy Board that has reviewed the research proposal and established rules to protect the privacy of your medical information. As allowed by law, we may allow a researcher to view medical information to prepare a research protocol, or we may use or disclose medical information of a deceased person for research purposes.

  11. TO AVERT A SERIOUS THREAT TO HEALTH OR SAFETY: We may use and disclose your health information when we believe it is necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent or lessen the threat or to law enforcement authorities in particular circumstances.

  12. MILITARY & VETERANS. If you are a member of the American armed forces or a foreign military, we may release your medical information to military command authorities as authorized or required by law.

  13. NATIONAL SECURITY AND INTELLIGENCE ACTIVITIES: We may release your health information to authorized federal officials for lawful intelligence, counterintelligence and other national security activities authorized by law.

  14. PROTECTIVE SERVICES FOR THE PRESIDENT AND OTHERS: We may disclose your health information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or for the conduct of special investigations.

  15. CUSTODIAL SITUATIONS: If you are an inmate in a correctional institution or under lawful custody of law enforcement, we may disclose your health information to a correctional institution or law enforcement official as allowed or required by law.

  16. WORKER’S COMPENSATION: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs established by law.

USE AND DISCLOSURE PERMITTED WITHOUT AUTHORIZATION, BUT AN OPPORTUNITY TO AGREE OR OBJECT

Facility Directory. Unless you notify us that you object, we will use your name, location in the facility and general condition for directory purposes while you are a patient at a Seton hospital or facility. This information may be provided to people who ask for you by name.

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 of your location and general condition or for disaster relief efforts.

USES AND DISCLOSURES YOU AUTHORIZE

Psychotherapy Notes. We will not use or disclose your psychotherapy notes without your written authorization, except for use by (1) the author of the information for treatment purposes, (2) Seton for its own training programs; or (3) Seton to defend itself in a legal action or other proceeding brought by the individual to whom the notes apply.

Marketing. We will not sell your medical information without your written authorization. We must obtain your written authorization before we may use or disclose your medical information for marketing purposes, except for face-to-face communications made by us to you, or if we give you a promotional gift of nominal value.

All other uses and disclosures of medical information not covered by this Notice or required by law will be made only with your written authorization.

Right To Revoke Written Authorization. If you give us authorization to use or disclose your medical information, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose medical information about you for the reasons allowed by your written authorization. We are unable to take back any disclosures we have already made with your authorization.

FOR MORE INFORMATION OR TO REPORT A PROBLEM

If you have questions regarding your privacy rights or would like additional information, you may contact the Seton Privacy Officer at 512-324-3280.

If you believe your privacy rights have been violated, you may file a written complaint with the Seton Privacy Officer, 1345 Philomena Street, Austin, Texas 78723 or with the Secretary of Health and Human Services, Office for Civil Rights, DHHS, 1301 Young St., Suite 1169, Dallas, TX 75202. There will be no retaliation for filing a complaint.


i Providers include, but are not limited to Physicians, Nurse Practitioners, Physician Assistants, Physical Therapists, Occupational Therapists, Social Workers and other similar health care providers who may be employees, contractors and those affiliated with Seton through Medical Staff privileges at Seton hospitals.

Washington DC - English (2017)

 

PROVIDENCE HOSPITAL

JOINT NOTICE OF PRIVACY PRACTICES

 

1. 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.

 

2. WE HAVE A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION (PHI)

 

We are legally required to protect the privacy of your health information. We call this information “protected health information” or “PHI” for short. PHI is information that can be used to identify you, which has been created or received about your past, present, or future health or condition, the provision of healthcare to you, or the payment for this health care. We are required to provide you with this notice about our privacy practices that explains how, when, and why we use and disclose your PHI. We are required to notify you in the event of a breach of your unsecured PHI. With some exceptions, we may not use or disclose any more of your PHI than is necessary to accomplish the purpose of the use or disclosure. We are legally required to follow the privacy practices that are described in this notice. However, we reserve the right to change the terms of this notice and our privacy policies at any time. Any changes will apply to the PHI we already have. Before we make an important change to our policies, we will promptly change this notice and post a new notice in a location clearly visible and accessible to all individuals who receive treatment or services at any Providence Hospital facility. You can also request a copy of this notice from the Providence Hospital HIPAA Privacy Office listed in Section 5 at any time and can view a copy of the notice on our website at www.provhosp.org.

 

3. HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION

 

We use and disclose health information for many different reasons. For some of these uses or disclosures, we must obtain your written authorization. Below, we describe the different categories of our uses and disclosures and give you some examples of each.

3.1. Uses and Disclosures Relating to Treatment, Payment or Health Care Operations

3.1.1. For treatment. We may disclose your PHI to physicians, nurses, medical students and other health care personnel who provide you with health care services or are involved in your care. For example, if you’re being treated for a knee injury, we may disclose your PHI to the physical therapy department in order to coordinate your care.

3.1.2. To obtain payment for treatment. We may use and disclose your PHI in order to bill and collect payment for the treatment and services provided to you. For example, we may provide portions of your PHI to our billing department and your health plan to get paid for the health care services we provided to you. We may also provide your PHI to our business associates, such as billing companies, claims processing companies, and others that process our health claims.

3.1.3. For health care operations. We may disclose your PHI in order to operate our hospital, clinics, home health, and other health care service locations. For example, we may use your PHI in order to evaluate the quality of health care services that you received or evaluate the performance of the health care professionals who provided health care services to you. We may also provide your PHI to our accountants, attorneys, consultants, and others in order to make sure we are complying with the laws that affect us.

3.1.4. For education/training. On occasion, we participate in the education and training of health care professionals. We may use and disclose your medical information to current and prospective students, residents, and/or observers as part of the training and educational process. For example, your physician may allow a student or observer to monitor your treatment as a part of a learning experience.

 

3.2. Certain Other Uses and Disclosures That Do Not Require Your Consent

3.2.1. When disclosure is required by federal, state, or local law, judicial or administrative proceedings, or law enforcement. For example, we make disclosures when a law requires that we report information to government agencies and law enforcement personnel about victims of abuse, neglect, or domestic violence; when dealing with gunshot and other wounds, or when ordered in a judicial or administrative proceeding.

3.2.2. For public health activities. For example, we report information about births, deaths, and various diseases to government officials in charge of collecting that information, and we provide coroners, medical examiners, and funeral directors necessary information relating to an individual’s death.

3.2.3. For health oversight activities. For example, we will provide information to assist the government when it conducts an investigation or inspection of a health care provider or organization.

3.2.4. For purposes of organ donation. We may notify organ procurement organizations to assist them in organ, eye, or tissue donation or transplants.

3.2.5. For research purposes. In certain circumstances, we may provide PHI in order to conduct research.

3.2.6. To avoid harm. In order to avoid a serious threat to the health or safety of a person or the public, we may provide PHI to law enforcement personnel or persons able to prevent or lessen such harm.

3.2.7. For specific government functions. We may disclose PHI of military personnel and veterans in certain situations. We may also disclose PHI for national security purposes, such as protecting the President of the United States or conducting intelligence operations.

3.2.8. For workers’ compensation purposes. We may provide PHI in order to comply with corkers’ compensation laws.

3.2.9. Appointment reminders and health-related benefits or services. We may use PHI to provide appointment reminders or give you information about treatment alternatives, or other health care services or benefits we offer.

3.2.10. Fundraising activities. We may use PHI to raise funds for our organization. The money raised through these activities is used to expand and support the health care services and educational programs we provide to the community. If you do not wish to be contacted as part of our fundraising efforts, you can opt out by notifying the Providence Hospital Foundation Office listed in Section 5.

3.2.11. Marketing. We must obtain your written authorization before we can use or disclose your PHI for marketing purposes, except for face to face communications made by us to you or a promotional gift of nominal value provided by us to you. We must also obtain your written authorization before we sell your PHI.

3.3. Uses and Disclosures to Which You Have an Opportunity to Object

3.3.1. Patient directories. We may include your name, location in this facility, general condition, and religious affiliation (if any) in our patient directory for use by clergy and visitors who ask for you by name, unless you object in whole or in part.

3.3.2. Disclosure to family, friends, or others. We may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment of your health care, unless you object in whole or in part.

 

3.3.3 Health Information Exchange. We may share information that we obtain or create about you with other health care providers or other health care entities, such as your health plan or health insurer, as permitted by law, through the Chesapeake Regional Information System for Our Patients, Inc. (CRISP), a regional Internet-based health information exchange. For example, information about your past medical care and current medical conditions and medications can be available to us or to your non-Providence primary care physician or hospital, if they participate in CRISP as well. Exchange of health information can provide faster access, better coordination of care and assist providers and public health officials in making more informed decisions. You may opt out of CRISP and disable access to your health information available through CRISP by contacting CRISP at 1-877-952-7477 or completing and submitting an Opt-Out form to CRISP by mail, fax, or through their website at crisphealth.org.

3.4. All Other Uses and Disclosures Require Your Prior Written Authorization. In any other situation not described in this section, we will ask for your written authorization before using or disclosing any of your PHI. If you choose to sign an authorization to disclose your PHI, you can later revoke that authorization in writing to stop any future uses and disclosures (to the extent that we haven’t taken any action relying on the authorization).

 

4. WHAT RIGHTS YOU HAVE REGARDING YOUR PHI

4.1. The Right to be Notified in the Event of a Breach of Your Unsecured PHI.

4.2. The Right to Request Restrictions on Uses and Disclosures of Your PHI. You have the right to ask that we restrict how we use and disclose your PHI. We are not required to agree to these requests, except for when you request that we not disclose information to your health plan about services for which you paid out-of-pocket in full. In those cases, we will honor your request, unless the disclosure is necessary for your treatment or is required by law.

4.3. The Right to Choose How We Send PHI to You. You have the right to ask that we send information to you at an alternate address (for example, to your work address rather than your home address) or by alternate means. We must agree to your request so long as we can easily provide it as you requested.

4.4. The Right to See and Get Copies of Your PHI. In most cases you have the right to look at or get copies of your PHI that we have, but you must make the request in writing. If we don’t have your PHI but we know who does, we will tell you how to get it. We will respond to you within 30 days after receiving your written request. In certain situations, we may deny your request. If we do, we will tell you, in writing, our reasons for the denial and explain your right to have the denial reviewed. If you request copies of your PHI, we will charge you a reasonable cost-based fee. We do not charge a fee for sending copies of your PHI to another health care facility or provider where you are or will be receiving health care services.

4.5. The Right to Get a List of the Disclosures We Have Made. You have the right to get a list of instances in which we have disclosed your PHI. The list will not include any of the uses or disclosures listed in section 3.1, 3.3, and 3.4. The list also won’t include any uses or disclosures made before April 14, 2003. We will respond within 60 days of receiving your request. The list we will give you will include disclosures made in the last six years unless you request a shorter time. The list will include the date of the disclosure, to whom PHI was disclosed (including their address, if known), a description of the information disclosed, and the reason for the disclosure. We will provide the list to you at no charge, but if you make more than one request in the same year, we will charge you for the cost to provide you each additional request.

4.6. The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI or that a piece of important information is missing, you have the right to request that we correct the existing information or add the missing information. You must provide the request and your reason for the request in writing. We will respond within 60 days of receiving your request. We may deny your request in writing if the PHI is (i) correct and complete, (ii) not created by us, (iii) not allowed to be disclosed, or (iv) not part of our records. Our written denial will state the reasons for the denial and explain your right to file a written statement of disagreement with the denial. If you don’t file one, you have the right to request that your request and our denial be attached to all future disclosures of your PHI. If we approve your request, we will make the change to your PHI, tell you that we have done it, and tell others that need to know about the change to your PHI.

4.7. The Right to Get This Notice electronically. You have the right to get a copy of this notice electronically. Even if you have agreed to receive notice electronically, you also have the right to request a paper copy of this notice.

4.8. The Right to Keep Your Mental Health Providers’ Private Notes Secure. We must obtain your written authorization before we may use or disclose your psychotherapy notes, except for: use by the originator of the psychotherapy notes for treatment; use or disclosure by the hospital for mental health training programs; or, use or disclosure by Providence Hospital to defend itself in a legal action or other proceeding brought by you.

 

5. PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR TO COMPLAIN ABOUT OUR PRIVACY PRACTICES

 

If you have questions about this notice or think that we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, please contact our Privacy Officer:

Providence Hospital

Privacy Officer

1150 Varnum Street, NE

Washington, DC 20017

Phone: 202-854-7037

 

For clarifications about Fundraising:

Providence Health Foundation

Fundraising Office, President

1150 Varnum Street, NE

Washington, DC 20017

Phone: (202) 854-7776

 

You also may send a written complaint to:

Secretary of the Department of Health and Human Services

200 Independence Avenue, SW

Washington, DC 20201

We will not take actions against you if you file a complaint about our privacy practices.

 

6. WHO WILL FOLLOW THIS NOTICE OF PRIVACY PRACTICES

 

This notice describes the practices of the employees, affiliates, staff, volunteers, departments and units of Providence Hospital.

Providence Hospital contracts with certain independent physicians and groups of healthcare

providers (for example, radiologists, anesthesiologists, pathologists, emergency room physicians etc.) who may provide services at some of our sites and locations even though Providence Hospital does not directly employ them. Unless one of these contracted groups provides you with its own Notice of Privacy Practices, this Notice applies to their uses and disclosures of PHI and they have agreed to abide by the terms of this Notice.

All Providence Hospital entities, sites, and locations follow the terms of this Notice. In addition, these Providence Hospital entities, sites, and locations may share PHI with each other for purposes of treatment, payment, or hospital operations as described in this Notice.

7. EFFECTIVE DATE OF THIS NOTICE

 

The initial notice was effective on April 14, 2003.

Revised September 23, 2013.

Revised March 31, 2017.

Revised October 16, 2017.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Wisconsin - English (2017)
WI_english_2017


Notice of

Privacy Practices

Important Information from Ascension Wisconsin


Our Mission

Rooted in the loving ministry of Jesus as healer, we commit ourselves to serving all persons with special attention to those who are poor and vulnerable.


Our Catholic health ministry is dedicated to spiritually centered, holistic care which sustains and improves the health of individuals and communities.


We are advocates for a compassionate and just society through our actions and our words.


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.


OUR RESPONSIBILITIES

We take the privacy of your health information seriously, as both an ethical and a legal obligation. We are required by law to:

  • Maintain the privacy of your health information.

  • Provide you with this Notice of Privacy Practices (“Notice”), which tells you about our legal duties and privacy practices with respect to your health information.

  • Notify you if a breach of your unsecured health information occurs.

    This Notice summarizes our duties and your rights concerning your health information. We are required to abide by the terms of our Notice that is currently in effect.


    WHO WILL FOLLOW THIS NOTICE?

    Ascension Wisconsin facilities located in Wisconsin (including all healthcare organizations wholly owned, controlled and/or managed indirectly or directly by Columbia St. Mary’s, Inc., Ministry Health Care, Inc. or Wheaton Franciscan Healthcare – Southeast Wisconsin, Inc. or their successor organization) provide health care to our patients, residents and clients (“Ascension Wisconsin”) in partnership with physicians and other professionals and affiliated health care organization. Our privacy practices will be followed by:

  • Any of our health care professionals who care for you at any one of our locations or sites.

  • All locations, departments and units that are part of Ascension Wisconsin and staffed by our workforce, regardless of geographic location.

  • All members of our workforce including medical staff members and other healthcare providers granted privileges to provide patient care in our facilities, employees, students and volunteers and our business associates.

Those following this Notice participate in an organized health care arrangement which will share protected health information with each other, as necessary to carry out treatment, payment, or health care operations relating to the organized health care arrangement.

USES AND DISCLOSURES OF HEALTH INFORMATION WE MAY MAKE WITHOUT WRITTEN AUTHORIZATION

The following categories describe different ways we may use and disclose your health information without your written authorization. Not every use or disclosure is listed. Health information is most often used and disclosed to provide treatment, to obtain payment for treatment or for health care operations. References to “you” and “your” information include your minor child’s information, when appropriate.

  • For Treatment. We may use and disclose your health information to provide treatment, health care or other related services. Your health information may be used by or disclosed to doctors, nurses, aides, technicians or other healthcare providers or employees who are involved in your care. Additionally, we may use or disclose your health information to manage or coordinate your treatment, health care or other related services. For example, we may use or disclose health information about you when you are referred to a specialist for care or when we send a prescription to a pharmacy to be filled for you.

  • For Payment. We may use and disclose your health information to bill and collect for the treatment and services we provide to you. We may send your health information to your insurance company or other third party payer for payment purposes. For example, we may use and disclose health information about you in order to send claims to your HMO for payment or to find out whether a proposed treatment is covered by your insurer.

  • For Health Care Operations. We may use and disclose your health information for health care operations. For example, we may use and disclose health information about you in order to renew our governmental licenses or other accreditations, and for quality improvement activities and teaching purposes.

  • Information Provided to You. We may use your health information to assist us in communicating with you about appointment reminders, test results and treatment information. Our communications to you may be by telephone, cell phone, e-mail, patient portal or by mail.

  • Facility Directory. If you are a patient at one of our hospitals, we may include certain limited information about you in our hospital directory. This information may include your name, location in the hospital, your general condition (e.g., fair, stable, etc.) and your religious affiliation. The directory information may be disclosed to people who ask for you by name, except for your religious affiliation, which may only be disclosed to clergy members. You have the right to not have your information included in our hospital directory (“opt-out”). To opt- out of our facility directory, we ask that you make this request during patient registration.

  • Individuals Involved in Your Care or Payment for Your Care. We may disclose to your family member, relative, close personal friend or other person identified by you, health information that is directly relevant to that person’s involvement with your care or payment for your care. We will not share this information with these individuals if we are aware of your desire not to have this information shared. If you are unable to object, our health professional will use their best judgment in communicating with your family or others.

  • Fundraising. We may use or disclose your health information for the purpose of raising funds to help support our mission. You have the right to opt-out of receiving fundraising communications. Our fundraising materials will indicate how you should let us know that you no longer want to receive them.

  • Research. Under certain circumstances, we may use and disclose your health information for research purposes. For example, a research project may involve comparing the health and recovery of all individuals who receive one medication to those who receive another. All research projects are subject to a special approval process.

  • Immunization Records. We may disclose your immunization records to a school where you are or will be a student, if the school is required by law to have proof of immunizations for admission purposes. We may also disclose your immunization records to the Wisconsin Immunization Registry.

  • For Public Health Purposes. We may disclose your health information for public health activities. Public health activities include, for example: preventing and controlling disease, injury or disability; reporting births and deaths; and reporting defective medical devices or problems with medications.

  • About Victims of Abuse. We may disclose your health information to notify the appropriate government authority if we believe that you have been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

  • Health Oversight Activities. We may disclose your health information to a health oversight agency for health oversight activities authorized by law. These activities include audits, investigations, licensure and disciplinary actions, and related activities which are necessary to monitor the health care system, governmental benefit programs, and compliance with civil rights laws.

  • Judicial and Administrative Proceedings. We may disclose your health information in response to a subpoena, court order, or administrative order, if certain requirements are met.

  • Law Enforcement. We may release your health information to law enforcement if the disclosure is required by law, necessary to identify or locate a suspect or missing person, about criminal conduct at an Ascension Wisconsin facility, about a victim of crime under certain circumstances, and in certain emergency situations.

  • To Avert a Serious Threat to Health or Safety. We may use and disclose your health information when we believe it is necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure would only be to someone able to help prevent or lessen the threat, or to law enforcement authorities.

  • Coroner, Medical Examiners, and Funeral Directors. We may disclose your health information to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death, or other duties authorized by law. We may disclose your health information to a funeral director, consistent with law, to permit the funeral director to carry out his/her duties.

  • Organ Donation Purposes. We may disclose your health information to organ procurement organizations and others engaged in procurement, banking or transplantation of cadaveric organs, eyes, or tissue, as necessary to facilitate organ or tissue donation and transplantation.

  • Military and Veterans. If you are a member of the armed forces, we may release your health information as required by military command authorities. We may also release health information about foreign military personnel to the appropriate foreign military authority.

  • National Security and Intelligence Activities. We may release your health information to authorized federal officials for intelligence, counterintelligence and other national security activities as authorized by law.

  • Protective Services for the President and Others. We may disclose your health information to authorized federal officials so they may provide protection to the President or other authorized persons, or for the conduct of special investigations authorized by law.

  • Inmates. If you are an inmate or in the custody of a correctional institution or law enforcement, we may disclose your health information to the correctional institution or law enforcement official for treatment and safety purposes.

  • Worker’s Compensation. We may disclose your health information as authorized by and to the extent necessary to comply with worker’s compensation laws or laws relating to similar programs.

  • As Required by Law. We may disclose your health information when required to do so by federal, state or local law, including the Secretary of Health and Human Services.


HEALTH INFORMATION EXCHANGE AND SHARED ELECTRONIC RECORD

In an effort to provide the best care to you, Ascension Wisconsin participates in arrangements between health care organizations that facilitate access to health care information that may be relevant to your care. For example, if you have an emergency and you cannot provide important information about your health, these arrangements will allow us to obtain information to treat you. Some Ascension Wisconsin facilities participate in health information exchange organizations (“HIE”) that permit computer- based transfer of health information directly between healthcare providers at different locations and institutions to facilitate your care and treatment. Some facilities store information in a shared electronic medical record with other health care providers who participate in this regional arrangement. The participants may share your medical information with each other through the shared electronic medical record.


SPECIAL RESTRICTIONS UNDER STATE AND OTHER FEDERAL LAWS

We will also comply with all other applicable state and federal laws. For example, under state law, there are more limits on when HIV and AIDS information may be disclosed. Under other federal law, there are more limits on when drug or alcohol abuse treatment information may be disclosed. We abide by all applicable state and federal laws.


USES AND DISCLOSURES THAT REQUIRE YOUR WRITTEN AUTHORIZATION

Any 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 authorization. An authorization is a special written permission from you that grants authority to Ascension Wisconsin to use or disclose your health information.

  • We must obtain your authorization to use or disclose psychotherapy notes. Psychotherapy notes may only be used for limited purposes, such by the treating professional. Disclosures are permitted only as required by law, for certain health oversight activities, or to avert a serious threat to health or safety.

  • We must obtain your authorization to use or disclose health information for marketing purposes (which does not include materials sent to you about health care services or other treatment options, including promotional gift of nominal value, by us), or for disclosures that constitute the sale of health information.

  • If you provide us an authorization to use or disclose your health information, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose health information about you for the reasons covered by your authorization. We want you to understand that when you take back your permission we are unable to retrieve any information we may have already shared with your permission. We also are required to maintain original records of the care that we provide to you.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION.


  • Right to Request Restrictions. You have the right to request additional restrictions or limitations on the health information we use or disclose about you for treatment, payment or health care operations. We ask that you make this request in writing. We are not required to agree to your requested restrictions except in the limited situation in which you (or someone on your behalf) pays for an item or service out-of pocket and you request that information concerning such item or service not be disclosed to your health plan. If we do agree to your requested restrictions, we will comply with your request unless the information is needed to provide you with emergency medical treatment.

  • Right to Request Confidential Communications. Typically, we communicate with you regarding your health care either by calling your primary phone or sending mail to your home address. You have the right to request that we communicate with you in an alternative way or at an alternative location. We will accommodate reasonable requests.

  • Right to Access. You have the right to access your health information by requesting to inspect and/or obtain a copy of your health information, with limited exceptions. We ask that your request be made in writing. You may request the copy of your health information be provided in a summary format. You may also request the copy be provided on paper (“hard copy”) or in an electronic form or format. We will also transmit a copy of your health information to another person designated by you in writing. We may charge reasonable fees for copies.

  • Right to Request Amendments. You may request that we amend your health information. To request an amendment, we ask that your request be made in writing. In addition, you must provide a reason that supports your request. We may deny your request in certain circumstances, such as if the information was not created by us, or if we believe the information in your record is accurate and complete. If we deny your request, you may appeal the denial.

  • Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures that we have made of your health information, not including those made for payment, treatment or health care operations. Your request must state a time period which may not be longer than six years. The first accounting of disclosures you request within a twelve (12) month period will be provided to you free of charge. We may charge a reasonable cost based fee for all subsequent requests during that twelve (12) month period.

  • Right to Notification of a Breach. We must notify you if your unsecured protected health information has been the subject of a breach.

  • Right to a Paper Copy of this Notice. You may ask us to give you a paper copy of

this Notice upon request. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice.


Ascension Wisconsin refers to all healthcare organizations wholly owned, controlled and/or managed indirectly or directly by Columbia St. Mary’s, Inc., Ministry Health Care, Inc. or Wheaton Franciscan Healthcare – Southeast Wisconsin, Inc. or their successor organization

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CHANGES TO THIS NOTICE

We reserve the right to make changes to this Notice at any time. We reserve the right to make the revised Notice effective for health information we already have,

as well as any information we receive or create in the future. The Notice will contain the current effective date. We will post a copy of the current Notice in our

locations and on our website. The Notice is also available to you upon request.


COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with Ascension Wisconsin or with the Secretary of the Department of Health and Human Services. To file a complaint with Ascension Wisconsin, please notify our Privacy Officer. We will not retaliate against you for filing a complaint.


If you have any questions about this Notice or a complaint, please contact: Ascension Wisconsin

Attn: Privacy Officer

Corporate Responsibility Department 400 W. River Woods Parkway Glendale, WI 53212

Corporate Responsibility Values Line 1-800-707-2198


ascension.org CC262 Revised 5/2017