Notice
of Privacy Practices
Introduction
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.
We are
required by federal law to maintain the privacy of your medical information and to give you our Notice of Privacy Practices
(this “Notice”) that describes our privacy practices, our legal duties and your
rights concerning your medical information.
This
Notice applies to Guthrie County Hospital, our clinics, and our organized health
care arrangement. This Notice applies to and will be followed by: (1) all
employees, staff, volunteers and other personnel of the Facility and clinics,
and (2) the physicians and other practitioners who are not employed by the
Facility, but who have privileges to treat patients at the Facility and who are
members of the Facility’s organized health care arrangement (see description of
the Facility’s organized health care arrangement, below).
How We May Use and Disclose Your Medical Information
EXCEPT WHERE SUCH USE OR DISCLOSURE IS OTHERWISE PROHIBITED BY STATE OR FEDERAL LAW, THE FACILITY IS PERMITTED OR REQUIRED TO USE OR DISCLOSE YOUR MEDICAL INFORMATION WITHOUT YOUR AUTHORIZATION (PERMISSION) IN THE FOLLOWING SITUATIONS. SOME, BUT NOT ALL, SPECIFIC EXAMPLES OF THE DIFFERENT TYPES OF DISCLOSURES HAVE BEEN LISTED.
TREATMENT. To
provide you with medical treatment or services (e.g., provide information to
doctors, nurses, technicians, students or other personnel who are involved in
your care).
PAYMENT. To
collect payment from you, an insurance company or a third party for the
treatment and services you receive (e.g., submitting a claim to your insurance
company).
HEALTH CARE
OPERATIONS. For
Facility health care operations (e.g., to evaluate our staff and internal
processes). As part of the Facility’s health care operations, certain limited
information may be used or disclosed to conduct fundraising activities on behalf
of the Facility. You have the right to request that you not receive fundraising
materials from the Facility.
APPOINTMENTS AND
HEALTH CARE SERVICES. To
provide you with appointment reminders or to notify you of possible treatment
alternatives or health-related benefits or services.
FACILITY DIRECTORY.
While
you are an inpatient, your name, location in the Facility, general condition
(e.g., fair, serious, etc.), and religious affiliation may be included in the
Facility directory and released (except religious affiliation) to people who ask
for you by name. This information and your religious affiliation may be given to
a member of the clergy, even if they do not ask for you by name. You have the
right to request that your name not be included in the
directory.
FRIENDS AND FAMILY.
To a
friend or family member involved in your medical care or payment for your care.
If you are available, such disclosures will be made only if we have obtained
your permission, if you do not object to the disclosure after having the
opportunity, or if it is reasonable for us, based on the circumstances, to
assume you have no objection to such disclosure. If you are unavailable,
incapacitated or in an emergency situation, the Facility may disclose limited
information to these persons if the Facility determines disclosure is in your
best interest.
HEALTH CARE PROVIDERS.
To
another health care provider involved in your treatment in order for that
provider to treat you, bill for its services and conduct certain of its health
care operations.
DISASTER RELIEF.
To a
public or private entity assisting in a disaster relief effort (e.g., to notify
your family about your location, condition or death).
PUBLIC HEALTH
ACTIVITIES. To
public health authorities for public health activities as permitted or required
by law (e.g., to report births, deaths, child abuse and neglect, immunizations
and communicable diseases).
ABUSE, NEGLECT AND
DOMESTIC VIOLENCE. The
Facility may notify the appropriate government authority if it believes you have
been the victim of abuse, neglect or domestic violence. Unless such disclosure
is required by law, the Facility will only make this disclosure if you agree or
under other limited circumstances when such disclosure is authorized by
law.
HEALTH SAFETY RISKS.
Under
certain circumstances, when necessary to prevent a serious threat to your health
and safety or to the health and safety of the public or another
person
ORGAN DONATIONS.
To
organ procurement or organ, eye or tissue transplantation organizations, or to
organ donation banks to facilitate organ or tissue donation and
transplantation.
MILITARY AND NATIONAL
SECURITY. If you
are a member of the armed forces, as required by military command authorities.
We may also release medical information about foreign military personnel to the
appropriate foreign military authority. The Facility may also release your
medical information to authorized federal officials for intelligence,
counterintelligence, and other authorized national security
activities.
WORKER’S COMPENSATION.
To
persons (e.g., employers, insurance carriers, attorneys) in order to comply with
workers’ compensation laws or other similar programs providing benefits for
work-related injuries.
HEALTH OVERSIGHT
ACTIVITIES. To a
health oversight agency for activities authorized by law to monitor the health
care system, government programs and compliance with civil rights laws (e.g.,
fraud and abuse investigations, inspections and licensure, or disciplinary
actions).
LEGAL PROCEEDINGS.
If you
are involved in a lawsuit or dispute, in response to a court or administrative
order. The Facility may also disclose medical information about you in response
to a subpoena or other lawful process by someone else involved in the dispute,
but only if the party seeking the information demonstrates that reasonable
efforts have been made to notify you of the request or to obtain a protective
order from the court.
LAW ENFORCEMENT.
To law
enforcement authorities for law enforcement purposes, such as (1) in response to
a court order, subpoena, warrant, summons or similar process, (2) to identify or
locate a suspect, fugitive, material witness or missing person, (3) if you are
the victim of a crime, but only if your agreement is obtained or in response to
a subpoena, (4) about a death which is believed to be the result of criminal
conduct, (5) to report a crime that occurred on Facility premises, and (6) 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. The facility must comply with federal and state laws in making such
disclosures.
DECEASED INDIVIDUALS.
To a
coroner or medical examiner as necessary to carry out their duties (e.g., to
identify a deceased person or determine the cause of death), or to funeral
directors as authorized by law.
CORRECTIONAL
INSTITUTIONS. To a
correctional institution where you are an inmate or to a law enforcement
official who has custody of you for certain limited purposes (e.g., to provide
you with health care).
RESEARCH. For research-related activities that meet all privacy law requirements.
LIMITED MEDICAL
INFORMATION. Limited
medical information to a third party for research purposes, public health
activities and Facility health care operations. The party to whom we disclose
the information is required to keep it confidential.
REQUIRED BY LAW.
When
required to do so by federal, state or local law (e.g., to report child or
dependent adult abuse and violent wounds).
INCIDENTAL
DISCLOSURES.
Occasional incidental, unintended disclosures of your medical information which
might occur during a permitted use or disclosure (e.g., information overheard
during a discussion regarding your care with you or a member of your family). We
will take reasonable steps to avoid these types of
disclosures.
BUSINESS ASSOCIATES.
Some of
the activities described above are performed through contracts with outside
persons or organizations, such as legal services. It may be necessary for the
Facility to provide some of your medical information to outside business
associates who assist the Facility with these activities. The Facility requires
that its business associates appropriately safeguard the privacy of your
information.
ORGANIZED HEALTH CARE
ARRANGEMENT. The
Facility is a clinically integrated care setting where patients receive care
from Facility personnel and from independent doctors and other practitioners who
provide care to patients at the Facility (collectively called “practitioners”).
The Facility and these practitioners need to share medical information freely to
provide care to patients, and to conduct Facility health care operations.
Therefore, the Facility and the practitioners have agreed to follow uniform
information practices when using or disclosing medical information related to
inpatient or outpatient hospital services. This arrangement is called an
“organized health care arrangement” and only covers information practices for
services rendered through the Facility.
It does
not cover the information practices of the practitioners in their offices or at
other care settings. It does not alter the independent status of the Facility
and the practitioners or make them jointly responsible for the clinical services
provided by them. In other words, the Facility is not responsible for (1) the
negligence (or mistakes) of the independent practitioners providing care at the
Facility; or (2) any violations of your privacy rights by the independent
practitioners.
YOU AND YOUR
AUTHORIZATION. The
Facility must also disclose your medical information to you, as described later
in this Notice. Uses and disclosures of medical information not covered by this
Notice or the laws that apply to us will be made only with your written
permission. If you give us permission to use or disclose medical information
about you, you may revoke (take back) that permission, in writing, at any time.
If you revoke your permission, we will no longer use or disclose medical
information about you for the reasons set forth in your written authorization.
We are unable to take back any disclosures we have already made with your
permission.
ACCESS TO MEDICAL
INFORMATION. You may
request to inspect and copy much of the medical information we maintain about
you, with some exceptions. This includes most medical and billing records, but
does not include psychotherapy notes. We may charge a fee for the costs of
copying, mailing, and other supplies associated with your
request.
REQUEST FOR
RESTRICTIONS. You
have the right to request a restriction on how we use or disclose your medical
information for treatment, payment, or health care operations, or to certain
family members or friends identified by you who are involved in your care or the
payment for your care. We are not required to agree to your request, but will
notify you if we are unable to agree.
AMENDMENT.
You may
request that we amend certain portions of your medical information if you
believe that it is incorrect or incomplete. We may require you to give a reason
to support your request. We are not required to make all requested amendments,
but we will give each request careful consideration. If we deny your request, we
will provide you with a written explanation of the reasons and your
rights.
ACCOUNTING.
You
have the right to receive a list of certain disclosures of your medical
information made by us or our business associates. You must state a time period
for your request, which may not be longer than six years and may not include
dates before April 14, 2003. The first list in any 12-month period will be
provided to you for free; you may be charged a fee for each subsequent list you
request within the same 12-month period.
CONFIDENTIAL
COMMUNICATIONS. You
have the right to request that we communicate with you about medical matters in
a different manner or at a different place. We will agree to your request if it
is reasonable, and you specify an alternative means or location to contact
you.
PAPER NOTICE.
You are
entitled to receive a written copy of this Notice at any
time.
HOW TO EXERCISE THESE
RIGHTS. All
requests to exercise these rights must be in writing. We will follow written
policies to handle requests, and we will notify you of our decision or actions
and your rights. Contact the clinic manager or our Privacy Officer at the
contact information at the end of this Notice for more information or to obtain
request forms.
COMPLAINTS.
If you
believe your privacy rights have been violated, you may file a complaint with
the Facility using the contact information at the end of this Notice. You may
also submit a complaint to the Secretary of the Department of Health and Human
Services. All complaints must be submitted in writing. You will not be penalized
or retaliated against for filing a complaint.
QUESTIONS.
If you
have questions about this Notice, please contact the clinic manager or the
Privacy Officer at the contact information at the end of this Notice.
About
This Notice
The
Facility is required to abide by the terms of the Notice currently in
effect.
The
Facility reserves the right to change the terms of this Notice and make the new
Notice provisions effective for all of your medical information that it
maintains, including that which it created or received while the prior Notice
was in effect. If the Facility makes a material change to its privacy practices,
it will amend its Notice. We will post a copy of the current Notice in the
Facility. The Notice will state the effective date.
Contact
Information
The
privacy officer for Guthrie County Hospital may be reached by mail or by
telephone:
PRIVACY
OFFICER
Guthrie
County Hospital
710 N
12th St.
Guthrie
Center, IA 50115
Phone
641-332-2201