MIDLAND MEMORIAL HOSPITAL 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 INFORMATION Midland Memorial Hospital, including its several health care facilities listed elsewhere in this Notice, (MMH) appreciates that medical information recorded about you and your health is personal and private. MMH is required to maintain the privacy of your health information and to provide you with this Notice of its legal duties and privacy practices. As used in this Notice, health information, protected health information and medical information mean your individually identifiable health information as more particularly defined in 45 CFR § 164.501. MMH will not use or disclose your health information except as described in this Notice. This Notice is applicable to all medical records generated by MMH's health care facilities. Although your medical records are the physical property of MMH, the health information belongs to you, and you have certain rights over that information. You have the right to: · inspect and copy your health information, as provided by 45 CFR §164.524; · request, in writing, that your health information be amended as provided by 45 CFR §164.526; · request that MMH communicate with you about your health information by alternative means or at alternative locations. For example, you may request that MMH contact you only at work or by mail. Reasonable requests will be accommodated; · receive an accounting of disclosures of your health information, as provided by 45 CFR §164.528; and · obtain a paper copy of this Notice upon request.
MMH RESPONSIBILITIES MMH has certain responsibilities regarding your health information, including requirements to: · maintain the privacy of your health information; · provide you with this Notice that describes MMH's legal duties and privacy practices with respect to your health information; · abide by the terms of this Notice currently in effect. MMH reserves the right to change the health information privacy practices described in this Notice, including MMH's related policies and procedures, and to make the provisions of a revised Notice effective for all protected health information that MMH maintains. Should such changes be made, the revised Notice of Health Information Privacy Practices will be: made available at each MMH facility, posted on MMH's INTERNET web site, and a paper copy will be supplied upon request. USES AND DISCLOSURES OF HEALTH INFORMATION MMH is permitted by law to make uses and disclosures of your health information for treatment, payment and health care operations. When you obtain services from MMH, certain uses and disclosures are necessary in order to treat you, process payments for your treatment and with respect to health care operations. The following categories describe ways in which MMH may use or disclose your information. The examples given are not exhaustive, but are ways in which your health information is used or disclosed. YOUR HEALTH INFORMATION WILL BE USED FOR TREATMENT For example: Disclosures of medical information about you may be made to doctors, nurses, technicians, medical residents and others involved in the provision and coordination of your health care, who have a legitimate need for such information in connection with your care and continued treatment. Different departments of MMH may share information about you in order to coordinate specific services, such as prescriptions, lab work and radiologic procedures. Information may be disclosed to people who may be involved in your health care during your stay in and after you leave the hospital, such as family members and others who are used to provide services that are part of your care. YOUR HEALTH INFORMATION WILL BE USED FOR PAYMENT PURPOSES For example: Health information about you may be released by MMH for determining insurance and third-party coverage, prior approval and reimbursement, billing, claims management, medical data processing and collection purposes. A typical example is MMH sends a bill to your third party payer which includes information that identifies you, your diagnosis and the procedures and supplies used in your treatment. YOUR HEALTH INFORMATION WILL BE USED FOR HEALTH CARE OPERATIONS For example: Information in your medical record may be used to evaluate and continually improve the quality of care and services provided by MMH, including in connection with quality assurance, utilization review, medical and peer review, internal auditing, accreditation, certification, licensing, credentialing activities, medical research and educational purposes. Students, volunteers and trainees will have access to your health information for training and treatment purposes as they participate in continuing education, training, internships and residency programs. Business Associates: There are some services that we provide through contracts with third-party business associates. A business associate is an individual or entity under contract with MMH, other than in the capacity of a member of the workforce of MMH, to perform, or assist in the performance of a function or activity involving the use or disclosure of health information. Examples include external laboratories, transcription agencies, copying services, claims processing, data analysis, utilization review, quality assurance, billing, benefit management, practice management, legal, actuarial, accounting, consulting, data aggregation, management, administrative, accreditation, and financial services. To protect your health information, MMH requires business associates to appropriately safeguard privacy of your health information. Directory: Unless you give notice of an objection or restriction to MMH, your name, location in the facility, general condition and religious affiliation may be utilized in MMH patient directories where such are maintained. This information may be provided to members of the clergy and, except for your religious affiliation, to other persons who ask for you by name. Notification: Unless you give notice of an objection or restriction to MMH, health information may be released to a family member or friend who is involved in your health care or who helps pay for your care. Information about you may be disclosed to notify or assist in notification of a family member or friend about your location and general condition. This may include disclosures of information about you (subject to your right to give notice of an objection or restriction) to an organization assisting in a disaster relief effort, such as the American Red Cross, so that your family can be notified about your condition. Continuity of Care: In order to provide for the continuity of care once you are discharged from MMH, your health information may be shared with other health care providers, such as home health agencies. Health information may be disclosed to community services agencies in order to obtain their services on your behalf. USES AND DISCLOSURES REQUIRED BY LAW OR OTHERWISE ALLOWED WITHOUT PRIOR AUTHORIZATION OR NOTIFICATION Instances in which health information may be disclosed according to state and federal law without your written authorization or verbal agreement include: · when a disclosure is required by federal, state or local law, judicial or administrative proceedings, or for authorized law enforcement purposes. Examples would be; reporting gun shot wounds, child abuse or in response to court orders; · for public health purposes, such as reporting information about births, deaths and various specified diseases, or disclosures to the Federal Drug Administration regarding adverse events with respect to food, medications or devices; · for health oversight purposes activities, such as audits, inspections or licensure investigations; · to organ procurement organizations for the purpose of tissue donation and transplant; · for research purposes, when the research has been approved by an institutional review board that has reviewed the research proposal and established protocols to provide for the privacy of your health information; · to coroners and funeral directors for the purpose of identification or determination of the cause of death, or performance of duties as authorized by law; · to avoid a serious threat to the health or safety of a person or the public; · for specific government functions, such as protection of the President of the United States; · for worker's compensation purposes; · to military command authorities as required for members of the armed forces; · to authorized federal officials for national security and intelligence activities as authorized by law; · to correctional institutions or law enforcement officials with respect to health information, as authorized by law. OTHER ALLOWABLE USES AND DISCLOSURES WITHOUT PRIOR AUTHORIZATION Other uses or disclosures of your health information that may be made without your prior authorization include: · use of your health information for purposes of fund-raising for MMH. You have the opportunity to opt out of any future communications by contacting the Privacy Officer listed in this Notice for instructions on opting out; · contacting you to provide appointment reminders for treatment or other health care, as well as for purposes of recommending treatment alternatives; · notifying you of health-related benefits and services that may be of interest to you. When, according to applicable law, we are called upon to do so, we must make disclosures to the Secretary of the United States Department of Health and Human Services (Secretary) in order to provide information for investigation or determination with respect to MMH's compliance with federal law, including federal privacy laws. USES AND DISCLOSURES REQUIRING AUTHORIZATION Any other uses or disclosures of your health information not addressed in this Notice or otherwise required by law will be made only with your written authorization. You may revoke such authorization at any time. PRIVACY VIOLATION COMPLAINTS You have the right to file a complaint if you believe your privacy rights have been violated. This complaint may be addressed to the Privacy Officer Contact at his number listed in this Notice, or to the Secretary of the United States Department of Health and Human Services in care of the Office of Civil Rights at 1-800-368-1019. There will be no retaliation against an individual for registering a complaint. · Midland Memorial Hospital - Main Campus · Midland Memorial Hospital - West Campus · Memorial Rehabilitation Hospital · Abell-Hanger Medical Pavilion · Diagnostic Imaging Associates
EFFECTIVE DATE OF THIS NOTICE April 14, 2003 PRIVACY OFFICER CONTACT MR. MICHAEL ROUTH: (432) 685-1604
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