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Joint Notice of 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.
Effective:
If
you have any questions or requests, please contact our
Privacy
Officer at 828-883-5343
This Notice describes our practices regarding the use and disclosure of
your protected health information and that of our employees, officers,
volunteers, and health care students associated with us.
It also describes your rights to access
your protected health information. “Protected
Health Information” (“PHI”) is information about you, including
demographic information, that may identify you and that relates to your past,
present or future physical or mental health or condition and related health care
services.
§
Make copies of the revised notice available upon request
; and
§
Post the revised notice on our website, www.tchospital.org.
Following are examples of permitted uses and disclosures of your PHI. These examples are not exhaustive.
We
may use and disclose PHI about you for payment.
§
Collection departments or
agencies;
§
Insurance companies, health
plans and their agents which provide you coverage;
§
Hospital departments that review
the care you received to check that it and the costs associated with it were
appropriate for your illness or injury; and
§
Consumer reporting agencies
(e.g., credit bureaus).
3. We may use and disclose
your PHI for health care operations.
We may use and disclose PHI in performing business
activities, which we call “health care operations”.
These
activities include, but are not limited to, quality assessment activities,
investigations, oversight or staff performance reviews, training of medical
students, licensing, accreditation, credentialing, communications about a
product or service, or conducting or arranging for other health care related
activities.
§
We may use medical information to review our treatment and services and
to evaluate the performance of our staff. We
may also disclose PHI to doctors, nurses, technicians, medical students, and
other hospital personnel for review and learning purposes.
§
We may use or disclose your PHI to provide you with information about
treatment alternatives or other health-related benefits and services that might
interest you. For example, your name
and address may be used to send you a newsletter about hospital services.
We may also send you information about products or services that we
believe might benefit you.
We may use and disclose PHI under
other circumstances without your authorization.
We may use and/or disclose PHI
about you for a number of circumstances in which you do not have to give
authorization or otherwise have an opportunity to agree or object.
Those circumstances include:
§
When the use and/or disclosure is required by federal,
state or local law or regulation.
§
When the use and/or disclosure is necessary for public
health activities which include, but
are not limited to, the following:
o
Prevent
or control disease, injury, or disability
o
Report
births and deaths
o
Report child abuse or neglect
o
Report
reactions to medications or problems with products
o
Notify
a person who may have been exposed to a disease or may be at risk for
contracting or spreading a disease or condition
o
Notify
the appropriate government authority if we believe a patient has been the victim
or abuse, neglect, or domestic violence
§
When the use and/or disclosure is for health oversight
activities. For example, we may
disclose PHI about you to a state or federal health oversight agency which is
authorized by law to oversee our operations.
§
When the disclosure is for judicial and administrative
proceedings. For example, we may
disclose PHI about you in response to an order of a court or administrative
tribunal.
§
When the disclosure is for law enforcement purposes.
For example, we may disclose PHI about you in order to comply with laws
that require the reporting of certain types of wounds or other physical
injuries. Other
examples include, but are not limited to, the following:
o
Responses to legal
proceedings
o
Information requests for
identification and location
o
Circumstances pertaining to
victims of a crime
o
Deaths suspected from
criminal conduct
o
Crimes occurring on
hospital premises
o
Medical emergencies (not on
hospital’s premises) believed to result from criminal conduct
§
When the disclosure is for coroners or medical examiners to use for
identification, determining the
cause of death, or other duties as authorized by law.
§
When the disclosure is to funeral directors, as
authorized by law, to carry out their duties with respect to the decedent.
§
When the use and/or disclosure relates to cadaveric
organ, eye or tissue donation purposes.
§
When the disclosure is for
workers’ compensation or similar programs.
§
When the use and/or disclosure relates to medical
research when authorized by law.
§
When the use and/or disclosure is to avert a serious
threat to health or safety. For
example, we may disclose PHI about you to prevent or lessen a serious and
eminent threat to the health or safety of a person or the public.
§
When the use and/or disclosure relates to specialized
government functions. For example,
we may disclose PHI about you if it relates to military and veterans’
activities, national security and intelligence activities, and protective services for the President.
§
When the use and/or disclosure relates to an
individual in a
correctional institution or in
the custody of a law
enforcement official.
You can object to certain uses and disclosures.
Unless you object in writing,
we may use or disclose PHI about you in the following circumstances:
·
We will use and disclose in our hospital inpatient directory your name,
the location at which you are receiving care, your condition (in general terms),
and your religious affiliation. All
of this information, except religious affiliation, will be disclosed to people
who ask for you by name. Only
members of the clergy will be told your religious affiliation.
§
We may disclose
to
a family member, relative, friend or other person identified by you, PHI
directly related to that person’s involvement in your care or payment for your
care. We may use
or disclose PHI to notify or a
family member, personal representative or other person responsible for your
care, of your location, general condition or death.
§
We may use or
disclose to
a public or private entity (for
example, American Red Cross) PHI about you for disaster relief purposes and coordinate uses and disclosures to family or other individuals
involved in your health care.
6.
We
may contact you for fundraising activities.
We may use and/or disclose PHI about you, including
disclosures to a foundation, to
contact you to raise money for the hospital and its operations.
We would only release contact information and the dates you received
treatment or services at the hospital.
If you do not want to be contacted for
fundraising efforts, you must notify the Privacy Officer in writing.
**
ANY OTHER USE OR DISCLOSURE OF PHI **
Other uses and disclosures of PHI not covered by
this Notice or the laws that apply to us will be made only with your written
authorization.
If you sign
a written authorization allowing us to disclose PHI about you in a specific
situation, you can later cancel your authorization in writing.
If you cancel your authorization in writing, we will no
longer use or disclose PHI about you for the reasons covered
by your written authorization.
We are unable to take back
any disclosures we have made per your authorization.
B.
YOUR RIGHTS
REGARDING PHI ABOUT YOU
1.
Right to Request
Restrictions
You may ask us not to
use or disclose any part of your PHI for treatment, payment, or health care
operations. Your request must be
made in writing to the Privacy Officer. In
your request, you must tell us (1) what information you want restricted; (2)
whether you want to restrict our use, disclosure, or both; (3) to whom you want
the restriction to apply; and (4) an expiration date.
If we believe that the restriction is not in the best interest of either
party, or that we cannot reasonably accommodate the request, we are not required
to agree. If we do agree, we will
comply with your request unless the information is needed to provide emergency
treatment. You may revoke a
previously agreed upon restriction, at any time, in writing.
2.
Right to Request
Confidential Communications
You
have the right to request how and where we contact you about PHI.
For example, you may request that we contact you at your work address.
We will accommodate reasonable requests, when
possible. However, any request we make for overdue payment will be sent
to any person or address we deem appropriate.
You may request that we
communicate with you using
alternative means or location
during the registration process or in writing at a later date by contacting the
Patient Accounts Department.
3. Right to Inspect and
Copy
You may inspect and
obtain a copy of your PHI that is contained in a designated record set for as
long as we maintain the PHI. A
designated record set contains medical and billing records and any other records
that the hospital uses for making decisions about you.
Under federal law, however, you may not inspect or copy the following
records: psychotherapy notes; information compiled in reasonable anticipation
of, or use in, a civil, criminal, or administrative action or proceeding, and
PHI that is subject to laws that prohibits access to PHI.
Depending on the
circumstances, a decision to deny access may be reviewable.
In some circumstances, you may have a right to have this decision
reviewed. To inspect and obtain a
copy of your PHI, you must submit your request in writing to the
Medical
Record Department.
Instead of providing you with a
full copy of the PHI, we may give you a summary or explanation of the PHI about
you, if you agree in advance to the form and cost of the summary or explanation.
You may
be charged a fee for the
costs of copying, mailing or other supplies associated with your request.
4.
Right to Request an Amendment
If you believe that
information about you in a designated record set is incorrect or incomplete, you
may request in writing to the Medical Records Department an amendment for as
long as the information is kept. We
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, we may deny your request if you ask to amend information that: 1) was
not created by us, unless the person or entity that created the information is
no longer available to make the amendment, 2) is not part of the designated
record kept by or for the hospital, 3) is not part of the information which you
would be permitted to inspect and copy, or 4) is accurate and complete.
If we deny your request for amendment, you have the right to file a
statement of disagreement with us and we may prepare a rebuttal to your
statement and will provide you a copy of any such rebuttal.
5.
Right to an Accounting of Disclosures
You may request in writing to the Medical Record
Department an accounting of
disclosures. You
may ask for disclosures made up to six (6) years before your request (not
including disclosures made prior to April 14, 2003).
We are required to provide an
accounting of all disclosures except the following:
§
For your treatment
§
For billing and collection of payment for your
treatment
§
For our health care operations
§
Made to or requested by you, or that you authorized
§
Occurring as a byproduct of permitted uses and
disclosures
§
Made to individuals involved in your care, for
directory or notification purposes
§
Allowed by law when the use and/or disclosure relates
to certain specialized government functions or relates to correctional
institutions and in other law enforcement custodial situations and
§
As part of a limited data set
The
accounting will include the date of the disclosure, the name (and address, if
available) of the person or organization receiving the information, a brief
description of the information disclosed, and the purpose of the disclosure.
If, under permitted circumstances, PHI about you has been disclosed for
certain types of research projects, the accounting
may include different types of information.
If
you request an accounting
of disclosures more than once in 12 months, we can charge you a reasonable
fee.
6.
Right to Obtain a Copy of this Notice
You have the right to request a paper 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 of this Notice, contact our Privacy Officer.
COMPLAINTS
If you
think your privacy rights have been violated you may
file a complaint with us or the United States Secretary of the
Department of Health and Human Services. You may file a complaint with us by
notifying our Privacy Officer. No
retaliation will occur against you for filing a complaint.
CONTACT
INFORMATION
You may contact our Privacy Officer by phone at
828-883-5343 or by writing to: Transylvania Community Hospital, Privacy Officer,
P.O. Box 1116, Hospital Drive, Brevard, North Carolina 28712 for further
information about the complaint process, or for further explanation of this
document.