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Notice of Privacy Practices Effective date: April 14, 2003 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. Alice Hyde Medical Center (the Medical Center) is strongly committed to protecting the confidentiality and security of your protected health information. This notice describes our privacy practices. Specifically, this notice describes: 1) how we will use or disclose medical information about you; 2) your rights with respect to your protected health information and how you may exercise your rights; and 3) the obligations we have regarding the use and disclosure of your protected health information. The law requires that we maintain the privacy of your protected health information, provide you with notice of our legal obligations and privacy practices with respect to your protected health information, and follow the terms of the notice that is currently in effect. FURTHER INFORMATION ABOUT THIS NOTICE Privacy Contact: If you have any questions or want further information about this notice, or anything contained in this notice, you should contact the individual listed at the end of this notice. WHO WILL FOLLOW THIS NOTICE All individuals who work for the Medical Center in our hospital, skilled nursing facility, outpatient clinics, and administrative offices will follow this notice. Examples of these individuals include employees (including employed physicians), persons we contract with who are authorized to access your protected health information, and volunteers that we permit to assist you. PROTECTED HEALTH INFORMATION "Protected health information" is information, including demographic information, that relates to your past, present or future physical or mental health or condition; or to the provision or payment of your health care; and that either identifies you or reasonably could be used to identify you. USES AND DISCLOSURES THAT DO NOT REQUIRE YOUR AUTHORIZATION OR AN OPPORTUNITY TO OBJECT For Treatment Within the Medical Center. We may use or disclose your protected health information to individuals within the Medical Center for the purpose of providing medical treatment and services to you. For example, we may disclose your protected health information to other doctors, nurses, technicians, medical students or other personnel within our Medical Center who are involved in treating and caring for you. For Health Care Operations. We may use or disclose your protected health information during the course of operating the Medical Center. For example, we may review our patients’ medical information to ensure that quality treatment or services were provided to our patients. Also, in conducting training programs, your medical information may be given to students, trainees, or other practitioners being supervised to learn or improve skills. Specific health care operations also include: Appointment Reminders. We may use and disclose your protected health information for the purpose of contacting you to remind you of an appointment you have for treatment or care. Treatment Alternatives and Other Health-Related Benefits or Services. We may use and disclose your protected health information to provide you with information about treatment alternatives or for the purpose of contacting you to alert you of other health-related benefits or services that may be of interest to you. As Required by Law. We will disclose your protected information when required to do so by federal, state or local law. To Qualified Persons. Under New York State law, a health care provider may disclose your patient information to “qualified persons” without your authorization. These “qualified persons” include: the subject of the information (you), a guardian appointed under the mental hygiene law, a parent of an infant, a guardian of an infant who has been appointed by the surrogate court, or an attorney appointed to act on behalf of the individual or the individual’s estate. Public Health Activities. Your protected health information may be disclosed to public health authorities authorized by law to collect and receive the information. For instance, the information may be disclosed for the purpose Abuse, Neglect or Domestic Violence. If it is reasonably believed that you are a victim of abuse, neglect or domestic violence, we are allowed to disclose your protected health information to government authorities, such as social or protective service agencies, that are authorized to receive reports on abuse, neglect and domestic violence. Health Oversight Activities. We may disclose protected health information to agencies authorized by law to conduct health oversight activities. Legal Disputes. We may disclose your protected health information as part of a court or government agency proceeding. Law Enforcement Officials. We may disclose your protected health information to law enforcement officials as required by law. Coroners and Medical Examiners. Your protected health information may be disclosed to coroners and medical examiners to identify the deceased or to determine the cause of death or to conduct other duties authorized by law. Funeral Directors. We may disclose your protected health information to a funeral director as required by law and additionally so that they may carry out their duties. Organ and Tissue Donation. We may disclose your protected health information to organ and tissue Medical Centers for the purpose of obtaining donations and transplantations. Prevention of Serious Threat to Health or Safety. We may disclose your protected health information to prevent serious threat to the health and safety of a specific person or the general public. Use and disclosure may only be made if necessary and to someone reasonably able to prevent or lessen the threat. Specialized Government Functions: Disclosures to the Secretary of the Department of Health and Human Services. We must make disclosures when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of the HIPAA regulations. WHERE YOUR AUTHORIZATION IS NOT REQUIRED BUT YOU HAVE THE OPPORTUNITY TO OBJECT PRIOR TO THE USE OR DISCLOSURE Notification. We may disclose your protected health information to a family member, other relative, close personal friend, or other person identified by you, who is involved in your care, or the payment of your care. The information disclosed must be relevant to the individual’s involvement. We may also disclose protected health information to notify a family member, or another person responsible for your care, of your location, general condition, or death. If you are unable to agree or object to such uses or disclosures of protected health information because of an emergency or because of your incapacity, we may exercise our professional judgment to determine whether the disclosure is in your best interest. Directory Use. Your protected health information may be disclosed to maintain a directory of patients in our facility. Such information is limited to your name, your location within our facility, your general condition, and your religious affiliation. The information contained within this directory may be disclosed to members of the clergy, or to other individuals who ask for you by name. If you are unable to agree or object to such disclosure, we may disclose the information contained within the directory only if it is consistent with your prior expressed preference, and if we determine that it is in your best interest based upon our professional judgment. USES AND DISCLOSURES WHERE YOUR AUTHORIZATION IS REQUIRED For all other uses and disclosures of your protected health information not described above, your authorization is required prior to such disclosure. Some examples include: For Treatment Outside the Medical Center. If your protected health information is shared with those outside the Medical Center for treatment purposes, your authorization is required under New York State law. For certain specific conditions (HIV, mental illness, and genetic information and testing), New York State law provides heightened protection and we must obtain written informed consent prior to disclosing information outside of the Medical Center. For Payment. Your authorization is required to disclose your protected health information in order to obtain payment for the treatment or services provided to you. For example, it may be necessary to provide your health plan with information about your condition and the treatment you received in order to establish the medical necessity for the treatment. Also, many plans require that certain medical procedures be approved for payment in advance of providing the treatment or procedure. You are able to revoke an authorization that was obtained for the use or disclosure of your protected health information, in writing, at any time. The authorization cannot be revoked to the extent: 1) we have already relied and acted upon the authorization; or 2) the authorization was made as a condition to obtaining insurance coverage. YOUR RIGHTS PERTAINING TO YOUR PROTECTED HEALTH INFORMATION Right to Access. You have the right to inspect and/or to obtain a copy of the health information pertaining to you. To request access to your protected health information, please contact our Privacy Contact, who is listed at the end of this notice. A reasonable fee may be charged to cover the costs of providing you with a copy of your protected health information, however, that fee may not exceed seventy-five cents per page. A charge will not be assessed for a copy of an original mammogram when the original is provided. Further, the release of your protected health information will not be denied solely because of an inability to pay. We will try our best to provide your protected health information to you in the form or format requested by you if such form or format is readily available. If it is not, the information will be provided in readable hard copy form or such other agreed upon form. If you agree in advance, we may provide you with a summary or explanation of your protected health information. You must also agree in advance to pay the fee for preparation of such summary or explanation. You have the right to timely access to your protected health information. Generally, your request must be acted upon within ten (10) days of receipt of the request. We may deny access to your protected health information in a limited number of instances. If we deny your request, you have the right to receive a timely written denial explaining the reasons for the denial. The written denial will also describe your right to review the denial and the procedures for filing a complaint. Your denial will be reviewed, without cost, by the appropriate Medical Record Access Committee appointed by the Commissioner of the New York State Department of Health. Right to Amend. If you believe that health information contained in your medical and billing records maintained by us is incorrect or incomplete, you have the right to request that it be amended. To request an amendment, please write to our Privacy Contact and include the information you want changed and the reason for wanting this information changed. We may deny your request for an amendment if your health information was not created by us (unless the originator of the health information is no longer available to act on your request); is not part of the medical and billing records kept by us; is accurate and complete; or would not be available to you for inspection. If we deny your request for amendment, we must provide you with a written denial explaining the reasons for the denial. You have the right to submit a written statement of disagreement. You may also file a complaint. If we prepare a written rebuttal, you will be provided a copy of the rebuttal. Right to an Accounting of Disclosures. You have the right to know who has received your protected health information other than disclosures made to you, disclosures made for treatment, payment, or health care operations, or those made pursuant to an authorization. You may request that we provide you with a written statement or listing (referred to as an "accounting") of disclosures of your protected health information that occurred during the six years prior to your request, provided that such disclosures were made after April 14, 2003. The accounting will include: dates of disclosures; name of entities or persons who received your protected health information; a brief description of the protected health information disclosed; and a statement regarding the purpose for the disclosure, or a copy of your written authorization for the disclosure. To request an accounting, please write to our Privacy Contact and include the time frame for which you wish to receive an accounting. The first accounting within a 12-month period will be provided free of charge. We may charge a reasonable fee for additional accountings requested within the same 12-month period. You will be advised of the charge before the accounting is prepared in order to provide you with an opportunity to withdraw or to modify your request. In limited circumstances, certain disclosures are not included in the accounting. If you have questions regarding which disclosures are not included, you may contact the person listed at the end of this Notice for more information. Right to Restrict Uses and Disclosure. We understand that there may be situations in which you do not want your protected health information used by or disclosed to others. You may request that the use and disclosure of your protected health information by us, within the Medical Center, for treatment, payment or health care operations, be restricted or limited. We are not required to agree to the restriction or limitation. If we do agree to the restriction or limitation, we will follow your wishes except to the extent that use or disclosure may be necessary to provide you emergency treatment. If we must use or disclose protected health information in order to provide emergency treatment, we will request that the disclosed information not be further used or disclosed. To request that a restriction or limitation be placed on your protected health information, please write to our Privacy Contact. You may also write to this person to terminate a restriction or limitation. We may terminate a restriction or limitation by informing you of the termination. A termination will only be effective for protected health information created or received after you have been informed of the termination. Right to Request Confidential Communications. You may request, in writing, to receive confidential communications regarding your protected health information by an alternative method or at an alternative location. For instance, if you wish to receive confidential communications by e-mail or at another address, such as at work or at a post office box, you may request it. We will not ask you to explain your reason for the request and will accommodate reasonable requests. To request confidential communications, please write to our Privacy Contact. COMPLAINT PROCEDURES If you believe that your protected health information was used or disclosed unlawfully, or that any of your rights with respect to your protected health information were violated, you may file a complaint with us or with the Secretary of the U.S. Department of Health and Human Services. If complaining to us, your complaint should be in writing and sent to our Privacy Contact. This is the same person you may contact with questions regarding any of the information contained in this notice. PLEASE BE ADVISED THAT NO ADVERSE ACTION WILL BE TAKEN AGAINST YOU FOR FILING A COMPLAINT. RIGHT TO CHANGE NOTICE We reserve the right to change this notice. We also reserve the right to make the revised or changed notice effective for medical information we already have about you and for information we may receive in the future. A current copy of this notice is always posted in the hospital, the skilled nursing facility and at each of our clinics, and you may find it on our web site at http://www.alicehyde.com. In addition, when we change the notice, we will mail a revised notice to you (or, you will be given the new notice on your first service date after the revised notice is effective). You may always request a copy of our current notice by contacting our Privacy Contact person. PRIVACY CONTACT If you have any questions about this Notice please contact: Ginger Carriero | |||||||||||||||||||||
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