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NOTICE OF PRIVACY PRACTICES
Clearfield Hospital
809 Turnpike Avenue
Clearfield, PA 16830
814.765.5341
Bridgett H. Sidorick, RHIA
HIPAA Privacy Officer
814.768.2371
Effective date of this notice: 4/14/03
You are receiving this information in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy Standards. If you have questions about this notice, please contact the person listed under “Whom to Contact” at the end of this notice.
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.
In the course of receiving services from Clearfield Hospital, you will provide us with personal information about your health, with the understanding that this information will be kept confidential. We may also obtain information about your health from examinations, tests, or from others who have provided you with care. This notice of our privacy practices is intended to inform you of the ways we may use your information and the occasions on which we may disclose this information to others.
We use patients’ information when providing treatment, and we disclose patients’ information to other health care providers to assist them to provide you with treatment. We may disclose information to insurance companies as necessary to receive payment. In addition, we may use the information within our organization to evaluate quality and improve health care operations, and we may make other uses and disclosures of patients’ information as required by law or as permitted by the covered entity policies.
This Notice Applies To the following information
This notice applies to any information in our possession that would allow someone to identify you and learn something about your health.
Who Must Abide by This Notice
Clearfield Hospital and OHCA (Organized Health Care Arrangement) between the Hospital and the Medical Staff.
All employees, staff, students, volunteers and other personnel whose work is under the direct control of Clearfield Hospital.
All members of the Clearfield Hospital Medical Staff, Home Health, Hospice, Physician Clinics, Therapy Works, Bright Horizons, and Outpatient Clinics.
The people and organizations to which this notice applies (referred to as “we,” “our,” and “us”) have agreed to abide by its terms. We may share your information with each other for purposes of treatment, and as necessary for payment and operations activities as described below.
This notice applies to services you receive in Clearfield Hospital’s facilities. This includes services from physicians who are not employed by Clearfield Hospital. If you also receive services from any of these physicians in their own offices, they may give you a different notice of privacy practices that applies to their offices.
· We are required by the Health Insurance Portability and Accountability Act of 1996 (HIPAA) law to maintain the privacy of your protected health information.
· We are required to provide this notice of our privacy practices and legal duties regarding health information to anyone who asks for it.
· We are required to abide by the terms of this notice until we officially adopt a new notice.
How We May Use or Disclose Your Health Information.
We may use your health information, or disclose it to others, for a number of different reasons. This notice describes these reasons. For each reason, we have written a brief explanation. We also provide some examples. These examples do not include all of the specific ways we may use or disclose your information. But any time we use your information, or disclose it to someone else, it will fit one of the reasons listed here.
1. Treatment. We will use your health information to provide you with medical care and services. This means that our employees, staff, students, volunteers and others whose work is under our direct control, may have access to your health information to learn about your medical condition and use it to make decisions about your care. For instance, a hospital nurse may read your medical chart in order to care for you properly. We will also disclose your information to others who need it in order to provide you with medical treatment or services. For instance, we may send your doctor the results of laboratory tests we perform. We will also provide your physician or a subsequent healthcare provider with copies of various reports that should assist him or her in treating you once you are discharged from this hospital.
2. Payment. We will use your health information, and disclose it to others, as necessary to obtain payment for the services we provide to you. For instance, an employee in our business office may use your health information to prepare a bill. And we may send that bill, and any health information it contains, to your insurance company. We may also disclose some of your health information to companies with whom we contract for payment-related services. For instance, we may give information about you to a collection company that we contract with to collect bills for us. We will not use or disclose more information for payment purposes than is necessary. We will disclose information to all physicians involved in your care and ambulance and medical transport services for their billing purposes.
3. Health Care Operations. We may use your health information for activities that are necessary to operate this organization. This includes reading your health information to review the performance of our staff. We may also use your information and the information of other patients to plan what services we need to provide, expand, or reduce. We may also provide health information to students who are authorized to receive training here. We may disclose your health information as necessary to others who we contract with to provide administrative services. This includes our lawyers, auditors, accreditation services, and consultants, for instance. We may disclose your health information to the PA Cancer Registry, Cost Containment Council, and the Department of Health Vital Statistics.
4. Legal Requirement to Disclose Information. We will disclose your information when we are required by law to do so. This includes reporting information to government agencies that have the legal responsibility to monitor the health care system. For instance, we may be required to disclose your health information, and the information of others, if we are audited by Medicare or Medicaid. We will also disclose your health information when we are required to do so by a court order or other judicial or administrative process.
5. Public Health Activities. We will disclose your health information when required to do so for public health purposes. This includes reporting certain diseases, births, deaths, and reactions to certain medications. It may also include notifying people who have been exposed to a disease.
6. To Report Abuse. We may disclose your health information when the information relates to a victim of abuse, neglect or domestic violence. We will make this report only in accordance with laws that require or allow such reporting, or with your permission.
7. Law Enforcement. We may disclose your health information for law enforcement purposes. This includes providing information to help locate a suspect, fugitive, material witness or missing person, or in connection with suspected criminal activity. We must also disclose your health information to a federal agency investigating our compliance with federal privacy regulations. We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena. Federal law makes provisions for your health information to be released to an appropriate health oversight agency, public heath authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers, or the public.
8. Specialized Purposes. We may disclose the health information of members of the armed forces as authorized by military command authorities. We may disclose your health information for a number of other specialized purposes. We will only disclose as much information as is necessary for the purpose. For instance, we may disclose your information to coroners, medical examiners and funeral directors; to organ procurement organizations (for organ, eye, or tissue donation); or for national security, intelligence, and protection of the president. We also may disclose health information about an inmate to a correctional institution or to law enforcement officials, to provide the inmate with health care, to protect the health and safety of the inmate and others, and for the safety, administration, and maintenance of the correctional institution. We may also disclose your health information to your employer for purposes of workers’ compensation and work site safety laws (OSHA, for instance). We may provide information to the airlines and Red Cross in order for family members to receive reduced rates and/or their services. We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacements.
9. To Avert a Serious Threat. We may disclose your health information if we decide that the disclosure is necessary to prevent serious harm to the public or to an individual. The disclosure will only be made to someone who is able to prevent or reduce the threat.
10. Family and Friends. We may disclose your health information to a member of your family or to someone else who is involved in your medical care or payment for care. We may notify family or friends if you are in the hospital, and tell them your general condition. In the event of a disaster, we may provide information about you to a disaster relief organization so they can notify your family of your condition and location. We will not disclose your information to family or friends if you decide not to be listed in the Hospital Directory.
11. Facility Directory. We may list you in our directory if you are admitted to the hospital. The directory listing may include name, general condition, and location in the hospital. We will also list your religion in the directory, but will disclose that information only to members of the clergy. Except for members of the clergy, we will only disclose the information in the directory to visitors who ask for you by name. If you ask, we will not list you in the directory. If the Hospital is unable to obtain your or your personal representative’s permission to be listed in the directory, you will be listed in the Hospital Directory.
12. Research. We may disclose your health information in connection with medical research projects. Federal rules govern any disclosure of your health information for research purposes without your authorization.
13. Information to Patients. We may use your health information to provide you with additional information. This may include phone appointment reminders or follow-up phone calls. This may also include giving you information about treatment options or other health-related services that we provide. Patient satisfaction surveys could also be mailed to you.
14. Fund Raising. We may use your information to contact you to ask for donations to the covered entity. We may disclose your information to a related foundation for the same purpose. If you do not want us to do this, contact the person listed under “Whom to Contact” at the end of this notice .
15. Health Benefits Information. Your health information may be disclosed by the Clearfield Hospital employee health benefit program to Clearfield Hospital employees, as necessary for the administration of the health benefit program. Employees who receive this information have special rules to prevent the misuse of your information for other purposes.
16. Psychotherapy Notes. We will only disclose or use this health information when you give us written authorization.
1. Authorization. We will not use or disclose your health information for any purpose that is not listed in this notice without your written authorization. If you authorize us to use or disclose your health information, you have the right to revoke the authorization at any time. For information about how to authorize us to use or disclose your health information, or about how to revoke an authorization, contact the person listed under “Whom to Contact” at the end of this notice. You may not revoke an authorization for us to use and disclose your information to the extent that we have taken action in reliance on the authorization. If the authorization is to permit disclosure of your information to an insurance company, as a condition of obtaining coverage, other law may allow the insurer to continue to use your information to contest claims or your coverage, even after you have revoked the authorization.
2. Request Restrictions. You have the right to ask us to restrict how we use or disclose your health information. We will consider your request. But we are not required to agree. If we do agree, we will comply with the request unless the information is needed to provide you with emergency treatment. We cannot agree to restrict disclosures that are required by law .
3. Confidential Communication. At this time, Clearfield Hospital cannot honor a request to contact you at a special address or by a special means.
4. Inspect And Receive a Copy of Health Information. You have a right to inspect the health information about you that we have in our records, and to receive a copy of it. This right is limited to information about you that is kept in records that are used to make decisions about you. For instance, this includes medical and billing records. If you want to review or receive a copy of these records, you must make the request in writing. We will charge a fee for the cost of copying and mailing the records. To ask to inspect your records, or to receive a copy, contact the person listed under “Whom to Contact” at the end of this notice. We will respond to your request within 30 days. We may deny you access to certain information. If we do, we will give you the reason, in writing. We will also explain how you may appeal the decision.
5. Amend Health Information. You have the right to ask us to amend health information about you, which you believe is not correct, or not complete. You must make this request in writing to the person listed under “Whom to Contact” at the end of this notice and give us the reason you believe the information is not correct or complete. We will respond to your request in writing within 30 days. We may deny your request if we did not create the information, if it is not part of the records we use to make decisions about you, if the information is something you would not be permitted to inspect or copy, or if it is complete and accurate.
6. Accounting of Disclosures. You have a right to receive an accounting of certain disclosures of your information to others. This accounting will list the times we have given your health information to others. The list will include dates of the disclosures, the names of the people or organizations to whom the information was disclosed, a description of the information, and the reason. We will provide the first list of disclosures you request at no charge. We may charge you for any additional lists you request during the following 12 months. You must tell us the time period you want the list to cover. You may not request a time period longer than six years. We cannot include disclosures made before April 14, 2003. Disclosures for the following reasons will not be included on the list: disclosures for treatment, payment, health care operations; disclosures of information in a facility directory , disclosures for national security purposes, disclosures to correctional or law enforcement personnel, disclosures that you have authorized, and disclosures made directly to you.
7. Paper Copy of this Privacy Notice. You have a right to receive a paper copy of this notice. If you have received this notice electronically, you may receive a paper copy by contacting the person listed under “Whom to Contact” at the end of this notice.
8. Complaints. You have a right to complain about our privacy practices, if you think your privacy has been violated. You may file your complaint with the person listed under “Whom to Contact” at the end of this notice . You may also file a complaint directly with the Secretary of the U. S. Department of Health and Human Services, Region III, Office for Civil Rights, U.S. Department of Health and Human Services, 150 S. Independence Mall West, Suite 372, Public Ledger Building, Philadelphia, PA 19106-9111. Main Line (215) 861-4441. Hotline (800) 368-1019. FAX (215) 861-4431. TDD (215) 861-4440. All complaints must be in writing, either on paper or electronically. We will not take any retaliation against you if you file a complaint.
Our Right to Change This Notice
We reserve the right to change our privacy practices, as described in this notice , at any time. We reserve the right to apply these changes to any health information, which we already have, as well as to health information we receive in the future. Before we make any change in the privacy practices described in this notice, we will write a new notice that includes the change. We will post the new notice at Registration and on our Hospital web site: www.clearfieldhosp.org. The new notice will include an effective date.
Contact the person listed below:
· For more information about this notice, or
· For more information about our privacy policies, or
· If you want to exercise any of your rights, as listed on this notice, or
· If you want to request a copy of our current notice of privacy practices.
Bridgett H. Sidorick, RHIA
HIPAA Privacy Officer
809 Turnpike Avenue
Clearfield, PA 16830
(814) 768-2371
Copies of this notice are also available at Registration.
An Interpreter will be provided to you if necessary.