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RC Hospital & Clinics, Olivia, Minnesota
Version 2 Effective Date: 7-1-2007
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.
PLEASE REVIEW IT CAREFULLY.
Who Will Follow This Notice
1. Any health care professional authorized to enter information into your medical record.
2. All employees, staff and other personnel of Renville County Hospital and Clinics.
3. Any member of a volunteer group we allow to help you while you are in our care.
4. All covered entities participating in the Renville County Hospital and Clinics Organized Health Care Arrangement which includes Renville County Hospital and Clinics Medical Staff members and ambulance services in Renville County. All covered entities will provide services at Renville County Hospital and Clinics or for hospice patients at their residence.
All these entities will follow the terms of this Notice. In addition, they may share medical information with each other, as necessary, for treatment, payment or health care operations purposes as described in this Notice
Our Duties
We are required by law:
1. To maintain the privacy of your medical information.
2. To give you this Notice describing our legal duties and privacy practices, and
3. To follow the terms of the Notice currently in effect.
How We May Use and Disclose Medical Information About You
In accordance with Federal law, we will not use or disclose your medical information without your authorization, except as described in this Notice.
We will use your medical information for Treatment.
For Example: Information obtained by a nurse, physician or other member of the health care team will be recorded in your medical record and used to determine the course of treatment that should work best for you. Your physician will note in your record his or her expectations of the members of the health care team. Members of your health care team will record the actions they took and their observations. In that way, the physician and the health care team will know how you are responding to treatment.
We will also provide your subsequent health care provider with copies of reports to assist him or her in treating you.
We will use your medical information for Payment.
For Example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you as well as your diagnosis, procedures and supplies used.
We will use your medical information for Health Care Operations.
For Example: Members of the medical staff, students in training, the risk or quality improvement manager or members of the quality improvement team may use information in your health records to assess the care and outcomes in your case and others like it. This information will then be used in an effort to improve the quality and effectiveness of the health care and services that we provide.
Business Associates: There are some services provided for our organization through contracts with business associates. An example would include a copy service we use when making copies of your medical record. We may disclose your medical information to our business associates so they can perform the job we have asked them to do. However, we require the business associate to take precautions to protect your medical information.
Facility Directory: Unless you notify us that you object, we may use your name, and location in the facility for directory purposes. This may also be provided to other people who ask for you by name. In addition, my religious preference will be shared with clergy.
Notification and Communication: We may use or disclose information to notify or assist in notifying a family member, personal representative, or other person responsible for your care of your location and general condition. Health professionals, using their best judgement, may disclose to a family member, other relative, close personal friend, or any other person you identify, medical information relevant to that person=s involvement in your care.
Funeral Director, Coroner and Medical Examiner: Consistent with applicable law, we may disclose health information to funeral directors, coroners, and medical examiners to help them carry out their duties.
Organ Procurement Organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
Fundraising: We may use certain information for purposes of raising funds for the facility and its operations.
Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events, product defects, or post marketing surveillance information to enable product recalls, repairs or replacement.
Public Health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.
Victims of Abuse, Neglect, or Domestic Violence: We may disclose to appropriate governmental agencies, such as adult protective or social services agencies, your health information, if we reasonably believe you are a victim of abuse, neglect or domestic violence when required by law.
Health Oversight: In order to oversee the health care system, government benefits programs, entities subject to governmental regulation and civil rights laws for which medical and health information is necessary to determine compliance, we may disclose health information for oversight activities authorized by law, such as audits and civil, administrative, or criminal investigations.
Court Proceeding: We may disclose health information in response to requests made during judicial and administrative proceedings, such as court orders or subpoenas.
Law Enforcement: Under certain circumstances, we may disclose health information to law enforcement officials. These circumstances include reporting required by certain laws (such as the reporting of certain types of wounds), pursuant to certain subpoenas or court orders, reporting limited information concerning identification and location at the request of a law enforcement official, reporting death, crimes on our premises, and crimes in emergencies.
Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety of the health and safety of others; or (3) for the safety and security of the correctional institution.
Threats to Public Health or Safety: We may disclose or use health information when it is our good faith belief, consistent with ethical and legal standards, that it is necessary to prevent or lessen a serious and imminent threat or is necessary to identify or apprehend an individual.
Specialized Government Functions: Subject to certain requirements, we may disclose or use medical information for military personnel and veterans, for national security and intelligence activities, for protective services for the President and others, for medical suitability determinations for the Department of State, for correctional institutions and other law enforcement custodial situations, and for government programs providing public benefits.
Workers Compensation: We may disclose medical information when authorized and necessary to comply with laws relating to workers compensation or other similar programs.
OTHER USES
We may also use and disclose your personal health information for the following purposes:
1. To contact you to remind you of an appointment for treatment.
2. To describe or recommend treatment alternatives to you.
3. To furnish information about health-related benefits and services that may be of interest to you, or
4. For certain charitable fundraising purposes
All other uses and disclosures of your medical information will be made only with your written permission. Once given, you may revoke the authorization by calling us to request a form to complete to revoke the authorization and mail the completed form to the address below:
RC Hospital and Clinics
611 East Fairview Avenue
Olivia, MN 56277
Attn: Privacy Officer
320-523-1261
You understand that we are unable to take back any disclosure we have already made with your permission.
INDIVIDUAL RIGHTS
You have many rights concerning the confidentiality of your medical information. You have the right:
1. To request restrictions on the medical information we may use and disclose for treatment, payment and health care operations. We are not required to agree to these requests. To request restrictions, please ask for an Restrictions Request form to complete.
2. To receive confidential communications of medical information about you in a certain manner or at a certain location. For instance, you may request that we only contact you at work or by mail. To make such a request, ask for an Confidential Communications form to complete.
3. To inspect or copy your medical information. You must submit your request in writing to the address below. If you request a copy of your medical information, we may charge you a fee for the cost of copying, mailing or other supplies. In certain circumstances, we may deny your request to inspect or copy your medical information. If you are denied access to your medical information, you may request that the denial be reviewed. Another licensed health care professional will then review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
4. To amend your medical information. If you feel the medical information we have about you is incorrect or incomplete, you may ask us to amend the information. To request an amendment, you must ask for a Request for Amendment form to complete and mail to us at the address below. You must also give us a reason to support your request. We may deny your request to amend your medical information if it is not in writing or does not provide a reason to support your request. We may deny your request if:
a. The information was not created by us, unless the person or entity who created the information is no longer available to make the amendment.
b. The information is not part of the medical information kept by or for us, or
c. The information is accurate and complete.
5. To receive an accounting of disclosures of your medical information that were made outside of reasons of treatment, payment and operation. You must ask for the Accounting of Disclosures form , complete and send the form to the address below. Your request must state a time period, no longer than 6 years and may not include dates before April 14, 2003. The first list you request within a 12 month period is free.
6. To obtain a copy of the Notice on our website, www.rchospital.com.
All requests to inspect and copy medical information, to amend your medical information, or to receive an accounting of disclosures of medical information must be by calling and requesting the appropriate form to complete and mailing it to the address below:
RC Hospital and Clinics
611 East Fairview Avenue
Olivia, MN 56277
Attn: Privacy Officer
320-523-1261
Complaints
If you believe that your privacy rights have been violated, a complaint may be made to our Privacy Officer. You may also submit a complaint to the Secretary of the Department of Health and Human Services.
You will not be penalized in any way for filing a complaint.
All complaints should be sent in writing to the following address or by calling 320-523-1261 and asking for the Privacy Officer:
RC Hospital and Clinics
611 East Fairview Avenue
Olivia, MN 56277
Attn: Privacy Officer
Changes to This Notice
We reserve the right to change our privacy practices and to apply the revised practices to medical information about you that we already have. We will post a copy of the current Notice at our hospital as well as on our website. The Notice will list on the first page, in the upper right-hand corner, the effective date. In addition, each time you register at or are admitted to our hospital for treatment or services you will have an opportunity to ask for a Notice.