Scott
Memorial Hospital
Jewish Hospital Health Network Partner
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.
PURPOSE
Scott Memorial Hospital (“SMH”) its Medical Staff, employees,
residents, fellows, students, contractors and volunteers follow the privacy
practices described in this Notice of Privacy Practices (“Notice”).
This Notice describes how SMH may use and disclose your health information
when you receive services and treatment at a SMH facility. SMH participates
in an organized health care arrangement with its Medical Staff and will
share your health information with the arrangement’s participants
to carry out treatment, payment or health care operations related to the
organized health care arrangement.
This Notice does not cover the privacy practices of your physician when
you see him or her in a private office setting. SMH facilities are committed
to protecting your health information in a confidential manner.
LEGAL RESPONSIBILITIES OF SMH
SMH is required by law to protect the privacy of your protected health
information (“PHI”) - health information about you and that
can identify you - and to give you notice of our legal duties and privacy
practices concerning your protected health information.
· SMH must abide by the terms of this Notice;
· SMH must notify you if we are unable to agree to
a restriction that you request about the use and disclosure of your protected
health information;
· SMH must accommodate reasonable requests you may
have to communicate health information by alternative means or at alternative
locations.
· SMH will not use or disclose your health information
without your authorization, except as described in this Notice.
REVISIONS TO THIS NOTICE
SMH may change our Notice at any time and make the new provisions
effective for all protected health information SMH maintains. Upon your
request, SMH will provide you with information about how to obtain a revised
Notice of Privacy Practices by accessing our web site, http://www.scottmemorial.com.
or by requesting one at the time of your next visit.
UNDERSTANDING YOUR MEDICAL RECORD
Each time you visit a SMH health care provider, a record of your visit
is made. Typically, this record includes, but is not limited to, your
demographic information, symptoms, examination and test results, diagnoses,
treatment, and a plan for future care or treatment, as well as payment
information. This information, often referred to as your medical record,
serves as a:
· Basis for planning your care and treatment;
· Means of communication among the health professionals
who contribute to your care;
· Legal document describing the care you received;
· Means by which you or your insurance provider can
verify that services billed were
· actually provided;
· Tool in education health professionals;
· Source of data for medical research;
· Source of information for public health officials
charged with improving the health of the nation;
· Source of data for facility planning and marketing;
· Tool SMH uses to assess and continually work to improve
SMH care.
Understanding what is in your record and how your health information is
used helps you to:
· Ensure its accuracy;
· Better understand who, what, when, where, and why
others may access your health information;
· Make more informed decisions when authorizing disclosure
to others.
HOW SMH WILL USE OR DISCLOSE YOUR PROTECTED HEALTH
INFORMATION
Treatment, Payment and Health Care Operations. SMH will
use or disclose your protected health information for treatment, to obtain
payment for treatment, and for health care operations. The categories
below describe the ways that SMH may use and disclose health information.
The examples given are not meant to be exhaustive, but describe common
types of disclosures SMH may make.
· Obtain payment for the services and
treatment you receive.
· Communicate with your health insurance plan to obtain
approval for the health care services SMH recommends for you.
· Request a determination from your health insurance
plan of your eligibility or coverage for insurance benefits.
· Obtain payment from your employer when your treatment
involves a work-related injury.
· Review the care you received to ensure the costs
associated with it were appropriate for your diagnosis.
· Collection departments or agencies.
Examples of Uses and Disclosures for Health Care
Operations. SMH will use and disclose your health information to support
SMH business activities. These activities include:
· Conducting quality assessment and improvement activities
in an effort to continually improve the quality and effectiveness of the
health care services we provide.
· Developing clinical guidelines.
· Evaluating clinical outcomes.
· Reviewing the competence or qualifications of health
care professionals.
· Evaluating physician and employee performance.
· Conducting training programs in which residents,
students, trainees or practitioners in areas of health care learn under
supervision to improve their skills as health care providers.
· Accreditation, certification, licensing or credentialing
activities.
· Conducting or arranging for medical review, legal
services and auditing functions.
· Sharing information with medical students and residents
who see patients at a SMH facility.
· Calling your name in a waiting area or over the overhead
paging system.
· Contacting you by mail or phone to remind you of
a scheduled appointment, procedure or test.
· Sharing information with volunteers who help family
and friends locate you in the facility, deliver mail and other items to
you.
· Provide information to the Chaplain who may visit
you while you are in the facility.
· Planning for the organization’s future operations.
· Complying with this Notice and applicable laws.
OTHER USES OR DISCLOSURES THAT MAY BE MADE WITHOUT
YOUR AUTHORIZATION
SMH may use or disclose your health information in the following
situations without your authorization. These situations include:
Business Associates of SMH: Some services are provided through
contracts with business associates. Examples include physician services
in the emergency department and radiology, certain laboratory tests. When
these services are contracted, SMH may disclose your health information
to our business associate so that they can perform the job SMH has asked
them to do and bill you or your insurance carrier for services rendered.
To protect your health information, however, SMH requires the business
associate to appropriately safeguard your information.
Research: SMH may disclose limited information for
medical research under certain circumstances.
Marketing: SMH may use or disclose health information to
contact you about treatment, services, products or information that may
be of interest to you.
Funeral Directors, Coroners and Medical Examiners: SMH
may disclose health information to a coroner, medical examiner or funeral
directors consistent with applicable law to carry out their duties.
Organ procurement organizations: Consistent with applicable
law, SMH 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.
Food and Drug Administration (FDA): SMH may disclose health
information to the FDA relative to adverse events with respect to food,
supplements, product and product defects, or post marketing surveillance
information to enable product recalls, repairs, or replacement.
Public Health: As required by law, SMH may disclose your
health information to public health or legal authorities charged with
preventing or controlling disease, injury, or disability. These activities
include but are not limited to reporting births, deaths, disease, injury,
child abuse or neglect and domestic violence.
Inmates: If you are an inmate of a correctional institution,
or under the custody of a law enforcement official, SMH may disclose your
health information to the institution or law enforcement official as may
be necessary for your health and the health and safety of other individuals.
Legal Proceedings: If you are involved in a lawsuit or dispute,
SMH may disclose your health information in response to a court or administrative
order. SMH also may disclose your health information in response to a
subpoena, discovery request, or other lawful process by someone else involved
in the dispute, but only if efforts have been made to tell you about the
request or to obtain an order protecting the information requested.
Law Enforcement: SMH may disclose health information for
law enforcement purposes as required by law or in response to a valid
court order, subpoena, warrant, summons or similar process. This includes
providing information about someone who is suspected to be a victim of
a crime, abuse, neglect or domestic violence; to provide information about
a crime that occurs at a SMH facility or to identify or locate a suspect,
fugitive, material witness or missing person.
Health Oversight Activities: SMH may disclose your health
information to a health oversight agency for activities authorized by
law. These oversight activities include, for example, audits, investigations,
inspections and licensure. These activities are necessary for the government
to monitor the health care system, government programs and compliance
with civil rights.
Military Activity and National Security: SMH may release
your health information to authorized federal officials for intelligence,
counterintelligence, and other national
Scott Memorial Hospital
Jewish Hospital Health Network Partner
Security activities authorized by law, including providing protection
to the President, other authorized persons or foreign heads of state or
to conduct special investigations.
USES AND DISCLOSURES TO WHICH YOU HAVE AN OPPORTUNITY TO OBJECT
Unless you notify SMH in writing that you object, SMH may use or disclose
PHI about you in the following circumstances:
· SMH will include your name, location
in the SMH facility, general condition (e.g. good, fair, serious, or critical)
if available, and religious affiliation in the facility directory. This
information may be provided to members of the clergy and, except for religious
affiliation, to other people who ask for you by name.
· SMH may disclose to a member of your family, a relative,
a close friend or any other person you identify as your emergency contacts,
your health information that relates to that person's involvement in your
care or payment related to your care. SMH may use or disclose your health
information to notify or assist in notifying a family member, personal
representative, or another person responsible for your care, about your
location, general condition or death.
· SMH may use or disclose your health information to
a public or private entity (such as the American Red Cross) assisting
in disaster relief efforts so that your family can be notified about your
condition, status and location.
SMH may use or disclose your health information for the
above activities when you are unable to agree or object to the use or
disclosure because of your incapacity or an emergency treatment circumstance
if such disclosure is consistent with a prior expressed preference and
if we determine such disclosure is in your best interest. When it becomes
practical to do so, we must provide you with an opportunity to object
to the uses or disclosures of your health information as described above.
USES AND DISCLOSURES THAT REQUIRE YOUR WRITTEN AUTHORIZATION
Except as described above, SMH will not use or disclosure
your protected health information unless you give written authorization
to SMH to do so. You may revoke your permission (as provided by §
164.508(b)(5)), which will be effective only after the date of your written
authorization. If you revoke your authorization in writing, SMH will not
disclose health information about you after SMH receives your revocation
except for disclosures that were being processed prior to receipt of your
request.
YOUR INDIVIDUAL RIGHTS
Below is a statement of your rights with respect to your protected health
information and a brief description of how you may exercise these rights.
Right of Access. You have the right to access, inspect and obtain a copy
of your protected health information that is contained in a designated
record set for as long as we maintain the protected health information.
A "designated record set" contains medical and billing records
and any other records that are used by SMH or its Medical Staff to make
decisions about you. Your request must be in writing. SMH must act on
your request no later than 30 days after receipt of the request. If the
protected health information is not maintained or accessible on-site,
SMH must take action no later than 60 days from receipt of your request.
SMH also may extend the time for such actions by no more than 30 days.
SMH must provide you with a written statement of the reasons for the delay
and the date by which it will complete your request. SMH may charge you
related fees if allowed by applicable law. Under federal law, however,
you may not access, inspect or copy the following records: psychotherapy
notes; information compiled in reasonable anticipation of, or for use
in, a civil, criminal, or administrative action or proceeding, and protected
health information that is subject to law that prohibits access to protected
health information. SMH may deny your request to inspect and copy in certain
circumstances. If you are denied access to health information, you may
request that the denial be reviewed. Another licensed health care professional
chosen by SMH will review your request and the denial. The person conducting
the review will not be the person who denied your request. SMH will comply
with the outcome of the review.
Right to request restrictions. You have the right to request restrictions
on certain uses or disclosures of your protected health information for
the purposes of treatment, payment or health care operations. You also
may request limits on the health information SMH discloses about you to
family members, friends or other individuals identified by you who may
be involved in your care or for notification purposes as described in
this Notice. Your request must be in writing and state the specific restriction
requested and to whom you want the restriction to apply. SMH is not required
to agree to your request. If SMH agrees, SMH will comply with the requested
restriction unless it is needed to provide emergency treatment.
Confidential Communications. You have the right to request to receive
confidential communications of protected health information from SMH by
alternative means or at an alternative location. For example, you can
ask that SMH only contact you at work or by mail. Your request must be
in writing. SMH will accommodate reasonable requests. SMH also may condition
this accommodation by asking you for information as to how payment will
be handled or specification of an alternative address or other method
of contact. SMH will not request an explanation from you as to the basis
for the request.
Right to Amend. If you believe that the health information SMH has about
you is incorrect or incomplete, you may request that the information be
amended. You have the right to request an amendment for as long as the
information is kept by or for the SMH facility that maintains the record.
Your request must be in writing and must explain the reason for the requested
amendment. SMH must act on your request for an amendment no later than
60 days after receipt of such a request. In certain cases, SMH may deny
your request for an amendment. If SMH denies your request for amendment,
you have the right to file a statement of disagreement with SMH and SMH
may prepare a rebuttal to your statement and will provide you with a copy
of any such rebuttal.
Right to an Accounting of Disclosures. You have the right to request a
list of the disclosures SMH made of your health information for purposes
other than treatment, payment or health care operations as described in
this Notice. It excludes disclosures SMH may have made to you, requested
by you or that you authorized, as well as for a facility directory, to
family members or friends involved in your care, or for notification purposes.
Your request must be in writing. SMH must act on your request for an accounting,
no later than 60 days after receipt of such a request. You have the right
to receive specific information regarding these disclosures made up to
six (6) years before your request (not including disclosures made before
April 14, 2003). You may request a shorter timeframe. The right to receive
this information is subject to certain exceptions, restrictions and limitations.
If you request a list of disclosures more than once in 12 months, SMH
may charge you a reasonable fee.
Right to a Copy of this Notice.
You have the right to receive, upon request, a written copy
of this Notice. You may obtain a copy of this Notice at the SMH web site,
http://www.scottmemorial.com. To obtain a paper copy of this Notice, visit
the Registration Department of the SMH facility where you are receiving
services.
TO REPORT A PROBLEM
If you believe your privacy rights have been violated, you
may file a complaint with the SMH Privacy officer and with the Secretary
of the U.S. Department of Health and Human Services. To file a complaint
with the Privacy Officer, send correspondence to:
Privacy Officer
Scott Memorial Hospital
1451 N Gardner
Scottsburg IN 47170
All complaints must be submitted in writing. SMH will not
retaliate against you for filing a complaint. Complaint information should
include:
· Name of the complainant;
· Name of person/patient/client affected if different
from name of complainant;
· Name of facility involved;
· Description of the facts of the complaint, including
how person/patient/client was affected;
· Names or descriptions of the alleged perpetrator(s);
· When the complaint or situation occurred and whether
it was an isolated event or an ongoing situation; (Include the date, time,
time between different events.)
· Where the event took place; (In what care unit, patient/client
room.)
· How the incident occurred and the sequence of events
that took place;
· Whether a patient/client or the family of a patient/client
were involved;
· The names or discriptions of those who witnessed
the complaint situation;
· Names of staff or other patient/client involved.
Also, include other persons involved, such as volunteers or visitors.
EFFECTIVE DATE:
This Notice becomes effective on April 14, 2003. |