Notice of Privacy Practices
Health Insurance Portability and Accountability Act (HIPAA)
OUR PRIVACY COMMITMENT TO YOU
Each time you visit a hospital, or physician, or utilize
other health care services, a record of your visit is made. Generally, the record contains such
information as your symptoms, examination and test results, your diagnosis, a
plan for future care and treatment, and billing-related information. This record is used to provide quality care
and to ensure compliance with legal requirements.
At Charles
Cole Memorial
Hospital, we understand
that the health information that is recorded about you is personal. Hospital personnel are trained to maintain
the confidentiality of your health information and to use or access that
information only if there is a professional need to know the information. We recognize that maintaining the privacy of
a patient’s health information is important to each patient. Maintaining the privacy of medical
information and appropriate use of medical information is a priority we all
share and is our commitment to you.
By law, the Hospital is required to provide you with a
Notice of Privacy Practices. The
following Notice describes in detail how the Hospital will use or disclose your
protected health information and identifies certain rights you have regarding
the use and disclosure of your health information. This Notice will be used by the Hospital and
all services which it owns and operates.
This Notice applies to the protected health information contained in
your medical record generated by the Hospital or your health care
provider. Your doctor may have different
policies or notices regarding the doctor’s use and disclosure of your medical
information created in his or her office.
Should you have any
questions concerning the following Notice, please do not hesitate to contact
the Hospital’s Patient and Community Relations Department by calling (814)
274-5204 or by calling the Hospital’s main number (814) 274-9300 and asking to
be connected with Care Managers.
Edward
C. Pitchford
President
and Chief Executive Officer
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY
BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY
DESCRIPTION OF USES/DISCLOSURES OF YOUR HEALTH INFORMATION
The following provides you with a summary description of how
health information about you may be used and disclosed and provides you with
examples of each. Not every use or
disclosure may be listed.
For Treatment – We may use health information about you to
treat you or provide you with health care services. We may disclose health information about you
to doctors, nurses, technicians, students, or other Hospital personnel who are
helping to care for you at the Hospital. For example, a doctor treating you for
a broken hip may need to know if you have diabetes because diabetes may slow
the healing process. Different
departments of the Hospital may share health information about you in order to
coordinate the various services you need such as medications, lab work, x-rays,
or meals. We also may disclose health
information about you to people outside the Hospital who may be involved in
your medical care after you leave the Hospital, such as other health care
facilities, family members, clergy, or others who provide services that are
part of your care.
For Payment – We may use and disclose health information
about you so that the services you receive at the Hospital may be approved by
your insurance company or billed and paid by an insurance company or a third
party. For example, we may need to give
your health plan information about the treatment you received at the Hospital
so your health plan will pay us or reimburse you for that treatment. We may also tell your health plan about a treatment
recommended for you in order to obtain prior approval or to determine whether
your plan will cover the treatment. For Health Care Operations – We may use and disclose health
information about you for Hospital operations, including processes to
continually improve the quality of care and outcomes for all patients we serve.
These uses and disclosures are necessary to run the Hospital. For example, we may use health information to
review our costs, treatment, services and/or the performance of our staff in
caring for you. We may also disclose
information to doctors, nurses, students and other Hospital personnel for
learning purposes. Other examples of how
we may use or disclose health information for operations include:
- To remind you of an appointment at the Hospital or a
physician office.
- To tell you about, or recommend, possible treatment options
or alternatives or health related benefits or services that may be of interest
to you, such as wellness programs or community based activities. For example, we may use information to tell
you about a new medical service being provided at the Hospital that may
interest you. We may communicate with
you by newsletters or other mailings.
- To assess your satisfaction with our services.
- To contact you as part of a fund raising effort. For example, to help provide care or to
provide a service which will improve the health of our community, we may want
to raise additional money and may contact you for a donation.
- To business associates we have contracted with to perform an
agreed upon service. For example, there
are some services the Hospital provides through contracts. Examples include physician services in the
emergency department, certain radiology services, certain laboratory tests, and
a copy service that makes copies of your medical record. We may disclose your health information to
the business associate so that they can perform the service we have asked them
to do and bill you or your third-party payer for services rendered. For these
types of contracted service, we require the business associate to appropriately
safeguard your health information.
Without your written consent or authorization or agreement,
we can use your health information for the following purposes:
Directory – Unless you request otherwise, we may include
certain information about you in a Hospital directory while you are a patient
at the Hospital. The information may
include your name, location in the Hospital, your general condition in terms
that do not communicate specific medical information about you (e.g.,
undetermined, good, fair, serious, critical), and, to your clergy, your
religious affiliation. Except for
religious affiliation, this information may be provided to individuals who ask
for you by name. Clergy are permitted
access to this type of information without specifying your name. This information is provided so your family,
friends, and clergy can visit you in the Hospital and generally know how you
are doing.
Individuals Involved in Your Care or Payment for Your Care –
We may release health information about you to a friend or family member who is
involved in your medical care or to someone who helps pay for your care. We may also disclose health information about
you to an organization assisting in disaster relief efforts so that your family
can be notified about your condition, status, and location. If you are unable to communicate your
wishes, such as in the case of a medical emergency, we may release information
to friends or family members as we, in the exercise of our professional
judgment, believe to be in your best interests.
As Required or Permitted by Law – We will disclose health
information about you if, and to the extent, we are required or permitted to do
so by federal, state, or local law. For
example, we may use or disclose health information to law enforcement to
identify or locate a suspect, fugitive, material witness, or missing person;
about the victim of a crime; about a death we believe may be the result of
criminal conduct; about criminal conduct on Hospital premises; or to report
abuse or neglect. Sometimes we must
report some of your health information to law enforcement officials, the court,
or government agencies, or in response to a subpoena, search warrant, or court
order. Public Health Activities –
We may be required to report your health information to authorities to
help prevent or control disease, injury, or disability. This may include using information from your
medical record to report certain diseases or injuries; birth or death
information; or information of concern to the U. S. Food and Drug
Administration.
Health Oversight Activities – We may disclose your health
information to an agency with responsibility for overseeing health care
activities. Health oversight activities
include audits, investigations, inspections, and licensure surveys. Examples of agencies with oversight
responsibilities include the Pennsylvania Department of Health and the
Pennsylvania Department of Public Welfare.
Research – Under certain circumstances, we may use and
disclose health information about you for research purposes. All research projects are subject to a
special review process that is designed to balance research needs with patient
privacy interests. Before your health
information is used or disclosed for research, the project will have been
reviewed and approved through this process.
We will usually ask for your specific written permission if the
researcher will be involved in your care at the Hospital.
Lawsuits and Disputes
- If you are involved in a lawsuit or a dispute, we may disclose health
information about you in response to a court or administrative order or in
response to a subpoena, discovery request, or other process initiated by
someone else involved in the dispute. In
some circumstances, efforts must be made to tell you about the request for your
health information or to obtain an order protecting information requested. State law may prohibit or restrict our
disclosure of certain behavioral health treatment records. In such instances, we would seek a signed
authorization from you to release such records.
Coroners, Medical Examiners, and Funeral Directors – We may
release health information to a coroner or medical examiner to identify a
deceased person or determine the cause of death. We may also release health information about
patients of the Hospital to funeral directors as necessary to carry out duties.
Organ and Tissue Donation – We may release health
information to organizations that handle organ procurement or organ, eye,
tissue transplantation or to an organ donation bank, as necessary to facilitate
organ or tissue donation and transplantation.
Military, National Security, Public Official – If you are involved with the military,
national security or intelligence activities, or are a public official, we may
release your health information to the appropriate authorities so they may
carry out their duties under the law.
Inmates – If you are an inmate of a correctional facility
(e.g., County Jail), we may disclose health
information to personnel of the correctional facility necessary for your health
and the health and safety of other individuals.
Worker’s Compensation – We may release health information to
persons or entities in order to comply with the laws related to workers’
compensation or other similar programs such as automobile or disability
insurance.
To Prevent a Serious Threat to Health or Safety – We may use
and disclose health information about you when necessary to prevent a serious
threat to your health and safety or the health and safety of the public or
another person.
Other uses and disclosures of medical information not
covered by this Notice or the laws that apply to us will be made only with your
written authorization. If you give
authorization to use or disclose health information about you, you may revoke
that authorization, in writing, at any time.
If you revoke your authorization, we will no longer use or disclose
health information about you for the reasons covered by your written
authorization. We are unable to take back
any disclosures we have already made with your authorization. We are required to retain our records of the
care that we provided to you.
YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION
Although your medical record is the property of the
Hospital, you have the following rights
regarding the health information we maintain about you:
Right to Request Restrictions – You have the right to
request a restriction or limitation on the health information we use or
disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on
the health information we disclose about you to someone who is involved in your
care or the payment for your care, like a family member or friend. For example, you could ask that we not use or
disclose information about a test you had to a particular individual. We are
not required to agree to your request; however, please know that we will give
every consideration to your request. If
we agree, we will comply with your request unless the information is needed to
provide you emergency treatment. We ask
that you make your request for restriction in writing advising us what
information you want to limit; whether you want to limit our use or disclosure,
or both; and to whom you want the limits to apply, for example, to your spouse.
Right to Request Confidential Communications – You have the
right to request that we communicate with you about medical matters in a
certain way or at a certain location.
For example, you can ask that we only contact you at home or only by
mail. To request confidential
communications, we ask that you submit your request in writing to the Hospital
or your health care provider responsible for contacting you with the information. Your request must specify how or where you
wish to be contacted. We are required
to accommodate all reasonable requests.
Right to Inspect and Copy – You have the right to inspect
and copy health information. However,
this right does not apply to psychotherapy notes or information gathered for
judicial proceedings. As to
psychotherapy notes, we may provide you with an opportunity to review your
records with your therapist. If
clinically appropriate, we may provide copies of these records to you with your
authorization. In addition, we may
charge you a reasonable fee if you want a copy of your health information. We
may deny your request to inspect and request to copy in certain limited
circumstances. If you are denied access
to health information, you may request a review of that decision. Another health care professional chosen by
the Hospital will 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.
Right to Amend – If you believe that health information we
have about you is incorrect or incomplete, you may ask us to amend the
information. An amendment of information does not mean that information
will be removed from your medical record.
Rather, this means that, if agreed to, we will permit a statement to be
included in your medical record. We ask that you submit your request for
amendment in writing and give a reason as to why your health information should
be changed. If we did not create the
health information that you believe is incorrect, or if we disagree with you
and believe your medical information is correct, we may deny your request.
Right to an Accounting of Disclosures – You have the right
to request an account of disclosures of your health information made by the
Hospital. If you request an accounting
of disclosures, we will provide you with the date of each disclosure; who
received the disclosed health information; a brief description of the health
information disclosed; and why the disclosure was made. We will provide this information within sixty
(60) days, unless you agree to an extension.
We will not charge you for the accounting of disclosures unless you
request an accounting more than once in a year.
We are not required to include in the accounting of disclosures, for
example, those disclosures made to you; for which you have signed an
authorization; for purposes of treatment, payment, or health care operations;
for the Hospital’s directory; to persons involved in your care or for notification
purposes; for national security or intelligence; to correctional facilities; or
other law enforcement custodial situations.
Right to Paper Copy of this Notice – You have the right to a
paper copy of this Notice, and you may ask us to give you a copy of this Notice
at any time. You may view an electronic
copy of this Notice at our website, www.charlescolehospital.com.
OUR RESPONSIBILTIES
By law,
the Hospital is required to maintain the privacy of your health information and
provide you with a description of our privacy practices, as contained in this
Notice. We will abide by the terms of
this Notice that are currently in effect and will notify you if we cannot agree
to a requested restriction.
CHANGES TO THIS NOTICE
The
Hospital reserves the right to change this Notice and to make the revised
Notice effective for health information we already have and for any information
we receive in the future. You will be
provided a copy of the revised Notice upon request. A current copy of the Notice will be posted
in the Hospital and include the effective date.
COMPLAINTS
If you believe your privacy rights have been violated, you
may file a complaint with the Hospital or with the Secretary of the Department
of Health and Human Services. All
complaints must be submitted in writing.
Please know that you will not be penalized for filing a complaint.
DESIGNATED HOSPITAL CONTACT
Should you have any questions or concerns regarding your
privacy rights or the information in this Notice, should you wish to exercise
any of the above listed rights as to your health information, or should you
wish to file a complaint, please submit your request in writing to the contacts
listed below who will process your request in accordance with this Notice and
Hospital policy. In order to process
your request, we may communicate and discuss your request with Hospital
personnel, including your physician.
Requests for confidential communications may also be directly referred
to your physician or other health care provider responsible for providing you
with certain health information.
Patient and Community Relations Department
Charles
Cole Memorial
Hospital
1001 East
Second Street
Coudersport,
PA 16915
Telephone: (814) 274-5204 or (814) 274-9300 and ask for Care Managers
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