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JACKSON HOSPITAL
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.
UNDERSTANDING YOUR HEALTH INFORMATION
Each time you visit Jackson Hospital, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your medical record, serves as a:
· Basis for planning your care & treatment
· Means of communication among the many health professionals who contribute to your care
· Legal document describing the care you received
· Means by which you or a third-party (insurance provider) can verify that services billed were actually provided
· A tool in educating health professionals
· A source of data for medical research
· A source of information for public health officials who oversee the delivery of health care in the United States
· A source of data for facility planning & marketing
· A tool with which we can assess and continually work to improve the care we provide
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, and make more informed decisions when authorizing disclosure to others.OUR RESPONSIBILITIES:
Jackson Hospital is required to:
· Maintain the privacy of your health information
· Provide you with a notice as to our legal duties & privacy practices with respect to information we collect & maintain about you
· Abide by the terms of this notice
· Notify you if we are unable to agree to a requested restriction
· Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations
We reserve the right to change this notice and the revised or changed notice will be effective for information we already have about you as well as any information we receive in the future. The current notice will be posted in the facility and include the effective date. In addition, each time you register at or are admitted to the facility for treatment or health care services as an inpatient or outpatient, we will offer you a copy of the current notice in effect.
HOW WE WILL USE OR DISCLOSE YOUR HEALTH INFORMATION
· Treatment. We will use your health information for treatment. For example, information obtained by a nurse, physician, or other member of your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your healthcare team. Members of your healthcare team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment. 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’re discharged from our facility.
· Payment. We will use your health information for payment. For example, a bill may be sent to you or a third-party payer, including Medicare or Medicaid. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.
· Health Care Operations. We will use your health information for regular health operations. For example, members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the health care and service we provide.
· Business Associates. There are some services provided in our organization through contracts with business associates. Examples include our accountants, consultants and attorneys. When these services are contracted, we may disclose your health information to our business associates so that they can perform the job we’ve asked them to do. To protect your health information, however, we require the business associates to appropriately safeguard your information.
· Directory. Unless you notify us that you object, we may use your name, location in the hospital, and general condition for hospital directory purposes. This information may be provided to other people who ask for you by name. We may also use your name on a name plate next to or on your door in order to identify your room, unless you notify us that you object.
· Communication with Family. We may release health information about you to a close personal friend, family member or other relative, or to a healthcare surrogate or patient representative who is involved in your medical care or who helps pay for your care. We may also tell your family, friends or your healthcare surrogate or patient representative your condition and that you are in the hospital.
· Research. Under certain circumstances, we may use and disclose information about you for research purposes. All research projects are subject to a special approval process that evaluates a proposed research project and its use of medical information. Before we use or disclose information for research, the project will have been approved through this research approval process; however, we may disclose information about you to people preparing to conduct a research project to help them look for patients with specific medical needs, so long as the information they review does not leave the facility.
· Funeral Directors. We may disclose health information to funeral directors and coroners to carry out their duties consistent with applicable law.
· 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.
· Health-Related Communications. We may contact you to provide appointment reminders or information about treatment alternatives.
· Fund Raising. We may contact you as part of a fund-raising effort.
· Workers Compensation. We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
· Public Health Risks. We will disclose information about you for public health activities as required by law. These activities generally include the following: (a) to prevent or control disease, injury or disability; (b) to report births and deaths; (c) to report child abuse or neglect; (d) to report reactions to medications or problems with products; (e) to notify people of recalls of products they may be using; (f) to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; and (g) to notify the appropriate government authority if we believe you have been the victim of abuse, neglect or domestic violence.
· Law Enforcement. We may disclose health information for law enforcement purposes as required by law.
· Reports. Federal law allows for your health information to be released to an appropriate health oversight agency, public health 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.
· Lawsuits and Disputes. We may disclose health information about you in response to a court order in a civil or criminal action, unless otherwise prohibited by law, upon the issuance of a subpoena from a court of competent jurisdiction and proper notice by the party seeking such records to you or your legal representative.
· Health Oversight. We may disclose health information to a health oversight agency for activities, authorized by law, such as audits, investigations, quality assurance, inspections, and health care cost containment.
· Disciplinary Proceedings. We may disclose health information to the Agency for Health Care Administration upon a valid subpoena for the purpose of the investigation, prosecution and appeal of disciplinary proceedings.
· As Required by Law. We will disclose health information about you when required to do so by Federal, state or local law.
· To Avert a Serious Threat to Health or Safety. We may use and disclose 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. Disclosures would only be to someone able to help prevent the threat.
· Military and Veterans. If you are a member of the armed forces, we may release information about you as required by military authorities. We may also release information about foreign military personnel to the appropriate foreign military authority.
· National Security and Intelligence Activities. We may release information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
· Protective Services for the President of the United States and others. We may disclose information about you to authorized Federal officials so they may conduct special investigations and provide protection to the President or other officials and dignitaries.
YOUR HEALTH INFORMATION RIGHTS Although your health record is the physical property of Jackson Hospital, the information in your health record belongs to you. You have the following rights:
· You may request that we not use or disclose your health information for a particular reason related to treatment, payment, and the facility’s general health care operations, and/or to someone who is involved in your care or the payment for your care, like a particular family member, other relative or close personal friend. We ask that such requests be made in writing on a form provided by our facility. Although we will consider your request, we are under no obligation to accept it or to abide by it.
· If you are dissatisfied with the manner in which or the location where you are receiving communications from us that are related to your health information, you may request that we provide you with such information by alternative means or at alternative locations. Such a request must be made in writing, and submitted to the Privacy Officer. We will attempt to accommodate all reasonable requests.
· You may request to inspect and/or obtain copies of health information about you, which will be provided to you in the time frames established by law. We may deny your request in certain limited circumstances. If you request copies, we will charge you a reasonable, cost-based fee.
· If you believe that any health information in your record is incorrect or if you believe that important information is missing you may request that we correct the existing information or add the missing information. Such requests must be made in writing, and must provide a reason to support the amendment. We ask that you use the form provided by our facility to make such requests. We may deny your request in certain limited circumstances. For a request form, please contact the Privacy Officer.
· You may request that we provide you with a written accounting of all disclosures made by us during the time period for which you request. The time period may not exceed 6 years from the date of your request and may not include dates before April 14, 2003. We ask that such requests be made in writing on a form provided by our facility. An accounting will not apply to certain types of disclosures such as: disclosures made for reasons of treatment, payment or health care operations; disclosures made to you or your legal representative, or any other individual involved with your care; disclosures to correctional institutions or law enforcement officials; and disclosures for national security purposes. You will not be charged for your first accounting request in any 12 month period. However, for any requests that you make thereafter, you will be charged a reasonable, cost-based fee. We will notify you in advance of the fee and you may choose to withdraw or modify your request at that time before any costs are incurred.
· You have a right to obtain a paper copy of our Notice of Privacy Practices upon request.
· Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, upon written request to the Privacy Officer, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
FOR MORE INFORMATION OR TO REPORT A PROBLEM If you have questions and would like additional information, you may contact our facility’s Privacy Officer at (850) 718-2556.
If you believe that your privacy rights have been violated, you may file a complaint with us. These complaints must be filed in writing on a form provided by our facility. The complaint form may be obtained from the Privacy Officer, and when completed should be returned to the Privacy Officer. You may also file a complaint with the Secretary of the Federal Department of Health and Human Services. There will be no retaliation for filing a complaint.
ACKNOWLEDGMENT OF RECEIPT OF THIS NOTICE You will be asked to provide a signed acknowledgment of receipt of this notice. Our privacy practices concerning your health information will not be affected if you decline to sign the acknowledgement.
EFFECTIVE DATE: April 14, 2003
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