Wyandot Memorial Hospital Notice of Privacy Practices - effective April 14, 2003
This notice of privacy practices describes the privacy practices of Wyandot Memorial Hospital, the specialty healthcare center, and the physician practices located in the medical office building and other areas within Wyandot Memorial Hospital.
This notice describes how your health information, information that constitutes protected health information as defined in the Privacy Rule of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996, may be used and disclosed, for purposes of providing you treatment, obtaining payment for your care and conducting health care operations. Protected health information is any health information about you that identifies you or for which there is a reasonable basis to believe the information can be used to identify you. This notice will also explain your legal rights and our duties regarding your health information.
Our pledge regarding your health information
We understand that your health information is personal. We create a record of the care and services you receive. We need this record to provide you with quality care and to comply with certain legal requirements. We are committed to protecting this information. We will safeguard your information in accordance with strict standards of privacy and confidentiality. We are also required by law to maintain the privacy of your health information and to provide to you this notice of our legal duties and privacy practices with respect to your health information. We are obligated to follow the terms of the notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
Established policies guard against unnecessary disclosure of your health information. It is, however, necessary to use and share information about you in order to provide you with treatment, obtain payment for your care and conduct health care operations. We are not able to list each specific way we may use or share your health information, but each situation will fall into one of the basic kinds of purposes listed below:
For your treatment
We may use your health information to provide, coordinate, and manage your health care. It is important that we be able to use or share your information to treat you. Your health information may be disclosed to and used by doctors, nurses, technicians, or other personnel who are involved in taking care of you. We may also consult other health care providers regarding your care and treatment, and in doing so, provide them with your health information, as part of the consultation process. We may refer you to another health care provider, for instance, to a specialist, another hospital, a home health agency, or a nursing home. If such a referral occurs, we may share the health information about you that they need to continue your care. Likewise, if family members are involved with your care, we may share your health information with them.
To obtain payment
We may use and share your health information so that we are paid for providing your care. This includes billing you, your insurance company, or other third party payer and providing the information needed to process your claim. For example, we may be required by your health insurer to provide information regarding the services you received and your medical condition in order for us to be paid or for you to be reimbursed for amounts you have already paid us. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. We may share your information with another provider so that they may be paid for services they have provided to you as well.
For health care operations
We may use and share your health information during the course of running the hospital and medical practices. These uses and disclosures are necessary for us to function and to maintain quality health care for all patients. Health care operations include activities such as: quality assessment and improvement; licensing, certification, and accreditation; protocol development, case management, and care coordination; professional review and performance evaluation; training programs in which students, trainees, or practitioners in health care learn under supervision; review and auditing, including compliance reviews, legal services, and financial audits; business management and general administrative activities.
To contact you
We may use your information to contact you as a reminder that you have an appointment for treatment, a diagnostic procedure or medical care, or, to provide you with instructions. This contact may be by telephone or by mail at either your home or your place of employment, unless you tell us otherwise in writing. At either location, we may leave messages for you on the answering machine or voice mail.
For health-related benefits and services
We may use and disclose your health information to inform you about treatment options, health-related benefits and services that may be of interest to you. This may include newsletters and pamphlets to inform you of health fairs, educational programs, new services, and other related activities.
For fundraising activities
We may use and disclose your health information to inform you of fundraising activities related to the hospital and its mission. Such information may be shared with our community relations & development department and with the Wyandot Memorial Hospital Foundation. Only demographic information, such as your name and address, will be disclosed. If you do not want to be contacted for fundraising efforts, you must notify, in writing, the director of community relations & development, Wyandot Memorial Hospital, 885 N. Sandusky Avenue, Upper Sandusky, Ohio 43351.
Hospital directory
While you are a patient in the hospital, we may include certain information about you in our facility directory. This information may include your name, your room number or location within our hospital, your condition described in general terms (for example, good, fair, serious, or critical), and your religious affiliation. Except for your religious affiliation, this information may be released to people who ask about you by name. Members of the clergy, such as a pastor, priest, or rabbi may be informed of your presence in our facility for the purpose of visiting with members of their parish, congregation, or religion, even if he or she does not ask for you by name. If you do not want to be included in our hospital directory, or you want to request a restriction to the information we include in the directory, you may notify the admitting office or the hospital’s privacy officer.
Communication with family or others involved with your care
We may disclose health information about you to a relative, a friend, your guardian, or any other person you identify, provided the information is relevant to that person’s involvement with your health care or payment for that care. For example, we may need to tell the person who comes to pick you up after a surgery, admission, or appointment what he or she may need to do to help you once you get home. We may need to use or share information about you in order to inform your family or persons responsible for your care where you are and of your condition. For instance, if you are admitted in an emergency and your family does not know where you are, we may contact them to tell them.
ADDITIONAL USES AND DISCLOSURES
Described below are additional uses and disclosures of health information for which authorization or opportunity to agree or object is not required by the Health Insurance Portability and Accountability Act:
When legally required
We will disclose your health information when required to do so by any federal, state, or local law.
For public health activities
We may disclose your health information as required or permitted for public health and safety. This includes reporting health information to a public health authority that is authorized by law to collect or receive the information for purposes of preventing or controlling disease, injury, or disability; reporting vital events, such as birth or death; and, as necessary, for conducting public health surveillance, investigations, and interventions. Health information may also be disclosed to report adverse events and product defects in compliance with requirements of the Food and Drug Administration. Personal health information may be used and disclosed to notify a person who has been exposed to a communicable disease or who may be at risk of contracting or spreading a disease, as required by law.
Victims of abuse, neglect, or domestic violence
We may disclose certain health information to government agencies authorized by law to receive reports of abuse, neglect, or domestic violence if we believe that you have been a victim.
For health oversight activities
We may disclose your health information to a health oversight agency for activities authorized by law, including: audits; civil, administrative, or criminal investigations; inspections, licensure, or disciplinary action. These activities are necessary for the government to monitor the healthcare system, government programs, and compliance with civil rights laws.
In response to judicial and administrative proceedings
We may disclose your health information in the course of an administrative or judicial proceeding, such as in response to a court order.
For disaster relief efforts
We may share information about you to an agency assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.
For law enforcement purposes
As permitted or required by law, we may disclose your health information to a law enforcement official for law enforcement purposes, such as:
• To report certain types of wounds or injuries as required by law
• For the purpose of identifying or locating a suspect, fugitive, material
witness, or missing person
• Pursuant to a court order, warrant, subpoena, summons, or similar
legal process
• Under certain circumstances, when you are the actual or suspected
victim of a crime
• In the event of your death, to alert law enforcement officials if we
suspect your death was the result of criminal conduct.
• About crimes that occur at our hospital or facility
• In an emergency, in order to report a crime
• As otherwise required by law
Deceased person information
We may release health information to a coroner, medical examiner, or funeral director as necessary to carry out their duties.
For organ, eye, or tissue donation
We may release your health information to organ procurement organizations for the purpose of facilitating organ, tissue, and eye donation and transplantation. These organizations may review death charts to determine compliance with federal and state regulations related to donation, procurement, and requests for transplantation.
For research purposes
Research can help find cures for diseases and help you and many other people. Under certain circumstances, we may use and disclose medical information about you for research purposes, or we may contact you about research projects that you may qualify for. All research projects are subject to a special approval process before we use or disclose medical information. If your information is used, the researcher is obligated to keep your information safe and confidential.
For worker’s compensation
We may release your health information to Worker’s Compensation, as required by Worker’s Compensation laws. This program provides benefits for work-related injuries or illnesses.
For specified government functions
We may disclose your health information to authorized federal officials for national security and intelligence, military, or veteran’s activities required by law. We may disclose your health information to a correctional institution or law enforcement official having custody of you, if the disclosure is necessary to provide health care to you, or for the health and safety of others, or for the safety, security, and good order of the correctional institution.
Uses of medical information that require authorization
Other uses and disclosures of your health information not covered by this notice or the laws that apply to us will be made only with your written permission. If you authorize us to use or disclose your health information, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose your health information, except to the extent that we already have used or disclosed your information.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
You have the following rights regarding health information that we maintain about you:
The right to review and obtain a copy of your health information
With very few exceptions, you have the right to inspect and obtain a copy of health information that may be used to make decisions about your care. Usually, this includes medical and billing records. As your access is limited to information we use to make decisions about your care, it does not include information compiled for use in or created in anticipation of a civil, criminal, or administrative action or proceeding, or other types of information not used by us to make decisions about your health care. To inspect or obtain a copy of your hospital medical records, you must submit your request in writing to the medical records department. To inspect or obtain a copy of your physician office medical records, you must submit your request in writing to your physician. To review or obtain a copy of your billing records, submit your request in writing to the business office of the hospital, or to your physician, as appropriate. If you request a copy of your health information, we may charge a fee for the costs of copying or mailing associated with your request.
The right to appeal a denial of access to your health information
You have the right to access your health information. However, there are some circumstances where this right is limited. For instance, if for clear treatment reasons your healthcare provider or practitioner had determined that access to your health information is likely to have an adverse effect on you, we may deny your request to inspect and copy that information. If we deny your request for access to your health information, we will inform you of the basis for the denial and how you may appeal the denial.
The right to amend your health information
We will attempt to keep your information complete, up-to-date, and accurate. If you feel that your health information in our records is incorrect or incomplete, you may ask us to amend the information. That request may be made as long as the information is maintained by us. We may deny your request if you ask us to amend information that is not part of the information which you would be permitted to inspect and copy, or information that we believe is accurate and complete. To request an amendment to your hospital records, submit your request an amendment to physician office medical records, submit your request to your physician or practitioner. Your request must be made in writing and include a reason that supports your request.
The right to request restrictions on the use or disclosure of your health information
You have the right to request a restriction or limitation on the health information we use or disclose about you for treatment, payment, or healthcare operations. You also have the right to request a limit on the medical 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 procedure you had. Although we will give consideration to your request, we are not required to agree to your request. If we do agree, we will comply with your request unless information is needed to provide you emergency treatment. If we agree to a restriction, either you or we may later remove that restriction. For information maintained by the hospital you must make your request for any restrictions in writing to the privacy officer of the hospital. For information maintained by a physician office practice, you must make your request for any restrictions in writing to the physician. In your request, you must tell us:
1.) What information you want to limit
2.) Whether you want to limit our use, disclosure, or both
3.) To whom you want the limits to apply (for example, disclosures to
your spouse).
The right to request confidential communications
You have the right to request that we communicate with you about your health information in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. For hospital services, you must make your request for confidential communications in writing to the privacy officer of the hospital. For physician office services, you must make your request in writing to the physician. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted. For example, if you wish to be contacted by telephone, be sure to provide an appropriate telephone number.
The right to an accounting of disclosures
You have the right to request an accounting of disclosures of your health information that may have been made in certain special situations as listed above. This accounting would not include the following:
1.) Disclosures to carry out treatment, payment and health care
operations
2.) Disclosures of your health information made to you
3.) Disclosures that you have authorized
4.) Disclosures for our hospital directory or to persons involved in your
care
5.) Disclosures that are incident to another use or disclosure
6.) Disclosures for disaster relief purposes;
7.) Disclosures for national security or intelligence purposes
8.) Disclosures to correctional institutions or law enforcement officials
having custody of you
9.) Disclosures that are part of a limited data set for purposes of
research, public health, or health care operations, where
information that would directly identify you have been removed
To request an accounting of disclosures of your hospital information you must submit your request in writing to the privacy officer of the hospital. To request an accounting of the information maintained by your physician or practitioner, you must submit your request in writing to your physician or practitioner. Your request must tell us the calendar dates you want to see. The time period cannot include more than six years of information and cannot begin prior to April 14, 2003. We will act on your request within 60 days of our receipt of your request. There will be no charge for the first list you request within a 12-month period. We may charge you for the costs of providing any additional lists. We will notify you of the cost involved. You may choose to withdraw or modify your request at that time before any costs are incurred.
The right to a paper copy of this notice
You have the right to a paper copy of this notice. You may ask us to give you a paper copy of this notice at any time, even if you have agreed to receive this notice electronically. To obtain a paper copy of this notice, contact the hospital privacy officer, or pick one up at the patient registration office or the front desk of a physician office covered by this privacy notice.
CHANGES TO THIS NOTICE
We reserve this right to change this notice. We reserve the right to make the new notice’s provisions effective for all medical information that we maintain, including that created or received by us prior to the effective date of the new notice. Current copies of this notice will be available at any admitting or registration location. The effective date of the notice will be posted on the first page.
COMPLAINTS
We are committed to protecting your privacy rights and encourage you to express any concerns you may have regarding the privacy of your health information. If you believe you privacy rights have been violated, you may file a complaint with us. To file a complaint, contact the office of the Chief Executive Officer, Wyandot Memorial Hospital, and your complaint will be investigated. You may also file a complaint with the Office of Civil Rights, U.S. Department of Health and Human Services, Washington, D.C., 20201. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
QUESTIONS AND ANSWERS
If you have any questions about this notice, please contact the hospital’s privacy officer or CEO at:
885 N. Sandusky Avenue
Upper Sandusky, OH 43351
(419) 294-4991