Understanding
Your Health Record This notice describes
how information about you may be used and disclosed
and how you can get access to this information. Please
review it carefully.
Each time you visit
a hospital, physician, or other healthcare provider,
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
health or medical record, serves as a:
Basis for planning your care
and treatment
Means of communication among
the many health professionals who contribute to
your care
Legal document describing the
care you receive
Means by which you or a third-party
payer can verify that services billed were actually
provided
Understanding what
is in your record and how your health information is
used helps 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
Your Health
Information Rights Although your health
record is the physical property of the healthcare practitioner
or facility that compiled it, the information belongs
to you. You have the right to:
Request a restriction on certain
uses and disclosures of your information as provided
by 45 CFR 164.522
Obtain a paper copy of the notice
of information practices upon request
Request a copy of your
health record as provided for in 45CFR 164.524 (Minimal
fee for services required)
Examples of
Disclosure for Treatment, Payment and Health Operations
We will use your
health information for payment:
For example:
Information obtained by the 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 subsequent healthcare provider with
copies of various reports that should assist him her
with your ongoing medical treatment.
We will use
your health 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 identified you,
as well as your diagnosis, procedures, and supplies
used.
We will use
your health information for regular health operations:
For example:
Members of the medical staff, the risk or quality improvement
manager, or member 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 healthcare
and service we provide.
Communication
with family: Health professionals,
using their best judgment, may disclose to a family
member or other family member you identify, health information
relevant to that person's involvement in our care, or
payment related to your care.
Public
health: As required by law, we may disclose your
health information to the public health or legal entity
authorized charge with preventing or controlling disease,
injury, or disability.
Law enforcement:
We may disclose health information for law enforcement
purposes as required by law or in response to a valid
subpoena.
Federal law makes
provisions 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 clinic standards and are potentially
endangering one or more patients, workers, or the public.
Request an amendment to your
health record as provided in 45 CFR 164.528
Obtain an accounting disclosure
of your health information as provided in 45 CFR
164.528
Request communications of your
health information by alternative means, i.e.: request
records to be mailed instead of faxed
Revoke your authorization to
use or disclose health information except to the
extent that action has already been taken
Our Responsibilities:
This organization is required to:
Maintain the privacy of your
health information
Provide you with a notice as
to our legal duties and privacy practices with respect
to information we collect and 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
We reserve the right
to change our practices and to make the new provisions
effective for all protected health information we maintain.
Should our information practices change, we will mail
a revised notice to the address you have supplied us.
We will not use or
disclose your health information without your authorization,
except as described in this notice.
For More Information
or to Report a Problem:
If you have questions, you may contact the director
of health information management/office manager at the
number below.
If you believe your
privacy rights have been violated, you can file a complaint
with the director of health information management/office
manager or with the Secretary of Health and Human Services.
There will be no retaliation for filing a complaint.
The U.S. Department
of Health and Human Services
200 Independence Avenue S.W.
Washington, D.C. 20201
Telephone: 202-619-0257
Toll Free: 1-877-696-6775
