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.
If you have any questions about this Notice, you may contact the Privacy Officer at MHCC, 307.358.2122, and have the Reception or Admissions staff provide you with the name and/or department number.
This Notice is effective as of April 14, 2003.
This Notice describes our facility's practices and that of any programs or clinics associated with Memorial Hospital of Converse County. Any healthcare professional authorized to enter information into your file or record, and all employees, staff and other personnel, will follow the terms of this notice. In addition, these entities, sites and locations may share medical information for treatment, payment or facility operation purposes described in this notice.
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive in our facilities. We need this record to provide you with quality care and to comply with certain legal requirements. This notice will tell you about the ways in which we may use and disclose medical information about you. We will describe your rights and certain obligations we have regarding the use and disclosure of medical information.
We are required by law to:
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in our facility in the following locations: Admissions area of MHCC and the reception areas of facilities associated with MHCC. This notice will contain the effective date. In addition, each time you are in our facilities for treatment we will offer you a copy of the current notice in effect.
The following categories cover most, but not exclusively all, of the ways in which your health information will be used and disclosed.
We may use medical information about you to provide you with medical treatment or services, and may disclose it to doctors, physician assistants, counselors, nurses, nurse practitioners, technicians, admissions and billing staff, medical records staff, compliance staff or other personnel who are involved in providing you with medical care. Different departments of the hospital services may share medical information about you to coordinate the different services you need, such as diagnostic testing. We may also disclose medical information about you to people outside of the hospital facilities who may be involved in your medical care, such as family members, at-home nursing, or to others who will provide services that are a part of your care.
We may need to use and disclose medical information about you so that the services you receive at the hospital and associated facilities may be billed properly and payment collected from you, an insurance company, or a 3rd party. For example, we may need to give your health plan or carrier information about surgery you receive so that your health plan will pay us or reimburse you for the surgery. We may also tell your health plan about a treatment you are planning to receive in order to obtain prior approval or to determine whether the plan will cover the treatment.
We may use and disclose medical information about you to make decisions necessary to provide the best care to our patients. For example we may use medical information to review our treatment and services and to evaluate our staff members who help care for you. When practicable, we may remove individual identifiers from such information so that your identity is protected.
We may contact you to provide appointment reminders, information about treatment alternatives, or health related services and benefits that may be of interest.
We may contact you as part of a fundraising effort. You have the right to request not to received subsequent fundraising materials.
We may include certain limited information about you such as name, location in facility, and religious affiliation for directory purposes. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name, unless indicated otherwise on a no publicity form.
We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who assists in paying for your care. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
The information in your health record may be used to assess the care and outcomes in your case and others like, it in an effort to continually improve the quality and effectiveness of the healthcare and service we provide.
Some services, provided in our organization by other companies such as physician services in the emergency department and patient satisfaction, require disclosure of your health information so that the requested services can be performed. We require that each company appropriately safeguard your information.
Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who take one particular medication to those who take another for the same condition. All research projects, however, are subject to a special approval process and you will be asked for your specific permission before your medical information would be provided for such a purpose.
We will disclose medical information about you when required to do so by federal, state, or local law.
We may use and disclose medical 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. Any disclosure, however, would only be to someone able to help prevent the threat, such as the target of the threat or law enforcement.
If you are an organ donor, we may release medical information to organizations that handle organ procurement or to an organ donation bank, as necessary to facilitate your donor request.
If you are a member of the Armed Forces, we may release medical information about you as required by military command authorities.
We may release medical information about you for workers' compensation or similar programs providing benefits for work-related injuries or illnesses.
We may disclose information about you for public health activities, such as to prevent or control disease, injury, or disability, or to report reactions to medication or problems with products.
We may disclose medical information to a health oversight agency for activities authorized by law. For example, audits, investigations, inspections, or licensure.
If you are involved in a lawsuit or dispute, we may disclose medical information about you in response to a court or administrative order, or in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only after efforts are made to tell you about the request.
We may release medical information about you if asked to do so by a law enforcement official, in response to a court order, subpoena, warrant, summons, or similar process. The hospital may also disclose the following information: name, address, date/place of birth, SS #, ABO/Rh blood type, type of injury, date/time of treatment, date/time of death, and if applicable description of distinguishing characteristics including height, weight, gender, race, hair/eye color, presence of facial hair, scars/tattoos.
We may release medical information to a coroner or medical examiner. This may be necessary to identify a deceased person or determine the cause of death. We may also release medical information about patients of the hospital to funeral directors as necessary to carry out their duties.
We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with healthcare; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
You have the following rights regarding medical information we maintain about you:
You have the right to inspect and copy medical information we maintain about you. Usually, this includes medical and billing records, but does not include psychotherapy notes. To inspect and copy medical information, you must submit your request to the Health Information Management department. We may charge a fee for the costs of retrieving, copying, mailing, and any other supplies associated with your request.
We may deny your request to inspect and copy in certain limited circumstances. If you are denied access to the medical information, you may request that the denial be reviewed by another licensed healthcare professional, who will be chosen by MHCC to review your request and the denial. MHCC will comply with the outcome of this review.
If you feel that medical information we have about you is inaccurate or incomplete, you may ask us to amend the information. You must request an amendment in writing and provide a reason that supports your request to amend the information. We may deny your request, in writing, if you ask us to alter information not created by us, or if the information is correct and complete. To request an amendment, you must submit your request in writing to the Health Information Management department. In addition, you must provide a reason that supports your request. The hospital will respond within sixty (60) days of this request.
You have the right to request an "accounting of disclosures," which is a list of the disclosures we made of medical information about you. To request this accounting of disclosures, you must submit your request in writing to the Health Information Management department. Your request must state a time period that may not be longer than six (6) years and may not include dates before April 14, 2003. The 1st accounting you request within a 12-month period will not include a cost for providing the list. For additional accountings, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
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 work or by mail. To request confidential communications, you must make your request in writing to the Health Information Management department. 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.
You have the right to a copy of this notice and may ask us to give you a copy at any time. This notice will be available at the admissions desk of the hospital and reception area of MHCC facilities.
You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or healthcare operations, and to request a limit on the medical information we disclose about you to someone who is involved in your care or payment, such a family member or friend. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request a restriction or limitation, your request must be in writing and submitted to the Health Information Management department.
You have the right to restrict certain disclosures to your health plan when:
You have the right to be notified in the event of a breach of your personal health information (PHI). A breach is defined as the inappropriate or unauthorized use or disclosure of PHI. This includes unauthorized disclosures to outside third parties as well as unauthorized internal access to PHI. You must be notified as soon as possible and within 60 days after the breach is discovered.
If more than 500 people are affected, we must notify the Department of Health and Human Services and local newspaper and radio stations.
If you believe your privacy rights have been violated, you may file a written complaint to the Privacy Officer of Memorial Hospital of Converse County or with the U. S. Department of Health and Human Services, Office of Civil Rights. You will not be penalized for filing a complaint.
Other uses and disclosures of medical information not covered by this notice or the law will be made only with your written permission and consent. If you provide us permission to use or disclose medical information about you, you may revoke that consent, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization or consent. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required by law to retain our records of the care we provide to you.