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.
Mount St. Mary's Hospital and Health Center and its Medical Staff physicians takes the privacy of your health information seriously. We call this health information "protected health information" or "PHI" for short. PHI includes information that can be used to identify you, and also information that we have created or received concerning your past, present, or future health or condition, the provision of healthcare to you, or payment for this health care. This Notice applies to all of the records of your care generated by Mount St. Mary's Hospital and Health Center, whether made by staff personnel or other authorized health care professionals including your personal physician. We are required by law to maintain your privacy and to provide you with this Notice. Your personal physicians may have different policies or notices regarding the use and disclosure of your health information created in their offices, for care provided outside the Hospital.
This Notice will tell you about the ways we may use and disclose health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of health information. We are required to abide by the terms of the Notice currently in effect. However, this Notice should not be construed to limit our rights under the law, and we reserve the right to change the terms of this Notice and our privacy policies at any time. Any changes will apply to the PHI we already have. Before we make an important change to our policies, we will promptly change this Notice and post a new Notice near the entrances to each Mount St. Mary's Hospital and Health Center facility. The Notice will contain on the first page, in the top right-hand corner, the effective date.
JOINT NOTICE OF PRIVACY PRACTICES
Mount St. Mary's Hospital and Health Center and its medical staff members participate in an Organized Health Care Arrangement (OHCA) and are presenting you with this document as a Joint Notice. Participants include:
- Any health care professional authorized to enter information into your medical record, including all non-employed doctors and other health care providers who take care of you while you are at Mount St. Mary's Hospital and Health Center, the Neighborhood Health Center, Clearview Treatment Services and Rehabilitation Services.
- Physicians participating in your care at Mount St. Mary's Hospital and Health Center (excluding certain physicians at the Neighborhood Health Center and Laboratory) are not employees or agents of Mount St. Mary's Hospital and Health Center and are not acting for or on the behalf of Mount St. Mary's Hospital and Health Center. These physicians are independent practitioners engaged in the private practice of medicine who have been granted privileges to use Mount St. Mary's Hospital and Health Center for the care of their patients. All medical decisions regarding your care and treatment at Mount St. Mary's Hospital and Health Center are made by such physicians, not by Mount St. Mary's Hospital and Health Center. These individuals do not assume joint and several liability through this sharing of your PHI.
- All Mount St. Mary's Hospital and Health Center departments and units, including Mount St. Mary's Hospital and Health Center, the Neighborhood Health Center, Clearview Treatment Services, and Rehabilitation Services;
- Any volunteers we allow to help you while you are in the Hospital or receiving care at a Mount St. Mary's Hospital and Health Center site; and
- All Mount St. Mary's Hospital and Health Center employees, staff, and other personnel.
All these entities, sites, individuals and locations follow the terms of this Notice. In addition, these entities, sites individuals and locations may share PHI with each other, as necessary to carry out treatment, payment or health care operations relating to the OHCA.
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
The following categories describe different ways that we use and disclose your PHI. For each category, we explain what we mean and in some cases, give examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
- For Treatment. We may use your PHI to enable us to provide you with medical treatment, health care or other related services. We may disclose your PHI to doctors, nurses, aides, technicians, students, or other Hospital personnel who are involved in taking care of you.
- We may also use or disclose your PHI to manage or coordinate your treatment, health care or other related services. For example, a doctor treating you for a broken leg would need to know if you have other illnesses that may slow your healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments or facilities of the Hospital also may share PHI about you in order to coordinate the different tests, care and treatment you need, such as prescriptions, lab work and x-rays.
- We may give your primary doctor, or another health care provider, copies of various reports that should assist him/her in treating you once you are discharged from this Hospital or upon completion of an outpatient service. For example, we would disclose your PHI, as necessary, to a home health agency that provides care to you, an ambulance service which transports you to or from the Hospital, or to a nursing home or other hospital to which you are transferred after receiving care from the Hospital.
- In addition, we may disclose your PHI from time-to-time to another health care provider (e.g., a specialist or laboratory) who, at the request of your physician, becomes involved in your care by providing assistance with your diagnosis or treatment, or to another health care provider that we use to provide services as part of your care.
- We will disclose your PHI to those individual(s) you indicate as your "Primary Emergency Contact" and/or "Secondary Contact Person" at the time of registration. We also may share this information with other people that may help with your medical care after you leave the Hospital, such as family members, clergy or others who are actively involved in your care.
- If you do not wish us to disclose your PHI to those individuals you have identified, please notify the Hospital's Privacy Officer, Mount St. Mary's Hospital and Health Center, 5300 Military Rd., Lewiston, N.Y. 14092 in writing of your request not to allow such disclosures. Once your written request has been received by the Privacy Officer, the Hospital will accommodate your request within a reasonable period of time.
- In emergencies, we will use and disclose your PHI to provide the treatment you require.
- For Payment. We may use and disclose your PHI to bill and collect for the treatment and services we provide to you. This may include certain activities that your health insurance plan may undertake before it approves or pays for the health care services recommended for you, such as making a determination of eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, obtaining approval for a Hospital stay may require that your relevant PHI be disclosed to the health plan to obtain approval for the Hospital admission. We may send your PHI to an insurance company or other third party for payment purposes, including to a collection service or attorney, if needed.
- For Health Care Operations. We may use and disclose your PHI for health care operations. These uses and disclosures are necessary to run Mount St. Mary's Hospital and Health Center, to make sure you receive competent, quality health care and to maintain and improve the quality of health care we provide. These activities include, but are not limited to, quality assessment activities, employee review activities, marketing, and conducting or arranging for other business activities. We may also provide your PHI to various governmental or accreditation entities to maintain our license and accreditation.
- For example, we may use medical information to review our treatment and services and to measure how well our staff cared for you. We may contact you to determine your satisfaction with the services that we provide at Mount St. Mary's Hospital and Health Center. We may also combine information about many hospital patients to decide what other types of services the Hospital should offer or what services are no longer needed. We may also combine information with other hospitals to find areas where we can improve the care given. We may remove information that identifies you from this set of health information so others may use it to study health care and health care delivery without learning patient-specific information.
- We may share your information for learning purposes, such as training of nursing and other health care students.
- We may also call you by name when our staff is ready to take care of you.
- For Public Health Purposes. We may disclose your PHI for public health activities. While there may be others, public health activities generally include the following:
- Preventing or controlling disease, injury or disability;
- Reporting births and deaths;
- Reporting defective medical devices or problems with medications;
- Notifying people of recalls of products they may be using; and
- Notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
- About Victims of Abuse. We may disclose your PHI to notify the appropriate government authority if we believe an individual has been the victim of abuse or neglect. We will only make this disclosure if required or authorized by law. If not required or authorized by law, we will only make such a disclosure if you agree.
- Health Oversight Activities. We may disclose your PHI to a health oversight agency for activities authorized by law. These oversight activities might include audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government benefit programs, and compliance with civil rights laws.
- Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose PHI about you in response to a court or administrative order. We may also disclose PHI about you in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute. The disclosure will be made after Mount St. Mary's Hospital and Health Center receives satisfactory assurances that a reasonable effort has been made either to give you notice of the request or to secure a qualified protective order.
- Law Enforcement. We may disclose PHI, so long as applicable legal requirements are met, for law enforcement purposes. For example, we will comply with a court-ordered warrant.
- Coroners, Medical Examiners and Funeral Directors. In certain circumstances, as required by law, we may disclose PHI to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release PHI about individuals to funeral directors as necessary to carry out their duties.
- Organ and Tissue Donation. As required by law, we may disclose your PHI to organizations that handle organ procurement, as necessary to facilitate organ, eye or tissue donation and transplantation.
- Research. Under certain circumstances, we may use and disclose PHI about you for research purposes. We may disclose your PHI to researchers when their research has been approved by an Institutional Review Board (IRB) that has reviewed the research proposal and established protocols to ensure the privacy of your PHI.
- To Avert a Serious Threat to Health or Safety. We may use and disclose your PHI when we believe it is 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 or lessen the threat or to law enforcement authorities in particular circumstances.
- Military and Veterans, National Security and Intelligence Activities, Protective Services for the President and Others. If you are a member of the armed forces, we may release your PHI as required by military command authorities. We may also release PHI about foreign military personnel to the appropriate foreign military authority. We may release your PHI to authorized federal officials for lawful intelligence, counterintelligence, and other national security activities authorized by law. We may disclose your PHI to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or for the conduct of special investigations.
- Custodial Situations. If you are an inmate in a correctional institution and if the correctional institution or law enforcement authority makes certain representations to us, we may disclose your PHI to a correctional institution or law enforcement official.
- Workers' Compensation. We may disclose your PHI as authorized by and to the extent necessary to comply with workers' compensation laws or laws relating to similar programs.
- Treatment Alternatives, Appointment Reminders and Health-Related Benefits. We may use and disclose your PHI to tell you about or recommend possible treatment alternatives or health-related benefits or services that may be of interest to you. Additionally, we may use and disclose your PHI to provide appointment reminders. If you do not wish us to contact you about treatment alternatives, health-related benefits or appointment reminders, you must notify the Privacy Officer, Mount St. Mary's Hospital and Health Center, 5300 Military Rd., Lewiston, N.Y. 14092, in writing, and state which of those activities you wish to be excluded from.
- Fundraising Activities. We may disclose PHI to the charitable foundation related to Mount St. Mary's Hospital and Health Center so that the foundation may contact you to raise money for Mount St. Mary's Hospital and Health Center and its operations. In these cases, we would release only contact information, such as your name, address and phone number and the dates you were here. If you do not want us to contact you for fundraising efforts, you must notify the Privacy Officer, Mount St. Mary's Hospital and Health Center, 5300 Military Rd., Lewiston, N.Y. 14092, in writing.
- Facility Directory. We will include certain limited information about you in our facility directory while you are a patient at Mount St. Mary's Hospital and Health Center. This information will include your name, location in the Hospital, your general condition (e.g., fair, stable, etc.) and your religious affiliation. The directory information, except for your religious affiliation, will be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest, rabbi or minister, or a layperson who has been appointed by your priest or minister as a pastoral visitor, even if they do not ask for you by name. This is so your family, friends and clergy can visit you and generally know how you are doing. If you do not wish to be included in the facility directory for family, friends or clergy visits, please notify us at the time of admission.
- Individuals Involved in Your Care or Payment for Your Care. We may release PHI about you to a family member, other relative, or any other person identified by you who is involved in your health care. We may also give information to someone who helps pay for your care. We may also tell your family, friends, personal representative or other person responsible for your health care your condition and that you are at the Hospital. In addition, we may disclose PHI about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location. You may object to this use by requesting not to be included in our Facility Directory.
- Parental Access New York State laws concerning minors permits, prohibits, or requires disclosure of PHI to parents, guardians, and persons acting in a similar legal status. We will act consistently within the laws of New York State and will make disclosures following such laws.
- Third Parties. We may disclose your PHI to third parties with whom we contract to perform services on our behalf. If we disclose your information to these entities, we will have an agreement by them to safeguard your information.
OTHER USES OF HEALTH INFORMATION
Other uses and disclosures of PHI not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you provide us authorization to use or disclose your PHI, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose PHI 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 under the authorization, and that we are required to retain our records of the care that we provided to you.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have the following rights regarding PHI we maintain about you:
- Right to Request Restrictions. You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the PHI we disclose about you to someone who is involved in your care or the payment for your care.
- 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 restrictions, you must make your request in writing to: Privacy Officer, Mount St. Mary's Hospital and Health Center, 5300 Military Rd., Lewiston, N.Y. 14092. 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; and (3) to whom you want the limits to apply.
- Right to Request Confidential Communications. You have the right to request that we communicate with you or your responsible party about your health care in an alternative way or at a certain location. For example, you may ask that we use an address other than your home address for billing purposes, or that we do not leave a message on your telephone voice mail.
- To request confidential communications, you must make your request at the time of registration for the Hospital service subject to the request. 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.
- Right to Inspect and Copy. In most circumstances, you have the right to inspect and obtain a copy of your PHI that may be used to make decisions about your care.
- To inspect and copy PHI that may be used to make decisions about you, you can submit your request in writing to Director of Health Information Management at 5300 Military Rd., Lewiston, N.Y. 14092. Once your request has been received by the Director of Health Information Management, the Hospital has 10 days to provide you with an opportunity to inspect your record. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
- We may deny your request to inspect and copy in certain circumstances. If you are denied access to PHI, you may request that the denial be reviewed. Once your request is received, another licensed health care professional chosen by Mount St. Mary's Hospital and Health Center 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 feel that PHI we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to ask us to amend your health and/or billing information for as long as the information is kept by us. This means you may add additional information to your file, it does not mean we will agree to remove documentation from your file.
- To request an amendment, your request must be made in writing and submitted to the Director of Health Information Management at 5300 Military Rd., Lewiston, N.Y. 14092 at. In addition, you must provide a reason that supports your request.
- We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:
- Was not created by us;
- Is not part of the health information kept by or for Mount St. Mary's Hospital and Health Center;
- Is not part of the information which you would be permitted to inspect and copy; or
- Is accurate and complete.
- Right to an Accounting of Disclosures. You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of PHI about you. The list will not include any of the uses and disclosures as described above for treatment, payment and health care operations, or disclosures made to you or authorized by you, or for certain other limited reasons.
- To request this list of disclosures, you must submit your request in writing to Director of Health Information Management at 5300 Military Rd., Lewiston, N.Y. 14092. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a twelve-month period will be free. For additional lists, during such twelve-month period, 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.
- Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice. You may also ask us to give you a copy of this Notice at any time.
- You may obtain a copy of this Notice at our web site at www.msmh.org.
- To obtain a paper copy of this Notice, contact Privacy Officer, Mount St. Mary's Hospital and Health Center, 5300 Military Rd., Lewiston, N.Y. 14092.
If you believe your privacy rights have been violated, you may file a complaint with Mount St. Mary's Hospital and Health Center or with the Secretary of the Department of Health and Human Services. To file a complaint with us, contact Privacy Officer, Mount St. Mary's Hospital and Health Center, 5300 Military Rd., Lewiston, N.Y. 14092, (716) 298-2047. All verbal complaints must be followed by a written description of the cause for the complaint.
- You will not be penalized for filing a complaint.
This Notice shall go into effect on April 14, 2003.
If you have any questions about this Notice, please contact:
Mount St. Mary's Hospital and Health Center
5300 Military Rd.
Lewiston, N.Y. 14092