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HIPAA NOTICE OF PRIVACY PRACTICES (Federal Law)

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.

PLEASE BE ADVISED THAT THIS HOSPITAL WILL USE THE MOST STRINGENT LAW (FEDERAL OR STATE) IN PROTECTING YOUR CONFIDENTIALITY.

This notice describes our hospital’s practices and that of:

• Any health care professional authorized to enter information into your hospital chart.
• All departments and units of the hospital.
• Any member of a volunteer group we allow to help you while you are in the hospital.
• All employees, staff and other hospital personnel.

OUR PLEDGE REGARDING MEDICAL INFORMATION

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 at the hospital.  We need this record to provide you with quality care and to comply with certain legal requirements.  This notice applies to all of the records of your care generated by the hospital, whether made by hospital personnel or your personal doctor who may have different policies or notices regarding the doctor’s use and disclosure of medical information created in the doctor’s office or clinic.

This notice will tell you about the ways in which we may use and disclose medical information about you.  We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.

We are required by law to:

• Make sure that medical information that identifies you is kept private;
• Give you this notice of our legal duties and privacy practices with respect to medical information about you; and
• Follow the terms of the notice that is currently in effect.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU

The following categories describe different ways that we use and disclose medical information.  For each category of uses or disclosures we will explain what we mean and try to give some examples.  Not every use of 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.

Disclosure at Your Request.  We may disclose information requested by you.  This disclosure at your request may require a written authorization by you.

For Treatment.  We may use medical information about you to provide you with medical treatment or services.  We may disclose medical information about you to doctors, nurses, technicians, medical students, or other hospitals who are involved in taking care of you at the hospital.  For example, a doctor treating you for depression may need to know if you have other medical problems that may affect your treatment.  Different departments of the hospital also may share medical information about you in order to coordinate the different services you need, such as prescriptions, lab work, and x-rays.  We also may disclose medical information about you to people outside the hospital who may be involved in your medical care after you leave the hospital, such as physicians, therapists or psychiatrists.

For Payment.  We may use and disclose medical information about you so that the treatment and services you receive at the hospital may be billed to and payment may be collected from you, an insurance company or a third party.  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.

To Business Associates.  We may enter into contracts with entities known as Business Associates that provide services to or perform functions on behalf of the hospital.  We may disclose protected health information to Business Associates once they have agreed in writing to safeguard the protected health information.  For example, we may disclose your protected health information to a Business Associate to administer claims.  Business Associates are also required by law to protect protected health information.

For Health Care Operation. We may use and disclose medical information about you for hospital operations.  These uses and disclosures are necessary to run the hospital and make sure that all of our patients receive quality care.  For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you.  We may also combine medical information about many hospital patients to decide what additional services the hospital should offer, what services are not needed, and whether certain new treatments are effective.  We may also disclose information to doctors, nurses, technicians, medical students, and other hospital personnel for review and learning purposes.  We may also combine the medical information we have with medical information from other hospitals to compare how we are doing and see where we can make improvements in the care and services we offer.  We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific patients are.

Appointment Reminders.  We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at the hospital.

Treatment Alternatives.  We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

Health-Related Products and Services.  We may use and disclose medical information to tell you about our health-related products or services that may be of interest to you.

Fundraising Activities.  We may use information about you in order to contact you for support of the hospital and its operations.  We will not release any information about your treatment but only would release contact information, such as your name, address and phone number, and the dates you received treatment or services at the hospital.  If you do not want to be contacted for fundraising efforts, you must notify the Department of Health Information Management in writing.

Research.  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 received one medication to those who received another, for the same condition.  All research projects, however, are subject to a special approval process.  This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with patients’ need for privacy of their medical information. Before we use or disclose medical information for research, the project will have been approved through this research approval process, but we may, however, disclose medical information about you to people preparing to conduct a research project, for example, to help them look for patients with specific medical needs, as long as the medical information they review does not leave the hospital.

To Individuals Involved in Your Care or Payment for Your Care. With your written consent 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 your insurance company who pays for your care.  In addition, we may disclose medical information about you to an entity assisting in disaster relief effort (in the event of a disaster) so that your family can be notified about your condition, status and location.

AS REQUIRED BY LAW.  WE WILL DISCLOSE MEDICAL 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 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.

SPECIAL SITUATIONS

Organ and Tissue Donation.  If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

Military and Veterans.  If you are a member of the armed forces, we may release medical information about you as required by military command authorities.  We may also release medical information about foreign military personnel to the appropriate foreign military authority.

Workers’ Compensation.  We may release medical information about you for Workers’ Compensation or similar programs.  These programs provide benefits for work-related injuries or illness.

Public Health Activities.  We may disclose medical information about you for public health activities.  These activities generally include the following:

• To prevent or control disease, injury or disability;
• To report birth and death;
• To report the abuse or neglect of children, elders and dependent adults;
• To report reactions to medications or problems with products;
• To notify people of recalls of products they may be using;
• 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;
• To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence.  We will only make this disclosure if you agree or when required or authorized by law.
• To notify emergency response employees regarding possible exposure to HIV/AIDS, to the extent necessary to comply with state and federal laws.

Health Oversight Activities.  We may disclose medical information to a health oversight agency for activities authorized by law.  These oversight activities include, for example, audits, investigations, inspections, and licensure.  These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.

Lawsuits and Disputes.  If you are involved in a lawsuit or dispute, we may disclose medical information about you in response to a court or administrative order.  We also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request (which may include written notice to you) or obtain an order protecting the information requested.

Law Enforcement.  We may release medical information if asked to do so by a law enforcement official:

• In response to a court order, subpoena, warrant, summons, or similar process;
• To identify or locate a suspect, fugitive, material witness, or missing person;
• About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
• About a death we believe may be the result of criminal conduct;
• About criminal conduct at the hospital:
• When requested by an officer who lodges a warrant with the facility;
• When requested at the time of a patient’s involuntary hospitalization, and
• In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.

Coroners, Medical Examiners and Funeral Directors.  We may release medical information 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 medical information about patients of the hospital to funeral directors as necessary to carry out their duties.

National Security and Intelligence Activities.  We may release medical information about you to authorized federal officials for intelligence, counter intelligence, and other national security activities authorized by law.

Security Clearances.  We may use medical information about you to make decisions regarding your medical suitability for a security clearance or service abroad.  We may also release your medical suitability determination to the officials in the U.S. Department of State who need access to that information for these purposes.

Protective Services for the President and Others.  We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state; or to conduct special investigations.

Inmates.  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. Disclosure may be made when required, as necessary to the administration of justice.

Advocacy Groups.  We may release medical information to the statewide protection and advocacy if it has a patient or patient representative’s authorization, or for investigations resulting from reports required by law to be submitted to the Director of Mental Health.

Department of Justice.  We may disclose limited information to the California Department of Justice for movement and identification purposes about certain criminal patients, or regarding persons who may not purchase, possess or control a firearm or deadly weapon.

Multidisplinary Personnel Teams.  We may disclose health information to a multidisciplinary personnel team relevant to the prevention, identification, management or treatment of an abused child and the child’s parents, or elder abuse and neglect.

Other Special Categories of Information.  Special legal requirements may apply to the use of disclosure of certain categories of information, e.g., tests for the human immunodeficiency virus (HIV) or treatment and services for alcohol and drug abuse.  In addition, somewhat different rules may apply to the use and disclosure of medical information related to any general medical (non-mental health) care you receive.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU

You have the following rights regarding medical information we maintain about you:

Right to Inspect and Copy.  You have the right to inspect and copy medical information that may be used to make a decision about your care.  Usually, this includes medical and billing records, but may not include some mental health information.  If the information you request is in an electronic health record, you may request that these records be transmitted electronically to yourself or a designated individual.

To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the Health Information Management Department.  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 very limited circumstances.  If you are denied access to medical information, you may request that the denial be reviewed.  Another licensed health care professional chosen by the hospital 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 medical information we have about you is incorrect or incomplete, you may ask us to amend the information.  You have the right to request an amendment for as long as the information is kept by or for the hospital.

To request an amendment, your request must be made in writing and submitted to the Health Information Management Department.  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 to amend information that:

• Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
• Is not part of the medical information kept by the hospital;
• Is not part of the information which you would be permitted to inspect and copy; or
• Is accurate and complete.

Even if we deny your request for amendment, you have the right to submit a written addendum, not to exceed 250 words, with respect to any item or statement in your record you believe is incomplete or incorrect. If you clearly state that you want an addendum to be made part of your medical record we will attach it to your records and include it whenever we make a disclosure of the item or statement you believe to be incomplete or incorrect.

Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures.”  This is a list of the disclosure we make of medical information about you other than our own uses for treatment, payment and health care operations, as those functions are described above.

To request this list of accounting of disclosures, you must submit your request in writing to the Health Information Management Department.  Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003.  Your request should indicate in what form you want the list (for example, on paper, electronically).  The first list you request within a 12–month period will be free.  For additional lists, we may charge you for the cost of providing the list.  We will notify you of the cost involved and you may choose to withdraw or modify your request at the time before any costs are incurred.

In addition, we will notify you as required by law if your health information is unlawfully accessed or disclosed.

Right to Request Restrictions.  You have the right to request a restriction of limitation on the medical information we use or disclose about you for treatment, payment or health care 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 type of therapy you had.

We are not required to agree to all restriction requests if it is not feasible for us to ensure our compliance or believe it will negatively impact the care we may provide you. We cannot, however, restrict your request to not disclose health information to a health plan for payment or health care operations.  This pertains solely to a health care item or service for which the provider involved has been paid out of pocket in full.

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 the Health Information Management Department.  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, for example, disclosures to your spouse.

Right to Request Confidential Communications.  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 who or where you wish to be contacted.

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 copy of this notice at any time.

CHANGES TO THIS NOTICE

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 the hospital.  The notice will contain on the first page, in the top right-hand corner, the effective date.  In addition, each time you register at or are admitted to the hospital for treatment or health care services as an inpatient or outpatient, we will offer you a copy of the current notice in effect.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with the hospital or with the Secretary of the Department of Health and Human Services.  To file a complaint with the hospital, contact the Privacy Officer, at 805-653-6434, extension 208.  The complaint will need to be submitted, in writing, on the form that will be provided to you by the Privacy Officer.

You will not be penalized for filing a complaint.

OTHER USES OF MEDICAL INFORMATION

Other uses and disclosures of medical 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 medical information about you, you may revoke that permission, 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.  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.

EA\Forms\HIPAA - NOTICE OF PRIVACY PRACTICES (Federal Law)

Effective:  04/13/03   REV 11/12