Joint Notice of Privacy Practices
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.
Effective: March 1, 2006 (Revision 1)
If you have any questions or requests, please contact our Privacy Officer at 828-883-5343
This Notice describes our practices regarding the use and disclosure of your protected health information and that of our employees, officers, volunteers, and health care students associated with us. It also describes your rights to access your protected health information. “Protected Health Information” (“PHI”) is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
We are required by law to protect the privacy of your PHI. We must give you notice of our legal duties and privacy practices related to the use and disclosure of PHI. We must follow the terms of the notice currently in effect, and we must communicate any changes in the notice to you.
We may change the terms of this Notice at any time. The new notice will be effective for all PHI that we maintain at that time. We will post a copy of the current notice in the hospital. We will also:
Make copies of the revised notice available upon request ; and
Post the revised notice on our Website, www.trhospital.org.
Transylvania Regional Hospital and its medical staff have formed an organized health care arrangement. This means that Transylvania Regional Hospital and its medical staff will share your PHI with each other as necessary to carry out treatment, payment and health care operations relating to the organized health care arrangement. Both Transylvania Regional Hospital and the medical staff have agreed to abide by the terms of this Notice with respect to PHI created or received as part of delivery of health care services to you in Transylvania Regional Hospital .
A. HOW WE MAY USE AND DISCLOSE YOUR PHI
Following are examples of permitted uses and disclosures of your PHI. These examples are not exhaustive.
1. We may use and disclose PHI about you to provide treatment.
We may use and disclose PHI about you to provide, coordinate or manage your health care and related services. This includes the coordination or management of your health care with a third party. For example, this may include communicating with other health care providers regarding your treatment and coordinating and managing your health care with others. We may also use and disclose PHI about you when you need a prescription, lab work, an x-ray, or other health care services. In addition, we may use and disclose PHI about you when referring you to another health care provider.
For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Departments of the hospital may also need to use or disclose your PHI in order to coordinate different services you may need, such as prescriptions, lab work and x-rays. We may also disclose PHI about you to people outside the hospital, such as home health providers or others who may provide services that are part of your care.
2. We may use and disclose PHI about you for payment.
We may use and disclose PHI about you so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company or a third party. Before you receive scheduled services, we may disclose information about these services to your health plan(s). Disclosing information allows us to ask for coverage under your plan or policy and for approval of payment before we provide the services. We may also disclose PHI to the following (non-exclusive list):
Billing departments;
Collection departments or agencies;
Insurance companies, health plans and their agents which provide you coverage;
Hospital departments that review the care you received to check that it and the costs associated with it were appropriate for your illness or injury; and
Consumer reporting agencies (e.g., credit bureaus).
We may need to disclose your health plan information about surgery you received at the hospital so your health plan will pay us or reimburse you for the surgery. We may also disclose to 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.
3. We may use and disclose your PHI for health care operations.
We may use and disclose PHI in performing business activities, which we call “health care operations”. These activities include, but are not limited to, quality assessment activities, investigations, oversight or staff performance reviews, training of medical students, licensing, accreditation, credentialing, communications about a product or service, or conducting or arranging for other health care related activities.
For example, we may call you by name in our waiting rooms. If you are an inpatient, we will post your last name and first initial on your door. We may use or disclose your PHI to contact you to remind you of your appointment.
We will share your PHI with third party “business associates” who perform various activities (for example, billing, transcription services) for the hospital. The business associate will also be required to protect your PHI.
We may use medical information to review our treatment and services and to evaluate the performance of our staff. We may also disclose PHI to doctors, nurses, technicians, medical students, and other hospital personnel for review and learning purposes.
We may use or disclose your PHI to provide you with information about treatment alternatives or other health-related benefits and services that might interest you. For example, your name and address may be used to send you a newsletter about hospital services. We may also send you information about products or services that we believe might benefit you.
4. We may use and disclose PHI under other circumstances without your authorization.
We may use and/or disclose PHI about you for a number of circumstances in which you do not have to give authorization or otherwise have an opportunity to agree or object. Those circumstances include:
When the use and/or disclosure is required by federal, state or local law or regulation.
When the use and/or disclosure is necessary for public health activities which include, but are not limited to, the following:
Prevent or control disease, injury, or disability
Report births and deaths
Report child abuse or neglect
Report reactions to medications or problems with products
Notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition
Notify the appropriate government authority if we believe a patient has been the victim or abuse, neglect, or domestic violence.
When the use and/or disclosure is for health oversight activities. For example, we may disclose PHI about you to a state or federal health oversight agency which is authorized by law to oversee our operations.
When the disclosure is for judicial and administrative proceedings. For example, we may disclose PHI about you in response to an order of a court or administrative tribunal.
When the disclosure is for law enforcement purposes. For example, we may disclose PHI about you in order to comply with laws that require the reporting of certain types of wounds or other physical injuries. Other examples include, but are not limited to, the following:
Responses to legal proceedings
Information requests for identification and location
Circumstances pertaining to victims of a crime
Deaths suspected from criminal conduct Crimes occurring on hospital premises
Medical emergencies (not on hospital’s premises) believed to result from criminal conduct.
When the disclosure is for coroners or medical examiners to use for identification, determining the cause of death, or other duties as authorized by law.
When the disclosure is to funeral directors, as authorized by law, to carry out their duties with respect to the decedent.
When the use and/or disclosure relates to cadaveric organ, eye or tissue donation purposes.
When the disclosure is for workers’ compensation or similar programs.
When the use and/or disclosure relates to medical research when authorized by law.
When the use and/or disclosure is to avert a serious threat to health or safety. For example, we may disclose PHI about you to prevent or lessen a serious and eminent threat to the health or safety of a person or the public.
When the use and/or disclosure relates to specialized government functions. For example, we may disclose PHI about you if it relates to military and veterans’ activities, national security and intelligence activities, and protective services for the President.
When the use and/or disclosure relates to an individual in a correctional institution or in the custody of a law enforcement official.
5. You can object to certain uses and disclosures.
Unless you object in writing, we may use or disclose PHI about you in the following circumstances:
We will use and disclose in our hospital inpatient directory your name, the location at which you are receiving care, your condition (in general terms), and your religious affiliation. All of this information, except religious affiliation, will be disclosed to people who ask for you by name. Only members of the clergy will be told your religious affiliation.
We may disclose to a family member, relative, friend or other person identified by you, PHI directly related to that person’s involvement in your care or payment for your care. We may use or disclose PHI to notify or a family member, personal representative or other person responsible for your care, of your location, general condition or death.
We may use or disclose to a public or private entity (for example, American Red Cross) PHI about you for disaster relief purposes and coordinate uses and disclosures to family or other individuals involved in your health care.
6. We may contact you for fundraising activities.
We may use and/or disclose PHI about you, including disclosures to a foundation, to contact you to raise money for the hospital and its operations. We would only release contact information 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 Privacy Officer in writing.
** ANY OTHER USE OR DISCLOSURE OF PHI **
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 sign a written authorization allowing us to disclose PHI about you in a specific situation, you can later cancel your authorization in writing. If you cancel your authorization in writing, we will no longer use or disclose PHI about you for the reasons covered by your written authorization. We are unable to take back any disclosures we have made per your authorization.
B. YOUR RIGHTS REGARDING PHI ABOUT YOU
1. Right to Request Restrictions
You may ask us not to use or disclose any part of your PHI for treatment, payment, or health care operations. Your request must be made in writing to the Privacy Officer. In your request, you must tell us (1) what information you want restricted; (2) whether you want to restrict our use, disclosure, or both; (3) to whom you want the restriction to apply; and (4) an expiration date. If we believe that the restriction is not in the best interest of either party, or that we cannot reasonably accommodate the request, we are not required to agree. If we do agree, we will comply with your request unless the information is needed to provide emergency treatment. You may revoke a previously agreed upon restriction, at any time, in writing.
2. Right to Request Confidential Communications
You have the right to request how and where we contact you about PHI. For example, you may request that we contact you at your work address. We will accommodate reasonable requests, when possible. However, any request we make for overdue payment will be sent to any person or address we deem appropriate. You may request that we communicate with you using alternative means or location during the registration process or in writing at a later date by contacting the Patient Accounts Department.
3. Right to Inspect and Copy
You may inspect and obtain a copy of your PHI that is contained in a designated record set for as long as we maintain the PHI. A designated record set contains medical and billing records and any other records that the hospital uses for making decisions about you. Under federal law, however, you may not inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and PHI that is subject to laws that prohibits access to PHI. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed. To inspect and obtain a copy of your PHI, you must submit your request in writing to the Medical Record Department. Instead of providing you with a full copy of the PHI, we may give you a summary or explanation of the PHI about you, if you agree in advance to the form and cost of the summary or explanation. You may be charged a fee for the costs of copying, mailing or other supplies associated with your request.
4. Right to Request an Amendment
If you believe that information about you in a designated record set is incorrect or incomplete, you may request in writing to the Medical Records Department an amendment for as long as the information is kept. 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: 1) was not created by us, unless the person or entity that created the information is no longer available to make the amendment, 2) is not part of the designated record kept by or for the hospital, 3) is not part of the information which you would be permitted to inspect and copy, or 4) is accurate and complete. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you a copy of any such rebuttal.
5. Right to an Accounting of Disclosures
You may request in writing to the Medical Record Department an accounting of disclosures. You may ask for disclosures made up to six (6) years before your request (not including disclosures made prior to April 14, 2003). We are required to provide an accounting of all disclosures except the following:
For your treatment
For billing and collection of payment for your treatment
For our health care operations
Made to or requested by you, or that you authorized
Occurring as a byproduct of permitted uses and disclosures
Made to individuals involved in your care, for directory or notification purposes
Allowed by law when the use and/or disclosure relates to certain specialized government functions or relates to correctional institutions and in other law enforcement custodial situations and
As part of a limited data set.
The accounting will include the date of the disclosure, the name (and address, if available) of the person or organization receiving the information, a brief description of the information disclosed, and the purpose of the disclosure. If, under permitted circumstances, PHI about you has been disclosed for certain types of research projects, the accounting may include different types of information.
If you request an accounting of disclosures more than once in 12 months, we can charge you a reasonable fee.
6. Right to Obtain a Copy of this Notice
You have the right to request a paper copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy. To obtain a paper copy of this Notice, contact our Privacy Officer.
COMPLAINTS
If you think your privacy rights have been violated you may file a complaint with us or the United States Secretary of the Department of Health and Human Services. You may file a complaint with us by notifying our Privacy Officer. No retaliation will occur against you for filing a complaint.
CONTACT INFORMATION
You may contact our Privacy Officer by phone at 828-883-5343 or by writing to: Transylvania Regional Hospital, Privacy Officer, P.O. Box 1116, 260 Hospital Drive, Brevard, North Carolina 28712 for further information about the complaint process, or for further explanation of this document.
This Notice of Privacy Practices is effective on March 1, 2006.
