NOTICE OF PRIVACY PRACTICES

Effective Date: July 9, 2019

 

OUR RESPONSIBILITIES

We are required by law to maintain the privacy of your health information and provide you a description of our privacy practices. We will abide by the terms of this notice.

HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU

The following categories describe examples of the way we use and disclose health information that identifies you. Except for the purpose described below, we will use and disclose your health information only with your written permission. You may revoke such permission at any time by writing to our facility privacy officer.

For treatment: We may use health information about you to provide you treatment and services. For example, we may disclose health information about you to doctors, nurses, technicians, medical students, or other hospital personnel who are involved in your medical care and need the information to provide you with medical care.

For payment: We may use and disclose health information about your treatment and services to bill and collect payment from you, your insurance company or a third party payer. For example, we may need to give your insurance company information about your surgery so they will pay us or reimburse you for the treatment.

For health care operations: Members of the medical staff and/or quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. The results will then be used to continually improve the quality of care for all patients we serve. For example, we may combine health information about many patients to evaluate the need for new services or treatment. We may disclose information to doctors, nurses, and other students for educational purposes. And we may combine health information we have with that of other hospitals to see where we can make improvements. We may remove information that identifies you from this set of health information to protect your privacy.

We may also use and disclose health information:

  • To business associates we have contracted with to perform the agreed upon service and billing for it;
  • To remind you that you have an appointment for medical care;
  • To assess our satisfaction with our services;
  • To tell you about possible treatment alternatives;
  • To tell you about health-related benefits or services;
  • To contact you as part of fundraising efforts;
  • To inform Funeral Directors consistent with applicable law;
  • For population based activities relating to improving health of reducing health care costs; and
  • For conducting training programs or reviewing competence of health care professional.

When disclosing information, primarily appointment reminders and billing/collections efforts, we may leave messages on your answering machine/voice mail.

Business associates: There are some services provided in our organization through contracts with business associates.

Examples include physician services in the emergency department and radiology, certain laboratory test, and a copy service we use when making copies of your health record. When these services are contracted, we may disclose your health information to our business associates so that they can perform the job we’ve asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

Directory: We may include certain limited information about you in the hospital directory while you are a patient at the hospital. The information may include your name, location in the hospital, your general condition (e.g., good, fair) and your religious affiliation. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name. If you would like to opt out of being in the facility directory please request the Opt Out Form from the admission staff or Facility Privacy Official.

Individuals involved in your care or payment for your care: We may release health information about you to a friend or family member who in involved in your medical care or who helps pay for the care. In addition, we may disclose health 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.

Research: We may disclose information to researchers when an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information has approved their research and granted a waiver of the authorization requirements.

Future communications: We may communicate to you via newsletters, mail outs or other means regarding treatment options, health-related information, disease-management programs, wellness programs, or other community-based initiatives or activities our facility is participating in.

Organized health care arrangement: This facility and its medical staff members have organized and are presenting you this document as a joint notice. Information will be shared as necessary to carry out treatment, payment and health care operations. Physicians and caregivers may have access to protected health information in their offices to assist in reviewing past treatment as it may affect treatment at the time.

Affiliated covered entity: Protected health information will be made available to hospital personnel at local affiliated hospitals as necessary to carry out treatment, payment and health care operations. Caregivers at other facilities may have access to protected health information at their locations to assist in reviewing past treatment information as it may affect treatment at the time. Please contact the facility privacy official for further information on the specific site included in these affiliated covered entity.

As required by law, we may also use and disclose health information for the following types of entities, including but not limited to:

  • Food and Drug Administration
  • Public health or legal authorities charged with preventing or controlling disease, injury or disability
  • Correctional institutions
  • Workers compensation agents
  • Organ and tissue donation organizations
  • Military command authorities
  • Health oversight agencies
  • Funeral directors, coroners and medical directors
  • National Security and Intelligence Agencies
  • Protective Services for the President and others

Law enforcement/legal proceedings: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.

State-specific requirement: Many states have requirements for reporting including population-based activities relating to improving health or reducing health care costs. Some states have separate privacy laws that may apply additional legal requirements. If the state privacy laws are more stringent than federal privacy laws, the state law preempts the federal law.

YOUR HEALTH INFORMATION RIGHTS

Although your health record is the physical property of the health care practitioner or facility that compiled it, you have the right to:

Inspect and copy: You have the right to inspect and obtain a copy of the health information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. We may deny your request to inspect and copy in certain very limited circumstance. If you are denied access to health 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.

An electronic copy of electronic medical record: If your health information is maintained in an electronic format, you have the right to request that an electronic copy of your record be given to you or transmitted to another person or entity. We will make every effort to provide electronic access in the form or format of your request. If your health information is not readily producible in the requested form or format, you will be provided a standard electronic format or readable hard copy at your request.

Receive notice of breach: You have the right to be notified upon a breach of any of your secured health information.

Amend: If you feel that health 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.

We may deny your request for an amendment and if this occurs, you will be notified of the reason for the denial.

An accounting of disclosures: You have the right to request an accounting of disclosures. This is a list of certain disclosures we make of your health information for purposes other than treatment, payment or health care operations where an authorization was not required.

Request restrictions: You have the right to request a restriction or limitation on the health 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 health information we disclose about you to someone who is involved in your care or the payment of your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had.

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.

Out of pocket payments: If you paid out-of –pocket (request to not bill your insurance) in full for a specific item or service, you have the right to ask that your health information related to the item or service not be disclosed to your insurance for purposes of payment or health care operations.

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 may ask that we contact you at work instead of your home. The facility will grant reasonable requests for confidential communications at alternative locations and/or via alternative means only if the request is submitted in writing and the written request includes a mailing address where the individual will receive bills for services rendered by the facility and related correspondence regarding payment for services. Please realize, we reserve the right to contact you by other means and at other locations if you fail to respond to any communication from us that requires a response. We will notify you in accordance with your original request prior to attempting to contact you by other means or at another location.

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. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.

If the facility has a website, you may print or view a copy of the notice by clicking on the Notice of Privacy Practices link.

To exercise any of your rights, please obtain the required forms from the facility privacy official and submit your request in writing.

CHANGES TO THIS NOTICE

We reserve the right to change this notice and the revised or changed notice will be effective for information we already have about you as well as any information we recive in the future. The current notice will be posted in the hospital and include 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 by following the process

outlined in the facility’s Patient Rights documentation. You may also file a complaint with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing.

You will not be penalized for filing a complaint.

WRITTEN AUTHORIZATION REQUIRED BY YOU FOR OTHER USES OF HEALTH INFORMATION

The following uses and disclosures of your health information will be made only with your written authorization:

  • Most uses and disclosures of psychotherapy notes
  • Uses and disclosures of health information for marketing purpose
  • Disclosures that constitute a sale of your health information

Other uses and disclosures of health 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 health 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 health 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.

FACILITY PRIVACY OFFICIAL

Jennifer Lee, Health Information Management
Capital Medical Center
3900 Capital Mall Drive SW Olympia, WA 98502
360-704-4715

 

PRINTABLE VERSION