Effective April 14, 2003
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 READ IT CAREFULLY.
OUR DUTIES
Harrison County Hospital’s (HCH) goal is to take appropriate steps to
attempt to safeguard any medical or other personal information that is provided
to us. We are required by law to:
1. Maintain the privacy of medical and financial information provided to us
that reasonably identifies HCH patients to their conditions;
2. Provide notice of our legal duties and privacy practices; and
3. Abide by the terms of our notice of Privacy Practices currently in effect.
WHO WILL FOLLOW THIS NOTICE
The practices described in this notice apply to the following persons or groups
of person:
1. All HCH personnel and students in training;
2. Any health care professional authorized to enter information into, or obtain
information from, your HCH record;
3. Any volunteer or member of a volunteer group that assists you while you
are at HCH.
HCH and those listed above may share information with each other for treatment,
payment or health care operations as described in this notice.
INFORMATION COLLECTED ABOUT YOU
In the ordinary course of receiving treatment and health care services from
HCH, you will be providing HCH with personal information such as:
1. Your name, address, and phone number;
2. Information relating to your medical history;
3. Your insurance information and coverage;
4. Information concerning your doctor, nurse or other medical providers.
In addition, HCH will gather certain medical information about you and will
create a record of the care provided to you by HCH and, in many cases, care
provided to you by other health care entities. Other individuals or organizations
that are part of your "circle of care" may also provide some information
to HCH. For example, a referring physician, your other doctors, your health
plan, and family members or close friends may provide information to HCH.
With some exceptions, medical or financial information collected or maintained
by HCH that reasonably identifies you to your condition must be protected
by HCH (such protected information will be referred to in this document as
"Health Information").
USE AND DISCLOURE OF HEALTH INFORMATION
I. How HCH May Use Your Health Information.
A. Treatment: HCH will use or disclose your health information as necessary
for HCH and other health care providers to provide you with medical care.
For example: HCH will use your medical history, such as the presence or absence
of heart disease, to assess your health and perform requested diagnostic services.
HCH may also disclose your health information to those other doctors, nurses,
therapist’s, or other health care providers not affiliated with HCH who
are providing you with medical care.
B. Payment: HCH will use and disclose your health information to obtain payment
for services provided to you by HCH and as necessary to assist other healthcare
providers, health plans and health care clearinghouses in obtaining payment
for health care services provided to you. For example: When you register for
service, HCH will use your information to verify that you have insurance coverage.
After you have received service, a bill identifying you, your diagnosis and
the procedures performed will be sent to your insurer or to you. Any bill
sent to you will be sent by regular mail at your home address as listed in
HCH’s records. HCH may also send your contact information to collections
agencies if your payment is overdue.
C. Health care operations: HCH may use and disclose your health information
for HCH’s health care operations or for limited types of health care
operations of other health care providers, health care plans and clearinghouses.
For example: HCH sometimes arranges for accreditation organizations, auditors
or other consultants to review HCH’s practice, evaluate operations, and
tell HCH how to improve its services. As part of that review process, HCH
may disclose your health information to said consultants.
D. Appointment reminders: HCH may use and disclose health information to contact
you as a reminder that you have an appointment or that you should schedule
an appointment.
E. Treatment alternatives, benefits and services: HCH may disclose your health
information to tell you about possible options or alternatives, health related
benefits or other services that may be of interest to you or to recommend
possible treatment options or alternatives that may be of interest to you.
F. Individuals involved in your care or payment for your care: Unless you
object, HCH may discuss your health care with members of your family, close
friends or other individuals you identify who may be involved in your care
or the payment for your care. If you have a mental health diagnosis, no information
about you will be shared with your family, friends or others identified by
you without your explicit written permission.
G. Research: HCH may use or disclose certain health information about your
condition and treatment for research purposes where an institutional review
board or similar body referred to as a privacy board determines that your
privacy interests will be adequately protected in the study. HCH may also
use and disclose your health information to prepare or analyze a research
protocol and for other research purposes.
H. HCH business associates: HCH sometimes works with outside individuals and
businesses that help HCH operate its business successfully. HCH may disclose
your health information to these business associates so that they can perform
the tasks that HCH hires them to do. HCH business associates must guarantee
that they will respect and protect the confidentiality of your health information.
II. How HCH Is Required By Law To Disclose Your Health Information.
A. Required by law: HCH may disclose health information about you when HCH
is required to do so by federal, state, or local law.
B. Public health activities: HCH may disclose health information about you
in connection with certain public health reporting activities. For instance,
HCH may disclose Health Information to a public health authority authorized
to collect or receive PHI for the purpose of preventing or controlling disease,
injury or disability, or at the direction of a public health authority, to
an official of a foreign government agency that is acting in collaboration
with a public health authority. Public health authorities include, but are
not limited to, state health departments, the Center for Disease Control,
the Food and Drug Administration, the Occupational Safety and Health Administration
and the Environmental Protection Agency.
C. Abuse and neglect: HCH is also permitted to disclose health information
to a public health authority or other government authority authorized by law
to receive reports of child abuse or neglect. HCH may also disclose your health
information in situations of domestic abuse or elder abuse.
D. FDA reports: HCH may disclose your health information if you are a person
subject to the Food and Drug Administration’s power for the following
activities: to report adverse events, product defects or problems, or biological
product deviations, to track products, to enable product recalls, repairs
or replacements, or to conduct post marketing surveillance.
E. Health care oversight activities: HCH may disclose your health information
in connection with certain health oversight activities of licensing and other
agencies. Health oversight activities include, but are not limited to, audit;
investigation; licensure or disciplinary actions; civil, criminal, or administrative
proceedings, or actions; or any other activity necessary for the oversight
of 1) the health care system, 2) governmental benefit programs for which health
information is relevant in determining beneficiary eligibility, 3) entities
subject to governmental regulatory programs for which health information is
necessary for determining compliance with program standards, or 4) entities
subject to civil rights laws for which health information is necessary for
determining compliance.
F. Threat to health and safety: Health information also will be disclosed
when necessary to prevent a serious threat to your health and safety or the
health and safety of others.
G. Legal actions and law enforcement: HCH may disclose health information
in response to a warrant, subpoena, or other order of a court or administrative
hearing body, and in connection with certain government investigations and
law enforcement activities.
H. National security and intelligence: HCH may disclose health information
for national security and intelligence activities and for the provision of
protective services to the president of the United States and other officials
or foreign heads of state.
III. Special Circumstances Requiring Disclosure Of Your Health Information
A. Coroners, medical examiners and funeral directors: HCH may release health
information to a coroner, medical examiner and/or funeral director to assist
in identifying a deceased person, determining the cause of death, or to otherwise
allow them to carry out their duties.
B. Organ and tissue procurement. HCH also may release health information to
organ procurement organizations, transplant centers, and eye or tissue banks.
C. Workers’ compensation and other employee benefit programs: HCH may
release health information to workers’ compensation or similar programs.
D. Military: If you are a member of the armed forces, HCH may release health
information about you as required by military command authorities. HCH also
may release health information about foreign military personnel to the appropriate
foreign military authority.
E. Litigation: HCH may disclose your health information for legal or administrative
proceedings that involve you. HCH may release such information upon order
of a court or administrative tribunal. HCH may also release health information
in the absence of such an order and in response to a discovery or other lawful
request, if efforts have been made to notify you or secure a protective order.
F. Inmates: If you are an inmate, HCH may release health information about
you to a correctional institution where you are incarcerated or to law enforcement
officials.
OTHER USES AND DISCLOSURE OF HEALTH INFORMATION
HCH is required to obtain written authorization from you for any uses and
disclosures of health information other than those described above. If you
provided HCH with such permission, you may revoke that permission, in writing,
at any time. If you revoke your permission, HCH will no longer use or disclose
personal information about you for the reasons covered by your written authorization.
HCH cannot be held responsible for valid disclosures of health information
made under an effective authorization prior to your revocation of that authorization.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
Right to request restrictions: You have the right to ask for restrictions
on the ways in which HCH uses and disclose your health information beyond
those imposed by law. HCH will consider your request, but is not required
to accept it.
Right to request alternative delivery of information: You have the right to
request that you receive communications containing your health information
from HCH by alternative means or at alternative locations. For example, you
may ask that we only contact you at home or by mail. HCH is not required to
accept any such requests that are unreasonable.
Right to inspect and copy: Except under certain circumstances, you have the
right to inspect and copy medical and billing records used to make decisions
about your care. If you ask for copies of this information, HCH may charge
you a fee for copying and mailing. Under some circumstances, if HCH denies
your request to inspect your records, you may request in writing that the
denial be reviewed.
Right to amend information: If you believe that information in your records
is incorrect or incomplete, you have the right to request, in writing, that
HCH correct the existing information or correct the missing information. Under
certain circumstances, we may deny your request.
Right to an accounting of disclosures: You have a right to ask for a list
of certain instances when HCH has used or disclosed your health information
for reasons other than your treatment (by HCH or other health care providers),
payment for services furnished to you (by HCH or other health care providers),
HCH health care operations, certain health care operations of other entities
or disclosures you give us authorization to make. The first list requested
in any 12-month period will be free. If you ask for this information from
us more than once every twelve months, we may charge you a fee.
To exercise any of your rights, please contact HCH in writing at:
Harrison County Hospital
C/O Lisa Mortenson, Privacy Officer
1141 Hospital Drive NW
Corydon, IN 47112
812-738-7884
CHANGES TO THIS NOTICE
HCH reserves the right to make changes to this notice at any time. HCH reserves
the right to make the revised notice effective for health information HCH
has about you as well as any information HCH receives in the future. In the
event this authorization is revised, a copy of the revised version will be
supplied to you upon your first visit after the effective date of the new
version. A copy of the new version will also be posted in a public area of
each of HCH’s locations, on HCH’s website, if any, and in hard copy
from any of HCH’s locations. In addition, you may request a copy of the
revised notice at any time.
COMPLAINTS/COMMENTS
If you have any complaints concerning our privacy policy, you may contact
our Privacy Officer by phone at 812-738-7884. A complaint can also be made
in writing and placed in the drop box at the hospital Financial Counselor's
office or mailed to Harrison County Hospital c/o Lisa Mortensen, 1141 Hospital Drive NW, Corydon, IN 47112. You also may contact the Secretary of the Department
of Health and Human Services at 200 Independence Avenue, S.W., Room 509F,
HHH Building, Washington D.C., 20201 (e-mail: ocrmail@hhs.gov).
HCH also maintains a complaint hotline through the law offices of Hall, Render,
Killian, Heath & Lyman. Complaints can be made anonymously to the hotline
at 1-800-808-3198. HCH is prohibited from interfering with your right to file
a complaint regarding HCH privacy practices and cannot retaliate against you
in any way based on your filing of such complaint. To obtain more information
concerning this Notice of Privacy Practices, you may contact HCH’s Privacy
Officer, at the address listed above.
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