Privacy Statement (English) - Faith Regional Health Services

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED, DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

If you have any questions about this Notice, please contact the Privacy Officer at Faith Regional Health Services, (402) 644-7574.

Who will follow this notice:
This notice describes Faith Regional Health Services’ practices and that of:

Any health care professional authorized to enter information into your hospital chart.
All departments and units of the hospital.
All members of the medical staff and their office staff.
All allied health licensed professionals and their office staff.
Any member of a volunteer group or health care students we allow to help you while you are receiving care from this hospital.
Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your medical information created in the doctor’s office or clinic.
All employees, staff and other hospital personnel.
All of these entities, sites and locations follow the terms of this notice. In addition, these entities, sites and locations may share medical information with each other for treatment, payment or health care operations purposes described in this Notice: Faith Regional Health Services, Saint Joseph’s Rehabilitation and Care Center, Faith Regional Health Services Home Health, Skyview Villa Assisted Living, Faith Regional Health Services Dialysis, Faith Regional CardioVascular Institute, Faith Regional Carson Cancer Center, Faith Regional Health Services Medical Staff.

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. This Notice of Privacy Practices will tell you the ways in which we may use and disclose medical information about you. It also describes your rights and certain obligations we have regarding the use and disclosure of your medical information.

We create a record of the care and services you receive at the hospital. We need this record so that we can provide you with quality care and 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. Your personal doctor may have different policies or notices regarding the doctor’s office or clinic.

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.
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 we use and disclose medical information. For each category of uses and disclosures, we will explain what we mean and give some examples. Not every category will be listed. All of the ways we are permitted to use and disclose information will fall within one of the identified categories:

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 hospital personnel who are involved in taking care of you at the hospital. Different departments of the hospital also may share medical information about you in order to coordinate the care 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, or other information used to provide services that are part of your care.
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. For example, we may need to give 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 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.
For Healthcare Operations. We may use and disclose medical information about you for hospital operations. These uses and disclosures are necessary to run the hospital and to 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 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 remove identifiable information from this set of medical information so others may use it to study health care delivery without learning who the specific patient is.
Business Associates. Some services of our organization are provided through contractual arrangements with business associates. These include radiology, certain laboratory services, supplemental staffing, transcription and data management. When services are provided by a business associate, we may disclose your health information to our business associate so that they can perform the job we have asked them to do and bill you or your insurance company for those services. In addition, we may disclose your health information to accrediting agencies and certain outside consultants. Our business associates must use appropriate safeguards to protect your health information.
Appointment Reminders. We may contact you to remind you of appointments for diagnostic testing or treatment or other health-related benefits and services that my be of interest to you, including educational opportunities.
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 Benefits and Services. We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
Fundraising Activities. We may use medical information about you to contact you in an effort to raise money for the hospital and its operations. We may disclose medical information to a foundation related to the hospital so that the foundation may contact you in raising money for the hospital. We would only release contact information, such as your name, address, phone number and the dates you received treatment or services at the hospital. If you do not want the hospital to contact you for fundraising efforts, you must notify Faith Regional Health Services Foundation in writing.
Hospital Directory. We will include certain limited information about you in the hospital directory while you are a patient. This information may include your name, location in the hospital, and your religious affiliation, and may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, even if they don’t ask for you by name. This is so your family, friends and clergy can visit you in the hospital and generally know how you are doing.
Individuals Involved in Your Care or Payment for Your Care. We may release health information about you to a friend, family member or any other person identified by you as being involved in your health care or who is involved in payment for your care. In addition, we may disclose medical information about you to an entity assisting in a disaster relief 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 Advert a Serious Threat to Health or Safety. We may use or disclose medical information about you when necessary to prevent a serious threat to your health and safety, or to 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. Consistent with applicable law, we may disclose your health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs for the purpose of tissue donation and transplant.

Specialized Governmental Functions. We may disclose your health information for military and veterans activities, national security and intelligence activities, and similar special governmental functions as required or permitted by law.

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 health information about you for public health activities. These activities generally include :

To prevent or control disease, injury, or disability.
To report births or deaths.
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 suspect a patient has been the victim of abuse, neglect or domestic violence. We will make this disclosure when required or authorized by law.

Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities may include, 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 law.

Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose protected health information about you in response to a court or administrative order. We may also disclose health 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 or to obtain an order protecting the information requested.

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

Response to a court order, subpoena, warrant, summons or similar process.
Identify or locate a suspect, fugitive, material witness or missing person.
Inquiries as to the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement.
Inquiries as to a death we believe may be the result of criminal conduct.
Inquiries as to criminal conduct at the hospital.
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 to 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, counterintelligence and other national security activities authorized by law.

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

Inmates. We may release health information to a correctional institution or law enforcement official about persons who are inmates of a correctional institution or under the custody of a law enforcement official. This release would be necessary (1) for the institution to provide health care; (2) to protect the health and safety of the inmate and others; or (3) for the safety and security of the correctional institution.

Research. We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information. In addition, we may disclose information to researchers in preparation for research.

Food and Drug Administration (FDA). We may disclose to the FDA your health information relating to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs or replacement.

Marketing. We may use your information to provide you with information regarding a health-related product or service provided by Faith Regional Health Services or affiliates of Faith Regional Health Services, or information regarding your treatment or care, such as appointment reminders or information about treatment alternatives. In addition, your health information may be used in face-to-face encounters or to provide you with gifts of nominal value.

Other uses of Medical Information. Other uses and disclosures of health information not covered by this Notice or by the laws that apply to us will be made only with your written authorization. If you provide us written authorization to use or disclose health information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose health information 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 authorization and that we are required to retain records of the care provided.

ORGANIZED HEALTH CARE ARRANGEMENT
Faith Regional Health Services and its medical staff must be able to share protected health information freely for treatment, payment and health care operations. Therefore, Faith Regional Health Services and all eligible providers on the Hospital’s Medical Staff have entered into an “organized health care arrangement” or OHCA. Under the OHCA, Faith Regional Health Services and the eligible providers will:

Use a joint notice of privacy practices (this Notice) for all inpatient and outpatient visits.
Obtain a single signed acknowledgement of receipt.
Share protected health information from inpatient and outpatient hospital visits with eligible providers so that they can help the Hospital with its health care operations.
Follow the privacy and information practices described in this Notice. Each OHCA participant is individually responsible to follow the practices in this Notice.

THIS NOTICE SERVES AS THE JOINT NOTICE OF PRIVACY PRACTICES OF THE ORGANIZED HEALTH CARE ARRANGEMENT FOR Faith Regional Health Services AND Faith Regional Health Services medical staff.

Who is included? The participants in each OHCA include Faith Regional Health Services and all eligible providers on its Medical Staff. Eligible providers are providers who are themselves covered health care providers under HIPAA.

What sites are included? Each OHCA covers only Faith Regional Health Services, Saint Joseph’s Rehabilitation and Care Center, Faith Regional Health Services Home Health, Faith Regional Health Services Dialysis, Faith Regional CardioVascular Institute, Faith Regional Carson Cancer Center, Skyview Villa Assisted Living and other Ancillary service sites. The OHCA does not cover the private offices of the providers, or their information practices there or at other practice locations.

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 decisions about your care. Usually this includes medical and billing records, but does not include psychotherapy notes.

To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the Medical Records Director. 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 Medical Records Director. 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, 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 or for the hospital.
Is not part of the information that you would be permitted to inspect and copy.
Is accurate and complete.

We will respond within 60 days of receiving your request.

Right to an Accounting of Disclosures. You have the right to request a list of the disclosures we have made of your protected health information for other than treatment, payment and health care operations, or as described in this Notice. To request this list or accounting of disclosure, you must submit your request in writing to the Medical Records Director. 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 12-month period will be free. For additional lists, 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 Request Restrictions. You have the right to request a restriction or 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.

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 with emergency treatment.

To request a restriction, you must make your request in writing to the Medical Records Director. 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 Medical Records Director. We will not ask you the reason for your request and we will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted. We must agree to your written request so long as we can easily provide it in the format you requested.

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

You may obtain a copy of this notice at our website, www.frhs.org. To obtain a paper copy of this notice, contact the Privacy Officer at Faith Regional Health Services.

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 and on our web site. The notice will contain on the first page, on 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 Privacy Officer at Faith Regional Health Services or with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized or otherwise retaliated against for filing a complaint.

Hay declaraciones de privacidad traducidos al español disponibles aquí.
Privacy Statement: Spanish Translation Available Here