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Effective February 1, 2009
Stephens Memorial Hospital
Notice of Health
Information Privacy Practices
THIS
NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE
USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS
INFORMATION. PLEASE REVIEW IT CAREFULLY.
If you
have any questions about this notice, please speak to
the person who issued it to you or contact the Privacy
Office, c/o Medical Records, 181 Main Street, Norway,
ME 04268 Phone number: 207-743-1562 ext 452.
YOUR
HEALTH INFORMATION
Each
time you visit a hospital, doctor or other health care
staff, a record of your visit is made that contains your
symptoms, test results, diagnoses, treatment, and a plan
for care. This is your health or medical record
and is the basis of the care we provide.
It:
Helps
us plan your care and treatment.
Helps the many
health care staff communicate with each
other.
Serves as a legal document describing
the care you received.
Is a means by which you or a
third-party payer can confirm that services billed
were provided.
Is a tool for teaching health care
staff
Is a source of data for medical
research.
Is information for public health
officials charged with improving the health of the
nation.
Helps with facility planning and
marketing.
Is a tool we can use to improve the care
we give.
The
confidentiality of the personal health information, on
your record is protected by State and Federal law. If
you know how we use and disclose your health
information you can:
Understand the importance of giving us
information
Understand who, what, when, where, and
why staff and others access your health information,
and
Decide when others may release your health
information.
WHO
WILL FOLLOW THIS NOTICE
This
notice applies to Western Maine Health Care (WMHCC)
and:
Doctors and group medical practices that treat
you while a WMHCC patient
Physician assistants,
nurse practioners, nurses, technicians, social workers
and other health care providers that treat you while a
WMHCC patient
WMHCC employees and
volunteers.
OUR
PLEDGE REGARDING MEDICAL INFORMATION
We know
that medical information about you and your health is
personal. We are charged with protecting your
health information. We create a record of the care
and services you receive at WMHCC. We need this
record to provide you with quality care and to comply
with certain laws. This notice applies to all the
records of your care developed by WMHCC, whether made by
WMHCC staff or your doctor. Your doctor may have
other policies or notices about the doctor's use and
release of your health information created in the
doctor's office or clinic.
This
notice will tell you about the ways in which we may use
and disclose health information about you. We also
describe your rights and certain duties we have with the
use and release of health
information.
YOUR
HEALTH INFORMATION RIGHTS
Although your physical health record belongs to
WMHCC, the information in your record belongs to
you. Under the Federal Privacy Rules, you have the
right to:
Receive notice of the uses and releases we
expect to make of your health information.
Ask for
added limits on uses and releases of your health
information (though we are not required to agree to
any such requests), or request that we send you
private communications to other places.
Inspect and
obtain a copy of your health record.
Request that
your health record be changed.
Obtain a list of
releases of your health information made after April
14, 2003 for a purpose other than treatment, payment,
or health care
operations.
Please
direct requests to: Privacy Officer, c/o Medical Records
Department, 207-743-1562 x 452
OUR
RESPONSIBILITIES
We
are required by the Federal Privacy Rules
to:
Maintain the privacy of your health
information
Provide you with this Notice that tells
you our legal duties and privacy practices about the
health information we collect and maintain about
you.
Agree to the terms of this Notice, subject to
the following:
We
reserve the right to change our health information
practices and the terms of this notice. Should
our health information practices change, we will
post and/or provide a revised notice. We will
not use or disclose your health information without
your consent or permission, except as described in
this
notice.
HOW WE
MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT
YOU
Listed
below are the ways that we use and disclose health
information. For each use or release we will
explain what we mean and give some examples. Not
every use or release is listed but all of the ways we
can use and disclose information will fall within one of
these areas.
» For Treatment: We may use health
information about you to provide you with medical
treatment or services. We may disclose health
information about you to doctors, nurses, health care
students, or other WMHCC staff who are involved in
taking care of you. 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. The doctor may also need to tell food
service staff so that you are served the right
meals. Other departments may also share health
information about you in order to arrange for the
things you need, such as medicines, lab work, and
x-rays. We also may disclose health information
about you to people outside WMHCC who may be involved
in your care after you leave the hospital, such as
family, your physician, clergy, or others that provide
services as part of your care.
» For Payment: We may use and release
health information about you to obtain payment for our
services. 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 tell your
health plan if we need approval from your health plan
before you can be treated, or to find out if the
treatment will be covered by the plan.
» For Health Care Operations: We may use
and disclose health information about you for hospital
actions. These uses and releases are needed to
run WMHCC and make sure that all of our patients
receive quality care. For example, we may use health
information to review our treatment and services and
to evaluate our staff that are taking care of
you. We may also combine health information
about many patients to decide what other services
WMHCC should offer, what services are not needed, and
whether certain new treatments are effective. We
may disclose information to doctors, nurses, students,
and other hospital staff for review and teaching
reasons. We may combine health information we
have with health information from other hospitals to
compare how we are doing and see where we can make
changes to improve the care and services we
offer. We may remove information that identifies
you from this set of health information so that others
may use it to study health care and health care
delivery without learning specific patient's
information.
» Treatment Alternatives We may use and
disclose health information to tell you about or
suggest treatment options or alternatives that may be
of interest to you.
» Ambulatory Electronic Medical
Records Your medical records also will be
shared with area physician practices participating in
the MaineHealth Ambulatory Electronic Medical Record
Program to ensure continuity of care, allow access to
information about your healthcare in remote areas,
promote quality of care improvement by way of greater
access to data, reduction in costs achieved either
through efficiency and productivity gains or avoidance
of redundant provider services, and improved patient
experience with the system.
» HealthInfoNet (HIN) We
participate in a regional arrangement of health care
organizations who have agreed to work with each other
to make available electronic health information that
may be relevant to your care. For example, if
you are admitted to a hospital on an emergency basis
and cannot provide important information about your
health condition, this regional arrangement will help
those who need to treat you at the hospital to see
your health information held by another participating
provider. When it is needed, ready access to
your health information means better care for
you. We also participate in a state-wide
arrangement of health care organizations who have
agreed to work with each other to make available
electronic health information that may be relevant to
your care. For example, if you are admitted to a
non-MaineHealth-affiliated hospital on an emergency
basis and cannot provide information about your health
condition, this state-wide arrangement will help those
who need to treat you at the hospital to see your
health information held by a MaineHealth-affiliated
hospital. When it is needed, ready access to
your health information means better care for
you. You may choose to not make your protected
health information available to this state-wide
arrangement by completing the paperwork provided to
you during the registration process and sending it to
Health Info Network (HIN) at the designated
address. You do not need to do anything to
participate. Your health care provider will send
the overview of your health information to HIN.
If you choose not to participate you need to fill out
a form that lets HIN know that you do not want to
participate. If you choose not to participate,
HIN will delete all health information about you that
it has in its system at that time. If you chose
not to participate, HIN will continue to maintain
basic demographic information about you so that it can
honor your choice not to participate. You can change
your mind about participating in HIN's system at any
time by filling out a form that your health care
provider has, calling HIN toll free (#866-592-4352) or
by going to the website www.hinfonet.org and making
your wishes known.
The
risks of participating in the HIN include the
possibility that an unauthorized person might access
HIN's record. It is also possible that
inaccurate information might be included accidentally in
HIN's record which could lead to mistakes about
diagnoses and medication. Another risk is the
potential reference to a medical condition you consider
sensitive (such as references to sexually transmitted
diseases, mental health issues, pregnancy, HIV status,
chronic conditions, alcohol or drug conditions, or
another condition you consider sensitive.
» Health Related
Benefits and Services We may use and disclose health
information to tell you about health-related benefits
or services that may be of interest to you.
»Stephens Memorial Hospital
Directory We may include certain information
about you in the hospital directory while you are a
patient at the hospital. This information may include
your name, location in the hospital, your general
condition (e.g, fair, stable, etc.) and your
religion. The directory information, except for
your religion, may also be released to people who ask
for you by name. Your religion may be given to a
member of the clergy, such as a priest, minister or
rabbi, even if they don't ask for you by name.
This is so your family, friends and clergy can visit
you and know in a general way, how you are doing. You
may choose not to be listed in the hospital directory
but that would mean that you may not be able to
receive visitors or telephone calls.
» Fundraising
Communications: We may use certain information (name,
address, telephone number, date of service, age and
gender) to contact you in the future to raise money
for WMHCC. The money raised will be used to
expand and improve the services and programs that we
provide the community. If you do not wish to be
contacted for our fundraising efforts, you must notify
Stephens Memorial Hospital Development Office, 181
Main Street, Norway, Maine 04268, phone 743-1562 ext
777.
» Individuals Involved
in Your Care or Payment for Your Care We may
release health information about you to a friend or
family member who is involved in your care. We
may also give information to someone who helps pay for
your care. We may also tell your family and
friends your condition and that you are in the
hospital. We may disclose health
information about you to an agency assisting in a
disaster relief effort so that your family can be
notified about your condition, status and
location. Please let a staff person or your
doctor know if you would not like us to release
information to a family member or friend.
» As Required By
Law We will disclose health 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
health information about you when needed to prevent a
threat to your health and safety or the health and
safety of the public or another person. Any
release would only be to someone able to help prevent
or reduce the threat.
SPECIAL SITUATIONS
» Organ and Tissue
Donation If you are an organ donor, we must
release health information to agencies that procure
organs, eyes or tissues for transplantation or
donation.
» Military and
Veterans If you are a member of the armed
forces, we may release health information about you as
required by the military. We may also release
health information about foreign military staff to the
appropriate foreign military agency.
»Workers'
Compensation We may release health information
about you for workers' compensation or similar
programs. These programs provide benefits for
work-related injuries or illness.
»Public Health Risks
We may disclose health information about you for
public health reasons. They include the
following:
To prevent or control
disease, injury or disability;
To report births
and deaths;
To report child abuse or
neglect;
To report reactions to medications or
problems with products;
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 a state agency if we believe
a patient has been a victim of abuse, neglect or
domestic violence. We will only make this
release if you agree or when required by law.
» Health Oversight We
may disclose health information to a health oversight
agency for actions required by law. Actions may
include, for example, audits, investigations,
inspections, and licensure. These actions are
needed for the government to monitor the healthcare
system, programs, and compliance with civil rights
laws.
» Lawsuits and
Disputes If you are involved in a lawsuit or
dispute, we may disclose health information about you
in response to a court 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 health 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 circumstances, we are unable to
obtain the person's agreement;
About a death we
believe may be the result of a crime;
About
a crime conducted at the hospital; and
In an
emergency to report a crime; the location of a crime
or victims; or the identity, description or location
of the person who committed the
crime.
»Medical Examiners and
Funeral Directors We may release health
information to a medical examiner. This may be
required, for example, to identify a deceased person
or decide the cause of death. We may also
disclose health information about patients to funeral
directors as needed to carry out their
duties.
» National Security
and Intelligence Activities We may release health
information about you to federal officials such as the
FBI or CIA or any other national securities activities
authorized by law.
» Protective Services
for the President and Others We may release health
information about you to federal officials so they may
protect the President, other persons or foreign heads
of state or conduct special investigations.
» Inmates If you are
an inmate of a state or local prison or under the
custody of a law enforcement official, we may release
health information about you to the facility or law
enforcement official. This release would be
necessary (1) to provide you with health care; (2) to
protect your health and safety; or (3) for the safety
and security of the facility.
YOUR RIGHTS REGARDING HEALTH
INFORMATION ABOUT YOU
You have the following rights
about the health information we maintain about
you.
»Right to Inspect and
Copy You have the right to inspect and copy
health information that may be used to make decisions
about your care. This includes health and
billing records.
To inspect and copy
health information that may be used to make
decisions about you, you must submit your request in
writing to the Department of Medical Records.
If you request a copy of the information, we may
charge a fee for the costs of copying, mailing or
other supplies needed to support your request.
We may deny your
request to inspect and copy in certain very limited
circumstances. In these circumstances, we will allow
you to designate in writing another person to
inspect and copy your medical record. If
you are denied access to a non-medical record, you
may request that the denial be reviewed. We
will choose a health care person to review your
request and the denial. This person will be
different from the person who denied your initial
request. We will comply with the decision of
the reviewing person.
»Right to Change (Amend) If
you feel that health information we have about you is
incorrect or incomplete, you may ask us to change
(amend) the information. You have the right to
request a change for as long as the information is
kept by or for WMHCC
To request a change, your
request must be made in writing and be sent to the
Director of Medical Records. You must also
provide a reason that supports your
request.
If you request a change
to your treatment record, we will include your
written changes as part of the medical record.
We may add to the record a response, and will
provide you a copy of our response.
If you request a change
to a non-treatment record, we may deny your request
if it is not in writing or does not include a reason
to support the request. 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 health
information kept by or for the hospital;
Is
not part of the information which you would be
allowed to inspect and copy; or
Is accurate
and
complete.
» Right to an
Accounting of Disclosures You have the right to
request an "accounting of disclosures." This is
a list of releases we made of medical information
about you that are not for treatment, payment, or
operations and have not already been authorized by
you.
To request this list or
accounting of disclosures you must submit your
request in writing to Privacy Officer c/o Medical
Records Department. Your request must state a
time period, which may not be longer that 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 limit on
the health information we use or disclose about you
for treatment, payment or health care operations.
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 restrictions,
you must make your request in writing to the Privacy
Officer c/o Medical Records Department. In
your request, you must tell us (1) what information
you want to limit; (2) whether you want to limit our
use, release or both; and (3) to whom you want the
limits to apply, for example, releases 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 in a certain
location. For example, you can ask that we only
contact you at work or by mail.
To request confidential
communication, you must make your request in writing
to the Privacy Officer c/o Medical Records
Department, 181 Main Street, Norway, ME,
04268.
We will not ask you the
reason for your request. We will support all
reasonable requests. Your request must specify
how or where you wish to be
contacted.
» Rights Related to
Alcohol and Drug Abuse Records Federal law
protects the confidentiality of alcohol and drug abuse
patient records maintained by WMHCC. WMHCC may
not tell anyone not a part of WMHCC or release any
information identifying a patient as an alcohol and
drug abuser, unless:
1. The patient authorizes
this in writing; or
2. The release is allowed
by a court order; or
3. The release is made to
WMHCC staff involved in a medical emergency or to
qualified personal for research, audit or program
evaluation.
Violation of Federal law
dealing with alcohol and drug abuse patient records
is a crime and suspected violations may be reported
to appropriate authorities in accordance with
Federal regulations. (See 42 U.S.C. 290dd-3,
42 U.S.C. 290ee-3 and 42 C.F.R. part
2).
CHANGES TO THIS
NOTICE
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We reserve the right to
change this notice at any time. We reserve the
right to make the revised or changed notice effective
for health 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 WMHCC. 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
out patient, you may request a copy of the current
notice in effect.
COMPLAINTS
If you believe your privacy
rights have been violated, you may file a complaint with
WMHCC or with the Secretary of the Department of Health
and Human Services. To file a complaint with
WMHCC, contact the Privacy Officer c/o Medical Records,
181 Main Street, Norway ME 04268, 207-743-1562 ext
452.
All complaints must be submitted in writing.
You will not be penalized for filing a
complaint.
OTHER USES OF THE HEALTH
INFORMATION
Other uses and releases of health
information not covered by this Notice or the laws that
apply to us will be made only with your written
authorization. If you allow us to use or disclose
health information about you, you may revoke that
authorization at any time except to the extent WMHCC has
already taken action on your authorization. In that
case, 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 releases we have already made
with your consent, and that we are required to retain
our records of the care that we provided to
you.
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