NOTICE OF PRIVACY PRACTICES FOR BROWNSVILLE GENERAL HOSPITAL
Effective Date: 5/1/2003
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.
If you have any questions about this notice, please contact:
The Privacy Officer at Brownsville General Hospital at 724.785.1757.
WHO WILL FOLLOW THIS NOTICE.
Brownsville General Hospital (the "Hospital") understands that medical information and other information about you and your health is personal and is committed to ensuring the privacy of your protected health information. This Notice, describes how medical information about you may be used and disclosed by the Hospital and how you may access this information. Protected health information is defined in the Privacy Regulations of the Health Insurance Portability and Accountability Act ("HIPAA") of 1996. Protected health information is your individually identifiable health information that relates to your past, present or future health, treatment or payment for health care services.
We create a record of the care and services you receive at the Hospital that includes your protected health information. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by the Hospital, whether made by personnel of the Hospital or your personal physician. Your personal physician may have different policies or notices regarding the physician's use and disclosure of your medical information created in the physician's office or clinic.
PURPOSE OF THIS NOTICE
This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
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; and
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 that we use and disclose medical information. For these categories of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category is listed.
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 the Physicians, nurses, technicians, medical students, or other personnel at the Hospital who are involved in taking care of you at the Hospital. For example, a physician treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the physician may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments of the Hospital also may share medical information about you in order to coordinate the different things 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, such as family members, clergy or others we use 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 Health Care Operations. We may use and disclose medical information about you for operations at the Hospital. These uses and disclosures are necessary to run the Hospital and 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 medical information about many patients at the Hospital to decide what additional services the Hospital should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to the Physicians, nurses, technicians, medical students, and other personnel at the Hospital for review and learning purposes. 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 may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific patients are.
Hospital Directory. We may include certain limited information about you in the Hospital's directories 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 religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, 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. You have the right to restrict or prohibit some or all uses or disclosures of your medical information for purposes of the Hospital's directories.
OTHER WAYS WE MAY GENERALLY USE YOUR MEDICAL INFORMATION.
To remind you that you have an appointment for medical care;
To tell you about possible treatment alternatives;
To tell you about health-related benefits or services;
To contact you as part of fundraising efforts for the Hospital and their operations, unless you inform us that you do not wish to be contacted for such purposes; or
To tell friends or family members who are involved in your medical care or who help pay for your care or to inform an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
SPECIAL SITUATIONS WHEN WE MAY USE AND/OR DISCLOSE YOUR MEDICAL INFORMATION TO OTHER INDIVIDUALS OR ENTITIES.
To comply with applicable law when such law requires disclosure of certain health information;
To comply with requests from law enforcement officials (including subpoenas and court orders);
To inform organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation;
To comply with Food and Drug Administration requirements for tracking medical devices;
To comply with military command authorities if you are a member of the armed forces;
To comply with laws regarding workers' compensation or similar benefit programs for work related injuries;
To inform Funeral Directors, Coroners or Medical Examiners for purposes consistent with applicable law;
To prevent a serious threat to your health and safety or the health and safety of the public or another person;
For research purposes 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;
For public health activities including the prevention or control of disease, the reporting of births and deaths, the reporting of abuse or neglect, and the reporting of reactions to medications or problems with products;
To inform health oversight agencies for activities authorized by law including audits, investigations, inspections and licensure;
For purposes of national security when required by authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law or for protection of the President of the United States of America; and
To business associates we have contracted with to perform services on our behalf.
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 Hospital Privacy Officer at the address indicated at the end of this Notice. 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, in some circumstances, you may request that the denial be reviewed. Another licensed health care professional chosen by the individual Hospital entity holding the records you requested 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 Hospital's Privacy Officer at the address indicated at the end of this Notice. 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:
*Is accurate and complete;
*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 designated record set; or
*Is not part of the information which you would be permitted to inspect and copy.
Right to an Accounting of Disclosures. You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of medical information about you.
To request this list or accounting of disclosures, you must submit your request in writing to the Hospital Privacy Officer at the address indicated at the end of this Notice. 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. Certain disclosures, for example those made in connection with treatment, payment or healthcare operations, are not included in the accounting of disclosures.
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. 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.
To request restrictions, you must make your request in writing to the Hospital Privacy Officer at the address indicated at the end of this Notice. 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 Hospital Privacy Officer at the address indicated at the end of this Notice. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
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.bghlink.com.
To obtain a paper copy of this notice, please contact the Hospital Privacy Officer at the address indicated at the end of this Notice
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 each Hospital entity. 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 outpatient, we will offer you a copy of the current notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with the Hospital or with the Secretary of the Department of Health and Human Services. To file a complaint with the Hospital, contact the Hospital Privacy Officer at the address indicated at the end of this Notice. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
OTHER USES OF MEDICAL INFORMATION.
Other uses and disclosures of medical 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 medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, from that point forward we will no longer use or disclose medical information about you which we had been permitted to use and/or disclose pursuant to the written authorization.
To the extent State law provides greater protection in connection with the privacy of your health information than a particular provision in this notice, State law shall apply as applicable.
HOSPITAL PRIVACY OFFICER ADDRESS
The following address should be used to submit items in writing to the Hospital Privacy Officer:
Brownsville General Hospital
125 Simpson Road
Brownsville, Pennsylvania 15417-9699