These facilities may share medical information with each
other for treatment, payment or health care operations as described in this
notice.
WHO
WILL FOLLOW THE TERMS OF THIS NOTICE
·
All health care professionals, employees,
students, volunteers, and other personnel from these facilities authorized to
access your medical record;
·
Independent health care providers
involved in your care while practicing in one or more of our facilities (such
as physicians);
·
Other entities that provide health
care services to you in a way that is integrated with our services at one or
more of our facilities and their health care professionals, employees, students,
volunteers and other personnel.
OUR PLEDGE REGARDING YOUR 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 this notice.
·
Payment. We may use and disclose medical information
so that services can be billed. For
example, we may need to give your health plan information about services that
you received so your health plan can pay us.
We may also tell your health plan about a planned treatment to determine
whether your plan will cover the treatment.
·
Health Care Operations. We may use and disclose medical information
about you for health system operations.
For example, we may use your information to review our treatment and
services and continually assess the care and services we offer.
·
Business Associates. We may disclose your health information to
contractors, agents and other associates who need information to assist us in
carrying out our business operations.
Our contracts with them require that they protect the privacy of your
health information.
·
Appointment Reminders. In the course of providing treatment to you,
we may use your health information to contact you (e.g.: by phone or postcard)
with a reminder that you have an appointment for treatment or services.
·
Health-related Benefits and
Treatment Alternatives. We may use and disclose medical information
to tell you about or recommend health-related benefits, services or treatment
alternatives that may be of interest to you.
·
Fundraising Activities. We may use your information to contact you in
an effort to raise money for one or more of our facilities. We may disclose information to a related foundation
so they may contact you for fundraising.
We would only release contact information, such as your name, address
and phone number and the dates you received services.
·
Patient Information
Directory.
While you are a hospital patient, your name, location, general condition (e.g.,
satisfactory) and your religious affiliation will be included in a patient
information directory. Directory
information, except for your religious affiliation, may be released to people
who ask for you by name. Your religious
affiliation may also be provided to members of the clergy of your congregation,
even if they don’t ask for you by name.
We will give you the opportunity to object to being included in the
directory, unless an emergency situation prevents us from asking you.
·
Individuals Involved in Your
Care or Payment for Your Care. If you do
not object, we may release medical information about you to a friend or family
member who is involved in your care or payment for your care. We may also tell your family or friends your
condition and that you are in the hospital.
During a disaster (e.g., a flood), medical information may be disclosed
to assist with relief efforts.
·
Research. We may use and disclose
medical information about you for research purposes. In most cases we will ask for your written
authorization. However, under some
circumstances we may use and disclose your health information without your
written authorization if doing so poses minimal risk to your privacy. We may also release your medical information
without your written authorization to people who are preparing a research
project, so long as any information identifying you does not leave our
facility. The researchers may use this
information to contact you to ask if you want to participate in such research.
·
Incidental Disclosures. Disclosures of your
information may occur during or as an unavoidable result of our otherwise
permissible uses or disclosures of your health information. For example, during the course of your
treatment, other patients in the area may see or overhear discussion of your
health information.
*IN
SPECIAL SITUATIONS:
·
As Required By Law. We may disclose medical information about you
without your authorization when required to do so by federal, state or local
law.
·
Victims of Abuse or Neglect. We may release your health information to a
public health authority authorized to receive reports of abuse or neglect.
·
Military and Veterans. If you are or have been a member of the armed
forces, we may release your medical information as required by the Departments
of Defense, Transportation or Veterans Affairs.
·
Workers' Compensation. We may release medical information about you
to programs that provide benefits for work-related injury or illness.
·
Public Health Purposes. We may disclose medical information about you
for public health activities related to prevention or control of disease,
injury or disability.
·
Health Oversight Activities. We may disclose your medical information to
health oversight organizations authorized to conduct audits, investigations,
and inspections of our facilities.
·
Lawsuits and Disputes. If you are involved in a lawsuit or a
dispute, we may disclose your medical information in response to a court or
administrative order, subpoena or other lawful process.
·
Law Enforcement. We may release health information for law
enforcement purposes. Examples include
in response to a court order, subpoena, warrant or summons.
·
To Avert a Serious and
Imminent Threat to Health or Safety. We may use
your health information or share it with others when necessary to prevent a
serious and imminent threat to your health or safety, or the health or safety
of another person or the public.
·
Organ and Tissue Donation. We may release medical information to
organizations that handle organ, eye or tissue transplantation.
·
Coroners, Medical Examiners
and Funeral Directors. We may disclose health
information to funeral directors, coroners and medical examiners as permitted
by law to carry out their duties.
·
Inmates. If you are an
inmate of a correctional facility, we may disclose to the institution or agents
of the institution health information necessary for your health and the health
and safety of other individuals.
YOUR
RIGHTS REGARDING YOUR MEDICAL INFORMATION
You have the following rights regarding medical information we maintain
about you:
·
Right to Inspect and Receive
Copies. You may ask to inspect and receive copies of
medical information that may be used to make decisions about your care. Usually
this includes medical and billing records but not psychotherapy notes.
To inspect or receive copies
of your medical information, submit your request in writing to the Health
Information Management (Medical Records) Department at the facility keeping
your medical information. We may charge a fee for the costs of copying, mailing
or other supplies associated with your request for copies.
We may deny your request to inspect or receive
copies in certain limited circumstances.
If your request is denied, you may ask that the denial be reviewed. Another licensed health care professional who
we choose will review your request and the denial. The person conducting the review will not be
the person who denied your request. You
have additional rights to appeal a denial to the New York State Department of
Health.
·
Right to Amend. If you feel your medical information is
incorrect or incomplete, you may ask to amend the information for as long as
the information is kept by the facility.
Your request must be made in writing to the Health Information
Management (Medical Records) Department of the facility keeping your medical
information. You must also provide a
reason that supports your request.
We may deny your request if
the information:
¨
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 us;
¨
Is not part of the
information that you would be permitted to inspect or receive copies; or
¨
Is already accurate and complete.
If your
request to amend your record is denied, you will have the right to have certain
information related to your requested amendment included in your records. These rights will be explained to you in the
written denial notice.
·
Right to a Listing of Persons
Receiving Your Medical Information. You may
request an "accounting of disclosures” of medical information released
about you. An accounting of disclosures
does not include disclosures made:
¨
to you or your personal representative;
¨
with your written authorization;
¨
for treatment, payment or health care operations;
¨
from the patient directory;
¨
to your family or friends involved in your care or payment for your
care;
¨
incidental to permissible uses or disclosures; or
¨
about inmates to correctional institutions or law enforcement officers.
To request this list, submit
your request in writing to the Health Information Management (Medical Records)
Department at the facility keeping your medical information. 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. We may
charge you for the costs of providing additional lists. We will notify you of the cost involved and
you may withdraw or change your request before you are charged any fees.
·
Right to Request
Restrictions. You have the right to request
a restriction on how we use or disclose your health information to treat your
condition, collect payment for your treatment or for our health care
operations. We are not required to agree to your
request. If we do agree, we will fulfill
your request unless the information is needed to provide you emergency
treatment.
·
Right to Request
Confidential Communications. You may
request that we communicate with you about medical matters in an alternative
way or at an alternative location (for example, you may wish to be contacted at
home rather than at work). Your request
should be directed to the area that would handle the communication. You do not need to provide a reason for your
request. Reasonable requests will be
accommodated.
·
Right to a Paper Copy of
This Notice. You may request a paper copy
of this notice. You may also obtain a
copy of this notice at the following website: www.stronghealth.com.
CHANGES TO THIS NOTICE
We reserve the right to
change this notice. We may 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. The current notice will be displayed and
available to you.
COMPLAINTS
If you believe your privacy rights have been
violated, you may file a complaint with us or with the Secretary of the
Department of Health and Human Services.
To file a privacy-related complaint with us, you may call the Strong
Health Integrity Hotline at 585-756-8888.
All complaints to the Department of Health and Human Services 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.
However, we are unable to take back any disclosures we have already made
with your permission.
|
