Effective: 4/13/2003; Revised: 7/1/2014
I. 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 or have a complaint or concern, please contact the Facility HIPAA Liaison or you may call our Compliance Hotline at 1-866-256-0955.
II. WE HAVE A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION (“PHI”).
We are legally required to protect the privacy of your health information. We call this information “Protected Health Information” or “PHI” for short, and it includes information that can be used to identify you that we have created or received about your past, present, or future health or condition; the provision of health care to you; or the payment for this health care. Health Information is considered protected for 50 years after death of the patient.
We must provide you with this notice about our privacy practices that explain how, when, and why we use and disclose your PHI. With some exceptions, we may not use or disclose any more of your PHI than is necessary to accomplish the purpose of the use or disclosure. We are legally required to follow the privacy practices described in this Notice.
We reserve the right to change the terms of this notice and our privacy policies at any time. Any changes will apply to the PHI we already have. Before we make an important change to our policies, we will promptly change this Notice and post a new Notice in the Facility’s main reception area. You can also request a copy of this Notice from the contact persons listed above.
III. HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU.
The following describes the way we use and disclose (or release) your medical information:
A. For Treatment: We may use medical information about you to provide you treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other healthcare personnel who are involved in taking care of you at the Facility. For example, a physician treating you for a broken leg may need to know whether you have diabetes because diabetes may slow the healing process. We may also share medical information about you to people outside of the Facility to coordinate your medical care during your stay or after you are discharged. Examples are family members, clergy, or others we use to provide services that are part of your plan of care.
B. For Payment: We may use and disclose medical information about your treatment and services to bill and collect payment from you, your insurance company, or a third-party payer. For example, we may need to give your insurance company information about your surgery so that they will pay us or reimburse you for the treatment. We may also tell your health plan about treatment you are going to receive to determine whether your plan will cover it.
C. For Healthcare Operations: Members of our medical staff and/or quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. The results will then be used to continually improve the quality of care for all patients we serve. For example, we may combine medical information about many patients to evaluate the need for new services or treatment. We may disclose information to doctors, nurses, and healthcare students for educational purposes. We may remove information that identifies you from this set of medical information to protect your privacy.
We may also use and disclose medical information:
· To business associates we have contracted with to perform the services and billing;
· To remind you that you have an appointment for medical care;
· To assess your satisfaction with our services;
· To inform you about possible treatment alternatives;
· To contact you as part of the Facility’s fundraising efforts;
· To inform funeral directors consistent with applicable law;
· For population-based activities relating to improving health or reducing healthcare costs; and
· For conducting training programs or reviewing competence of healthcare professionals.
D. Business Associates: Some services are provided in our organization through contracts with business associates. Examples include physician services in the emergency department and radiology, and certain laboratory tests. When these services are contracted, we may disclose your health information to our business associates so that they can perform the job we've asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.
E. Directory: We may include certain limited information about you in the Facility directory while you are a resident. The information may include your name, location in the facility, general condition (e.g., good, fair, etc.), and religious affiliation. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name. You may “opt out” of the directory by completing the attached form and returning to the attention of the Facility Privacy Officer/Medical Records Director. If you do so, we will not acknowledge your presence in the facility.
F. Individuals Involved in Your Care or Payment for Your Care: We may release medical information about you to a friend or family member who is involved in your medical care or who helps pay for your care. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location. You may restrict disclosure of information as described in this paragraph by completing the attached form and returning to the attention of the Facility Privacy Officer/Medical Records Director.
G. Research: We may disclose information to researchers 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.
H. Marketing: The Privacy Rule defines marketing as making a communication about a product service that encourages recipients of the communication to purchase or use their product or services. Your written consent is required before any use and disclosure of your health information for the purpose of marketing. An example of marketing is a communication from a hospital informing former patients about a new facility, not a part of that hospital that is offering a health service or product. If the communication is to inform you of health related services and benefits this is a part of Health Care Operations and not marketing.
I. Future Communications: We may communicate with you via newsletters, mailings, or other means regarding treatment options, health-related information, disease-management programs, wellness programs, or other community-based initiatives or activities in which our facility is participating.
J. As Required by Law: We may disclose health information to the following types of entities without a signed authorization form or written consent:
· Public health/legal authorities charged with preventing or controlling disease, injury, or disability;
· Correctional institutions (if you are in custody);
· Workers’ compensation agents for the purpose of obtaining payment;
· Organ and tissue donation organizations;
· Military command authorities;
· Health oversight agencies;
· Funeral directors, coroners, and medical examiners;
· National security and intelligence agencies;
· Protective services for the President and others.
K. Law enforcement/legal proceedings: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena or court order. We may also inform law enforcement of the death of a patient, if we feel that death was as a result of a crime.
IV. YOUR HEALTH INFORMATION RIGHTS
Although your health record is the property of the Facility, you have the right to:
A. Inspect and Copy: You have the right to inspect, review and copy medical information that may be used to make decisions about your care. Copies can be on paper or on electronic media such as a thumb drive, if provided by the patient. Your request must be in writing. All requests will be reviewed by a licensed healthcare provider before you are given access. Requests may be denied under limited circumstances. If you are denied access, you may request that the denial be reviewed in some situations. Another licensed healthcare professional chosen by the Facility 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. All requests must be responded to, in writing, within 30 days either by granting access, denying access or notification that an additional 30 days is needed to review the request.
B. 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 Facility. We may deny your request for an amendment, and if this occurs, you will be notified of the reason for the denial. Approved amendments will not replace the incorrect information simply clarify or note your disagreement.
C. An Accounting of Disclosures: You have the right to request an accounting of disclosures made by the facility that are permitted by law and without a signed authorization. This excludes disclosures for purposes other than treatment, payment, or healthcare operations and those disclosures based on valid authorizations you signed and asked us to make.
D. 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 healthcare operations. You also have the right to request a limit on the medical information we disclose about you to someone involved in your care or the payment for your care, such as a family member or friend. For example, you could ask that we not use or disclose information about a procedure or lab test that 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.
E. 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 may ask that we communicate with you only in your room. We will grant requests for confidential communications at alternative locations and/or via alternative means only if the request is submitted in writing and the written request includes a mailing address where you will receive bills for services rendered by the facility and related correspondence regarding payment for services. We retain the right to contact you by other means and at other locations if you fail to respond to any communication from us that requires a response. We will notify you in accordance with your original request prior to attempting to contact you by other means or at another location.
F. Receive a Paper Copy or Electronic 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.
To exercise any of your rights, you must provide us with notice in writing. We have forms available that will assist you in describing your need, request or direction. Please obtain these forms from the Facility HIPAA Liaison.
If you believe your privacy rights have been violated, you may file a complaint by stating the violation you believe to have occurred or which is occurring and deliver it to the Facility HIPAA Liaison or the Secretary of the U.S. Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized for filing a complaint. You may also contact our Compliance Hotline at 1-866-256-0955 which is available 24 hours per day, 7 days per week.
You can file a complaint with the U.S. Department of Health and Human
Services Office for Civil Rights by sending a letter to 200 Independence
Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting
VI. OTHER USES OF THIS 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 give 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, we will no longer use or disclose medical information about you 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 permission, and that we are required to retain our records of the care that we provided to you.
VII. PRIVACY OFFICER/MEDICAL RECORDS DIRECTOR
Please contact the Facility HIPAA Liaison at the address and telephone number listed below:
Attention: HIPAA Compliance Partner or Privacy Officer
27101 Puerta Real Suite 450
Mission Viejo CA 92691