Privacy Statement (English) - Faith Regional Health Services

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.

We are required by law to maintain the privacy of your medical information and to provide you with notice of our legal duties, privacy practices and your rights with respect to your medical information. Medical information includes medical, insurance and medical payment information, such as your diagnosis, medications or medical payment history, which identifies you.

OUR PLEDGE REGARDING MEDICAL INFORMATION

We understand that medical information about you and your health is personal. We are committed to protecting patient 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 the 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.

WHO WILL FOLLOW THIS NOTICE

FAITH REGIONAL HEALTH SERVICES (HOSPITAL). This Notice describes the privacy practices of Hospital and all of its programs and departments, including its rural health clinics.

MEDICAL STAFF. This Notice also describes the privacy practices of an “organized health care arrangement” or “OHCA” between the Hospital and eligible providers on its Medical Staff. Because the Hospital is a clinically-integrated care setting, our patients receive care from Hospital staff and from independent practitioners on the Medical Staff. The Hospital and its Medical Staff must be able to share your medical information freely for treatment, payment and health care operations as described in this Notice. Because of this, the Hospital and all eligible providers on the Hospital’s medical staff have entered into the OHCA under which the Hospital and eligible providers will:

Use this Notice as a joint Notice of Privacy Practices for all inpatient and outpatient visits and follow all information practices described in this notice;
Obtain a single signed acknowledgment of receipt; and
Share medical information from inpatient and outpatient hospital visits with eligible providers so that they can help the Hospital with its health care operations.

The OHCA does not cover the information practices of practitioners in their private offices or at other practice locations.

USES AND DISCLOSURES OF INFORMATION WITHOUT YOUR AUTHORIZATION

The following categories describe different ways we use and disclose protected health 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 protected health information will fall within one of the identified categories:

Treatment. We may use protected health information about you to provide you with medical treatment or services. We may disclose protected health 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 protected health 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.

Payment. We may use and disclose protected health 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 protected health 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. We may also disclose protected health information about you to other medical care providers, medical plans and health care clearinghouses for their payment purposes. For example, if you are brought in by ambulance, the information collected will be given to the ambulance provider for its billing purposes.

Health Care Operations. We may use and disclose protected health information about you for Hospital operations. 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 protected health information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine the protected health information we have with protected health 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 protected health information so others may use it to study health care delivery without learning who the specific patient is. The ambulance company, for example, may also want information on your condition to help them know whether they have done an effective job of providing care.

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 protected 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 protected health information to accrediting agencies and certain outside consultants. Our business associates must use appropriate safeguards to protect your protected 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 may be of interest to you, including educational opportunities.

Treatment Alternatives. We may use and disclose protected health 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 protected health information to tell you about health-related benefits or services that may be of interest to you.

Fundraising. We may contact you as part of a fundraising effort. We may use protected health information about you to contact you in an effort to raise money for the Hospital and its operations. We may also disclose protected health 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 certain elements of your protected health information, such as your name, address, phone number and dates you received treatment or services. If you do not wish to receive further fundraising communications, you should follow the instructions written on the Privacy Notification form. This document informs you what you need to do to be removed from any fundraising lists. You will not receive any fundraising communications from us after we receive your request to opt out, unless we have already prepared a communication prior to receiving notice of your election to opt out.

Hospital Directory. We will include certain protected health 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. This enables your family, friends and clergy to visit you in the hospital and generally know how you are doing. Your religious affiliation may be given to a member of the clergy, even if they don’t ask for you by name. We will not include your information in the Hospital directory if you object or if we are prohibited by State or federal law.

Family and Friends. We may disclose your location or general health condition 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. We will release this protected health information in our professional judgment or if we feel it is in your best interest to allow the person to receive the protected health information or act on your behalf unless you object and inform someone of your objection. For example, we may allow a family member to pick up your prescriptions, medical supplies or X-rays. In addition, we may disclose protected health information about you to an entity assisting in a disaster relief so that your family can be notified about your condition, status and location.

Required by Law. We will disclose protected health information about you when required to do so by Federal, State or local law.

Threats to Health or Safety. Under certain circumstances, we may use or disclose your protected health information to avert a serious threat to health and safety if we, in good faith, believe the use or disclosure is necessary to prevent or lessen the threat and is to a person reasonably able to prevent or lessen the threat (including the target) or is necessary for law enforcement authorities to identify or apprehend an individual involved in a crime.

Organ and Tissue Donation. Consistent with applicable law, we may disclose your protected 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 Government Functions. We may use and disclose your protected health information for national security and intelligence activities authorized by law or for protective services of the President of the United States of America. If you are a military member, we may disclose your protected health information to military authorities under certain circumstances.

Worker’s Compensation. We may release protected health 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 protected health information about you for public health activities. These activities may include but are not limited to the following disclosures:

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 protected health 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.

Laws 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 protected 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 protected health information if asked to do so by a law enforcement officials including but not limited to the following situations:

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 protected health 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 protected health information about patients of the Hospital to funeral directors, as necessary, to carry out their duties.

Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose to the institution, its agents or the law enforcement official your medical information necessary for your health and the health and safety of other individuals. 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 protected health 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 protected health information. In addition, we may disclose protected health information to researchers in preparation for research.

Food and Drug Administration (FDA). We may disclose to the FDA your protected 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 protected health information to provide you with information regarding a health-related product or service provided by Hospital or affiliates of Hospital, or information regarding your treatment or care, such as appointment reminders or information about treatment alternatives. In addition, your protected 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 protected 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 protected 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 protected 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 (OHCA)

Hospital and its medical staff must be able to share protected health information freely for treatment, payment and health care operations. Therefore, Hospital and all eligible providers on the Hospital’s Medical Staff have entered into an “organized health care arrangement” or OHCA. Under the OHCA, Hospital 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 Hospital AND hospital medical staff.

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

What sites are included? Each OHCA covers only Hospital, 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

Request for Restrictions. You have the right to request a restriction or limitation on the protected health information we use or disclose about you for treatment, payment or health care operations or to persons involved in your care. We are required to agree to your request that we not disclose certain protected health information to your health insurance carrier IF you pay out-of-pocket in full for all expenses related to that service prior to your request. Your restriction will only apply to records that relate solely to the service for which you have paid in full. We are not required to agree to any other request, and will notify you if we are unable to agree.

Many different covered entities participate in this Notice as part of an OHCA. You must make a separate request to each covered entity from whom you will receive services that are involved in your request for restriction. Contact the Hospital at the address listed below if you have questions regarding which providers will be involved in your care.

If we later receive an Authorization from you dated after the date of your requested restriction which authorizes us to disclose all of your protected health information to your health insurance carrier, we will assume you have withdrawn your request for restriction

Access to Medical Information. You may request to inspect and ask for a copy of the protected health information we maintain about you, with some exceptions. If you request copies, we may charge you a copying fee plus postage. If we agree to prepare a summary of your protected health information, we will charge a fee to prepare the summary. If we maintain an electronic health record about you, you have the right to request a copy in electronic format. If we are able, we will electronically transmit your record to anyone you designate, as long as your designation is clear, conspicuous and specific. We may charge you for our labor costs in responding to your request for an electronic copy.

Amendment. You may request that we amend certain protected health information that we keep in your records. We are not required to make all requested amendments, but will give each request careful consideration. If we deny your request, we will provide you with a written explanation of the reasons and your rights.

Accounting of Disclosures. You have the right to receive an accounting of certain disclosures of your protected health information made by us or our business associates for reasons other than treatment, payment and health care operations for six years prior to your request. In addition, for disclosures of your protected health information for treatment, payment or health care operations through an electronic health record, you have the right to request an accounting of such disclosures, for the three-year period prior to your request. These dates may be extended by law. Contact the Privacy Officer at the address listed at the end of this Notice for information on whether we maintain an electronic health record and when this right becomes effective. For disclosures made by a business associate, we may choose to provide you with contact information for all business associates acting on our behalf. The first accounting in any 12-month period is free; you will be charged a fee for each subsequent accounting you request within the same 12-month period. Requests must be in writing. You may contact the Privacy Officer to obtain a form to request an accounting.

Confidential Communications. You may request that we communicate with you about your protected health information in a certain way or at a certain location. We must agree to your request if it is reasonable and specifies the alternate means or location.

Notice in the Case of Breach. You have the right to receive notice of an access, acquisition, use or disclosure of your protected health information that is not permitted by HIPAA, if such access, acquisition, use or disclosure compromises the security or privacy of your protected health information. We will provide such notice to you without unreasonable delay but in no case later than 60 days after discovery of the Breach.

How to Exercise These Rights. All requests to exercise these rights must be in writing. We will follow written polices to handle requests and notify you of our decision or actions and your rights. Contact Privacy Officer at (402) 644-7574 for more information or to obtain request forms.

ABOUT THIS NOTICE

We are required to follow the terms of the Notice currently in effect. We reserve the right to change our practices and the terms of this Notice and to make the new practices and notice provisions effective for all protected health information that we maintain. Before we make such changes effective, we will make available the revised Notice by posting it in the Hospital where copies will also be available. The revised Notice will also be posted on our website at www.frhs.org. You are entitled to receive this Notice in written form. Please contact Privacy Officer via phone at (402) 644-7574 or at the address listed below to obtain a written copy.

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.

CONTACT INFORMATION

Privacy Officer, Health Information Department, Faith Regional Health Services, 2700 W Norfolk Ave, Norfolk, NE 68701 or call (402) 644-7574.

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Privacy Statement: Spanish Translation Available Here