CRISP REGIONAL HEALTH SERVICES, INC.
NOTICE OF PRIVACY PRACTICES
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.
Health Systems make and
keep records of medical information. While you are a patient here, we will use
and disclose your medical information
* To provide treatment to you and to keep a record describing your care
* To receive payment for the care we provide
* To administer the Health System properly
* To comply with law
This Notice summarizes the ways we may use and disclose medical information about you. It also describes your rights and our duties regarding the use and disclosure of your medical information. This Notice applies to all records of your care in our Health System, whether made by Health System personnel or by your personal doctor. Your doctor and other health care providers may use a different Notice and policy regarding the use and disclosure of your medical information in their offices.
When we use the word "we"
or "Health System" we mean the Crisp Regional Health Services, its affiliates,
medical professionals and other parties who assist us in our
business. We are required by law
* To keep your medical information confidential in accordance with legal
requirements
* To give you this Notice of our legal duties and privacy practices with
respect to your medical
information
* To follow the terms of the Notice that is currently in effect
PERSONS COVERED BY THIS NOTICE
*
All
employees, staff and other health system personnel
* The following entities, sites and locations: Crisp Regional Hospital,
Inc. In addition, these entities, sites and locations may share
medical information
with each other for the
treatment, payment and administrative purposes
described in this Notice.
* Persons or entities performing services for the Health System
under
agreements containing
privacy protections or to which disclosure of
medical information is
permitted by law
*
Persons or entities with whom the Health System participates in
managed care
arrangements
* Our volunteers and medical, nursing and other health care students
* Members of the Hospital Medical Staff and other medical professionals
involved in your care or performing peer review, quality improvement,
medical evaluation and other services for the Health System.
USES AND DISCLOSURES OF YOUR MEDICAL INFORMATION
We use and disclose medical information in the ways described below.
Treatment.
We may use your medical information to provide medical treatment or
services to you. We may disclose medical information about you to doctors,
nurses, technicians, medical, nursing or other health care students, or other
personnel 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. In addition,
the doctor may
need to tell the dietician if you have diabetes so you can have appropriate
meals. Departments of the Health System may share your medical information to
schedule the
tests and procedures you need, such as prescriptions, laboratory tests and
x-rays. We
also may disclose your medical information to health care facilities if you need
to be transferred from the Health System to another hospital, a nursing home, a
home health provider or a rehabilitation center. We also may disclose your
medical information to
people outside the Health System who are involved in your care after you leave
the
Health System, such as family members or pharmacists.
Payment.
We may use and disclose your medical information so that the treatment and
services you receive can be billed and collected from you, an insurance company
or
another third party. For example, we may give your health plan information
about surgery you received so your health plan will pay us for the surgery. We
also may tell your health plan about a treatment you are going to receive in
order to obtain prior approval from your plan to cover payment for the
treatment.
Health Care
Operations. We may use and disclose your medical information for
health system operations, such as for peer review, performance improvement, risk
management, and our compliance with licensure, accreditation or certification
requirements. For example, we may disclose your medical information to
physicians on
our Medical Staff who review treatment of patients. We may disclose information
to doctors, nurses, technicians, medical, nursing or other health care students,
and health system personnel for teaching. We may combine medical information
about many
patients to decide what services the Health System should offer, and whether new
services are cost-effective and how we compare with other health systems.
Sometimes,
we may remove identifying information from this medical information so others
may use
it to study health care and health care delivery without learning who you are.
We may disclose information to other health care providers involved in your
treatment to permit
them to carry out the work of their facility or to get paid. For example, we
may provide
information about your treatment to an ambulance company that brought you to the
hospital so that the ambulance company can get paid for their services.
Activities of Our
Affiliates. We may disclose your medical information to our
affiliates in connection with your treatment or other health system activities.
Activities of an
Organized Health Care Arrangement in Which We Participate.
For certain activities, the Health System, members of its Medical Staff and
other independent professionals are called an Organized Health Care
Arrangement. We may disclose information about you to health care providers
participating in our Organized
Health Care Arrangements, such as a managed care or physician-hospital
organization. Such disclosures would be made in connection with our services,
your treatment under
a health plan arrangement, and other activities of the Organized Health Care
Arrangement.
IMPORTANT NOTICE
The Health
System may share your medical information with members of the
Hospital Medical Staff and other independent medical professionals in order to
provide treatment and perform other activities such as peer review, quality
improvement, medical education and other services for the Health System.
While those professionals may follow this Notice and otherwise participate in
the privacy program of the Health System, they are independent professionals and
the Hospital expressly disclaims any responsibility or liability for
their acts or omissions.
Health
Services, Treatment Alternatives and Health-Related Benefits. We may
use and disclose your medical information to tell you about (a) health-related
products or services that we offer, (b) other providers participating in a
health care network that we participate in, (c) possible treatment options or
alternatives, or (d) health-related benefits
or services that may be of interest to you. We also may use that information to
communicate with you to coordinate your care. We may use and disclose your
medical information to contact and remind you of an appointment for treatment or
medical care.
Fundraising.
We may use your medical information to raise money for the Health
System. We may disclose information such as your name, address, telephone
number,
gender, age and the dates you received treatment in the Health System to a
Hospital foundation so it can contact you. If you do not want the Health System
to contact you
for fundraising, please notify the Contact Person listed below in writing.
Hospital Directory.
We may include certain information about you in the Hospital
Directory while you are a patient in the Health System. This information may
include your name, your room number, your general condition (fair, stable, etc.)
and your religious affiliation. Your religious affiliation may be given to a
member of the clergy, such as a
priest or rabbi, even if they do not ask for you by name. Disclosure of your
room will not reveal that you are in a specific unit or area of the hospital, if
such information would
reveal that you are at the hospital for treatment of rape or attempted rape,
HIV/AIDS, or alcohol/drug abuse. Directory information, except for your
religious affiliation, may be released to people who 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. If you do
not want
this information given out, please tell the Registration Clerk.
Individuals Involved
in Your Care or Payment for Your Care. We may release
your medical information to the person named in your Durable Power of Attorney
for
Health Care (if you have one), or to a friend or family member who is your
personal representative (i.e., empowered under state or other law to make
health-related decisions for you). We may give information to someone who helps
pay for your care. In addition, we may disclose your medical information to an
entity assisting in disaster relief efforts so that your family can be notified
about your condition.
Research.
We may use and disclose your medical information for research purposes.
Most research projects, however, are subject to a special approval process.
Most research projects require your permission if a researcher will be involved
in your care or will have access to your name, address or other information that
identifies you. However, the law allows some research to be done using your
medical information without requiring your authorization.
Required By Law.
We will disclose your medical information when federal, state or
local law requires it. For example, the Health System must comply with child
abuse
reporting laws and laws requiring us to report certain diseases or injuries to
state or
federal agencies.
Serious Threat to
Health or Safety. We may use and disclose your medical
information when necessary to prevent a serious threat to your health and safety
or to the health and safety of the public or another person.
Note: Georgia and
Federal Law provide protection for certain types of health information,
including information about alcohol or drug abuse, mental health and AIDS/HIV,
and may limit whether and how we may disclose information about you
to others.
SPECIAL SITUATIONS
Organ and Tissue Donation. If you are an organ donor, we may release your medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to aid in its organ or tissue donation and transplantation process.
Military and Veterans. If you are a member of the U. S. or foreign armed forces, we may release your medical information as required by military command authorities.
Workers' Compensation. We may release medical information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Minors. If you are a minor (under 18 years old), the Health System will comply with Georgia law regarding minors. We may release certain types of your medical information to your parent or guardian, if such release is required or permitted by law.
Public Health Risks.
We may disclose your medical information for public health
purposes
* To prevent or control disease, injury or disability
* To reports births and deaths
* To report child or adult abuse, neglect or violence
* 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 getting or spreading a disease or condition
Health Oversight
Activities. We may disclose your medical information to a federal
or state agency for health oversight activities such as audits, investigations,
inspections,
and licensure of the Health System and of the providers who treated you in the
Health System. These activities are necessary for the government to monitor the
health care
system, government programs, and compliance with laws.
Lawsuits and
Disputes. We may disclose your medical information to respond to a
court or administrative order or a search warrant. We also may disclose your
medical information in response to a subpoena, discovery request, or other
lawful process by someone else involved in a dispute, but only if efforts have
been made to tell you about the request and you have been provided an
opportunity to object or to obtain an appropriate court order protecting the
information requested.
Law Enforcement.
Subject to certain conditions, we may disclose your medical information for a
law enforcement purpose upon the request of a law enforcement
official.
Medical Examiners
and Funeral Directors. We may disclose your medical
information to a medical examiner or funeral director so they may carry out
their duties.
National Security. We may disclose your medical information to authorized federal officials for national security activities authorized by law.
Protective Services. We may disclose your medical information to authorized federal officials so they may provide protection to the President and other persons.
Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement officer, we may release your medical information to the correctional institution or a law enforcement officer. This release would be necessary for the Health System to provide you with health care, to protect your health and safety or the health and safety of others, or for the safety and security of the law enforcement officer or the correctional institution.
YOUR PRIVACY RIGHTS
Right to Review and
Right to Request a Copy. You have the right to review and
copy medical information in your medical and billing records. The Health
Information Department has a form you can fill out to request to review or copy
your medical information, and can tell you how much it will cost. The Health
System will tell you if it cannot fulfill your request. If you are denied the
right to see or copy your medical information, you may ask us to reconsider its
decision. Depending on the reason for the decision, we may ask a licensed
health care professional to review your request and its denial. We will comply
with this person's decision.
Right to Amend.
If you feel your medical information in our records is incorrect or incomplete,
you may ask us in writing to amend the information. You must provide a
reason to support your requested amendment. We will tell you if we cannot
fulfill your request. The Contact Person listed below can help you with your
request.
Right to an
Accounting of Disclosures. You have the right to make a written request
for a list of certain disclosures the Health System has made of your medical
information. This list is not required to include all disclosures we make.
Disclosure for treatment, payment, or health system administration purposes,
disclosures made before April 14,
2003, disclosures made to you or which you authorized, and other disclosures are
not required to be listed. The Contact Person listed below can help you with
this process, if needed, and can tell you how much it will cost.
Right to Request
Restrictions on Disclosures. You have the right to make a written
request to restrict or put a limitation on the medical information we use or
disclose about
you for treatment, payment or health care. You also have the right to request a
limit on
your medical information that we disclose to someone involved in your care or
the
payment for your care, like a family member or friend.
We are not required to
agree to your request. However, if we do agree, we will
comply with your request unless the information is needed to provide you with
emergency treatment or to make a disclosure that is required under law. 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 adult children.
Right to Request
Confidential Communications. You have the right to make a
written 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 contact you only at
work or by mail. 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. The Contact Person listed below can help you with these requests if
needed.
Right to a Paper
Copy of This Notice. You have the right to receive a paper copy
of this Notice at any time even if you have agreed to receive this Notice
electronically.
You may obtain a copy of this Notice at our website,
www.crispregional.org
or a paper copy from the Contact Person listed below.
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
for any information we receive in the future. We will post the current Notice
in the Health System.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a written complaint with the Hospital or with the Secretary of the Department of Health and Human Services or HHS. Generally a complaint must be filed with HHS within 180 days after the act or omission occurred, or within 180 days of when you knew or should have known of the action or omission. To file a complaint with the Health System, contact the Privacy Officer. You will not be denied care or discriminated against by the Hospital for filing a complaint.
OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures
of your medical information not covered by this Notice or the laws and
regulations that apply to the Health System 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 your medical information for the reasons
covered by your written authorization, but the revocation will not affect
actions we have taken in reliance on your permission. You understand that we are
unable to take back any disclosures we
have already made with your permission, we still continue to comply with laws
that
require certain disclosures, and we are required to retain our records of the
care that we provided to you.
If you have any questions about this Notice, please contact the Privacy Officer at 229-276-3100.
Effective Date: 04/01/03