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 a member of the HIPAA Core Group through Gibson General Hospital’s operator at (812) 385-3401, or in writing at the following address:
HIPAA Core Group
Gibson General Hospital
1808 Sherman Drive
Princeton, IN 47670
WHO WILL FOLLOW THIS NOTICE:
This Notice describes Gibson General Hospital’s (“Hospital (’s)”) privacy practices and that of:
Any health care professional authorized to enter information into or consult your hospital chart;
All departments and units of the Hospital;
Any member of a volunteer group that helps you while you are in the Hospital;
All employees, staff and other Hospital personnel; and
Other Healthcare Providers, as described in the Inventory of Healthcare Providers located in the Admitting Office.
All of these entities, sites, and locations listed above must follow the terms of this Notice when providing care at the Hospital. In addition, these entities, sites, and locations may share medical information with each other for the purpose of treatment, payment, or health care operations as described in this Notice.
OUR PLEDGE REGARDING MEDICAL INFORMATION:
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at the Hospital. 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 Hospital personnel or your personal doctor. Your personal doctor may have different policies or notices regarding his/her use and disclosure of your medical information created in his/her office or clinic.
This Notice tells you about the ways in which the Hospital may use and disclose medical information about you. It also describes your rights and certain obligations the Hospital has regarding the use and disclosure of medical information.
The Hospital is required by law to:
Make sure that medical information that identifies you is kept private;
Give you this Notice of its legal duties and privacy practices with respect to medical information about you; and
Follow the terms of the Notice that is currently in effect;
Notify the appropriate government authority if it believes a patient has been the victim of abuse, neglect, or domestic violence; and
Report child abuse or neglect to the appropriate authorities.
HOW THE HOSPITAL MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU: The following categories describe different ways that the Hospital uses and discloses medical information. For each category of uses or disclosures, we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
For Treatment: We may use medical information about you to provide you with medical treatment, health care, or other related services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other Hospital personnel who are involved in taking care of you at the Hospital. 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 dietitian if you have diabetes so that we can arrange for appropriate meals. We may also disclose your medical information to other health care providers who are providing treatment to you, whether or not we are involved with your treatment at the time. In addition, we may use or disclose your health information to manage or coordinate your treatment, health care, or other related services. Different departments of the Hospital may share medical information about you in order to coordinate the different things that 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.
For Payment: We may use and disclose medical information about you so that treatment and services provided by the Hospital may be billed, 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 that 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 information about you to a collection agency if necessary, and to other health care providers or payors of health care for the payment activities of that entity.
For Health Care Operations: We may use and disclose medical information about you for health care operations. These uses and disclosures are necessary to run the Hospital, to make sure that all of our patients receive quality care, and to maintain and improve the quality of care we provide. 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 Hospital patients 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 doctors, nurses, technicians, medical students, and other Hospital personnel 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 your identity. We may provide your health information to various governmental or accreditation entities to maintain our license and accreditation status. We may also disclose your health information to another health care provider or payor for certain health care operations activities of that entity, if that entity also has a relationship with you.
Appointment Reminders: We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at the Hospital. If you do not wish to be contacted for this purpose, you must notify us in writing.
Treatment Alternatives: We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you. If you do not wish to be contacted for this purpose, you must notify us in writing.
Health-Related Benefits and Services: We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you. If you do not wish to be contacted for this purpose, you must notify us in writing.
Incidental Uses and Disclosures: We may, on occasion, inadvertently use or disclose your medical information when such use or disclosure is incident to another use or disclosure that is permitted or required by law. For example, while we have taken steps to protect against others overhearing conversations that take place between doctors, nurses, or other Hospital personnel, there may be times when such conversations are in fact overheard. Please be assured, however, that we have appropriate safeguards in place to avoid such situations to the extent possible.
Hospital Directory: We may include certain limited information about you in the Hospital directory 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. This is so your family, friends, and clergy can visit you in the Hospital and generally know how you are doing. 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 minister, even if they do not ask for you by name. If you do not wish to be included in the facility’s directory, please notify us at the time of admission.
Individuals Involved in Your Care or Payment for Your Care: We may release medical information about you to a friend or family member, or other person identified by you, who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family, friends, personal representative, or other person responsible for your care, your condition and that you are in the Hospital. 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.
Research: Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, trying to balance that research needs with patients’ need for privacy of their medical information. Before we use or disclose medical information for research, the project will have been approved through this research approval process, but we may, however, disclose medical information about you to researchers preparing to conduct a research project, for example, to help them look for patients with specific medical needs, so long as the medical information they review does not leave the Hospital. We will request your specific permission if the researcher will have access to your name, address, or other information that reveals who you are, or will be involved in your care at the Hospital.
As Required By Law: We will disclose medical information about you when required to do so by federal, state, or local law.
To Avert a Serious Threat to Health or Safety: We may use and disclose medical information about you when we believe it is necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent or lessen the threat or to law enforcement authorities in particular circumstances.
Organ and Tissue Donation: If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ bank, as necessary to facilitate organ or tissue donation and transplantation.
Military and Veterans: If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
Workers’ Compensation: We many release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Public Health Risks: We may disclose medical information about you for public health activities. These activities generally include, but are not limited to, the following:
- to prevent or control disease, injury or disability;
- to report births and deaths;
- to report reactions to medications or problems with products
- or defective medical devices;
- to notify people of recalls of products they may be using; and
- to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or conditions.
Health Oversight Activities: We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government benefit programs, and compliance with civil rights laws.
Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you 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, in which you were given an opportunity to object to the request, or to obtain an order protecting the information requested.
Law Enforcement: We may release medical information if asked to do so by a law enforcement official, if such disclosure is:
Required by law;
- In response to a court order, subpoena, warrant, summons or similar process;
- To identify or locate a suspect, fugitive, material witness, or missing person;
- About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement;
- About a death we believe may be the result of criminal conduct;
- About criminal conduct at the Hospital; and
- In 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 medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients of the Hospital to funeral directors as necessary to carry out their duties.
National Security and Intelligence Activities: We may release medical information about you to authorized federal officials for lawful intelligence, counterintelligence, and other national security activities authorized by law.
Protective Services for the President and Other: We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state, or for the conduct of special investigations.
Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary: (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
Third Parties: We may disclose your health information to certain third parties with whom we contract to perform services on our behalf. If we disclose your information to these entities, we will have an agreement by them to safeguard your information.
About Victims of Abuse: We may disclose your health information to notify the appropriate government authority if we believe an individual has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure with your permission, or when required or authorized by law.
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.
To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the Medical Records Department at Gibson General Hospital, 1808 Sherman Drive, Princeton, Indiana 47670. If you request a copy of the information, then 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, then you may request that the denial be reviewed. If the grounds for denial are reviewable, then another licensed health care professional chosen by the Hospital 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 Medical Records Department at Gibson General Hospital, 1808 Sherman Drive, Princeton, Indiana 47670. 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:
- 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 the Hospital;
- Is not part of the information which you would be permitted to inspect and copy; or
- Is accurate and complete.
Right to an Accounting of Disclosures: You have the right to request an “accounting of disclosures.” This is a list of the disclosures of medical information that we have made about you.
To request this list or accounting of disclosures, you must submit your request in writing to the Medical Records Department at Gibson General Hospital, 1808 Sherman Drive, Princeton, Indiana 47670. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list you request within a 12-month period will be free. For additional lists during such 12-month period, 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.
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.
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 with emergency treatment.
To request restrictions, you must make your request in writing to the Medical Records Department, Gibson General Hospital, 1808 Sherman Drive, Princeton, Indiana 47670. 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 or your responsible party about your 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.
It is your responsibility to request confidential communications; you must make your request in writing to the department responsible for service. 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.
To obtain a paper copy of this Notice, contact the Hospital’s Admitting Department at Gibson General Hospital, 1808 Sherman Drive, Princeton, Indiana 47670.
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 a clear and prominent location in the Hospital to which you have access. 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, please forward you written complaint to:
Attn: HIPAA Core Group
Gibson General Hospital
1808 Sherman Dr.
Princeton, IN 47670
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, 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.