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Decatur Health Systems, Inc.
Notice of Privacy Practices
for Protected Health Information
This
notice describes how medical information about you may be used and disclosed and how you can get access to this information.
Please read carefully!
If you consent, the office/hospital is permitted by federal privacy laws
to make uses and disclosures of your health information for purposes of treatment, payment and health care operations. Protected
health information is the information we create and obtain in providing our services to you. Such information may include
documenting your symptoms, examination and test results, diagnoses, treatment, and applying for future care or treatment.
It also includes billing documents for those services.
Examples of
uses of your health information for treatment purposes are:
A nurse obtains treatment information about you
and records it in a health record.
During the course of your treatment, the physician determines he/she will consult with
another specialist in the area. He/she will share the information with such specialist and obtain his/her input.
An example of use of your health information for payment purposes:
We
submit a request for payment to your health insurance company, the health insurance company requests information from us regarding
medical care given. We will provide information to them about you and the care given.
An example of use of your health information for health care operations:
The state licensing authority
wants to review records to assure that we have acted consistent with state law regarding your care. In doing so, it wants
to take a sampling that includes review of your chart. At the licensing authority’s request, we will provide it with
a copy of your record.
Your Health Information Rights
The
health record we maintain and billing records are physical property of the office/hospital. The information in it, however,
belongs to you. You have a right to:
Request a restriction on certain uses and disclosures of your health information
by delivering the request in writing to our office/hospital-we are not required to grant the request but we will comply with
any request granted;
Obtain a paper copy of the Notice of Privacy Practices for Protected Health Information (“Notice”)
by making a request at our office/hospital;
Request that you be allowed to inspect and copy your health record and billing
record-you may exercise this right by delivering in writing to our office/hospital using the form we provide to you upon request;
Appeal
a denial of access to your protected health information except in certain circumstances.
Request that your health care
record be amended to correct incomplete or incorrect information by delivering a written request to our office/hospital using
the form we provide to you upon request;
File a statement of disagreement if your amendment is denied, and require that
the request for amendment and any denial be attached in all future disclosures of your protected health information;
Obtain
an accounting of disclosures of your health information as required to be maintained by law by delivering a written request
to our office/hospital using the form we provide to you upon request; an accounting will not include internal uses of information
for treatment, payment, or operations, disclosures made to you or made at your request, or disclosures made to family members
or friends in the course of providing care;
Request that communication of your health information be made by alternative
means or at an alternative location by delivering the request in writing to our office/hospital using the form we give you
upon request; and
Revoke authorizations that you made previously to use or disclose information except to the extent information
or action has already been taken by delivering a written revocation to our office/hospital.
You have a right to review
this Notice before signing the consent authorizing use and disclosure of your protected health information for treatment,
payment, and health care operations purposes.
If you want to exercise any of the above rights
please contact:
Karol Styles
HIM Manager
810 W Columbia Street
Oberlin,
Kansas 67749
785-475-2208
In person or in writing, during normal hours. She will provide you with assistance on
the steps to take to exercise your rights.
Our Responsibilities
The
office/hospital is required to:
Maintain the privacy of your health information as required by law
Provide you with
a notice as to our duties and privacy practices as to the information we collect and maintain about you
Abide by the terms
of this Notice;
Notify you if we cannot accommodate a requested restriction or request; and
Accommodate your reasonable
requests regarding methods to communicate health information with you.
We reserve the right to amend, change, or eliminate
provisions in our privacy practices and access practices and to enact new provisions regarding the protected health information
we maintain. If our information practices change, we will amend this Notice. You are entitled to receive a revised copy of
the Notice by calling and requesting a copy of our “Notice” or by visiting our office and picking up a copy.
To Request Information or File a Complaint
If you have questions, would like additional information, or want to report a problem regarding the handling
of your information, or want to report a problem regarding the handling of your information, you may contact us.
Additionally,
if you believe your privacy rights have been violated, you may file a written complaint at our office by delivering the written
complaint to Karol Styles, RHIT, Health Information Manager. You may also file a complaint by mailing it or e-mailing
it to the Secretary of Health and Human Services whose street address is:
Office for Civil
Rights
U.S. Dept. of Health & Human Services
601 East 12th St., Rm. 248
Kansas City, MO 64106
Phone:
816-426-7278
FAX: 816-426-3688
Toll-Free 800-368-1019
The e-mail address is: OCRComplaint@hhs.gov
We cannot, and will not require you to waive the right to file a complaint with the Secretary of
Health and Human Services (HHS) as a condition of receiving treatment from the office/hospital.
We cannot and will not
retaliate against you for filing a complaint with the Secretary.
Other Disclosures and Uses
Business Associates
We have business associates with whom we may share your protected
health information. For example, in preparing our annual financial statement, auditors may need to review samples of the medical
care given. We may disclose your health information to the accounting firm to prepare this material.
Directory
Unless you notify us that you object, we will use and disclose your name,
location, general condition, and religious affiliation in a hospital directory. This information may be provided to members
of clergy and, except for religious affiliation, to other people who ask for you by name.
Notification
Unless you object, we may use or disclose your protected health information
to notify, or assist in notifying, a member, personal representative, or other person responsible for your care, about your
location, and about your general condition, or your death.
Communications
with Family
Using our best judgment, we may disclose to a family member, other relative, close personal friend,
or any other person you identify, health information relevant to that person’s involvement in your care or in payment
for such care if you do not object or in an emergency.
Research
We
may disclose 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.
Disaster Relief
We may use and disclose your protected health
information to assist in disaster relief efforts.
Funeral Directors/Coroners
We
may disclose your protected health information to funeral directors or coroners with applicable law to allow them to carry
out their duties.
Organ Procurement Organizations
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.
Marketing
We may contact you to provide you with appointment reminders,
with information about treatment alternatives, or with information about other health-related benefits and services that may
be of interest to you.
Fund Raising
We may contact
you as part of a fund raising effort.
Food and Drug Administration (FDA)
We may disclose
to the FDA your protected health information relating to adverse events with respect to food, supplements, products and product
defects, or post-marketing surveillance information to enable product recalls, repairs, or replacements.
Workers Compensation
If you are seeking compensation through Workers Compensation, we
may disclose your protected health information to the extent necessary to comply with laws relating to workers Compensation.
Public Health
As required by law, we may disclose
your protected health information to public health or legal authorities charged with preventing or controlling disease, injury,
or disability.
Abuse & Neglect
We may disclose
your protected health information to public authorities as allowed by law to report abuse or neglect.
Correctional Institutions
If you are an inmate of a correctional institution, we may
disclose to the institution or agents there of your protected health information necessary for your health and the health
and safety of other individuals.
Law Enforcement
We
may disclose your protected health information for law enforcement purposes as required by law, such as when required by a
court order, or in cases involving felony prosecutions, or to the extent an individual is in custody of law enforcement.
Health Oversight
Federal law allows us to release your protected
health information to appropriate health oversight agencies or for health oversight activities.
Judicial/Administrative Proceedings
We may disclose your protected health
information in the course of any judicial or administrative proceeding as allowed or required by law, with your consent, or
as directed by a proper court order.
To avert a serious threat to health or safety, we may disclose your protected
health information consistent with applicable law to prevent or lessen a serious, imminent threat to the health or safety
of a person or the public.
For Specialized Governmental Functions
We
may disclose your protected health information for specialized government functions as authorized by law such as to Armed
Forces personnel, for national security purposes, or to public assistance program personnel.
Effective Date: 04/14/2003
Other Uses
Other uses and disclosures besides those
identified in this Notice will be made only as otherwise authorized by law or with your written authorization and you may
revoke the authorization as previously provided.
Website
We
maintain a website that provides information about our entity.
This
Notice is on the website.
Information about your right to privacy or filing a complaint may be found by visiting
the website http://www.hhs.gov/ocr/hipaa or by calling 866-627-7748.
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