Effective Date: September 23, 2013
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 respect the privacy of your health information and are committed to maintaining our patients’ confidentiality. This Notice describes your rights and our obligations regarding your health information and informs you about the possible uses and disclosures of your health information. This Notice applies to all information and records related to your care that we have received or created. It extends to information received or created by our employees, staff, and volunteers as well as by doctors and other health care practitioners practicing at the Hospital.
We are required by law to maintain the privacy of your health information; to provide you this detailed Notice of our legal duties and privacy practices relating to your health information; and to abide by the terms of the Notice that are currently in effect.
- WITH YOUR CONSENT WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS
We may use and disclose your health information for purposes of treatment, payment and health care operations as described below.
For Treatment. We will use and disclose your health information in providing you with treatment and services and coordinating your care. Your health information may be used by doctors and nurses, as well as by lab technicians, dieticians, physical therapists, radiologists or other personnel involved in your care. For example, the hospital pharmacist will need certain information to fill a prescription ordered by your doctor. We also may disclose health information to individuals or facilities that will be involved in your care after you leave the Hospital.
For Payment. We will disclose your health information so that we can bill and receive payment for the treatment and services you receive. For billing and payment purposes, we may disclose your health information to your representative, an insurance or managed care company, Medicare, Medicaid or another third party payer. For example, we may contact Medicare or your health plan to confirm your coverage or to request prior approval for a proposed treatment or service.
For Health Care Operations. We may use and disclose your health information as necessary for hospital operations, such as for management purposes and to monitor our quality of care. For example, health information of many patients may be combined and analyzed for purposes such as evaluating and improving quality of care and planning for services. Health information is used in evaluating our employees and in reviewing the qualifications and practices of doctors and other practitioners at the Hospital. We also may use and disclose health information for education and training purposes.
In addition, we may use a sign-in sheet at the registration desk where you will be asked to sign your name and indicate your physician or health care provider. We may also call you by name in the waiting room when your physician is ready to see you. We may use or disclose your protected health information, as necessary, to contact you to remind you of your appointment.
- WE ALSO MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT
YOU FOR SPECIFIC PURPOSES
The following lists various ways in which we may use or disclose your health information.
Hospital Directory. Unless you object, or are a Behavioral Health Patient, we will include certain limited information about you in our directory while you are a patient. This information may include your name, your location in the Hospital, your general condition and your religious affiliation. Our directory does not include specific medical information about you. We may disclose directory information, except for your religious affiliation, to people who ask for you by name. We may provide the directory information, including your religious affiliation, to any member of the clergy.
Patient Information Display. Unless you object, we will include name, physician, Room #, and other pertinent information on the Patient Display Board located in the Emergency Room or the patient care area you are admitted to. The Patient Information Display will not include specific medical information about you
Individuals Involved in Your Care or Payment for Your Care. Unless you object, we may disclose health information about you to a family member, close personal friend or other person you identify, including clergy, who is involved in your care. These disclosures are limited to information relevant to the person’s involvement in your care or in arranging payment for your care.
Disaster Relief. We may disclose health information about you to an organization assisting in a disaster relief effort.
Emergencies. We may use or disclose your health information as necessary in emergency treatment situations. We will attempt to obtain authorization from you or your representative as soon as possible.
Communication Barriers. We may use and disclose your protected health information if your physician or another physician in the practice attempts to obtain consent from you but is unable to do so due to substantial communication barriers and the physician determines, using reasonable judgment, that you intend to consent to use or disclosure under the circumstances.
As Required By Law. We may disclose your health information when required by law to do so.
Public Health Activities. We may disclose your health information for public health activities. These activities may include, for example
- reporting to a public health or other government authority for the purpose of preventing or controlling disease, injury or disability, reporting child abuse or neglect, reporting births and deaths;
- reporting to the federal Food and Drug Administration (FDA) issues concerning problems with products and product recalls, etc., or
- to notify a person who may have been exposed to or is at risk of spreading a communicable disease, if authorized by law.
Reporting Victims of Abuse, Neglect or Domestic Violence. If we believe that you have been a victim of abuse, neglect or domestic violence, we may use and disclose your health information to notify a government authority, if authorized or mandated by law or if you agree to the report. For child abuse or neglect or elder abuse or neglect we will disclose your health information to government authorities.
Health Oversight Activities. We may disclose your health information to a health oversight agency for activities authorized by law. These may include, for example, Medicare audits, investigations, State Health Department inspections and licensure actions or other legal proceedings.
Legal Proceedings. We may disclose your health information in response to a court or administrative order. We also may disclose information in response to a subpoena, discovery request, or other lawful process; efforts must be made to contact you about the request or to obtain an order or agreement protecting the information.
Law Enforcement. We may disclose your health information for certain law enforcement purposes, including, for example, to comply with reporting requirements or report emergencies or suspicious deaths; to comply with a court order, warrant, or similar legal process; to identify or locate a suspect or missing person; or to answer certain requests for information concerning crimes.
Research. Your health information may be used for research purposes, but only if the privacy aspects of the research have been reviewed and approved by an Institutional Review Board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.
Coroners, Medical Examiners, Funeral Directors, Organ Procurement Organizations. We may release your health information to a coroner, medical examiner, funeral director or, if you are an organ donor, to an organization involved in the donation of organs and tissue.
To Avert a Serious Threat to Health or Safety. When necessary to prevent a serious threat to your health or safety or the health or safety of the public or another person, we may use or disclose health information, limiting disclosures to someone able to help lessen or prevent the threatened harm.
Military Activity and National Security: When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities: (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military services. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.
Workers’ Compensation. We may use or disclose your health information to comply with laws relating to workers’ compensation or similar programs.
Inmates/Law Enforcement Custody. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose your health information to the institution or official for certain purposes including the health and safety of you and others.
Fundraising Activities. We may use certain health information to contact you in an effort to raise money for the Hospital. Such information is limited to: demographic information, including name, address, other contact information, age, gender, and date of birth; the dates you received treatment or services; information about which hospital department provided services to you; who your treating physician is; information about outcomes, and your health insurance status. We also may disclose contact information for fundraising purposes to a foundation related to the Hospital. Please note that you have a right to opt out of receiving fundraising communications.
Appointment Reminders. We may use or disclose health information to remind you about appointments.
- YOUR AUTHORIZATION IS REQUIRED FOR OTHER USES OF
Except as described in this Notice, we will use and disclose your health information only with your written Authorization. While your general Consent allows us to use and disclose your health information for treatment, payment and health care operations, an Authorization must specify other particular uses or disclosures that you may allow. Please note that our use or disclosure of your health information relating to psychotherapy notes (if we have such notes), for marketing purposes, and for the sale of your health information generally require your authorization. You may revoke an Authorization to use or disclose health information, in writing, at any time. If you revoke an Authorization, we will no longer use or disclose your health information for the purposes covered by that Authorization, except where we have already relied on the Authorization.
- YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You have the following rights regarding your health information at the Hospital:
Right to Request Restrictions. You have the right to request restrictions on our use or disclosure of your health information for treatment, payment or health care operations. You also have the right to request restrictions on the health information we disclose about you to a family member, friend or other person who is involved in your care or the payment for your care.
Generally, we are not required to agree to your requested restriction, except that you have a right to request that we withhold health information from a health plan for the purpose of payment or health care operations (unless the disclosure is required by law – such as for Medicaid) and, subject to you paying in full for the items or services that you do not wish disclosed to the health lan and other specific conditions, we will honor that request. If we do agree to accept your requested restriction, we will comply with your request except as needed to provide you emergency treatment.
Right of Access to Personal Health Information. You have the right to inspect and obtain a copy (including a digital, electronic copy if available) of your medical or billing records or other written information that may be used to make decisions about your care, subject to some limited exceptions. In most cases, we may charge a reasonable fee for our costs in copying and mailing your requested information.
We may deny your request to inspect or receive copies in certain limited circumstances. If you are denied access to health information, in some cases you will have a right to request review of the denial. A licensed health care professional designated by the Hospital who did not participate in the decision to deny would perform this review.
Right to Request Amendment. You have the right to request amendment of your health information maintained by the Hospital for as long as the information is kept by or for the Hospital. Your request must be made in writing and must state the reason for the requested amendment.
We may deny your request for amendment if the information (a) was not created by the Hospital, unless the originator of the information is no longer available to act on your request; (b) is not part of the health information maintained by or for the Hospital; (c) is not part of the information to which you have a right of access; or (d) is already accurate and complete, as determined by the Hospital.
If we deny your request for amendment, we will give you a written denial including the reasons for the denial and the right to submit a written statement disagreeing with the denial.
Right to an Accounting of Disclosures. You have the right to request an “accounting” of certain disclosures of your health information. This is a listing of disclosures made by the Hospital or by others on our behalf, but does not include disclosures for treatment, payment and health care operations or certain other exceptions.
To request an accounting of disclosures, you must submit a request in writing, stating a time period beginning after April 13, 2003 that is within six years from the date of your request. An accounting will include, if requested: the disclosure date; the name of the person or entity that received the information and address, if known; a brief description of the information disclosed; and a brief statement of the purpose of the disclosure or a copy of the authorization or request or certain summary information concerning multiple disclosures. The first accounting provided within a 12-month period will be free; for further requests, we may charge you our costs.
Right to Notice of a Breach Involving Your Unsecured Health Information. You have the right to be notified in the event that there is a data breach involving unsecured health information about you. If such an event occurs, we will notify you and provide additional information.
Right to a Paper Copy of This Notice. You have the right to obtain a paper copy of this Notice, even if you have agreed to access this Notice electronically. You may request a copy of this Notice at any time. In addition, you may obtain a copy of this notice at our website, www. waterburyhospital.org.
Right to Request Confidential Communications. You have the right to request that we communicate with you concerning your health matters in a certain manner or at a certain location. For example, you can request that we contact you only at a certain phone number or address. We will accommodate your reasonable requests.
- SPECIAL RULES REGARDING DISCLOSURE OF PSYCHIATRIC, BEHAVIORAL HEALTH, SUBSTANCE ABUSE AND HIV-RELATED INFORMATION
For disclosures concerning health information relating to care for psychiatric conditions, substance abuse or HIV-related testing and treatment, special restrictions may apply. For example, we generally may not disclose this specially protected information in response to a subpoena, warrant or other legal process unless you sign a special Authorization or a court orders the disclosure.
- Psychiatric (Behavioral Health) information. If needed for your diagnosis or treatment in a mental health program, psychiatric information may be disclosed based on your general Consent, and very limited information may be disclosed for payment purposes. Otherwise, psychiatric information may not be disclosed without your special Consent or Authorization except as specifically permitted under state law.
- HIV-related information. HIV-related information may be disclosed based on your general Consent for purposes of treatment or payment, but your special Consent or Authorization will be necessary for other disclosures except as permitted under state law.
- Substance abuse treatment. If you are treated in a specialized substance abuse program, your special Consent or Authorization will be needed for most disclosures, not including emergencies, certain reporting requirements and other disclosures specifically allowed under federal law.
If you believe that your privacy rights have been violated, you may file a complaint in writing with the Hospital or with the Office of Civil Rights in the U.S. Department of Health and Human Services. To file a complaint with the Hospital, contact the Privacy Office at 203-573-7053.
You will not be penalized if you file a complaint.
- 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 the hospital. 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.
- EFFECTIVE DATE
This Notice went into effect on September 23, 2013.
- FOR FURTHER INFORMATION
If you have any questions about this Notice or would like further information concerning your privacy rights, please contact the Privacy Office at 203-573-7053.