Effective Date: 09-23-13
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.
OUR COMMITMENT TO YOU:
We understand that your medical information is personal. We are committed to protecting medical information about you. This notice applies to all of the records of your care that we maintain. We are required by law to:
WHO IS BOUND BY THIS NOTICE:
This Notice of Privacy Practices describes the practices of Rush Memorial Hospital (RMH) and the following groups of persons at the listed sites and locations:
WHAT IS THIS NOTICE:
This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment, or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including personal information such as name, address, phone number, your insurance information and coverage, and medical information gathered by us into a record of care. Protected health information will be referred to as “health information” hereafter in this notice.
USES AND DISCLOSURE OF YOUR HEALTH INFORMATION:
Your health information may be used and disclosed by your physician, our employees, students in educational programs, volunteers and others outside our hospital and doctors’ offices that are involved in your care and treatment for the purpose of providing health care services to you. Your health information may also be used and disclosed for payment of your health care bills and to support the operation of the hospital and doctors’ offices. We may share medical information about you with each other as necessary to carry out treatment, payment, or our health care operations. We are also bound by law to release certain health information about you. Following are examples of the types of uses and disclosures of your health information that those that are bound by this notice may make. These examples in each type of use and disclosure are not meant to be all inclusive.
For Treatment: We will use and disclose your health information to provide, coordinate, or manage your health care and related services by both us and other health care providers. For example, we would disclose your health information to doctors, social workers, therapists, or others who are helping to take care of you. We also may share health information about you to health care providers who may be involved in your care after you leave our services, such as a family doctor, specialist, or pharmacist.
For Payment: Your protected health information will be used, as needed, to bill and collect payment for our health care services given to you. We may send your health information to your insurance company, a healthcare clearinghouse, or a third party for payment of services, such as a collection agency. We may also disclose your health information to another health care provider for payment activities of that entity.
For Health Care Operations: We may use and disclose health information about you for our own health care operations. For example, we may use health information about you to review the services we provide and the performance of our employees in caring for you. We will share your health information with third party “business associates” that perform various activities, such as billing or transcription services, for us.
Appointment Reminders: We may use and disclose health information to contact you as a reminder that you have an appointment, or should schedule an appointment, or to give you information you need about an upcoming service. We will leave minimal information, unless you have otherwise specified, on an answering machine.
Treatment Alternatives, Benefits and Services: We may use and disclose health information to tell you about treatment options, health-related benefits, or other services that may be of interest of you.
Fundraising Activities: We may use and disclose limited information to the Rush Memorial Hospital Foundation so that the Foundation may contact you to raise money for Rush Memorial Hospital or to a foundation related to the hospital so that its foundation may contact you. In these cases, we will release only contact information such as your name and address, dates you were here, departments of service and treating provider, health insurance status, and basic outcome information. If you do not wish Rush Memorial Hospital or its foundation to contact you for fundraising, you must notify in writing the RMH Foundation Director. An opt out form is included with each fundraising mailing.
Hospital Directory: If you have agreed, we will list certain information such as your name, location in the hospital, and general condition in the Hospital Directory. All of this information will be disclosed to people that ask for you by name. Also, if you have agreed, your presence in the hospital will be disclosed to clergy members and to the hospital chaplain even if they don’t ask for you by name. If you object to this information being listed in the Directory, you must notify the Admissions personnel.
Others Involved in Your Health Care: Unless you object, we may disclose to a member of your family, a relative, a close friend, or any other person you identify, your health information that directly relates to that person’s involvement in your health care or payment related to your care. If you are unable to object to such a disclosure, we may disclose necessary information to those who care for you. We may also use or disclose health information to an entity assisting in disaster relief efforts so that your family can be notified about your condition, status, and location.
Incidental Uses and Disclosures: There may be an occasion when your health information is used or disclosed incidental to another permitted or required use or disclosure. For example, while treating you, a conversation about your care taking place between doctors, nurses, or other personnel might be overheard by someone else.
Limited Data Sets: We may use or disclose certain parts of your health information, called a “limited data set”, for purposes of research, public health reasons, or for our health care operations. We would disclose a limited data set only to third parties that have provided us with satisfactory assurances that they will use or disclose your health information only for limited purposes.
Disclosures to the Secretary of Health and Human Services: We might be required by law to disclose your health information to the Secretary of the Department of Health and Human Services, or his/her designee, in the case of a compliance review to determine whether we are complying with privacy laws.
De-identified Information: We may use your health information, or disclose it to a third party whom we have hired, to create information that does not identify you in any way. Once we have de-identified your information, it can be used or disclosed in any way according to the law.
Disclosures by Members of Our Workforce: Members of our workforce, including employees, volunteers, students or independent contractors, may disclose your health information to a health oversight agency, public health authority, health care accreditation organization or attorney hired by the workforce member, to report the workforce member’s belief that we have engaged in unlawful conduct or that our care or services could endanger a patient, workers or the public. In addition, if the workforce member is a crime victim, the member may disclose your health information about the suspected perpetrator of the criminal act to a law enforcement official.
Disclosure of Immunization Information to a School: In Indiana we are permitted to disclose immunization information to a school as long as we obtain documented agreement with the parent.
Disclosure of Health Information of Minors: Under Indiana law, we can disclose the health information of minors to non-custodial parents unless there is a court order or decree in place that prohibits the non-custodial parent from receiving such information. However, we must have documentation of the court order prior to denying the non-custodial parent such access.
Public Health Purposes: We may use or disclose health information for public health activities, such as the following:
Health Oversight Agency: We may disclose health information to a health oversight agency for activities authorized by law, such as audits, investigations, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and various governmental regulations.
Research: Under certain circumstances we may use and disclose health 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 same condition. All research projects, however, are subject to a special approval process that ensures the privacy of your information. Before we use or disclose medical information for research, the project will have been approved through this research approval process.
Health Information Exchanges: Rush Memorial Hospital may participate in various regional, state and/or federal Health Information Exchanges (HIEs) to make certain patient information is available electronically to participating hospitals, doctors, and others participating in the HIE for purposes of treatment, payment and/or health care operations. Use of the HIE is limited to authorized users who confirm that they will comply with applicable federal and state privacy and security laws.
Coroners, Funeral Directors, and Organ and Tissue Donation: We may release health 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 health information about patients to funeral directors, as necessary and authorized by law, to permit the funeral directors to carry out their duties. If you are a potential organ/tissue donor, we may release health information to organizations that handle organ procurement or organ, eye, or tissue transplantation to facilitate the organ, eye, or tissue donation process.
Workers’ Compensation: We may release health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
To Avert a Serious Threat to Health or Safety or In Disaster Situations: We may use and disclose health information about you when necessary to lessen or prevent a serious threat to your health and safety or the health and safety of the public, another person or in the event of a disaster. Any disclosure, however, would only be to someone able to help prevent the threat or to assist in the disaster relief efforts.
Military Activity and National Security: If you are a member of the armed forces, we may release health information about you as required by military command authorities. We may also release health information about foreign military personnel to the appropriate foreign military authority. We may also disclose your health information to authorized federal officials for lawful intelligence, counterintelligence, investigations, and other national security activities authorized by law.
Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other legal process 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 health information if asked to do so by a law enforcement official as required by law:
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.
OTHER USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION:
Other uses and disclosures of your health information not covered in this notice or in the laws that apply to us will be made only with your written authorization. You may revoke this authorization at any time, in writing. However, we cannot be held responsible for valid disclosure of information made under an effective authorization prior to the revocation.
Separate individual authorizations signed by you are required for subsidized marketing purposes and disclosures of health information that constitute sale.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU:
You may request, in writing, that we restrict our use or disclosure of your health information for treatment, payment, or healthcare operations. You also have a right to request a limit on the health information we disclosure to someone involved in your care or payment of your care. We will consider your request, but we are not legally required to accept it. We will inform you of our decision regarding your request. To request a restriction, you should complete an appropriate form in the Health Information Department. The Privacy Officer will notify you of the decision regarding your request.
You may specifically request us to restrict disclosure of information to a health plan for a specific service and date if you pay out of pocket in full for that service. We are then required to not release that information to the specified health plan. You may complete the request for this restriction in the RMH Patient Accounts Offices.
You have the right to request that health information about you be communicated to you via alternative means, such as sending mail to an address other than your home, by notifying us in writing of the specific way or location for us to use to communicate with you. For example, you can ask that we only contact you at work. We will not request an explanation from you as to the basis of this request. We will accommodate all reasonable requests. A Request for Confidential Communication form must be completed in the Health Information Department. We will inform you of our decision regarding your request. A complete explanation of this process will be provided upon request to the Privacy Officer.
You have the right to look at or get a copy of medical and billing information, in most cases, that we use to make decisions about your care, when you submit a written request. If you request copies, we may charge a fee for the cost of copying, mailing, or other related supplies. If we deny your request to review or obtain a copy, you may submit a written request for a review of that decision. A complete explanation of this process will be provided upon request to the Director of Health Information.
You have the right to request an electronic copy of your health information if it is maintained in electronic format. We will provide a copy of your health information in the format requested, or, if unavailable, in an agreed upon electronic format. We may charge you for labor for copying and the cost of the electronic media used. If there is no agreed upon electronic format, we may provide you a hard copy of your health information.
You have the right to request that we correct your records if you believe that information in your record is incorrect or if important information is missing. You must submit a request in writing to the Health Information Department that provides your reason for requesting the amendment. We could deny your request to amend a record if the information was not created by us, if it is not part of the medical information maintained by us, or if we determine that the record is accurate. You may appeal, in writing, a decision by us not to amend a record. A complete explanation of this process will be provided upon request to the Director of Health Information.
You have the right to a list of those instances where we have disclosed health information about you, other than for treatment, payment, health care operations, where you specifically authorized a disclosure, disclosures incident to another use or disclosure, and disclosures to our facility directory. You must submit a written request to the Health Information Department. The request must state the time period desired for the accounting of disclosures, which may go back up in time up to six years. The first disclosure list request in a 12 month period is free; other requests will be charged according to our cost of producing the list. We will inform you of the cost involved before you incur any costs. A complete explanation of this process will be provided upon request to the Director of Health Information.
You have the right to receive notification of any breach of your health information. A breach is an impermissible use or disclosure that compromises the privacy or security of any of your unsecured health information. The Risk Manager will notify you if this occurs.
You have a right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Request should be made to the registration areas of the hospital or physician practices’ offices. The notice is also available on our website, www.rushmemorial.com. You will also be asked to acknowledge, in writing, your receipt of this notice when you first receive it.
Changes to This Notice: We may change our policies at any time. Changes will apply to health information we already hold, as well as new information after the changes occur. Before we make a significant change in our policies, we will change our notice and post the new notice at the hospital entrances and in the entrance area of the RMH Physician Practices’ offices. We also will post the new notice on our hospital website. A current copy of the notice may be obtained at any time upon request. The effective date is listed just below the title of this notice.
Complaints: If you are concerned that your privacy rights may have been violated, or you disagree with a decision we made about access to or amendments to your records, you may contact our Risk Manager at 765-932-7474. You may also use our compliance reporting line, which is checked weekly, at 765-932-7590. You may send a written complaint to the U.S. Department of Health and Human Services Office of Civil Rights; 200 Independence Ave SW; Washington, DC. 20201. Under no circumstances will you be penalized or retaliated against for filing a complaint.
Questions: If you have questions or want more information concerning this Notice of Privacy Practices, please contact the Rush Memorial Hospital Privacy Officer at 765-932-7402.
Other Contact Information:
RMH Health Information Department
1300 North Main Street
Rushville, Indiana 46173