Notice of Privacy Practices

Jefferson Public Hospital District #2
Notice of Privacy Practices Summary

The following pages describe how medical information about you may be used and disclosed and how you can obtain access to this information. Please review it carefully. The notice is provided in two sections. The top section briefly summarizes how we handle your health information. This is followed by an expanded version, which provides further details of our privacy policy and procedures.

How We May Use and Disclose Your Health Information

We use health information about you for treatment, to obtain payment, for administrative purposes, and to evaluate the quality of care. Information may be shared on paper, by fax, electronically, or verbally. We may disclose information without your authorization for several reasons. For example, your health information may be shared with other providers to whom you are referred and for reasons required by law. Beyond those situations, we will ask for your written authorization before using or disclosing health information. If you sign an authorization to disclose information, you can later revoke it to stop future uses and disclosures.

In an effort to better serve our patients by providing coordinated care within the health care system, Jefferson Healthcare has implemented a centralized documentation and management system. The system incorporates all of Jefferson Healthcare’s affiliated sites and practitioners. Members of your health care team have online access to your health information on a need-to-know basis. The goal of this collaborative project is to improve care for patients by using a central system to facilitate communication, synchronize care, and decrease potential sources of error. Information includes physicians’ office and hospital visits, nursing notes, lab and radiology results, and scheduling and billing information.

Your Rights

In most cases you have the right to look at or get a copy of your health information. If you request copies we may charge you a fee. You also have the right to request a list of certain types of disclosures we have made of your information. If you believe your health information is incorrect or information is missing, you have the right to request that we correct the information.

Our Duty

We are required by law to protect the privacy of your health information, provide this notice about our privacy practices, follow the privacy practices that are described in this notice, and seek your acknowledgment of receipt of this notice. We may change our privacy policies at any time and will post the most current version on our Web site as well as having copies available upon request.

Privacy Complaints

If you are concerned that we have violated your privacy rights or our privacy policies, or if you disagree with a decision we make about access to your health information, you may contact the Jefferson Healthcare privacy officer at 360-385-2200, ext. 2497. You also have the option of sending a written complaint to the U.S. Department of Health and Human Services.

JEFFERSON COUNTY PUBLIC HOSPITAL DISTRICT #2
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.

If you have any questions about this notice, please contact the Jefferson Healthcare privacy officer at 360-385-2200, ext. 2497.

WHO WILL FOLLOW THIS NOTICE

This notice describes our hospital’s practices and that of

• any health care professional authorized to enter information into your chart;
• all departments and units of the hospital, affiliated clinics, and Home Health & Hospice;
• any member of a volunteer group we allow to help you while you are in the hospital; and
• all employees, staff, and other hospital district personnel.

All these entities, sites, and locations of Hospital District #2 follow the terms of this notice. In addition, these entities, sites, and locations may share medical information with each other for treatment, payment, or operations purposes 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 our facilities. 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, affiliated clinics, and Home Health & Hospice, whether made by hospital personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of medical information created in the doctor’s office or clinic.

This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.

We are required by law to

• make sure that medical information that identifies you is kept private,
• give you this notice of our legal duties and privacy practices with respect to medical information about you, and
• follow the terms of the notice that is currently in effect.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU

In an effort to better serve our patients by providing coordinated care within the health care system, Jefferson Healthcare has implemented a centralized documentation and management system. The system incorporates all of Jefferson Healthcare’s affiliated sites and practitioners. Members of your health care team have online access  to your health information on a need-to-know basis. The goal of this collaborative project is to improve care for patients by using a central system to facilitate communication, synchronize care, and decrease potential sources of error. Information includes physicians’ office and hospital visits, nursing notes, lab and radiology results, and scheduling and billing information.

The following describes the different ways that we use and disclose medical information. Each category of uses or disclosures includes an explanation and examples. Not every use or disclosure in a category is listed; however, all of the ways we are permitted to use and disclose information will fall within one of these categories.

• For treatment. We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other hospital, affiliated clinic, or Home Health/Hospice personnel who are involved in 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 dietitian that you have diabetes so that we can arrange for appropriate meals. Different departments of the hospital, affiliated clinic, or Home Health/Hospice also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work, and X-rays. We also may disclose medical information about you to people outside the hospital, affiliated clinic, or Home Health/Hospice who may be involved in your medical care after you leave the hospital, affiliated clinic, or Home Health/Hospice, such as family members, clergy, or others we use to provide services that are part of your care.

• For payment. We may use and disclose medical information about you so that the treatment and services you receive at the hospital, affiliated clinic, or Home Health/Hospice may be billed to 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, affiliated clinic, or Home Health/Hospice so 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.

• For health care operations. We may use and disclose medical information about you for hospital, affiliated clinic, or Home Health/Hospice operations. These uses and disclosures are necessary to run the hospital, affiliated clinic, or Home Health/Hospice and to ensure that all of our patients receive quality care. 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 also may combine medical information about many hospital, affiliated clinic, or Home Health/Hospice patients to decide what additional services the hospital district should offer, what services are not needed, and whether certain new treatments are effective. We also may disclose information to doctors, nurses, technicians, medical students, and other hospital, affiliated clinic, or Home Health/Hospice personnel for review and learning purposes. We also may combine the medical information we have with medical information from other hospitals, affiliated clinics, or Home Health/Hospice programs to compare how we are doing and to 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 that others may use it to study health care and health care delivery without learning who the specific patients are.

• 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, affiliated clinic, or Home Health/Hospice.

• 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.

• 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.

• Fundraising activities. We may use medical information about you to contact you in an effort to raise money for the hospital and its operations. We may disclose medical information to a foundation related to the hospital so that the foundation may contact you in raising money for the hospital. We only would release contact information, such as your name, address, and phone number and the dates you received treatment or services at the hospital. If you do not want the hospital to contact you for fundraising efforts, you must notify the hospital privacy officer in writing.

• 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 (for example, fair or stable) and your religious affiliation. 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 rabbi, even if they don’t 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.

• Individuals involved in your care or payment for your care. We may release medical information about you to a friend or family member who is involved in your medical care. We also may give information to someone who helps pay for your care. We also may tell your family or friends 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 same 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 the research needs with patients’ need for medical information to remain confidential. Before we use or disclose medical information for research, the project will have been approved through this research approval process. We may disclose medical information about you to people 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, affiliated clinic, or Home Health/Hospice. We will almost always ask for your specific permission if the researcher will have access to your name, address, or other information that reveals who you are or if the researcher will be involved in your care at the hospital, affiliated clinic, or Home Health/Hospice.

• 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 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 the threat.

SPECIAL SITUATIONS

• 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 donation 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 also may release medical information about foreign military personnel to the appropriate foreign military authority.

• 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.

• Public health risks. We may disclose medical information about you for public health activities. In general, such disclosures are made to
  • prevent or control disease, injury, or disability;
  • report births and deaths;
  • report child or elder abuse or neglect;
  • report reactions to medications or problems with products;
  • notify people of recalls of products they may be using;
  • notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; or
  • notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

• 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 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 also may disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.

• Law enforcement. If asked to do so by a law enforcement official, we may release medical information
  • 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, affiliated clinic, or Home Health/Hospice; 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 also may release medical information about patients of the hospital, affiliated clinic, or Home Health/Hospice 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 intelligence, counterintelligence, and other national security activities authorized by law.

• Protective services for the president and others. We may disclose medical information about you to authorized federal officials so that they may provide protection to the president, other authorized persons, or foreign heads of state or may conduct 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.

YOUR RIGHTS REGARDING MEDICAL INFORMATION 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. Usually, this includes medical and billing records but does not include psychotherapy notes. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the Jefferson Healthcare privacy officer. If you request a copy of the information, 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, you may request that the denial be reviewed. Another licensed health care professional, chosen by the hospital district, 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, affiliated clinic, or Home Health/Hospice. To request an amendment, your request must be made in writing and submitted to the Jefferson Healthcare privacy officer. 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, affiliated clinic, or Home Health/Hospice;
  • is not part of the information that 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 we have made of medical information about you. To request this accounting of disclosures, you must submit your request in writing to the Jefferson Healthcare privacy officer. 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 or electronically). The first list you request within a 12 month period will be free. For additional lists, 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, such as a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had. 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 Jefferson Healthcare privacy officer. 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 about 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. To request confidential communications, you must make your request in writing to the Jefferson Healthcare privacy officer. 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. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain a copy of this notice on our Web site. To obtain a paper copy of this notice, call the Jefferson Healthcare privacy officer at 360-385-2200, ext. 2497, or request a copy at any registration desk.

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 a copy of the current notice in the hospital, affiliated clinic, or Home Health/Hospice. The notice will contain the effective date on the first page, in the top right-hand corner. The most current notice will be posted on the Jefferson Healthcare Web site. In addition, you may request a copy of the notice each time you register at or are admitted to the hospital, affiliated clinic, or Home Health/Hospice for treatment or health care services as an inpatient or outpatient.

COMPLAINTS

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, contact the Jefferson Healthcare privacy officer at 360-385-2200, ext. 2497. All complaints must be submitted in writing and a form will be provided upon request. If you require assistance in outlining your concern, please contact the privacy officer. 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 with 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.

Notice of Privacy Practices
Form A221 9/09.