NOTICE OF
PRIVACY PRACTICES
OF
WEBSTER COUNTY
COMMUNITY HOSPITAL
We
are required by law to maintain the privacy of your medical information and to
provide you with notice of our legal duties, privacy practices and your rights
with respect to your medical information.
Medical information includes medical, insurance and medical payment
information, such as your diagnosis, medications or medical payment history,
which identifies you.
WHO WILL
FOLLOW THIS NOTICE
WEBSTER COUNTY
COMMUNITY HOSPITAL. This Notice describes the
privacy practices of Webster County Community Hospital (the “Hospital”) and all
of its programs and departments, including its rural health clinics.
MEDICAL STAFF. This Notice also describes the privacy practices of an “organized
health care arrangement” or “OHCA” between the Hospital and eligible providers
on its Medical Staff. Because the
Hospital is a clinically-integrated care setting, our patients receive care from
Hospital staff and from independent practitioners on the Medical Staff. The Hospital and its Medical Staff must be
able to share your medical information freely for treatment, payment and health
care operations as described in this Notice.
Because of this, the Hospital and all eligible providers on the
Hospital's Medical Staff have entered into the OHCA under which the Hospital
and the eligible providers will:
§
Use
this Notice as a joint notice of privacy practices for all inpatient and
outpatient visits and follow all information practices described in this
notice;
§
Obtain
a single signed acknowledgment of receipt; and
§
Share
medical information from inpatient and outpatient hospital visits with eligible
providers so that they can help the Hospital with its health care operations.
The OHCA does not cover the information practices of practitioners in
their private offices or at other practice locations.
USES AND
DISCLOSURES OF INFORMATION WITHOUT YOUR AUTHORIZATION
The
following are the types of uses and disclosures we may make of your medical
information without your permission.
Medical information includes medical, insurance and medical payment
information, such as your diagnosis, medications or medical payment history, which
identifies you. Where State or federal law restricts one of the described
uses or disclosures, we follow the requirements of such State or federal
law. These are general descriptions
only. They do not cover every example
of disclosure within a category.
Treatment. We will use and disclose your medical information for treatment.
For example, we will share medical information about you with our nurses, your
physicians and others who are involved in your care at the Hospital. We will also disclose your medical
information to your physician and other practitioners, providers and health
care facilities for their use in treating you in the future. For example, if you are transferred to a
nursing facility, we will send medical information about you to the nursing
facility.
Payment. We will use and disclose your medical information for payment
purposes. For example, we will use your
medical information to prepare your bill and we will send medical information
to your insurance company with your bill.
We may also disclose medical information about you to other medical care
providers, medical plans and health care clearinghouses for their payment
purposes. For example, if you are
brought in by ambulance, the information collected will be given to the ambulance
provider for its billing purposes. If
State law requires, we will obtain your permission prior to disclosing to other
providers or health insurance companies for payment purposes.
Health Care Operations. We may use or disclose your medical information for our health
care operations. For example, medical
staff members may review your medical information to evaluate the treatment and
services provided, and the performance of our staff in caring for you. In some cases, we will furnish other qualified
parties with your medical information for their health care operations. The ambulance company, for example, may also
want information on your condition to help them know whether they have done an
effective job of providing care. If
State law requires, we will obtain your permission prior to disclosing to other
providers or health insurance companies for their operations.
Business Associates. We will disclose your medical information to our
business associates and allow them to create, use and disclose your medical
information to perform their job. For
example, we may disclose your medical information to an outside billing company
who assists us in billing insurance companies.
Appointment Reminders. We may contact you as a reminder that you have an
appointment for treatment or medical services.
Treatment Alternatives. We may contact you to provide information about
treatment alternatives or other health-related benefits and services that may
be of interest to you.
Fundraising. We may contact you as part
of a fundraising effort. We may also
disclose certain elements of your medical information, such as your name,
address, phone number and dates you received treatment or services, to a
business associate or a foundation related to the Hospital so that they may
contact you to raise money for the Hospital.
Hospital Directory. We may include your name, location in the facility, general
condition and religious affiliation in a facility directory. This information may be provided to members
of the clergy and, except for religious affiliation, to other people who ask
for you by name. We will not include
your information in the facility directory if you object or if we are
prohibited by State or federal law.
Family and Friends. We may disclose your location or general condition
to a family member or your personal representative. If any of these individuals or others you identify are involved
in your care, we may also disclose such information as is directly relevant to
their involvement. We will only release
this information if you agree, are given the opportunity to object and do not,
or if in our professional judgment, it would be in your best interest to allow
the person to receive the information or act on your behalf. For example, we may allow a family member to
pick up your prescriptions, medical supplies or X-rays. We may also disclose your information to an
entity assisting in disaster relief efforts so that your family or individual
responsible for your care may be notified of your location and condition.
Required by Law. We will use and disclose your information as required by federal,
State or local law
Public Health
Activities. We may disclose medical
information about you for public health activities. These activities may include disclosures:
·
To
a public health authority authorized by law to collect or receive such
information for the purpose of preventing or controlling disease, injury or
disability;
·
To
appropriate authorities authorized to receive reports of child abuse and
neglect;
·
To
FDA-regulated entities for purposes of monitoring or reporting the quality,
safety or effectiveness of FDA-regulated products; or
·
To
notify a person who may have been exposed to a disease or may be at risk for
contracting or spreading a disease or condition.
Abuse, Neglect or Domestic
Violence. We may notify the appropriate government
authority if we believe a patient has been the victim of abuse, neglect or
domestic violence. Unless such
disclosure is required by law, we will only make this disclosure if you agree.
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.
Judicial and Administrative
Proceedings. 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 the
dispute, but only if reasonable efforts have been made to notify you of the
request or to obtain an order from the court protecting the information
requested.
Law Enforcement. We may release certain
medical information if asked to do so by a law enforcement official:
·
As
required by law, including reporting wounds and physical injuries;
·
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 we obtain the individual's agreement or, under certain
limited circumstances, if we are unable to obtain the individual's agreement;
·
To
alert authorities of a death we believe may be the result of criminal conduct;
·
Information
we believe is evidence of criminal conduct occurring on our premises; 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.
Deceased Individuals. We may release medical
information to a coroner, medical examiner or funeral director as necessary for
them to carry out their duties.
Organ, Eye or Tissue
Donation: We may release medical information to organ,
eye or tissue procurement, transplantation or banking organizations or entities
as necessary to facilitate organ, eye or tissue donation and transplantation.
Research: Under certain circumstances, we may use or disclose your medical
information for research, subject to certain safeguards. For example, we may disclose information to
researchers when their research has been approved by a special committee that
has reviewed the research proposal and established protocols to ensure the
privacy of your medical information. We
may disclose medical information about you to people preparing to conduct a
research project, but the information will stay on site.
Threats to Health or Safety. Under certain circumstances, we may use or disclose your medical
information to avert a serious threat to health and safety if we, in good
faith, believe the use or disclosure is necessary to prevent or lessen the
threat and is to a person reasonably able to prevent or lessen the threat
(including the target) or is necessary for law enforcement authorities to
identify or apprehend an individual involved in a crime.
Specialized Government Functions. We may use and disclose your
medical information for national security and intelligence activities
authorized by law or for protective services of the President. If you are a military member, we may
disclose to military authorities under certain circumstances. If you are an inmate of a correctional
institution or under the custody of a law enforcement official, we may disclose
to the institution, its agents or the law enforcement official your medical
information necessary for your health and the health and safety of other
individuals.
Workers' Compensation: We may release medical information about you as authorized by law
for workers' compensation or similar programs that provide benefits for
work-related injuries or illness.
Incidental Uses and
Disclosures. There are certain incidental
uses or disclosures of your information that occur while we are providing
service to you or conducting our business.
For example, after surgery the nurse or doctor may need to use your name
to identify family members that may be waiting for you in a waiting area. Other individuals waiting in the same area
may hear your name called. We will make
reasonable efforts to limit these incidental uses and disclosures.
Other Uses and
Disclosures. Other uses and disclosures
of your medical information not covered above will be made only with your
written permission. If you authorize us
to use and disclose your information, you may revoke that authorization at any
time. Such revocation will not affect
any action we have taken in reliance on your authorization.
INDIVIDUAL
RIGHTS
Request for Voluntary
Restrictions. You have the right to request a restriction
on how we use and disclose your medical information for treatment, payment and
health care operations, or to certain family members or friends identified by
you who are involved in your care or the payment for your care. We are not required to agree to your
request, and will notify you if we are unable to agree.
Access to Medical Information. You may request to inspect and copy much of the medical
information we maintain about you, with some exceptions. If you request copies, we may charge you a
copying fee plus postage. If we agree
to prepare a summary of your medical information, we will charge a fee to
prepare the summary.
Amendment. You may request that we amend certain medical information that we
keep in your records. We are not
required to make all requested amendments, but will give each request careful
consideration. If we deny your request,
we will provide you with a written explanation of the reasons and your rights.
Accounting. You have the right to receive an accounting of certain
disclosures of your medical information made by us or our business
associates. The first accounting in any
12-month period is free; you may be charged a fee for each subsequent
accounting you request within the same 12-month period.
Confidential Communications. You may request that we communicate with you about your medical
information in a certain way or at a certain location. We must agree to your request if it is
reasonable and specifies the alternate means or location.
How to Exercise These Rights. All requests to exercise these rights must be in writing. We will follow written polices to handle
requests and notify you of our decision or actions and your rights. Contact Privacy Officer at the Webster
County Community Hospital, 6th & Franklin, PO Box 465, Red
Cloud, NE 68970 (402-746-2291) for more information or to obtain request forms.
ABOUT THIS
NOTICE
We
are required to follow the terms of the Notice currently in effect. We reserve the right to change our practices
and the terms of this Notice and to make the new practices and notice
provisions effective for all medical information that we maintain. Before we make such changes effective, we
will make available the revised Notice by posting it in the business office,
emergency room entrance, and in our rural health clinic, where copies will also
be available. The revised Notice will
also be posted on our website at websterhospital.org. You are entitled to receive this Notice in written form. Please contact the Privacy Officer at the
address listed below to obtain a written copy.
COMPLAINTS
If
you have concerns about any of our privacy practices or believe that your
privacy rights have been violated, you may file a complaint with the Hospital
using the contact information at the end of this Notice. You may also submit a written complaint to
the U.S. Department of Health and Human Services. There will be no retaliation for filing a complaint.
CONTACT
INFORMATION
Privacy
Officer
Webster
County Community Hospital
6th
& Franklin
PO
Box 465
Red
Cloud, NE 68970
EFFECTIVE DATE OF NOTICE: April 14, 2003.
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