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En Español
SISTERS OF
CHARITY PROVIDENCE HOSPITALS 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. WHO WILL FOLLOW THIS NOTICE: Any health care professional authorized
to enter protected health information into your record, including members of
our medical staff; any member of a volunteer group we allow to help you while
you are at Sisters of Charity Providence Hospitals (the “Hospital”);
all employees, staff and other Hospital personnel; all departments and units of
the Hospital including the Transitional Care Unit, Wound Care, Occupational
Health and the Surgery Center on Forest Drive, will follow this Notice.
This Notice also applies to MRI, Inc. of the OUR PLEDGE REGARDING PHI: We are committed to protecting the
privacy of your protected health information. We will refer to your protected health
information in this Notice as your “PHI.” We create a record of the care and
services you receive at the Hospital to provide you with quality care and to
comply with certain legal requirements.
This Notice applies to all records of your care generated by the Hospital,
whether made by Hospital personnel or your doctor. Your doctor may have different policies
or notices regarding the doctor’s use and disclosure of your PHI created
in the doctor’s office or clinic. This Notice will tell you about the ways in which we
may use and disclose your PHI. We
also describe your rights and certain obligations we have regarding the use and
disclosure of your PHI. We are required by law to: (1) maintain the privacy
of your PHI; (2) give you this Notice of our legal duties and privacy practices
with respect to your PHI; and (3) follow the terms of the Notice that is
currently in effect. HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH
INFORMATION ABOUT YOU The following categories describe different ways
that we use and disclose PHI. For
each category of uses or disclosures, we will explain what we mean and provide
examples as required. Not every use
or disclosure in a category will be listed. However, all of the ways we are
permitted to use and disclose information will fall within one of the
categories. ·
For Treatment: We may use your PHI to
provide you with and manage your health care treatment or services. We may disclose your PHI to doctors,
nurses, technicians, medical students, or other professionals 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 if you have diabetes so that we can arrange for appropriate
meals. Different departments of the
Hospital also may share PHI about you in order to coordinate the different
things that you need, such as prescriptions, lab work, and x-rays. We may also disclose your PHI to another
health care facility or professional that is not affiliated with our
organization but that is or may be providing treatment to you. For instance, if, after you leave the
Hospital, you are going to receive home health care, we may disclose your PHI
to home health care agencies so that an appropriate agency may be selected and
a plan of care can be prepared for you. ·
For Payment: We may use and disclose
PHI about you so that the treatment and services you receive 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 PHI about surgery you had at the Hospital so your health
plan will pay 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. We may use your
information to prepare a bill to send to you or the person responsible for your
payments. We may also use or
disclose your PHI to (1) make eligibility and coverage decisions about you; (2)
seek judgment on or subrogate health benefit claims; (3) perform risk adjusting
activities; (4) support utilization review activities; and (5) review services
provided to you for the following: (a) medical necessity determination; (b)
coverage under a health plan; (c) appropriateness of care; and (d)
justification of charges. ·
For Health Care Operations: We may
use and disclose PHI about you for health care operations. Health care operations are those
activities that are necessary to run our facility and make sure that all of our
patients receive quality care. For
example, we may use PHI to review our treatment and services and to evaluate
the performance of our staff in caring for you. We may also combine PHI about many
Hospital patients to decide what additional services the Hospital should offer,
what services are not needed, and whether certain new treatments are
effective. We may also disclose PHI
to doctors, nurses, technicians, medical students, and other Hospital personnel
for review and learning purposes.
We may also use and disclose information for accreditation, licensing,
and case management. We may use or
disclose your PHI to conduct or arrange for medical review, legal services, and
auditing functions or to provide for business planning and development,
business management and general administration. ·
Appointment Reminders: We may
use and disclose PHI to contact you as a reminder that you have an appointment
for treatment or health care at the Hospital. ·
Health-Related Benefits and Services or Treatment Alternatives: We may use and disclose your PHI to tell
you about or recommend possible treatment options or alternatives. We may also use and disclose PHI to tell
you about health-related benefits or services that may be of interest to you. ·
Fundraising Activities: We may
use limited PHI about you (name, address and phone number and the dates you
received treatment or services at the Hospital) to contact you in an effort to
raise money for the Hospital and its operations. We may disclose limited PHI to a
foundation related to the Hospital so that the foundation may contact you in
raising money for the Hospital. ·
Patient Directory: Unless you object, we may
include limited information about you in the Hospital directory while you are a
patient at the Hospital. This
information includes your name, location in the Hospital, your general
condition (e.g., fair, stable, etc.) 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. ·
Family and Friends Involved in Your Care or Payment for Your Care: Unless you object, we may disclose PHI
about you to a friend or family member who is involved in your health
care. We may also disclose PHI to
someone who helps pay for your care.
In addition, we may disclose PHI about you to an entity assisting in a disaster
relief effort so your family can be notified about your condition, status and
location. ·
Business Associates: Some of our services are
performed through contracts with outside persons or organizations, such as
auditing, accreditation, legal services, etc. At times it may be necessary for us to
disclose certain PHI to one or more of these outside persons or organizations
who assist us with our certain payment and health care operations activities. In all cases, we require these business
associates to appropriately safeguard the privacy of your PHI.
SPECIAL SITUATIONS ·
To Avert a Serious Threat to Health or Safety: We may use and disclose your PHI 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 or avert the threat. ·
Organ and Tissue Donation: We are
required by federal law to notify organizations that handle organ procurement,
organ, eye or tissue transplantation or to an organ donation bank, as necessary
to facilitate organ or tissue donation and transplantation, whenever there is a
death in our facility. This is to
facilitate a patient or family’s request to be an organ or tissue donor. ·
Military and Veterans: If you
are a member of the armed forces, we may disclose PHI about you as required by
military command authorities. We
may also disclose PHI about foreign military personnel to the appropriate
foreign military authority. ·
Workers’ Compensation: We may
use or disclose your PHI to comply with worker’s compensation or other
similar programs established by law for work-related injuries or illness. ·
As Required by Law: We will disclose PHI
about you when required to do so by federal, state or local law. ·
Public Health: We will disclose PHI
about you for public health activities.
These activities generally include the following: (1) to prevent or
control disease, injury or disability; (2) to report births and deaths,
including stillbirths; (3) to report certain injuries, cancer surveillance
data, trauma registry data, birth defects, heart attacks to the national
registry of myocardial infarctions and for required public health
investigations; (4) to report child abuse or neglect; (5) to report reactions
to medications or problems with products; (6) to notify people of recalls of
products they may be using; (7) to report adverse events or product defects to
the Food and Drug Administration; (8) 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; (9) to your employer, as allowed by occupational health and
safety laws, regarding work-related illness or injury or concerning medical
surveillance activities so long as certain notice requirements are met. ·
Health Oversight Activities: We may
disclose your PHI 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: We may
disclose your PHI in response to a court or administrative order. We may also disclose PHI about you in
response to a subpoena, discovery request, or other lawful process by someone
else involved in a 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: We may disclose your PHI
to a law enforcement official: (1) to help you get financial assistance if you
have been the victim of a crime or sexual assault; (2) if you are the victim of
elder abuse or neglect, domestic violence if serious physical injury is
present; (3) to report gunshot wounds, knife stabbing, suspicious injury and
burns, as required by law; (4) in response to a court order, subpoena, warrant,
summons or similar process; (5) to identify or locate a suspect, fugitive,
material witness, or missing person; (6) about the victim of a crime, if under
certain limited circumstances, we are unable to obtain the person’s
agreement; (7) about a death we believe may be the result of criminal conduct;
(8) about a crime committed on our premises; and (9) 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 disclose PHI 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 will disclose PHI about patients to funeral directors and others as
necessary to carry out their duties and as required by law. ·
National Security and Intelligence Activities: We may disclose your PHI 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 PHI about you to
authorized federal officials so they may provide protection to the President,
other authorized persons or foreign heads of state or conduct special
investigations. OTHER USES AND DISCLOSURES OF PROTECTED
HEALTH INFORMATION Other uses and disclosures of PHI not covered by
this Notice or the laws that apply to us will be made only with your written
authorization. If you authorize us
to use or disclose PHI about you, you may revoke that authorization in writing
at any time, except to the extent that your PHI has already been used or
disclosed before you revoked your authorization. If you revoke your authorization, we
will no longer use or disclose PHI about you for the reasons covered by your
written authorization. If we receive PHI from a facility covered by the
Alcohol and Drug Rehabilitation Act, or if we receive or create certain
psychiatric PHI, we will not further disclose or disclose that PHI without your
express permission or as allowed or required by law. YOUR RIGHTS REGARDING PROTECTED HEALTH
INFORMATION ABOUT YOU You have the following rights regarding your PHI we
maintain: ·
Right to Inspect and Copy: You
have the right to inspect and copy your PHI. This usually includes medical and
billing records. To inspect and
copy your PHI, you must submit your request in writing to Health Information
Management Services at the address provided on the last page of this
Notice. If you are a current
resident of our Transitional Care Unit, you may make this request
verbally. We
may deny your request to inspect and copy your PHI in certain very limited
circumstances. If you are denied
access to PHI, in certain circumstances, you may request that the denial be
reviewed. If you request a
copy of your PHI, we may charge a fee for the costs of copying, mailing or
other supplies associated with your request. This fee is
set by ·
Right to Amend: If you feel that your PHI
we maintain 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 our
facility. To request an amendment,
your request must be made in writing on our designated forms and submitted to
Health Information Management Services at the address provided on the last page
of this Notice. 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 PHI that:
(1) was not created by us, unless the person or entity that created the
information is no longer available to make the amendment; (2) is not part of
the PHI kept by or for the Hospital; (3) is not part of the PHI which you would
be permitted to inspect and copy; or (4) is accurate and complete. ·
Right to an Accounting of Disclosures:
You have the right to request an “accounting of
disclosures,” which is a list of the disclosures we have made of your
PHI. This right applies to disclosures
for purposes other than treatment, payment or healthcare operations, as
described in this Notice, and certain other disclosures. To
request this list or accounting of disclosures, you must submit your request in
writing to Health Information Management Services at the address provided on
the last page of this Notice. Your
request must state a time period, which may not be longer than six (6) 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 our uses or discloses
of your PHI. You also have the
right to request a limit on the PHI we disclose about you to someone who is
involved in your care or the payment for your care, like a family member or
friend. For example, you could ask
that we not use or disclose PHI 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 PHI is needed to provide you emergency
treatment. To
request restrictions, you must make your request in writing on our designated
forms to Health Information Management Services at the address provided on the
last page of this Notice. In your
request, you must tell us: (1) what
PHI you want to limit; (2) whether you want to limit use, disclosure, or both;
and (3) to whom you want the limits to apply. These restrictions will not apply if
disclosure is required by law. ·
Rights to Confidential Communications:
You have the right to request that we communicate with you about health
care matters in a certain way or to 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
Health Information Management Services at the address provided on the last page
of this Notice. We will not ask you
the reason for your request and 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:
Even if you have agreed to receive this Notice electronically, you still
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. To obtain a paper copy of this Notice, contact
the Admitting Office or the Emergency Registration Department. You may obtain a copy of this Notice at
our website: http://www.provhosp.com/ RELEASE OF PROTECTED HEALTH INFORMATION
Your privacy is very important to Providence, but when the need arises, you may request a copy of your medical records by calling the Release of Information office at (803) 256-5722 on weekdays between 8:30 a.m. and 4 p.m.
A copy of a patient’s Protected Health Information will be released upon completion of the following:
1. The requestor provides the following information on the appropriate form, available from the Release of Information office:
Identifying information of the patient whose protected health information is being requested;
Type of information requested;
Reason for the request or disclosure of the information;
Name and address of the recipient of the information;
Requestor's signature.
2. The requestor must present a picture ID before information is released.
3. The requestor shows under what authority he or she is receiving the requested protected health information. For example, a requestor must prove that he or she is the patient, or that he or she has legal documentation giving them rights to that patient's protected health information.
Please note that these instructions do not pertain to healthcare providers.
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 PHI we already have about you as well as any
PHI we receive in the future. We
will post a copy of the current Notice in the Hospital. The Notice will contain the effective
date at the bottom of its last page. CONTACT Contact the Privacy Officer at (800) 565-0675 if you have any questions
about the Notice or for further information. Our address is: Sisters
of Charity Providence Hospitals, 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 Privacy Officer at (800) 565-0675. All complaints must be submitted in
writing. You will not be penalized for filing a complaint. EFFECTIVE
DATE The
effective date of this Notice is December 27, 2004. |
