NOTICE OF PRIVACY PRACTICES:
Douglas County
Memorial Hospital
708 8th Street
Armour, South Dakota 57313
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. THE PRIVACY OF YOUR HEALTH INFORMATION IS IMPORTANT TO US.
Effective Date: April 14, 2003
If you have any questions, please contact our Privacy Officer at the address or phone number on the bottom of this notice.
Who will follow this notice?
Douglas County Memorial Hospital provides health care to our patients, residents, and clients in partnership with physicians and other professionals and organizations. The information privacy practices in this notice will be followed by:
· Any credentialed health care professional who is a member of Douglas County Memorial Hospital Medical Staff
· All departments and units of the hospital and to include Douglas County Memorial Hospital, Prairie Health Clinic, Douglas County Homehealth and Hospice, Prairie Villa, and pharmacy.
· All employees, staff, volunteers, and other hospital personnel with whom we share information.
Our Responsibilities:
We understand that medical information about you is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive to provide quality care and to comply with legal requirements. This notice applies to all of the records of your care that we maintain, whether created by facility staff or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your medical information created in the doctor’s office. We are required by law to:
· Keep medical information about you 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.
The following categories describe different ways that we use and disclose medical information. 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 and disclose medical information about you to provide you treatment and services, such as sending medical information about you to a specialist as part of a referral or to coordinate the different things you may need such as prescriptions and lab work.
· For Payment. We may use and disclose medical information about you so that the treatment and services you receive at the Douglas County Memorial Hospital may be billed to and payment may be collected from you, an insurance company, third party, or Medicare.
· For Health Care Operations. We may use and disclose medical information about you for hospital operations. These uses and disclosures are necessary to run the hospital and make sure 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.
Disclosures for Treatment, Payment, and Health Care Operations may also be made to members of our credentialed medical staff who have an organized health care arrangement with Douglas County Memorial Hospital.
We may use or disclose medical information about you without your prior authorization for several other reasons for example in certain situations such as:
· For public health purposes such as reporting communicable diseases or notifying a person who may have been exposed to a communicable disease.
· Business Associates we have contracted with to perform the agreed upon service and billing for it.
· For reporting adverse events related to food, medications, or products.
· For notifying persons of recalls, repairs or replacements of products they may be using
· For reporting vital events such as births and deaths
· For abuse, neglect or domestic violence reporting
· For health oversight activities such as licensing, auditing, or inspection agencies authorized by law.
· In connection with lawsuits or other legal proceedings in response to a court order, warrant, summons, or subpoena.
· To Coroners, Medical examiners, and Funeral Directors. This may be necessary or required by law in certain circumstances; for example to identify a deceased person or determine the cause of death. We may also release medical information about patients of the hospital to funeral directors as necessary to carry out their duties.
· For 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.
· For Workers’ Compensation. We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
· When required by law such as request from law enforcement to help identify or locate a suspect, fugitive, witness, or missing person. Other examples would include information about a death suspected to be the result of criminal conduct.
· Military and Veterans, If you are or were a member of the armed forces, we may release information about you to military command authorities as required or authorized by law.
· Correctional Institution. Should you be an inmate of a correctional institution or under the custody of law enforcement, we may disclose to the institution or agents thereof, health information necessary for your health, and the health and safety of other individuals as required or authorized by law.
We may also contact you for:
· Appointment reminders
· To assess your satisfaction with our services, tell you about possible treatment options, alternatives and health related benefits or services that may be of interest to you.
· To contact you as part of fundraising efforts
If admitted as a patient, unless you tell us otherwise, we will:
· List certain limited information about you in the facility directory, such as name, location in the facility, your general condition (good, fair, etc..) and your religious affiliation. The directory information, except for religious affiliation, may also be released to people who ask for you by name. Your religious affiliation will only be given to a clergy member, even if they do not ask for you by name.
· Disclose medical information about you to a friend or family member who is involved in your medical care or helps pay for your care. 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.
In any other situation not covered by this notice, we will ask for your written authorization before using or disclosing medical information about you. If you choose to authorize use or disclosure, you can later revoke that authorization by notifying us in writing of your decision.
Although your health record is the physical property of the healthcare practitioner or facility that compiled it, you have the Right to:
· Inspect and Copy medical information, 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.
· Amend medical information we have about you that you feel is incorrect or incomplete. You must make this request in writing and state your reason for requesting this amendment. We may 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 record is accurate. You may appeal, in writing, a decision by us not to amend the record.
· An Accounting of Disclosures. You have a right to a list of those instances where we have disclosed medical information about you, other than for treatment, payment, health care operations or where you specifically authorized a disclosure. This request must be submitted in writing and must state the time period desired for the accounting, which must be less than a 6 year period and starting after April 14, 2003. 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 fee before you incur any costs.
· Request Confidential Communications. You have the right to request that medical information about you be communicated to you in a confidential manner, such as sending mail to an address other than your home. We will agree to the request to the extent that it is reasonable for us to do so.
· Request Restrictions. You have the right to request a restriction or limitations 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 payment for your care, like 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 emergency treatment.
All written requests or appeals should be submitted to our Privacy Office listed at the bottom of this notice.
Changes to this notice
We may change our policies at any time. Changes will apply to medical information we already hold, as well as new information after the change occurs. The current notice will be posted in the hospital, other waiting areas and on our web site at www.dcmhsd.org The notice will include the effective date. You can receive a copy of the current notice at any time. Upon your initial visit you will be asked to acknowledge in writing your receipt 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 your records, you may file a complaint with the hospital by contacting the hospital and asking for the facility Privacy Officer or with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing.
Under no circumstances will you be penalized or retaliated against for filing a complaint.
Douglas County Memorial Hospital
708 8th Street
Armour, South Dakota 57313
605-724-2159