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Patient Privacy
Notice
Joint Notice of Privacy Practices for Health
Information
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 the practices outlined in
this notice?
St. Elizabeth Community Hospital provides health care to our
patients in partnership with physicians, health care providers, and
other professionals and organizations in an organized health care
arrangement (hereinafter referred to as we, our or us). This
is a joint notice of our information privacy practices. The
practices in this notice will be followed by:
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Any health care professional who participates in an organized
health care arrangement with us to assist in providing
treatment to you. These professionals may include, but
are not limited to, physicians, allied health professionals,
and other licensed health care professionals;
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All departments and units of our organization, including
skilled nursing, home health, clinics, outpatient services,
mobile units, hospice, and emergency department; and
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Our employees, staff and volunteers, including regional
support offices and affiliates.
Our pledge to you:
We understand that medical information about you is private and
personal, and we are committed to protecting it. Each time
you visit a hospital, physician or other healthcare provider, a
record of your visit is made. This notice applies to the
records of your care at St. Elizabeth Community Hospital, whether
created by facility staff or your personal physician. Other
health care providers providing treatment to you may have different
practices or notices regarding their use and disclosure of medical
information about you maintained in their own offices or
clinics.
We will:
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Keep medical information about you private, as provided by
law;
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Provide, or make available, as applicable, this notice of our
legal duties and privacy practices for medical information
about you; and
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Follow the terms of the notice that is currently in effect.
Changes to this Notice:
We may change our practices from time to time. Changes will
apply to medical information we already hold, as well as new
information after the change occurs. If we make a significant
change in our practices, we will change our notice and post the new
notice in prominent locations in our facilities and on our Web site
at: www.chw.edu/privacy. Even though you
may have agreed to receive this notice electronically, you can
request a paper copy of the notice currently in effect at any time
by sending a note to St. Elizabeth Community Hospital,
Facility Privacy Office. We will also offer you a paper copy
of the notice, if it has changed, the next time you register for
treatment with us.
How we may use and disclose medical
information about you:
We will share medical information about you for purposes of
treatment (such as sending medical information about you to your
physician or to a specialist as part of a referral); to obtain
payment for treatment (such as submitting information that
identifies you and your diagnosis to a payer or Medicare); and to
support health care operations (such as using information about you
to assess the quality of care we have provided, utilization and
patient satisfaction review).
We may use health information about you
without your prior permission for several other reasons.
Subject to applicable law, we may give out medical information
about you to other persons or entities to carry out their duties
for (a) public health purposes (such as, births, deaths, public
health surveillance); (b) abuse, neglect or domestic violence
reporting; (c) health oversight audits or inspections; (d) research
studies; (e) coroners or medical examiner services; (f) funeral
arrangements; (g) organ donation; (h) tracking of FDA-regulated
products, (i) workers’ compensation purposes; (j)
emergencies; (k) data de-identification; and (l) data
aggregation. We may also use limited demographic information
about you for fundraising or share such data with our fundraising
foundation for fundraising purposes, as permitted by law. We
also share medical information with others when required by law,
such as in response to a request from law enforcement in specific
circumstances, or in response to valid judicial or administrative
orders.
We also may contact you for appointment
reminders, or to tell you about or recommend possible treatment
options, alternatives, health-related benefits or services that may
be of interest to you, or to support fundraising efforts.
If admitted as a patient, unless you tell us
otherwise, we may list in the patient directory your name, location
in the hospital, your general condition (good, fair, etc.) and your
religious affiliation, and will release all but your religious
affiliation to anyone who asks about you by name. Your
religious affiliation may be shared only with clergy members, even
if they do not ask for you by name.
We may share medical information about you
with a friend or family member who is involved in your medical
care, with others whom you designate as involved in your medical
care, or with disaster relief authorities so that your family can
be notified of your location and condition.
Other uses of medical
information:
In any other situation not covered by this notice, where we may
wish to use or share medical information about you, we will ask for
your written permission. You can later cancel your permission
by notifying us in writing.
Your rights regarding medical information
about you:
In most cases, when you give us a written request, you have the
right to look at or get a copy of medical information that we use
to make decisions about your care. We will give you a form
that you can complete to make the request. If you request
copies of the information, however, we may charge a fee for cost of
copying, mailing or other related supplies. If we deny your
request to look at the information or get a copy of it, you may
give us a written request for a review of that decision.
If you believe that information in our
records about you is incorrect or if important information is
missing, you have the right to request that we change the records,
by submitting a request in writing and including your reason for
requesting the change. We will provide you a form that you
can complete to make the request. We may deny your request to
change a record if the information was not created by us; if it is
not part of the medical information kept by us; or if we determine
the record is complete and correct. If we deny your request
to change, you may submit a written request to review that
denial.
You have the right to make a written request
to us for a list of those instances where we have shared medical
information about you, other than for treatment, payment, health
care operations or where you have specifically given us written
permission for the sharing. Your request must state the time
period desired for the listing, which must be less than a 6-year
period starting after April 14, 2003. The first list request
in a 12-month period is free; other list requests will be charged
according to our cost of producing the list. We will inform
you of the cost when you request the list.
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, by
telling us in writing of the specific way or location for us to
communicate with you.
You may request, in writing, that we not use
or share medical information about you for treatment, payment or
healthcare operations or to persons involved in your care except
when specifically permitted by you, when required by law, or in an
emergency. We will consider your request but we may not be
able to agree to it and we are not legally required to agree to
your request. We will inform you of our decision on your
request.
All written requests or requests for review
of denials should be submitted to our Facility Privacy Office
listed at the bottom 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 contact our Facility Privacy
Office (listed below). You may also contact our Chief Privacy
and Data Security Administrator at (415) 438-5565. Finally,
you may send a written complaint to the U.S. Department of Health
and Human Services, Office of Civil Rights. Our Facility
Privacy Office can provide you the address. We will not
penalize or retaliate against you for filing a complaint.
St. Elizabeth Community Hospital
Privacy Office
185 Berry Street, Suite 300
San Francisco, CA 94107
(415) 438-5565
(415) 591-2436
www.chw.edu/privacy
Version effective November 1,
2003
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