| TRIHEALTH
JOINT NOTICE OF PRIVACY PRACTICES
This Revised Notice Effective: October 6, 2003
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.
This Notice will tell you about the ways in which we
may use and disclose medical information about you. It also describes
your rights and certain obligations that we have regarding the use and
disclosure of your medical information.
TriHealth entities which are covered by regulations
pursuant to the Health Insurance Portability and Accountability Act of
1996 (“HIPAA”) are required by law to maintain the privacy
of your health information, give you notice of our privacy practices
with respect to your medical information, and follow the terms of this
Notice. This Notice applies to all of the records of your care generated
and maintained by TriHealth affiliated entities, including Bethesda North
Hospital, Bethesda Warren County, Good Samaritan Hospital of Cincinnati,
Ohio, Bethesda Family Practice, Bethesda Group Practice, Montgomery Internal
Medicine, Physician Associates of Good Samaritan, Optimum Services, and
Universal Health Corporation (“TriHealth Facilities”). While
you are a patient at a TriHealth Facility, you may also receive health
care services from other health care providers who are not employees
or agents of TriHealth but who will follow the terms of this Notice with
respect to the privacy of your health information. Accordingly, this
Notice also applies to the records of your care kept at a TriHealth facility
and created by any physician or licensed professional seeing and treating
you while you are a patient at a TriHealth Facility, even if they are
not employed by TriHealth. These health care providers include, but are
not limited to: Physicians Anesthesia Service, Anesthesia Group Practice,
Obstetrics Anesthesia Associates, Inc., Qualified Emergency Specialists,
Inc., Medical X-Ray, Inc. and Northeast Radiology, Inc. These entities
and the TriHealth Facilities will share your medical information as necessary
with each other in order to carry out your treatment, obtain payment
for the services provided to you or operate their health care facilities.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION
ABOUT YOU: The following categories describe different ways
that we may use and disclose your medical information. These are examples
and, therefore, not every permitted use and disclosure is listed.
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 and other trainees, or other personnel who are involved
in taking care of you at the hospital or health care facility. Different
departments of the hospital or health care facility may share medical
information about you in order to coordinate the different services
you need, such as prescriptions, lab work and x-rays. We may also disclose
medical information about you to people outside the hospital or health
care facility who may be involved in your medical care after you leave
the hospital or health care facility, such as other physicians involved
in your care, family members, or other health care related entities
such as skilled nursing care facilities with whom you seek treatment.
For Payment. We may use and disclose
medical information about you so that the treatment and services you
receive at the hospital or health care facility 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 insurance company
information about surgery you received at the hospital so your health
insurance company will pay us or reimburse you for the surgery. We
may also tell your health insurance company about a treatment that
you are going to receive in order to obtain prior approval or to determine
whether your health insurance company will cover the treatment. We
may also disclose your medical information to other healthcare providers
so that they can bill for health care services that they provided to
you, such as ambulance services.
For Health Care Operations. We may
use and disclose medical information about you in order to operate
the hospital or health care facility. These uses and disclosures are
necessary to run the hospital or health care facility and make sure
that our patients receive quality health 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 may also
disclose medical information to doctors, nurses, technicians, medical
and nursing students, and other personnel for review and learning purposes.
We may also provide medical information to other healthcare providers
who have a relationship with you and need the information for their
own healthcare operations.
Business Associates. We may disclose
medical information about you to our business associates who need that
information in order to provide a service to us or on behalf of us.
A business associate is a person who is not part of the hospital’s
or health care facility’s workforce, a company or other entity
which uses or has access to protected health information in order to
perform a function on behalf of the hospital or health care facility.
For example, business associates of TriHealth may include billing companies,
copying companies, document shredding companies, consultants, accountants
and attorneys.
Appointment Reminders. We may use
and disclose your medical information to contact you as a reminder
that you have an appointment for treatment or medical care at the hospital
or health care facility.
Treatment Alternatives. We may use
and disclose your 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 your medical information to tell you about health-related
benefits or services that may be of interest to you.
Fundraising Activities. We may disclose
medical information about you to a foundation related to the hospital
so that the foundation may contact you to raise money for the hospital.
We only release contact information, such as your name, address and
phone number and the dates you received treatment or services at the
hospital.
Hospital Directory. We may include
certain information about you in the hospital directory while you are
a patient in the hospital. This information may include your name,
location in the hospital, your general condition (for example, fair,
serious, etc.). The directory information may be released to people
who 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 With or Concerned About
Your Care. We may release information about your condition
to a friend or family member relevant to his/her involvement in your
care or payment for your care. We may also disclose your location
and condition to assist or notify a family member or personal representative
who is involved in your care. We may also disclose your information
in a disaster relief effort so that your family can be notified about
your condition 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. Research projects
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 privacy
of their medical information.
As Required by Law. We will disclose
medical information about you when required to do so by federal, state
or local law. For example, Ohio law requires hospitals to report cases
of cancer to a registry called the Ohio Cancer Incidence Surveillance
System.
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.
Organ and Tissue Donation. If you
are an organ donor, we may release medical information to organizations
that handle organ procurement or transplantation or to an organ donation
bank, as necessary to facilitate organ or tissue donation and transplantation.
Worker’s Compensation. We may
release medical information about you for worker’s compensation
or similar programs which provide benefits for work-related injuries
or illness.
Public Health Activities. We may
disclose medical information about you for public health activities
such as the prevention or control of disease, injury or disability;
reporting of births and deaths; reporting of child abuse or neglect;
and, reporting of reactions to medications or problems with products
and to fulfill requirements of the U.S. Food and Drug Administration.
Health Oversight Activities. We may
disclose medical information to a health oversight agency for activities
allowed by law such as audits, investigations, inspections and licensure
or disciplinary actions.
Lawsuits and Disputes. We may disclose medical information
about you in response to a Court Order or Administrative Order.
Law Enforcement. We may release medical
information to a law enforcement official about a death we believe
may be the result of criminal conduct; about criminal conduct at the
hospital or health care facility; and, in emergency circumstances,
to report a crime, the location of a 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 may also release medical information about patients
of the hospital to funeral directors as necessary to carry out their
duties.
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 may also release
medical information about foreign military personnel to the appropriate
foreign military authority.
National Security and Intelligence Activities. We
may release medical information about you to authorized federal officials
for intelligence 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 they may provide protection to the
President, other authorized persons or foreign heads of state or
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 the law enforcement official.
OTHER USES OF YOUR MEDICAL INFORMATION: Other
uses and disclosures of your medical information not covered by this
Notice or required by the laws that apply to TriHealth, will be made
only with your written permission (your written permission is referred
to as an Authorization). If you provide your 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 indicated in your
written Authorization. You understand that we are unable to take back
any disclosures that we made before we received your written notice revoking
your Authorization.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT
YOU: You have the following rights regarding medical information
we maintain about you:
Right to Inspect and Copy. You have
the right to inspect and obtain a copy of your medical information.
This includes your medical and billing records but does not include
psychotherapy notes. 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.
If you are a patient at Bethesda North Hospital or
Bethesda Warren County, to inspect or obtain a copy of your medical
information, you must submit your request in writing to Bethesda North
Hospital, Medical Records Department, 10500 Montgomery Road, Cincinnati,
Ohio 45242, Attention: Supervisor.
If you are a patient at Good Samaritan Hospital, to
inspect or obtain a copy of your medical information, you must submit
your request in writing to Good Samaritan Hospital, Medical Records
Department, 375 Dixmyth, Cincinnati, Ohio 45220, Attention: Supervisor.
If you are a patient at one of the TriHealth affiliated
physician practices or another TriHealth affiliated health care facility,
to inspect or obtain a copy of your medical information, you must submit
your request in writing to the Office Manager at the address of the
physician practice or facility where you received treatment.
We may deny your request in certain circumstances.
If you are denied access to your medical information, you may request
that the denial be reviewed. Another licensed health care professional
chosen by the hospital will review your request and the denial. The
person conducting the review will not be the same 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.
If you are a patient at Bethesda North Hospital or
Bethesda Warren County, to request an amendment to your medical information,
you must submit your request for an amendment, along with your reason
for the request, in writing to Bethesda North Hospital, Medical Records
Department, 10500 Montgomery Road, Cincinnati, Ohio 45242, Attention:
Supervisor.
If you are a patient at Good Samaritan Hospital, to
request an amendment to your medical information, you must submit your
request for an amendment, along with your reason for the request, in
writing to Good Samaritan Hospital, Medical Records Department, 375
Dixmyth, Cincinnati, Ohio 45220, Attention: Supervisor.
If you are a patient at one of the TriHealth affiliated
physician practices or another TriHealth affiliated health care facility,
to request an amendment to your medical information, you must submit
your request in writing to the Office Manager at the address of the
physician practice or facility where you received treatment.
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, 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
or health care facility;
- Is not part of the information which 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 made of your medical information.
This list will not include disclosures that we made for purposes of
treatment, payment and health care operations. We are also not required
to include in this list the disclosures we made by acting upon your
written authorizations.
If you are a patient at Bethesda North Hospital or
Bethesda Warren County, to request an accounting of disclosures, you
must submit your request in writing to Bethesda North Hospital, Medical
Records Department, 10500 Montgomery Road, Cincinnati, Ohio 45242,
Attention: Supervisor.
If you are a patient at Good Samaritan Hospital, to
request an accounting of disclosures, you must submit your request
in writing to Good Samaritan Hospital, Medical Records Department,
375 Dixmyth, Cincinnati, Ohio 45220, Attention: Supervisor.
If you are a patient at one of the TriHealth affiliated
physician practices or another TriHealth affiliated health care facility,
to request an accounting of disclosures, you must submit your request
in writing to the Office Manager at the address of the physician practice
or facility where you received treatment.
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. The first accounting you request within a twelve (12) month
period will be free. For additional accountings, we may charge you
for the costs of providing the list.
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 restriction
or limit on the medical information we disclose about you to someone
who is involved in your care or the payment for your care, like a family
member or friend.
We are not required to agree to your request
for a restriction or limitation. If we do agree, we will
comply with your request unless the information is needed to provide
you emergency treatment.
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.
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 a right to a paper copy of this Notice. You may ask us to give
you a copy of this Notice at any time. You may also obtain a copy of
this Notice at our website, www.TriHealth.com.
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 any information we receive in the future. We will post
a copy of the current Notice in the hospital and health care facilities.
The Notice will contain on the first page, in the top right-hand corner,
the effective date. In addition, if you are a patient at the hospital,
each time you register at or are admitted to the hospital for treatment
or health care services as an inpatient or outpatient, we will offer
you a copy of the current Notice in effect.
FOR FURTHER INFORMATION: For further
information about the matters covered by this Notice, you may contact
the following:
If you are a patient at Bethesda North Hospital or Bethesda
Warren County, contact the Patient Representative at 513-745-1115;
If you are a patient at Good Samaritan Hospital, contact
the Patient Representative at 513-872-2582; or
If you are a patient at one of the TriHealth affiliated
physician practices or another TriHealth affiliated health care facility,
contact TriHealth’s Privacy Officer at 513-569-6507.
COMPLAINTS: If you believe your privacy
rights have been violated, you may file a complaint with the
hospital or with the Secretary of the U. S. Department of Health and
Human Services. To file a complaint with the hospital, you must submit
your complaint in writing as follows:
If you are a patient at Bethesda North Hospital or Bethesda
Warren County, send your written complaint to the attention of the Patient
Representative, Bethesda North Hospital, 10500 Montgomery Road, Cincinnati,
Ohio 45242.
If you are a patient at Good Samaritan Hospital, send
your written complaint to the attention of the Patient Representative,
Good Samaritan Hospital, 375 Dixmyth Avenue, Cincinnati, Ohio 45220.
If you are a patient at one of the TriHealth affiliated
physician practices or another TriHealth affiliated health care facility,
send your written complaint to the attention of TriHealth’s Privacy
Officer, TriHealth, Inc., Corporate Administration Department, 619 Oak
Street, Cincinnati, Ohio 45206.
You will not be penalized for filing a complaint. |
