This notice describes how medication information about you may be used and disclosed, and how you can get access to this information. Please review it carefully.

Understanding Your Health Record Information

Each time you visit a hospital, a physician or another health care provider, the provider makes a record
of your visit. Typically, this record contains your health history, current symptoms, examination and test
results, diagnoses, treatment, and plan for the future care or treatment. This information, often referred
to as your medical record, serves as the following:

• Basis for planning your care and treatment.
• Means of communication among the many health professionals who contribute to your care.
• Legal documentation describing the care that you received.
• Means by which you or a third-party payer can verify that you actually received the services
• billed for.
• Tool in medical education.
• Source of information for public health officials charged with improving the health of the regions
• that they serve.
• Tool to assess the appropriateness and quality of the care that you received.
• Tool to improve the quality of health care and achieve better patient outcomes

Understanding what is in your health record and how your health information is used helps you to –of

• Ensure its accuracy and completeness.
• Understand who, what, where, why and how others may access your health information.
• Make informed decisions about authorizing disclosure to others.
• Better understand the health information rights detailed below.

Your Rights under the Federal Privacy Standard

Although your health records are the physical property of the health care provider who completed the records, you have the following rights with regard to the information contained therein:

• Request restriction on uses and disclosures of your health information for treatment, payment and health care operations. “Health care operations” consist of activities that are necessary to carry out the operations of the provider, such as quality assurance and peer review. The right to request restriction does not extend to uses or disclosures permitted or required under the following sections of the federal privacy regulations: *164.502(a)(2)(i) (disclosures to you), *164.510 (a) (for facility directories, but note that you have the right to object to such uses), or *164.512 (uses and disclosures not requiring a consent or an authorization). The latter uses and disclosures include, for example, those required by law, such as mandatory communicable disease reporting. In those cases, you do not have a right to request restriction. The consent to use and disclose your individually identifiable health information provides the ability to request restriction. We do not, however, have to agree with the restriction, except in the situation explained below. If we do, we will adhere to it unless you request otherwise or we give you advance notice. You may also ask us to communicate with you by alternate means, and if that method of communication is reasonable, we must grant the alternate communication request. You may request restriction or alternate communications on the consent form for treatment, payment and heath care operations. If, however, you request restriction on a disclosure to a health plan for purposes of payment or health care operations (not for treatment), we must grant the request if the health information pertains solely to an item or service for which we have been paid in full.
• Obtain a copy of this notice of information practices. Although we have posted a copy in the prominent locations throughout the facility and on our website, you have a right to a hard copy upon request.
• Inspect and copy your health information upon request. Again, this right is not absolute. In certain situations, such as if access would cause harm, we can deny access. You do not have a right of access to the following:
• Psychotherapy notes. Such notes consist of those notes that are recorded in any medium by a health care provider who is a mental health professional documenting or analyzing a conversation during a private, group, joint or family counseling session and that are separated from the rest of your medical record.
• Information compiled in reasonable anticipation of or for use in civil, criminal or administrative actions or proceedings.
• Protected health information (“PHI”) that is subject to the Clinical Laboratory Improvement Amendments of 1988 (“CLIA”), 42 U.S.C. *263a, to the extent that giving you access would be prohibited by law.
• Information that was obtained from someone other than a health care provider under the promise of confidentiality and the requested access would be reasonably likely to reveal the source of the information.
• Information that is copyright protected, such as certain raw data obtained from testing.

In other situations, we may deny you access. But if we do, we much provide you with a review of our decision denying access. These “reviewable: grounds for denial include the following:

• A licensed health care professional, such as your attending physician, has determined, in the exercise of professional judgment, that the access is reasonably likely to endanger the life or physical safety of yourself or another person.
• PHI makes reference to another person (other than a health care provider) and a licensed health care provider has determined, in the exercise of professional judgment, that the access is reasonably likely to cause substantial harm to such other person.
• The request is made by your personal representative and a licensed health care profession has determined, in the exercise of professional judgment, that giving access to such personal representative is reasonably likely to cause substantial harm to you or another person.

For these reviewable grounds, another licensed professional must review the decision of the provider denying access within 60 days. If we deny you access, we will explain why and what your rights are, including how to seek review. If we grant access, we will tell you what, if anything, you have to do to get the access. We reserve the right to charge a reasonable, cost-based fee for making copies.

• Request amendment/correction of your health information. We do not have to grant the request if the following conditions exist:
• We did not create the record. If, as in the case of consultation report from another provider, we did not create the record, we cannot know whether it is accurate or not. Thus, in such cases, you must seek amendment/correction from the party creating the record. If the party amends or corrects the record, we will put the corrected record into our records.
• The records are not available to you as discussed immediately above.
• The record is accurate and complete.

If we deny your request for amendment/correction, we will notify you why, how you can attach a statement of disagreement to your records (which we may rebut), and how you can complain. If we grant the request, we will make the correction and distribute the correction to those who need it and those whom you identify to us that you want to receive the corrected information.

• Obtain an accounting of nonroutine uses and disclosures, those other than for treatment, payment and health care operations until a date that the federal Department of Health and Human Services will set after January 1, 2011. After that date, we will have to provide an accounting to you upon request for uses and disclosures for treatment, payment and health care operations under certain circumstances, primarily if we maintain an electronic health record. We do not need to provide an accounting for the following disclosures:
• To you for disclosures of protected health information (“PHI”) to you.
• For the facility directory or to persons involved in your care or for other notification purposes as provided in *164.510 of the federal privacy regulations (uses and disclosures requiring an opportunity for the individual to agree or to object, including notification to family members, personal representatives, or other persons responsible for your care of your location, general condition or death).
• For national security or intelligence purposes under *164.512(k)(2) of the federal privacy regulations (disclosures not requiring consent, authorization or an opportunity to object).
• To correctional institutions or law enforcement officials under *164.512(k)(5) of the federal privacy regulations (disclosures not requiring consent, authorization or an opportunity to object).
• That occurred before April 14, 2003.

We must provide the accounting within 60 days. The accounting must include the following information:

• Date of each disclosure.
• Name and address of the organization or person who received the protected health information.
• Brief description of the information disclosed.
• Brief statement of the purpose of the disclosure that reasonably informs you of the basis for the disclosure or, in lieu of such statement, a copy of your written authorization or a copy of the written request for the disclosure.

The first accounting in any 12-month period is free. Thereafter, we reserve the right to charge a reasonable, cost-based fee.

• Revoke your consent or authorization to use or disclose health information except to the extent that we have taken action in reliance on the consent or authorization.

Our Responsibilities under the Federal Privacy Standard

In addition to providing you your rights, as detailed above, the federal privacy standard requires us to take the following measures:

• Maintain the privacy of your health information, including implementing reasonable and appropriate physical, administrative and technical safeguards to protect the information.
• Provide you this notice as to our legal duties and privacy practices with respect to individually identifiable health information that we collect and maintain about you.
• Abide by the terms of this notice.
• Train our personnel concerning privacy and confidentiality.
• Implement a sanction policy to discipline those to breach privacy/confidentiality or our policies with regard thereto.
• Mitigate (lessen the harm of) any breach of privacy/confidentiality.

We will not use or disclose your health information without your consent or authorization, except as described in this notice or otherwise required
by law. These include most uses or disclosures of psychotherapy notes, marketing communications and sales of PHI. Other uses and disclosures not described in this notice will be made only with your written authorization.

To download the printable version of the Notice of Privacy Practices click on the button below: