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
Milford
Hospital cares about you, our patients, and your privacy. We understand that medical information about
you is personal, and protecting that information is important. We create records of the care and services
you receive here so that we can continue to provide you with quality care and
so that we can comply with certain legal and accreditation requirements. This
notice tells you the ways in which we may use and disclose your personal
information, and our obligations to keep your information private. This notice also describes your privacy
rights. We are required by law to keep
your personal health information private; to give you this notice of our legal
duties and our privacy practices; and to follow the terms of the notice
currently in effect.
The
following categories show the different ways we may use and disclose to others
your medical information. For each
category we give some examples, but not every use or disclosure in a category
is listed. Your health information will
not be used or disclosed for purposes other than those described in this notice
without your authorization.
For Treatment: Your health information may be used or
released to other healthcare professionals to provide you with medical treatment
or services, as well as emergency care provided in another facility. We may share information about you with
doctors, nurses, technicians, or other healthcare professionals involved in
taking care of you. For example, a
doctor treating you for a broken leg may need to know if you have diabetes
since that could affect the healing process.
Other health care professionals may need to share your information to
coordinate your care with people outside the Hospital such as for
prescriptions, lab work, and x-rays.
And we may disclose information about you to people outside the Hospital
who may be involved in your medical care after you leave the Hospital.
For Payment: Your health information may be used and
disclosed by the Hospital so that the Hospital can receive payment from you,
your insurance company, or a third party, for providing you with needed
healthcare services. For example, your
insurance company may need to know about the surgery you received so that they
will pay us or reimburse you. The Hospital
may also disclose your information to obtain prior approval for your care or to
determine if your insurance policy will cover the treatment.
For Hospital Functions Other than
Treatment and Payment:
Your health information may be used or disclosed for a variety of
healthcare-related purposes which are necessary for the Hospital to
function. We may use your information
to ensure that all our patients receive quality care and to ensure that the
Hospital continues to earn professional accreditation. For example, we may use your information so
that the Hospital can evaluate the performance of our staff in caring for
you.
In
addition, we may utilize your information to contact you for purposes such as
the following:
·
Appointment
reminders: We may
disclose your information to contact you as a reminder that you have an
upcoming appointment for an office visit, lab test, or other treatment.
·
Treatment
alternatives and health-related services: We may use and disclose your information to
tell you about alternative treatments or health-related services that may be of
interest to you.
·
Fundraising: We may use and disclose limited information
about you to contact you in an effort to raise money for the Hospital. If you prefer not to receive such fundraising
notices, you must notify our Privacy Officer in writing (see below).
·
Hospital
patient directory:
With your permission we may list limited information about you (name,
room number, general condition such as “fair”) in our directory while you are a
patient in the Hospital. We will give
this information to anyone who asks for you.
In this way family and friends can visit or check on your progress and
florists can deliver flowers to you while the Hospital still keeps your medical
information private. In addition, if
you choose, you may provide us with your religious affiliation so that clergy –
such as your priest, minister, or rabbi – can identify their congregants who
are hospitalized.
·
Individuals
involved in your care:
With your permission we may release information about you to a family
member or friend who is involved in your care.
We may also release information about you to such an individual in a
medical emergency.
Special Situations: In addition to the above, there may be times
when we use or disclose your health information for the following reasons:
·
As
Required By Law: We will disclose health information
about you when required to do so by federal, state, or local law.
·
To
Avert a Serious Threat to Health or Safety: We
may use and disclose health 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. Any disclosure,
however, would only be to someone able to help prevent the threat. This may include disaster relief agencies.
·
Research: We may use and disclose health information
about you for officially-approved research as permitted by law, when a waiver
of authorization is obtained from an Institutional Review Board or a Privacy
Board, or through a limited set of information. Otherwise, we will only use or disclose your information for
research with your specific authorization.
·
Organ
and Tissue Donation: If
you are an organ donor, we may release health 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.
·
Military
and Veterans: If
you are a member of the armed forces, we may release health information about
you as required by military authorities.
·
Workers’
Compensation: We
may release health information about you for workers’ compensation or similar
programs. These programs provide
benefits for work-related injuries or illness.
·
Public
Health Risks: We
may disclose health information about you for public health activities. These activities generally include the
following: to prevent or control disease, injury, or disability, to report
child abuse or neglect; to report reactions to medications or problems with
products; to notify people of recalls of products they may be using; 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; to notify an employer about a
workforce member when necessary to evaluate a work-related illness or injury,
when we notify you of this disclosure.
·
Abuse,
Neglect, or Domestic Violence: We may disclose health information about you
to social service or government authorities if we believe you have been the
victim of abuse, neglect, or domestic violence if you agree or if we are
required by law and we believe it is necessary to prevent serious harm.
·
Health
Oversight Activities: We
may disclose health information 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 laws.
·
Lawsuits
and Disputes: We
may disclose health information about you in response to a subpoena, discovery
request, or other lawful order from a court.
·
Law
Enforcement: We
may release health information if asked to do so by a law enforcement official
as part of law enforcement activities; in investigations of criminal conduct or
of victims of crime; in response to court orders; in emergency circumstances;
or when required to do so by law.
·
Coroners,
Medical Examiners and Funeral Directors:
We may release health 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.
·
National
Security: We
may release health 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, or for intelligence,
counterintelligence, and other national security activities authorized by law.
·
Inmates: If you are an inmate
of a correctional institution or under the custody of a law enforcement
official, we may release health information about you to the correctional
institution or law enforcement official.
This release would be necessary (1) for the institution to provide you
with health care; (2) to protect your health and safety or the health and
safety of others; (3) for the safety and security of the correctional
institution.
Other
uses and disclosures of medical information not covered by this notice or the
laws that apply to us will be made only with your written permission. If you give us permission to use or disclose
medical information about you, you may revoke that permission, in writing, at
any time. If you revoke your
permission, thereafter we will no longer use or disclose medical information
about you for the reasons covered by your written authorization. You must understand that we are unable to
take back any disclosures we have already made with your permission, and that
we are required to retain our records of the care that we provided to you.
You
have the following rights regarding the health information about you:
Right to Inspect and Copy:
You have the right to inspect and copy medical
information that may be used by the Hospital to make decisions about you. Usually, this includes medical and billing
records, but it does not include psychotherapy notes. To inspect and copy
medical information that may be used to make decisions about you, you must
submit your request in writing to our Privacy Officer. If you request a copy of the information, we
may charge a fee for the costs of copying and postage. We may deny your request to
inspect and copy your information in certain very limited circumstances. If so, we will inform you of the denial, the
reason for it, and how to request a review of the denial, if review is
permitted by law. A licensed health
care professional not involved with the denial will review your request and the
denial. We will comply with the outcome
of the review.
Right to Request Amendment:
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 the Hospital. To
request an amendment, your request must be made in writing and submitted to our
Privacy Officer. In addition, you must
provide a reason that supports your request.
We may deny your request for an amendment if it 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
created by another hospital or healthcare provider. But we will inform you of the source of that information if we
know it. We may also deny your request
if we believe the information is complete and accurate, and for other reasons
as permitted by law.
Right to an Accounting of Disclosures: You have the right to
an “accounting of certain disclosures.”
This is a list or report of the disclosures we made of medical
information about you for reasons other than your care, payment, and other
Hospital purposes for which you did not sign an authorization. To request this list or accounting of
disclosures, you must submit your request in writing to our Privacy
Officer. Your request must state a time
period that may not be longer than six years prior to the request date and may
not include dates before April 14, 2003.
The first list you request within a 12-month period will be free. For additional lists during the same
12-month period, we may charge you for the cost of providing the list. We will notify you of the cost involved and
you may choose to withdraw or modify your request at the time before any costs
are incurred. We may also provide a
summary list as an option.
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 limit on the medical information we
disclose about you to someone who is involved in your care or the payment of
your care, such as a family member or friend.
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 with emergency treatment. To request restrictions, you must make your
request in writing to our Privacy Officer.
In your request, you must state (1) what use or disclosure you want to
limit, (2) what information you want to limit, and/or (3) to whom you want the
limits to apply.
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 or by mail. To request confidential
communications, you must make your request in writing to our Privacy
Officer. We will not ask you the reason
for your request. 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 the right to a paper copy of this notice at any time. Even if you have agreed to receive this
notice electronically, you are still entitled to a paper copy of this
notice. To obtain a paper copy of this
notice, please request one from our Privacy Officer or pick one up in your
physician’s office or the Hospital’s Admitting Office.
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. The notice
will contain the effective date in the top right-hand corner of the first page.
If you believe your
privacy rights have been violated or the Hospital is not in compliance with
these privacy practices, 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 us, call or write
to our Privacy Officer whose contact information is below. All complaints must be submitted in writing.
All complaints will be investigated by the Hospital. You will not be penalized in any way for filing a complaint.
Complaints filed with the Secretary of Health and Human Services must be in
writing and must be sent within 180 days of when you knew (or should have
known) that the act or omission occurred.
Send to U.S. Department of Health and Human Services, Office for Civil
Rights, 200 Independence Avenue SW, Room 509 F, HHH Building, Washington
D.C. 20201. Your letter must include
the following points:
To
request any of the above rights, or for further information about this Privacy
Notice, please contact: Privacy Officer, Milford Hospital, 300 Seaside Avenue,
Milford, CT 06460, Telephone: 203-876-4000