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.
If you have any questions about this notice, please contact the
Jewish Hospital & St. Mary?s HealthCare, Inc.,
Privacy Officer at (502) 560-8404
PURPOSE
Jewish
Hospital & St. Mary?s HealthCare, Inc. (JHSMH), its team members, medical
staff, employed physicians, residents, fellows, students, contractors and
volunteers follow the privacy practices described in this Notice of Privacy
Practices (Notice). This Notice describes the ways in which we may use and
disclose your health information in JHSMH and with other entities. We also
describe your rights and certain obligations we have regarding the use and
disclosure of your health information. JHSMH participates in an Organized
Health Care Arrangement (OHCA) with its Medical Staff and will share your
health information with the arrangement's participants to carry out treatment,
payment or health care operations related to the OHCA. This Notice does not
cover the privacy practices of your physician when you see him or her in a
private office. JHSMH facilities are committed to protecting your health
information in a confidential manner.
WHO WILL FOLLOW THIS NOTICE?
JHSMH
includes, but is not limited to, the following facilities: Jewish Hospital,
Jewish Hospital Medical Center East, Jewish Hospital Medical Center South,
Jewish Hospital Shelbyville, Sts. Mary &
OUR LEGAL RESPONSIBILITIES
JHSMH is required by law to protect the privacy of your health
information that can identify you, inform you about our legal duties and
privacy practices with respect to your health information, and follow the terms
of this Notice. This Notice applies to all of your health information held by
JHSMH.
JHSMH must abide by the terms of this Notice.
JHSMH must notify you if we are unable to agree to a restriction
that you request about the use and disclosure of your protected health
information.
JHSMH must accommodate reasonable requests you may have to
communicate health information by alternative means or at alternative
locations.
JHSMH
will not use or disclose your health information without your authorization,
except as described in this Notice.
REVISIONS TO THIS NOTICE
JHSMH
may change its Notice at any time and make the new provisions effective for all
health information JHSMH maintains. Upon your request, JHSMH will provide you
with information about how to obtain a revised Notice of Privacy Practices by
accessing our web site, www.jhsmh.org, by calling the JHSMH Privacy Officer at (502)
560-8404 to request a revised copy be mailed to you or by requesting one at the
time of your next visit.
HOW JHSMH WILL USE AND DISCLOSE YOUR HEALTH INFORMATION
Treatment, Payment and Health Care Operations
(TPO). JHSMH will use or
disclose your health information for treatment, to obtain payment for treatment
and for health care operations. The examples below are not meant to be
exhaustive, but describe common types of disclosures JHSMH may make.
Examples of Uses and Disclosures for Treatment
JHSMH will use and disclose your health information to:
Anyone involved in your treatment, including physicians, nurses,
therapists, pharmacists, radiologists, discharge planners, dietitians, laboratory
and others who need access to your health information to assist in your
diagnosis and treatment.
Anyone necessary to provide or manage your health care treatment,
including the coordination or management of your care with a provider outside
JHSMH, such as a home health agency that is evaluating your need for home
health services.
The physician who referred you to JHSMH
or who will provide follow-up care to you after you are discharged from JHSMH.
Examples of Uses and Disclosures for Payment
JHSMH will use and disclose your health information to:
Obtain payment for the services and treatment you receive.
Communicate with your health insurance plan to obtain approval for
the health care services JHSMH recommends for you.
Request a determination from your health insurance plan of your
eligibility or coverage for insurance benefits.
Obtain payment from your employer when your treatment involves a
work-related injury.
Other health care providers so they can receive payment for health
care services that they provided to you, such as ambulance services.
Review the care you received to ensure the costs associated with
it were appropriate for your diagnosis.
Examples of Uses and Disclosures for Health Care Operations
JHSMH will use and disclose your health information to support
JHSMH business activities. These activities include:
Conducting quality assessment and improvement activities in an
effort to continually improve the quality and effectiveness of the health care
services we provide
Developing clinical guidelines
Evaluating clinical outcomes
Reviewing the competence or qualifications of health care
professionals
Evaluating physician and employee performance
Conducting training programs in which residents, students,
trainees or practitioners in areas of health care learn under supervision to
improve their skills as health care providers
Participating in accreditation, certification, licensing or
credentialing activities
Conducting or arranging for medical review, legal services and
auditing functions
Sharing information with medical students and residents who see
patients at a JHSMH facility
Calling your name in a waiting area or over the overhead paging
system
Contacting you by mail or phone to remind you of a scheduled
appointment, procedure or test
Sharing information with volunteers who help family and friends
locate you in the facility, deliver mail and other
items to you
Providing information to the Chaplain who may visit you while you
are in the facility
Planning for the organization's future operations
Complying with this
Notice and applicable laws.
OTHER USES AND DISCLOSURES REQUIRED BY HIPAA
JHSMH may use and disclose your health information in the
following situations without your authorization. These situations include:
Business Associates of JHSMH: Some services are provided through
contracts with business associates. Examples include certain laboratory tests
and the service JHSMH uses when making copies of your medical record. When
these services are contracted, JHSMH may disclose your health information to
our business associates so that they can perform the job JHSMH has asked them
to do and bill you or your insurance carrier for services rendered. To protect
your health information, however, JHSMH requires the business associate to
appropriately safeguard your information.
Research: JHSMH may disclose your health information for medical research
when the Institutional Review Board or Privacy Board approves the research
study and the use of your health information.
Marketing: JHSMH may use and disclose health information
to contact you with information about treatment, services, products or health
care providers that may be of interest to you.
Fundraising: JHSMH may use your demographic information (such as your
name, address, phone number and the dates that you received treatment or
services from us) for fundraising efforts to support the educational and
medical research mission of JHSMH. JHSMH may disclose the information to the
Jewish Hospital or CARITAS Foundations so that they may contact you about their
fundraising efforts. If you do not want to be contacted for fundraising, please
contact the JHSMH Privacy Officer at (502) 560-8404.
Funeral Directors, Coroners and Medical Examiners: JHSMH may disclose
health information to a coroner, medical examiner or funeral directors
consistent with applicable law to carry out their duties.
Organ procurement organizations: Consistent with applicable law, JHSMH
may disclose health information to organ procurement organizations or other entities
engaged in the procurement, banking, or transplantation of organs for the
purpose of tissue donation and transplant.
Food and Drug Administration (FDA): JHSMH may disclose
health information to the FDA relative to adverse events with respect to food,
supplements, product and product defects or post marketing surveillance
information to enable product recalls, repairs or replacement.
Public Health: As required by law, JHSMH may disclose your health
information to public health or legal authorities charged with preventing or
controlling disease, injury or disability. These activities include but are not
limited to reporting births, deaths, disease, injury, child abuse or neglect
and domestic violence.
Inmates: If you are an inmate of a correctional institution, or under the
custody of a law enforcement official, JHSMH may disclose your health
information to the institution or law enforcement official as may be necessary
for your health and the health and safety of other individuals.
Legal Proceedings: If you are involved in a lawsuit or dispute,
JHSMH may disclose your health information in response to a HIPAA-compliant
subpoena, valid court or administrative order, or discovery request. JHSMH also
may disclose your health information in response to a subpoena, discovery
request or other lawful process by someone else involved in the dispute.
Law Enforcement: JHSMH may disclose health information as
required by law or in response to a HIPAA-compliant subpoena, valid court or
administrative order, warrant, summons, or other lawful process. We must
provide information about someone who is suspected of being a victim abuse,
neglect or domestic violence; to provide information about a crime that occurs
at a JHSMH facility or to identify or locate a suspect, fugitive, material
witness or missing person.
Health Oversight Activities: JHSMH may disclose your 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 rights.
Military Activity and National Security: JHSMH may release your
health information to authorized federal officials for intelligence,
counterintelligence and other national security activities authorized by law,
including providing protection to the President, other authorized persons or
foreign heads of state or to conduct special investigations.
USES AND DISCLOSURES TO WHICH YOU MAY OBJECT
Unless you notify us in writing that you object, JHSMH may use or
disclose your health information in the following circumstances:
Each
JHSMH facility maintains a facility directory. JHSMH will include your name,
location in the JHSMH facility, general condition (e.g. good, fair, serious or
critical) if available, and religious affiliation in the facility directory.
This information may be provided to members of the clergy and, except for
religious affiliation, to other people who ask for you by name. Your name and
religious affiliation may be given to a member of the clergy, such as a priest
or rabbi, with the same religious affiliation even if they don?t ask for you by name. The facility directory is available
so your family, friends and clergy can visit you and generally know how you are
doing. If you do not want information released in the facility directory, we
cannot tell members of the public, flower or other service persons and
organizations, and even your friends and family that you are here and your
general condition. (At Our Lady of Peace, we have no open facility directory.
Each patient is provided an Access Number to be shared with family and friends
whom the patient chooses to have know of his/her presence
in the facility. Only with that Access Number will those patient contacts be
allowed.)
JHSMH
may disclose to a member of your family, a relative, a close friend or any
other person you identify as your emergency contacts, your health information that
relates to that person's involvement in your care or payment related to your
care. JHSMH may use or disclose your health information to notify or assist in
notifying a family member, personal representative or another person
responsible for your care, about your location, general condition or death.
JHSMH
may use and disclose your health information to a public or private entity
(such as the American Red Cross) assisting in disaster relief efforts so that
your family can be notified about your condition, status and location.
JHSMH
may use and disclose your health information for the above activities when you
are unable to agree or object to the use or disclosure because of your
incapacity or an emergency treatment circumstance, if such disclosure is consistent
with a prior expressed preference and if we determine such disclosure is in
your best interest. When it becomes practical to do so, we must provide you
with an opportunity to object to the uses or disclosures of your health
information as described above.
To
object to these uses or disclosures, please contact the JHSMH Privacy Officer
at (502) 560-8404.
USES AND DISCLOSURES YOU MUST AUTHORIZE
Except as described above, JHSMH will not use or disclose
your protected health information unless you give written authorization to
JHSMH to do so. You may revoke your permission, which will be effective only
after the date of your written authorization. If you revoke your authorization
in writing, JHSMH will not disclose health information about you after JHSMH
receives your revocation except for disclosures that were being processed prior
to receipt of your request.
YOUR INDIVIDUAL RIGHTS
Below is a statement of your rights with
respect to your health information and a brief description of how you may exercise
these rights. For more information about your rights, please contact the JHSMH
Privacy Officer at (502) 560-8404.
Right of Access. You have the right to
access, inspect and obtain a copy of your health information that is contained
in a designated record set for as long as we maintain the health information. A
"designated record set" contains medical and billing records and any
other records that are used by JHSMH or its Medical Staff to make decisions
about you. Your request must be in writing. JHSMH must act on your request no
later than 30 days after receipt of the request. If the protected health
information is not maintained or accessible on-site, JHSMH must take action no
later than 60 days from receipt of your request. JHSMH also may extend the time
for such actions by no more than 30 days. JHSMH must provide you with a written
statement of the reasons for the delay and the date by which it will complete
your request. In
Right to request restrictions. You have the right to
request restrictions on certain uses or disclosures of your health information
for the purposes of treatment, payment or health care operations. You also may
request limits on the health information JHSMH discloses about you to family
members, friends or other individuals identified by you who may be involved in
your care or for notification purposes as described in this Notice. JHSMH is
not required to agree to your request. If JHSMH agrees, JHSMH will comply with
the requested restriction unless it is needed to provide emergency treatment.
Your request must be in writing and state the specific restriction requested
and to whom you want the restriction to apply.
Confidential Communications. You have the right to
request that we communicate with you about health care matters in a certain way
or at a certain location. For example, you can ask that we only contact you at
an alternative location from your home address, such as work, or only contact
you by mail instead of by phone. Your request must be in writing. JHSMH will
accommodate reasonable requests. JHSMH also may condition this accommodation by
asking you for information as to how payment will be handled or specification
of an alternative address or other method of contact. JHSMH will not request an
explanation from you as to the basis for the request.
Right to Amend. If you believe the
health information JHSMH has about you is incorrect or incomplete, you may
request the information be amended. You have the right to request an amendment
for as long as the information is kept by or for the JHSMH facility that
maintains the record. Your request must be in writing and must explain the
reason for the requested amendment. JHSMH must act on your request for an amendment
no later than 60 days after receipt of such a request. In certain cases, JHSMH
may deny your request for an amendment. If JHSMH denies your request for
amendment, you have the right to file a statement of disagreement with JHSMH
and JHSMH may prepare a rebuttal to your statement and will provide you with a
copy of any such rebuttal.
Right to an Accounting of Disclosures. You have the right to
request a list of the disclosures JHSMH made of your health information for
purposes other than treatment, payment or health care operations as described
in this Notice. It excludes disclosures JHSMH may have made to you, requested
by you or that you authorized, as well as for a facility directory, to family
members or friends involved in your care, or for notification purposes. Your
request must be in writing. JHSMH must act on your request for an accounting no
later than 60 days after receipt of such a request. You have the right to
receive specific information regarding these disclosures made up to six (6) years
before your request (not including disclosures made before
Right to a Copy of this Notice. On your first visit to a
JHSMH facility, you will be given a copy of this Notice. You also may request a
summary of this Notice. You may obtain a copy of this Notice at the JHSMH web
site, www.jhsmh.org. To obtain a paper copy
of this Notice, visit the Registration Department of the JHSMH facility where
you are receiving services.
IF YOU HAVE A PROBLEM
If you believe your privacy rights have been violated, you may
file a complaint with the JHSMH Privacy Officer, with the Secretary of the U.S.
Department of Health and Human Services or with the U.S. Department of Health
and Human Services Office of Civil Rights. JHSMH will not retaliate against you
for filing a complaint. To file a complaint, contact the Privacy Officer at
(502) 560-8404 or send correspondence to:
Privacy Officer
Jewish Hospital & St. Mary?s
HealthCare
Revised: