JOINT NOTICE OF HEALTH INFORMATION PRACTICES
Effective Date: April 14, 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 this carefully.
OUR PLEDGE REGARDING MEDICAL INFORMATION:
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. This notice applies to all of the records generated by Myrtue Medical Center for the services and care you receive.
We are required by law to:
- Maintain the privacy of your health information.
- Give you this notice of your legal duties and privacy practices with respect to medical information we collect and maintain about you.
- Follow the terms of the notice that is currently in effect.
HOW YOUR PROTECTED INFORMATION MAY BE USED AND DISCLOSED:
Medical information may be used and disclosed by us only with your express written consent or authorization. This information may be shared within Myrtue Medical Center, as necessary. However, there will be some exceptions to this general rule.
- 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, students, or other hospital personnel who are involved in taking care of you at the hospital. We may also disclose medical information about you to people outside the hospital who may be involved in your medical care after you leave the hospital, such as family members, clergy or others we use to provide services that are part of your care.
- For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals.
- For payment: We may use and disclose medical information about you so that the treatment and services you receive at the hospital 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 plan information about surgery you received at the hospital so that your health plan will pay us or reimburse you for the surgery. We may also tell your health plan about a treatment you are going to receive in order to obtain prior approval or to determine whether your plan will cover the treatment.
- Health Care Operations: With your consent, your information may be used for a facility operation, which is necessary to insure our facility provides the highest quality of care.
- For example, your information may be used for learning or quality assurance purposes to continually improve the quality and effectiveness of our care.
- Appointment Reminders: We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at the hospital.
- Treatment Alternatives: We may use and disclose 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 medical information to tell you about health-related benefits or services that may be of interest to you.
USES AND DISCLOSURES THAT WE MAY MAKE UNLESS YOU OBJECT
HOSPITAL DIRECTORY:
Our facility maintains a directory of patient names and their location within our facility. With your permission, this information may be provided to members of your family, friends, members of the clergy, and, except for religious affiliation, to other people who ask for you by name.
INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE:
Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend, or any other person you identify, health information relevant to the person’s involvement in your care or payment related to your care.
REQUIRED DISCLOSURES
RESEARCH:
For research approved by an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.
AS REQUIRED BY LAW:
We will disclose medical information about you when required to do so by federal, state or local law.
ORGAN AND TISSUE DONATION:
To organ procurement organizations for purposes of organ or tissue donation and transplantation, consistent with applicable law.
MILITARY AND VETERANS:
If you are a member of an armed force, foreign or domestic, we may release medical information about you as required by military command or authorities.
WORKER’S COMPENSATION:
As authorized by law in connection with Workers’ Compensation programs.
PUBLIC HEALTH RISKS:
We may disclose medical information about you for public health activities. These activities generally include the following:
- To prevent or control disease, injury or disability
- To report births, deaths, etc.
- To report reactions to medications, or problems with products, or product recalls.
- To notify the appropriate government authority if we believe a patient has been a victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
HEALTH OVERSIGHT ACTIVITIES:
We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities may include audits, investigations, inspections, and licensure.
In most cases, the oversight authority will be for the purpose of overseeing the care rendered by our facility or our facility’s compliance with certain laws and regulations.
LAWSUITS AND DISPUTES:
When required or court ordered in a judicial or administrative proceeding.
NATIONAL SECURITY AND INTELLIGENCE ACTIVITIES:
We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
INMATES:
If you are an inmate of a correctional institution or are under the custody of a law enforcement officer, we may release medical information about you to the correctional institution or the 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; or (3) for the safety and security of the correctional institution.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU:
Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you under the Federal Privacy Rules, 45CFR, Part 164. You have the right to:
Receive notice of the uses and disclosures we expect to make of your health information including a paper copy of the notice as provided in Rule 520. You may view and/or print a paper copy of this notice on our website at www.myrtuemedical.org.
Request additional restrictions on uses and disclosures of your information (though we are not required to agree to any such requests), or request that we send you confidential communications by alternative means or at alternative locations, as provided in Rule 522.
Inspect and obtain a copy of your health record as provided in Rule 524. Usually this includes medical and billing records, but does not include psychotherapy notes.
Request that your health record be amended if it contains incorrect or incomplete protected health information as provided in Rule 526.
Obtain an accounting of disclosures of your health information made after April 14, 2003, for purposes other than treatment, payment, or health care operations as provided in Rule 528.
Please direct requests to:
Director of Health Information Services
Myrtue Medical Center
1213 Garfield Avenue
Harlan, Iowa 51537
Phone number: 712-755-5161
Office Manager
Myrtue Medical Center Harlan Clinic
1220 Chatburn Avenue
Harlan, Iowa 51537
Phone number: 712-755-5130
You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or healthcare operations.
You 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 for your care like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had.
We are not required to agree to your requests. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
To request restrictions, you must make your request in writing to:
Director of Health Information Services
Myrtue Medical Center
1213 Garfield Avenue
Harlan, Iowa 51537
Phone number: 712-755-5161
Office Manager
Myrtue Medical Center Harlan Clinic
1220 Chatburn Avenue
Harlan, Iowa 51537
Phone number: 712-755-5130
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.
CHANGES TO THIS NOTICE:
We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will post and/or provide a revised notice.
COMPLAINTS:
If you believe your privacy rights have been violated, you may file a complaint with the Shelby County Health System or with the Secretary of the Department of Health and Human Services. To file a complaint, contact in writing:
Director of Health Information Services
Myrtue Medical Center
1213 Garfield Avenue
Harlan, Iowa 51537
Phone number: 712-755-5161
Office Manager
Myrtue Medical Center Harlan Clinic
1220 Chatburn Avenue
Harlan, Iowa 51537
Phone number: 712-755-5130
You will not be penalized for filing a complaint.
OTHER USES OF MEDICAL INFORMATION:
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 provide 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, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand we are unable to take back any disclosures already made with your permission and that we are required to retain our records of the care that we provided to you.
TO OBTAIN A COPY OF THIS NOTICE:
You may obtain a copy of this notice at our website: www.myrtuemedical.org. You may obtain a paper copy of this notice from:
Director of Health Information Services
Myrtue Medical Center
1213 Garfield Avenue
Harlan, Iowa 51537
Phone number: 712-755-5161
Office Manager
Myrtue Medical Center Harlan Clinic
1220 Chatburn Avenue
Harlan, Iowa 51537
Phone number: 712-755-5130
