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Privacy Practices
Effective
12/01/2003
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.
If you have any questions, please contact our Privacy Office at the
address or phone number at the bottom of this notice.
Who will follow this notice?
Our Lady of Bellefonte Hospital (OLBH) provides health care to our
patients, residents, and clients in partnership with physicians and
other professionals and organizations. The information privacy practices
in this notice will be followed by:
- Any health care professional who treats you at
any of our locations.
- All departments and units of our organization,
including, Home Health Agency, all Outreach Centers, and all off-campus
units or departments.
- All employed associates, staff or volunteers
of our organization, including staff at Bon Secours Health System,
our parent organization, with whom we may share information.
- Any business associate or partner of OLBH with
whom we share health information.
Our pledge to you.
We understand that medical information about you is personal. We are
committed to protecting medical information about you. We create a
record of the care and services you receive to provide quality care
and to comply with legal requirements. This notice applies to all
of the records of your care that we maintain, whether created by facility
staff or your personal doctor. Your personal doctor may have different
policies or notices regarding the doctor's use and disclosure of your
medical information created in the doctor's office. We are required
by law to:
- Keep medical information about you private.
- Give you this notice of our legal duties and
privacy practices with respect to medical information about you.
- Follow the terms of the notice that is currently
in effect.
Changes to this Notice.
We may change our policies at any time. Changes will apply to medical
information we already hold, as well as new information after the
change occurs. Before we make a significant change in our policies,
we will change our notice and post the new notice in waiting areas,
exam rooms, and on our Web site at www.olbh.com . You can receive
a copy of the current notice at any time. The effective date is listed
just below the title. You will be offered a copy of the current notice
each time you register at our facility for treatment. You will also
be asked to acknowledge in writing your receipt of this notice.
How we may use and disclose medical information about you.
- We may use and disclose medical information about
you for treatment (such as sending medical information about you
to a specialist as part of a referral); to obtain payment for
treatment (such as sending billing information to your insurance
company or Medicare); and to support our health care operations
(such as comparing patient data to improve treatment methods.)
- We may use or disclose medical information about
you without your prior authorization for several other reasons.
Subject to certain requirements, we may give out medical information
about you without prior authorization for public health purposes,
abuse or neglect reporting, health oversight audits or inspections,
research studies, funeral arrangements and organ donation, workers'
compensation purposes, and emergencies. We also disclose medical
information when required by law, such as in response to a request
from law enforcement in specific circumstances, or in response
to valid judicial or administrative orders.
- We also may contact you for appointment reminders,
or to tell you about or recommend possible treatment options,
alternatives, health-related benefits or services that may be
of interest to you, or to support fundraising efforts.
- If admitted as a patient, unless you tell us
otherwise, we will list in the patient directory your name, location
in the hospital, your general condition (good, fair, etc) and
your religious affiliation, and will release all but your religious
affiliation to anyone who asks about you by name. Your religious
affiliation may be disclosed only to a clergy member, and even
if they do not ask for you by name.
- We may disclose medical information about you
to a friend or family member who is involved in your medical care,
or to disaster relief authorities so that your family can be notified
of your location and condition.
Other uses of medical information
- In any other situation not covered by this notice,
we will ask for your written authorization before using or disclosing
medical information about you. If you chose to authorize use or
disclosure, you can later revoke that authorization by notifying
us in writing of your decision.
Your rights regarding medical information about you.
- In most cases, you have the right to look at
or get a copy of medical information that we use to make decisions
about your care, when you submit a written request. If you request
copies, we may charge a fee for the cost of copying, mailing or
other related supplies. If we deny your request to review or obtain
a copy, you may submit a written request for a review of that
decision.
- If you believe that information in your record
is incorrect or if important information is missing, you have
the right to request that we correct the records, by submitting
a request in writing that provides your reason for requesting
the amendment. We could deny your request to amend a record if
the information was not created by us; if it is not part of the
medical information maintained by us; or if we determine that
record is accurate. You may appeal, in writing, a decision by
us not to amend a record.
- You have the right to a list of those instances
where we have disclosed medical information about you, other than
for treatment, payment, health care operations or where you specifically
authorized a disclosure, when you submit a written request. The
request must state the time period desired for the accounting,
which must be less than a 6-year period and starting after April
14, 2003. You may receive the list in paper or electronic form.
The first disclosure list request in a 12-month period is free;
other requests will be charged according to our cost of producing
the list. We will inform you of the cost before you incur any
costs.
- If this notice was sent to you electronically,
you have the right to a paper copy of this notice.
- You have the right to request that medical information
about you be communicated to you in a confidential manner, such
as sending mail to an address other than your home, by notifying
us in writing of the specific way or location for us to use to
communicate with you.
- You may request, in writing, that we not use
or disclose medical information about you for treatment, payment
or healthcare operations or to persons involved in your care except
when specifically authorized by you, when required by law, or
in an emergency. We will consider your request but we are not
legally required to accept it. We will inform you of our decision
on your request. All written requests or appeals should be submitted
to our Medical Records Department.
Complaints
- If
you are concerned that your privacy rights may have been violated,
or you disagree with a decision we made about access to your records,
you may contact our Privacy Office (listed below). You may also
contact our Corporate Responsibility Officer at 606-833-3170 or
the Values Line a 24-hour hotline, at (888-880-1286 ).
- Finally,
you may send a written complaint to the U.S. Department of Health
and Human Services Office of Civil Rights. Our Privacy Office
can provide you the address.
- Under
no circumstance will you be penalized or retaliated against for
filing a complaint.
Privacy Office:
Lori Cleary
1000 St Christopher Dr
Ashland, KY 41101
606-833-3170
lcleary@olbh.com
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