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Notice of Privacy Practices
As
Required by the Privacy Regulations Created as a Result of the
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE
USED AND DISCLOSED, AS WELL AS HOW YOU CAN GET ACCESS TO THIS
INFORMATION.
PLEASE REVIEW THIS NOTICE CAREFULLY.
UNDERSTANDING YOUR MEDICAL RECORD AND HEALTH INFORMATION
Each time you
visit a hospital, physician, or other healthcare provider, a
record of your visit is made. Typically, this record
contains your symptoms, examination and test results,
diagnoses, treatment, and a plan for future care or
treatment. This information, often referred to as your
medical or health record, serves as a:
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Basis for planning your care and treatment
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Means of communication among the many health professionals who
contribute to your care
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Legal document describing the care you received
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Means by which you or a third-party payer can verify that
services billed were actually provided
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Tool in educating heath professional
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Source of data for medical research
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Source of information for public health officials charged with
improving the health of the nation
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Source of data for facility planning and marketing
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Tool with which we can assess and continually work to improve
the care we render and the outcomes we achieve.
Understanding what is in your record and how your health
information is used helps you to:
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Ensure its accuracy
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Better understand who, what, when, where, and why others may
access your health information
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Make more informed decisions when authorizing disclosure to
others
OUR
COMMITMENT TO YOUR PRIVACY
Mammoth Hospital is dedicated to maintaining the privacy of your
health information. In conducting our business, we will create
records regarding you and the treatment and services we provide
to you. We are required by law to maintain the confidentiality
of health information that identifies you. We also are required
by law to provide you with this notice of our legal duties and
the privacy practices that we maintain in our practice
concerning your health information. By federal and state law, we
must follow the terms of the notice of privacy practices that we
have in effect at the time.
We realize that these laws are complicated, but we must provide
you with the following important information:
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How we
may use and disclose your health information
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Your
privacy rights in regard to your health information
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Our
obligations concerning the use and disclosure of
your health information
The terms of this notice apply to all records containing your
health information that are created or retained by Mammoth
Hospital. We reserve the right to revise or amend this Notice of
Privacy Practices. Any revision or amendment to this notice will
be effective for all of your records that our practice has
created or maintained in the past, and for any of your records
that we may create or maintain in the future. Mammoth Hospital
will post a copy of our current Notice in our offices in a
visible location at all times, on our website, and you may
request a copy of our most current Notice at any time.
OUR
RESPONSIBILITIES
Mammoth Hospital is required to:
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Maintain the privacy of your health information
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Provide you with a notice as to our legal duties and privacy
practices with respect to information we collect and maintain
about you
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Abide by the terms of this notice
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Notify you if we are unable to agree to a requested restriction
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Accommodate reasonable requests you may have to communicate
health information by alternative means or at alternative
locations
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 mail
a revised notice to the address you’ve supplied us.
We will not use or disclose your health information without your
authorization, except as described in this notice.
HOW WE MAY
USE AND DISCLOSE YOUR HEALTH INFORMATION:
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The
following categories describe different ways that we may
use and disclose health information. Not every use and
disclosure in a category will be listed. However, all of
the ways we are permitted to use and disclose
information will fall within one of the categories.
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Treatment:
We may use
your health information to treat you. For example, we
may ask you to have laboratory tests (such as blood or
urine tests), and we may use the results to help us
reach a diagnosis. We might use your health information
in order to write a prescription for you, or we might
disclose your health information to a pharmacy when we
order a prescription for you. Many of the people who
work for our practice including, but not limited to, our
doctors and nurses, may use or disclose your health
information in order to treat you or to assist others in
your treatment. Additionally, we may disclose your
health information to others who may assist in your
care, such as your spouse, children or parents.
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Payment:
We may use and disclose your health information in order
to bill and collect payment for the services and items
you may receive from us. For example, we may contact
your health insurer to certify that you are eligible for
benefits (and for what range of benefits), and we may
provide your insurer with details regarding your
treatment to determine if your insurer will cover, or
pay for, your treatment. We also may use and disclose
your health information to obtain payment from third
parties that may be responsible for such costs, such as
family members. Also, we may use your health information
to bill you directly for services and items.
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Health
Care Operations: Members of the medical staff, the risk
or utilization review manager, or members of the quality
improvement team may use information in your health
record to assess the care and outcomes in your case and
others like it. This information will then be used in an
effort to continually improve the quality and
effectiveness of the healthcare and services we provide.
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Business
Associates: There are some services provided in our
organization through contracts with business associates.
Examples include physician services in the emergency
department and radiology, and certain laboratory tests.
When these services are contracted, we may disclose your
health information to our business associate so that
they can perform the job we’ve asked them to do and bill
you or your third-party payer for services rendered. To
protect your health information, however, we require the
business associate to appropriately safeguard your
information.
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Hospital
Directory: Unless you notify us that you object, we will
use your name, location in the facility, general
condition, and religious affiliation for directory
purposes. This information may be provided to members of
the clergy and, except for religious affiliation, to
other people who ask for you by name. This information
is released so your family, friends and clergy can visit
you in the hospital and generally know how you are
doing.
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Appointment Reminders:
We may use
and disclose your health information to contact you as a
reminder that you have an appointment for treatment or
medical care at the hospital.
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Treatment
Alternatives: We may use and disclose your health
information to tell you about or recommend possible
treatment options or alternatives that may be of
interest to you.
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Health-Related Products and Services: We may use and
disclose health information to tell you about our
health-related products or services that may be of
interest to you.
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Individuals Involved in Your Care or Payment for Your
Care: We may use or disclose information about you to a
friend or family member who is involved in your medical
care. For example, a parent or guardian may ask that a
babysitter take their child to the pediatrician’s office
for treatment of a cold. In this example, the
babysitter may have access to this child’s health
information. We may also give information to someone who
helps pay for your care. Unless there is a specific
written request from you to the contrary, we may also
tell your family or friends your condition and that you
are in the hospital. In addition, we may disclose
information about you to an entity assisting in a
disaster relief effort so that your family can be
notified about your condition, status and location.
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Fundraising: We may contact you in an effort to raise
money for the hospital and its operations. We may
disclose information to a foundation related to the
hospital so that the foundation may contact you in
raising money for the hospital. We will only release
contact information, such as your name, address and
phone number and the dates you received treatment or
services at the hospital. If you do not want the
hospital to contact you for fundraising efforts you must
notify, in writing, the Mammoth Hospital, Privacy
Officer, P.O. Box 660, Mammoth Lakes, CA 93546.
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Research:
Under certain circumstances, we may use and disclose
health information about you for research purposes. For
example, a research project may involve comparing the
health and recovery of all patients who received one
medication to those who received another, for the same
condition. All research projects, however, are subject
to a special approval process. This process evaluates a
proposed research project and its use of health
information, trying to balance the research needs with
the patients’ need for privacy of their health
information. Before we use or disclose health
information for research, the project will have been
approved through this approval process, but we may,
however, disclose health information about you to people
preparing to conduct a research project, for example, to
help them look for patients with specific medical needs,
so long as the health information they review does not
leave the hospital. We will almost always ask for your
specific permission if the researcher will have access
to your name, address or other information that reveals
who you are, or will be involved in your care at the
hospital.
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Coroners,
Medical Examiners and Funeral Directors:
We may
release health information to a medical examiner or
coroner to identify a deceased individual or to identify
the cause of death. If necessary, we also may release
information in order for funeral directors to perform
their jobs.
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Organ
Procurement Organizations: Consistent with applicable
law, we 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.
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Workers
compensation: We may disclose health information to the
extent authorized by and to the extent necessary to
comply with laws relating to workers compensation or
other similar programs established by law. These
programs provide benefits for work-related injuries or
illness.
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Public
Health Activities: As required by law, we may disclose
health information about you for public health
activities. These activities include disclosures in
order to:
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Prevent
or control disease, injury or disability
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Report
births and deaths
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Report
the abuse or neglect of children, elders and
dependent adults
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Report
reactions to medications or problems with products
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Notify
people of recalls of products they may be using
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Notify a
person who may have been exposed to a disease or may
be at risk for contracting or spreading a disease or
condition
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Notify
the appropriate government authority if we believe a
patient has been the victim of abuse, neglect or
domestic violence. We will only make this disclosure
if you agree or when required or authorized by law
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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 rights laws.
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Mammoth
Mountain:
Should your care at Mammoth Hospital result from an
accident sustained during recreational activities at
Mammoth Mountain, we may disclose limited health
information in order for Mammoth Mountain to perform
their own quality and outcome improvement activities.
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Ambulance/Air Transport: Should you need to be
transferred from/to Mammoth Hospital, we may disclose
limited health information to the transporting company
for their own billing and/or quality and outcome
improvement activities.
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Manufacturers of Implants and Devices: We may disclose
limited health information to the manufacturers of
implants and devices you acquire due to treatment at the
hospital. For example, the manufacturer of hardware used
for internal fixations of fractures will be given health
information for tracking purposes in the event a product
is recalled.
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Military
and Veterans: If you are a member of the armed forces,
we may release health information about you as required
by military command authorities. We may also release
health information about foreign military personnel to
the appropriate foreign military authority.
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Correctional Institution:
If you are an inmate of a correctional institution or
under the custody of a law enforcement official, we may
disclose health information about you to the
correctional institution or law enforcement official.
This disclosure 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.
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Lawsuits
and Disputes: If you are involved in a lawsuit or
dispute, we may disclose health information about you in
response to a court or administrative order. We may
also disclose health information about you in response
to a subpoena, discovery request, or other lawful
process by someone else involved in the dispute, but
only if efforts have been made to tell you about the
request (as shown by a written notice to you) or to
obtain an order protecting the information requested.
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National
Security and Intelligence Activities:
We may disclose health information about you to
authorized federal officials for intelligence,
counterintelligence, and other national security
activities authorized by law.
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Law
enforcement:
We may disclose health information if asked to do so by
a law enforcement official:
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In
response to a court order, subpoena, warrant,
summons or similar process
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To
identify or locate a suspect, fugitive, material
witness, or missing person
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About
the victim of a crime if, under certain limited
circumstances, we are unable to obtain the person’s
agreement
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About a
death we believe may be the result of criminal
conduct;
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About
criminal conduct at the hospital
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In
emergency circumstance to report a crime, the
location of the crime or victims, or the identity,
description or location of the person who committed
the crime.
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YOUR
RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
You have the
following rights regarding the health information that
we maintain about you:
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Confidential Communications: You have the right to
request that Mammoth Hospital communicate with you about
your health and related issues in a particular manner or
at a certain location. For example, you may ask that we
contact you at home, rather than work. In order to
request a type of confidential communication, you must
make a written request to Mammoth Hospital, Privacy
Officer, P.O. Box 660, Mammoth Lakes, CA 93546
specifying the requested method of contact, or the
location where you wish to be contacted. Our practice
will accommodate
reasonable requests. You do not need to give a reason
for your request.
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Requesting Restrictions: You have the right to request a
restriction in our use or disclosure of your health
information for treatment, payment or health care
operations. Additionally, you have the right to request
that we restrict our disclosure of your health
information to only certain individuals involved in your
care or the payment for your care, such as family
members and friends. We are not required to agree to
your request;
however, if we do agree, we are bound by our agreement
except when otherwise required by law, in emergencies,
or when the information is necessary to treat you. In
order to request a restriction in our use or disclosure
of your health information, you must make your request
in writing to the Mammoth Hospital, Privacy Officer,
P.O. Box 660, Mammoth Lakes, CA 93546. Your request
must describe in a clear and concise fashion (1) the
information you wish restricted; (2) whether you are
requesting to limit our practice’s use, disclosure or
both; and (3) to whom you want the limits to apply, for
example, disclosures to your spouse.
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Inspection and Copies:
You have the right to inspect and obtain a copy of the
health information that may be used to make decisions
about you, including patient health records and billing
records. You must submit your request in writing to
Mammoth Hospital, Health Information Management
Services, Release of Information, P.O. Box 660, Mammoth
Lakes, CA 93546, (760) 934-3311 ext. 2378 in order to
inspect and/or obtain a copy of your health information.
Mammoth Hospital may charge a fee for the costs of
copying, mailing, labor and supplies associated with
your request. Mammoth Hospital may deny your request to
inspect and/or copy in certain limited circumstances;
however, you may request a review of our denial. Another
licensed health care professional chosen by us will
conduct reviews.
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Amendment:
You may ask us to amend your health information if you
believe it is incorrect or incomplete, and you may
request an amendment for as long as the information is
kept by or for Mammoth Hospital. To request an
amendment, your request must be made in writing and
submitted to the Mammoth Hospital, Privacy Officer, P.O.
Box 660, Mammoth Lakes, CA 93546. You must provide us
with a reason that supports your request for amendment.
Mammoth Hospital will deny your request if you fail to
submit your request (and the reason supporting your
request) in writing. Also, we may deny your request if
you ask us to amend information that is in our opinion:
(a) accurate and complete; (b) not part of the health
information kept by or for the practice; (c) not part of
the health information which you would be permitted to
inspect and copy; or (d) not created by our practice,
unless the individual or entity that created the
information is not available to amend the information.
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Even if we
deny your request for amendment, you have the right to
submit a written addendum, not to exceed 250 words, with
respect to any item or statement in your record you
believe is incomplete or incorrect. If you clearly
indicate in writing that you want the addendum to be
made part of your health record we will attach it to
your records and include it whenever we make a
disclosure of the item or statement you believe to be
incomplete or incorrect.
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Accounting of Disclosures:
All of our
patients have the right to request an “accounting of
disclosures.” An “accounting of disclosures” is a list
of certain non-routine disclosures our practice has made
of your health information for non-treatment or
operations purposes. Use of your health information as
part of the routine patient care in Mammoth Hospital is
not required to be documented. For example, a doctor
sharing information with the nurse; or the billing
department using your information to file your insurance
claim. In order to obtain an accounting of disclosures,
you must submit your request in writing to Mammoth
Hospital, Health Information Management Services,
Release of Information, P.O. Box 660, Mammoth Lakes, CA
93546. All requests for an “accounting of disclosures”
must state a time period, which may not be longer than
six (6) years from the date of disclosure and may not
include dates before April 14, 2003. The first list you
request within a 12-month period is free of charge, but
our practice may charge you for additional lists within
the same 12-month period.
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Mammoth
Hospital will notify you of the costs involved with
additional requests, and you may withdraw your request
before you incur any costs.
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Right to
a Paper Copy of This Notice:
You are
entitled to receive a paper copy of this notice. You may
ask us to give you a copy of this notice at any time. To
obtain a paper copy of this notice, contact the Mammoth
Hospital, Health Information Management Services, P.O.
Box 660, Mammoth Lakes, CA 93546, (760) 924-4041.
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Right to
File a Complaint:
Maintaining
the confidentiality of the health information of our
patients is of the utmost importance. If you believe
your privacy rights have been violated, you may file a
complaint with our practice by contacting the Mammoth
Hospital, Privacy Officer, P.O. Box 660, Mammoth Lakes,
CA 93546. All complaints must be submitted in writing.
You will not be penalized for filing a complaint. You
may always file a complaint with the Secretary of the
Department of Health and Human Services.
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Right to
Provide an Authorization for Other Uses and Disclosures:
Mammoth Hospital will obtain your written authorization
for uses and disclosures that are not identified by this
notice or permitted by applicable law. Any authorization
you provide to us regarding the use and disclosure of
your health information may be revoked at any time in
writing. After you revoke your authorization, we will no
longer use or disclose your health information for the
reasons described in the authorization.
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Again, if
you have any questions regarding this notice or our
health information privacy policies, please contact the
Mammoth Hospital, Privacy Officer, P.O. Box 660,
Mammoth Lakes, CA 93546, (760) 934-3311.
Effective Date: 04/14/2003
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Privacy Statement