Notice of Privacy Practices of Bladen
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
Effective: April 14, 2003
If you have any questions or requests, please refer to the contact list at the end of this Notice.
WE HAVE A LEGAL DUTY TO PROTECT HEALTH INFORMATION ABOUT YOU.
We are required to protect the privacy of health information about you and that can be identified with you, which we call "protected health information," or "PHI" for short. We must give you notice of our legal duties and privacy practices concerning PHI:
This Notice describes the types of uses and disclosures that we may make and gives you some examples. In addition, we may make other uses and disclosures which occur as a byproduct of the permitted uses and disclosures described in this Notice.
We are required to follow the procedures in this Notice. We reserve the right to change the terms of this Notice and to make new notice provisions effective for all PHI that we maintain by first:
Bladen County and Bladen Family Health Services have established an Organized Health Care Arrangement (OHCA), whereas if you are currently or at any point become a patient of Bladen Family Health Services your information may be disclosed to Bladen County in order to assist in providing your continued care.
A. WE MAY USE AND DISCLOSE PHI ABOUT YOU WITHOUT YOUR AUTHORIZATION IN THE FOLLOWING CIRCUMSTANCES.
1. We may use and disclose PHI about you to provide health care treatment to you.
We may use and disclose PHI about you to provide, coordinate or manage your health care and related services. This may include communicating with other health care providers regarding your treatment and coordinating and managing your health care with others, including transfer of PHI via radio or telephone to the hospital or ambulance dispatch center. For example, we may use and disclose PHI about you when you need a prescription, lab work, an x-ray, or other health care services. In addition, we may use and disclose PHI about you when referring you to another health care provider. There are some services provided in our organization through contracts with business associates. Examples include physician services in the emergency department and radiology, certain diagnostic tests, imaging services used to microfilm records, and collection agencies. When these services are contracted, we may disclose information contained in your health record 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 provided. To protect your health information, all business associates sign an agreement to maintain patient confidentiality and take appropriate measures to safeguard your health information.
EXAMPLE :Your doctor may share medical information about you with another health care provider. For example, if you are referred to another doctor, that doctor will need to know if you are allergic to any medications. Similarly, your doctor may share PHI about you with a pharmacy when calling in a prescription.
2. We may use and disclose PHI about you to obtain payment for services.
Generally, we may use and give your medical information to others to bill and collect payment for the treatment and services provided to you. Before you receive scheduled services, we may share information about these services with your health plan(s). Sharing information allows us to ask for coverage under your plan or policy and for approval of payment before we provide the services. We may also share portions of your medical information with the following:
EXAMPLE: Let's say you are receiving maternity care from us. We may need to give your health plan(s) information about your condition, supplies used and services you received (such as ultrasounds, fetal monitoring, etc.). The information is given to our billing department and your health plan so we can be paid or you can be reimbursed.
3. We may use and disclose your PHI for health care operations.
We may use and disclose PHI in performing business activities, which we call "health care operations". These "health care operations" allow us to improve the quality of care we provide and reduce health care costs. Examples of the way we may use or disclose PHI about you for "health care operations" include the following:
4. We may use and disclose PHI under other circumstances without your authorization.
We may use and/or disclose PHI about you for a number of circumstances in which you do not have to consent, give authorization or otherwise have an opportunity to agree or object. Those circumstances include:
5. You can object to certain uses and disclosures.
Unless you object, we may use or disclose PHI about you in the following circumstances:
6. We may contact you to provide appointment reminders.
We may use and/or disclose PHI to contact you to provide a reminder to you about an appointment you have for treatment or medical care.
7. We may contact you with information about treatment, services, products or health care providers.
We may use and/or disclose PHI to manage or coordinate your healthcare. This may include telling you about treatments, services, products and/or other healthcare providers. We may also use and/or disclose PHI to give you gifts of a small value.
EXAMPLE: If you are diagnosed with diabetes, we may tell you about nutritional and other counseling services that may be of interest to you.
** ANY OTHER USE OR DISCLOSURE OF PHI ABOUT YOU REQUIRES YOUR WRITTEN AUTHORIZATION **
Under any circumstances other than those listed above, we will ask for your written authorization before we use or disclose PHI about you. If you sign a written authorization allowing us to disclose PHI about you in a specific situation, you can later cancel your authorization in writing. If you cancel your authorization in writing, we will not disclose PHI about you after we receive your cancellation, except for disclosures which were being processed before we received your cancellation.
B. YOU HAVE SEVERAL RIGHTS REGARDING PHI ABOUT YOU.
1. You have the right to request restrictions on uses and disclosures of PHI about you.
You have the right to request that we restrict the use and disclosure of PHI about you. We are not required to agree to your requested restrictions. However, even if we agree to your request, in certain situations your restrictions may not be followed. These situations include emergency treatment, disclosures to the Secretary of the Department of Health and Human Services, and uses and disclosures described in subsection 4 of the previous section of this Notice. You may request a restriction by submitting a written request.
2. You have the right to request different ways to communicate with you.
You have the right to request how and where we contact you about PHI. For example, you may request that we contact you at your work address or phone number or by email. Your request must be in writing. We must accommodate reasonable requests, but, when appropriate, may condition that accommodation on your providing us with information regarding how payment, if any, will be handled and your specification of an alternative address or other method of contact. You may request alternative communications by submitting a written request.
3. You have the right to see and copy PHI about you.
You have the right to request to see and receive a copy of PHI contained in clinical, billing and other records used to make decisions about you. Your request must be in writing. We may charge you related fees. Instead of providing you with a full copy of the PHI, we may give you a summary or explanation of the PHI about you, if you agree in advance to the form and cost of the summary or explanation. There are certain situations in which we are not required to comply with your request. Under these circumstances, we will respond to you in writing, stating why we will not grant your request and describing any rights you may have to request a review of our denial. You may request to see and receive a copy of PHI by submitting a written request.
4. You have the right to request amendment of PHI about you.
You have the right to request that we make amendments to clinical, billing and other records used to make decisions about you. Your request must be in writing and must explain your reason(s) for the amendment. We may deny your request if: 1) the information was not created by us (unless you prove the creator of the information is no longer available to amend the record); 2) the information is not part of the records used to make decisions about you; 3) we believe the information is correct and complete; or 4) you would not have the right to see and copy the record as described in paragraph 3 above. We will tell you in writing the reasons for the denial and describe your rights to give us a written statement disagreeing with the denial. If we accept your request to amend the information, we will make reasonable efforts to inform others of the amendment, including persons you name who have received PHI about you and who need the amendment. You may request an amendment of your PHI by submitting a written request.
5. You have the right to a listing of disclosures we have made.
If you ask our contact person in writing, you have the right to receive a written list of certain disclosures of PHI about you. You may ask for disclosures made up to six (6) years before your request (not including disclosures made prior to April 14, 2003). We are required to provide a listing of all disclosures except the following:
The list will include the date of the disclosure, the name (and address, if available) of the person or organization receiving the information, a brief description of the information disclosed, and the purpose of the disclosure. If, under permitted circumstances, PHI about you has been disclosed for certain types of research projects, the list may include different types of information.
If you request a list of disclosures more than once in 12 months, we can charge you a reasonable fee. You may request a listing of disclosures by submitting a written request.
6. You have the right to a copy of this Notice.
You have the right to request a paper copy of this Notice at any time by requesting verbally or in writing. We will provide a copy of this Notice no later than the date you first receive service from us after the effective date of this notice (except for emergency services, and then we will provide the Notice to you as soon as possible).
We reserve the right to change our privacy practices and to make the new provisions effective for all protected health information we maintain. Should our privacy practices change, a notice of this change will be displayed. Revised copies will be made available upon verbal or written request.
C. YOU MAY FILE A COMPLAINT ABOUT OUR PRIVACY PRACTICES
If you think your privacy rights have been violated by us, or you want to complain to us about our privacy practices, you may contact the following:
You may call and ask for the Privacy Officer of the County department in which you received care:
1. Department of Social Services: 910-862-6800
2. Bladen County Health Department: 910-862-6900
You may also send a written complaint to the United States Secretary of the Department of Health and Human Services.
Region IV, Office of Civil Rights, US Dept. of Health and Human Services
If you file a complaint, we will not take any action against you or change our treatment of you in any way.