Notice of Privacy Practices
Our Legal Duty: We are required by
applicable federal and state law to maintain the privacy of
your health information. We are also required to give you
Notice about our privacy practices, our legal duties and your
rights concerning your health information. We must follow
the privacy practices that are described in this Notice while
in effect. This notice takes effect 4/14/03 and will remain
in effect until we replace it.
Please review it carefully.
We reserve the right to change our privacy practices and the
terms of this Notice at any time, provided such changes are
permitted by applicable law. We reserve the right to make
the changes in our privacy practices and the new terms of
our notice effect all health information that we maintain,
including health information we created or received before
we made the changes. If there are changes this notice, we
will make new notices available upon request.
Who Will Follow This Notice: This
notice describes the facility’s practices and that of
any programs associated with St. Luke Health Services. Any
health care professional authorized to enter information into
your file or record and all employees, staff and other personnel
will follow the terms of this notice. In addition, these entities,
sites and locations may share medical information with each
other for treatment, payment or facility operation purposes
described in this notice.
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. We create a record of care and services
your receive in our facility. We need this record to provide
you with quality care and to comply with certain legal requirements.
This notice applies to all records of your care.
This notice describes how medical information about you may
be used and disclosed and how you can get access to this information.
It also describes your rights and certain obligations we have
regarding the use and disclosure of medical information. We
are required by law to:
• Make sure that medical information that identifies
you is kept private
• Give you this notice of our legal duties and privacy
practices with respect to medical information about you; and
• Follow the terms of the notice that is currently in
effect
This Notice of Privacy Practices describes how we may use
and disclose your protected health information to carry out
treatment, payment or healthcare operations and for other
purposes that are permitted or required by law. It also describes
your rights to access and control your protected health information.
“Protected Health Information (PHI)” is information
about you, including demographic information that may identify
you and items that relate to your past, present, or future
physical or mental health or condition and related health
care services.
Uses and Disclosures of Your Medical Health Information:
We use and disclose health information about you for treatment,
payment and healthcare operations. For example:
For Treatment: We may use medical information
about you to provide you with medical treatment. We may disclose
medical information about you to the various departments of
our facility to coordinate medical care. We also may disclose
medical information about you to people outside the facility
who may be involved in your medical care, such as a designated
family member in case of an emergency or others we use to
provide services that are a part of your care, such as your
HMO and you DSS caseworker. When required to, we will obtain
your authorization before disclosing any of your information.
Only the minimally necessary information will be revealed
during any disclosures.
For Payment: We may use and disclose medical
information about you so that the treatment and services you
receive 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 treatment
you received so your plan will pay us or reimburse you. We
may also tell your health plan about treatment you are going
to receive to obtain prior approval or in order to determine
whether you plan will cover the treatment.
As Required By Law: We will disclose minimally necessary
medical information about you when required to do so by federal, state,
or local law.
To Avert a Serious Threat to Health or Safety: We may
use and disclose minimally necessary medical information about you when
necessary to prevent a serious threat to your health and safety of the
health and safety of the public or another person. Any disclosure, however,
would only be to someone able to help prevent threat.
Worker’s Compensation: We may release minimally
necessary medical information about you for workers’ compensation
or similar programs. These programs provide benefits for work related
injuries or illness. State and/or federal law control the release of
such information.
Public Health Risk: We may disclose minimally necessary
medical information about you for public health activities. These activities
generally include the following:
• To prevent or control disease or injury or disability;
• To report victims of abuse, neglect or domestic violence or
other crimes;
• To report reaction to medication or problems with products;
or
• To notify a person why you may have been exposed to a disease
or may be at risk for contracting or spreading a disease or condition
Health Oversight Activities: We may disclose minimally necessary medical
information to 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.
Law Enforcement and Disputes: If you are involved in
a lawsuit or dispute, we may disclose minimally necessary medical information
about you if asked to do so by a law enforcement official.
• In response to a proper court order or similar process;
• In response to a subpoena for a member of the St. Luke Health
Services staff;
• About criminal conduct involving our facility; and
• In emergency circumstances to report a crime; the location of
the crime or victims; or the identity, description or location of a
person who commits the crime if the crime is on agency premises or against
agency personal.
Coroners, Medical Examiners and Funeral Directors:
We may also release minimally necessary medical information about you
to a medical examiner. This may be necessary, for example, to identify
a deceased person or determine the cause of death.
National Security and Intelligence Activities: We may
release minimally necessary medical information about you to authorized
federal officials for intelligence, counterintelligence, and other national
security activities authorized by law.
Marketing Health-Related: We will not use your health
information for marketing communications without your written permission.
Individual Rights Regarding Medical Information about You:
You have the following rights regarding medical information we maintain
about you:
Right to Inspect and Copy: You have the right to inspect
and copy medical information that may be used to make decisions about
your care, within limited exceptions.
To inspect and copy medical information that may be used to make decisions
about you, you must submit your request to the Health Information Management
Department. (All requests to obtain access to your health information
must be in writing. If you request copies we can charge you $.75 for
each page).
Right to Amend: If you feel that any of the medical
information we have about you is incorrect or incomplete, you may ask
us to amend the information. You have the right to request an amendment
for as long as the information is kept by our facility.
To request an amendment, your request must be made in writing
and submitted to the Health Information Management Department. In addition,
you must provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing or
does not include a reason to support the request. In addition, we may
deny your request if you ask us to amend information that:
• Was not created by us, unless the person or entity that created
the information is no longer available to made the amendment;
• Is not part of the medical information kept by our facility;
• Is not part of the information which you would be permitted
to inspect and copy; or
• Is accurate and complete.
Right to an Accounting of Disclosures: You have the
right to request an “accounting of disclosures.” This is
a list of the disclosures we have made of your medical information.
We are not required to account for routine disclosures.
To request this accounting of disclosures; you must submit your request
in writing to the Health Information Management Department. Your request
must state a time period which may not be longer than six years and
may not include dates before April 14, 2003. The first accounting you
request within a twelve-month period will not include a cost for providing
the disclosure list. For additional accountings, we may charge you for
the costs of providing the list. We will notify you of the cost involved
and you may choose to withdraw or modify your request at that time before
any costs are incurred.
Right to Request Confidential Communications: You have
the right to request that we communicate with you about medical matters
in certain way or at a certain location. For example you can ask that
we only speak to you when your roommate is not in the room. We must
accommodate your request if it is reasonable and specifies the alternate
location.
Right to Request Restrictions: Even though all disclosures
we already make are minimally necessary, you have the right to request
a restriction or limitation on the medical information we use or disclose
about you for treatment, payment or health care operations. You also
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
you care. Finally, you have the right to request restriction on the
people who are able to obtain information we disclose. However, we are
not required to agree to your request. If we do agree, we will comply
with your request unless the information is needed to provide you emergency
treatment. To request a restriction or limitation, your request must
be made in writing and submitted to the Health Information Management
Department.
If you any questions about our privacy practices or have concerns, please
contact us using the contact information at the end of this notice.
On or after 4/14/03, if you are concerned that we may have violated
your privacy rights, as described above, or you disagree with a decision
we made about access to your protected health information or in response
to a request you made to amend or restrict the use or disclosure of
your protected health information, you may contact the following person:
Privacy Officer
St. Luke Health Services
299 East River Road
Oswego, NY 13126
315-342-3166, Ext. 155
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