EMH Elyria Medical Center
630 E. River St., Elyria, Ohio 44035
HIPAA NOTICE OF PRIVACY 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 IT CAREFULLY.
If you have any questions about this notice, please contact the Privacy Officer at 440.326.4399.
WHO WILL FOLLOW THIS NOTICE
This notice describes our hospital's practices and that of:
- Any health care professional authorized to enter information into your hospital chart.
- All departments and units of the hospital.
- Any member of a volunteer group we allow to help you while you are in the hospital.
- All employees, staff and other hospital personnel.
EMH Healthcare and its affiliated facilities will follow this notice. Our hospitals, employed physicians, doctors' offices, entities, foundations, facilities, home care programs, other services, and affiliated facilities follow the terms of this notice. In addition, these entities, sites and locations may share medical information with each other for treatment, payment or hospital operations purposes described in this notice. Doctors and others not employed by EMH may exchange information with EMH employees. These health care practitioners may also give you other Notice of Privacy practices which describe their office practices.
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 the care and services you receive at the hospital. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by the hospital, whether made by hospital personnel 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 doctors' office or clinic.
This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe 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.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
Except as outlined below, we will not use or disclose your protected health information for any purpose, unless you have signed a form authorizing the use or disclosure. You have the right to revoke that authorization in writing unless we have taken any action in reliance on the authorization.
Uses & Disclosures For Treatment: We will make uses and disclosures of your protected health information as necessary for your treatment. For instance, doctors, nurses and other professionals involved in your care will use information in your medical record and information that you provide about yourself to plan a course of treatment for you that may include procedures, medications, tests, etc. We may also release your protected health information to another health care facility or professional who is not affiliated with our organization but may be providing treatment to you presently or in the future, for example, nursing homes, rehab centers, home health care, etc.
Uses & Disclosures For Payment: We will make uses and disclosures of your protected health information as necessary for the payment purposes of those health professionals and facilities that have treated you or provided services to you. For instance, we may forward information regarding your medical procedures and treatment to your insurance company to arrange payment for the services provided to you or we may use your information to prepare a bill to send to you or to the person responsible for your payment.
Uses & Disclosures For Health Care Operations: We will use and disclose your protected health information as necessary, and as permitted by law, for our health care operations, which include clinical improvement, professional peer review, business management, accreditation and licensing, etc. For instance, we may use and disclose your protected health information for purposes of improving the clinical treatment and care of our patients. We may also disclose your protected health information to another health care facility, health care professional, or health plan for such things as quality assurance and case management, but only if that facility, professional, or plan also has or had a patient relationship with you.
Appointment Reminders: We may contact you to provide appointment reminders or test results. You have the right to request and we will attempt to accommodate reasonable requests by you to receive communications regarding your protected health information from us by alternative means or at alternative locations.
For instance, if you do not wish appointment reminders to be left on voice mail or sent to a particular address, we will attempt to accommodate reasonable requests. You may request such confidential communication in writing and may send your request to the department or office scheduling your visit who will also forward a copy to the Privacy Officer if your request is unable to be accommodated.
Health-Related Benefits and Services: We may from time to time use your protected health information to communicate with you about health products and services necessary for your treatment, to advise you of new products and services we offer, and to provide general health and wellness information.
Fundraising Activities: We may contact you to donate to a fundraising effort for or on our behalf. You have the right to "opt-out" of receiving fundraising materials/communications and may do so by sending your name and address to the EMH Foundation, 630 E. River St., Elyria, Ohio 44035 together with your request to be removed from our fundraising mailing and contact lists.
Our Facility Directory: We maintain a facility directory listing the name, room number, general condition and, if you wish, your religious affiliation. Unless you choose to have your information excluded from this directory, the information, excluding your religious affiliation, will be disclosed to anyone who requests it by asking for you by name. This information, including your religious affiliation, may be also provided to members of the clergy. You have the right during registration to have your information excluded from this directory.
Friends and Family Involved in Your Care: With your approval, we may from time to time disclose your protected health information to designated family, friends, and others who are involved in your care or in payment of your care in order to facilitate that person's involvement in caring for you or paying for your care. If you are unavailable, incapacitated, or facing an emergency medical situation and we determine that a limited disclosure may be in your best interest, we may share limited protected health information with such individuals without your approval. We may also disclose limited protected health information to a public or private entity that is authorized to assist in disaster relief efforts in order for that entity to locate a family member or other persons that may be involved in some aspect of caring for you.
Research: In limited circumstances, we may use and disclose your protected health information for research purposes. For example, a research organization may wish to compare outcomes of all patients that received a particular drug and will need to review a series of medical records. In all cases where your specific authorization has not been obtained, your privacy will be protected by strict confidentiality requirements applied by the Institutional Review Board which oversees the research or by representations of the researchers that limit their use and disclosure of patient information.
Business Associates: Certain aspects and components of our services are performed through contracts with outside persons or organizations, such as auditing, accreditation, legal services, etc. At times it may be necessary for us to provide certain items of your protected health information to one or more of these outside persons or organizations who assist us with our health care operations. In all cases, we require these business associates to appropriately safeguard the privacy of your information.
Other Uses and Disclosures: We are permitted or required by law to make certain other uses and disclosures of your protected health information without your consent or authorization. We may release your protected health information:
- for any purpose required by law;
- for public health activities, such as required reporting of disease, injury, birth, death, and for required public health investigations;
- as required by law if we suspect child abuse or neglect;
- if we believe you to be a victim of abuse, neglect, or domestic violence;
- to the Food and Drug Administration as required by law to report adverse events, product defects, or to participate in product recalls;
- to your employer when we have provided health care to you at the request of your employer to determine workplace-related illness or injury; in most cases you will receive notice that information is disclosed to your employer;
- to a government oversight agency as required by law to conduct audits, investigations, or civil or criminal proceedings;
- if required to respond to a court ordered subpoena or discovery request; in most cases you will have notice of such release;
- to law enforcement officials as required by law to report wounds and injuries and crimes;
- to coroners and/or funeral directors consistent with law;
- to arrange an organ or tissue donation from you or a transplant for you;to the armed forces services if you are a member of the military as required by law;
- to federal agencies for national security or intelligence activities;
- to workers' compensation agencies if necessary for your workers' compensation benefit determination; and
- to respond to a serious threat to health or safety of yourself or others as permitted by law
Ohio law requires that we obtain an authorization from you before disclosing the performance or results of an HIV test or diagnosis of AIDS or an AIDS-related condition.
YOUR 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 request a copy of medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes.
To inspect and request a copy of your medical information submit your request in writing to the Health Information Services (HIS) Release of Information Department, 630 E. River St., Elyria, Ohio 44035. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. A fee schedule is available on request.
We may deny your request to inspect and obtain a copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another professional chosen by the hospital will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Right to Amend: If you feel that medical information we have about you is incorrect or incomplete; you may ask us to amend the information. An amendment does not mean information can be removed. You have the right to request an amendment for as long as the information is kept by or for the hospital. You may obtain an amendment request form from the HIS Department Release of Information Office. Return your completed form including the reason which supports your request to the HIS Release of Information Department.
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 make the amendment;
Is not part of the medical information kept by or for the hospital;
Is not part of the information which you would be permitted to inspect and obtain a copy; or
Is accurate and complete.
Accounting for Disclosures of Your Protected Health Information: You have the right to receive an accounting of certain disclosures* made by us of your protected health information after April 14, 2003. Requests must be made in writing and signed by you or your representative. Accounting request forms are available from the HIS Department Release of Information Office. The first accounting in any 12-month period is free; you will be charged a fee for each subsequent accounting you request within the same 12-month period. This does not include accounting for treatment, payment and health care operations.
*Receive an accounting of our disclosures of your medical information except when those disclosures are made for treatment, payment or health care operations or, the law otherwise restricts the accounting. We are not required to give you a list of disclosures made before April 14, 2003.
Restrictions on Use and Disclosure of Your Protected Health Information: You have the right to request restrictions on certain of our uses and disclosures of your protected health information for treatment, payment, or health care operations. A restriction request form can be obtained from the HIS Office. We are not required to agree to your restriction request but will attempt to accommodate reasonable requests when appropriate and we retain the right to terminate an agreed to restriction if we believe such termination is appropriate. In the event of a termination by us, we will notify you of such termination. You also have the right to terminate, in writing or orally, any agreed to restriction to sending such termination notice to the HIS Office.
Right to a Paper Copy of This Notice: You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice.
You may obtain a copy of this notice at our website, www.emh-healthcare.org
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the hospital. The notice will contain on the first page, in the top right-hand corner, the effective date.
If you believe your privacy rights have been violated, you may file a complaint with the hospital or with the Secretary of the U.S. Department of Health and Human Services. To file a complaint with the hospital, you must submit your complaint in writing to the Privacy Office at EMH Elyria Medical Center, 630 E. River St., Elyria, Ohio 44035.
You will not be penalized for filing a complaint.
ACKNOWLEDGMENT OF RECEIPT OF NOTICE: You will be asked to sign an acknowledgement form that you received this Notice of Privacy Practices.