Notice
of Privacy Practices
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This
Notice of Privacy Practices applies to Morrow County
Hospital ("the Hospital") operating as a
community of health professionals. These
professionals include the staff of the Hospital,
Medical Specialty Center, Home Health, Extended
Care, an the physicians who practice here an their
staff.
Our
healthcare providers work together to provide the
best care to our patients. As allowed by law, and
only if needed , health information is shared to
provide the best treatment, arrange for payment an
improve how we provide care in the future. The
purpose of this notice is to tell you how we share
you information and how you can find out more about
our information sharing practices.
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USES
AND DISCLOSURES OF YOUR PERSONAL HEALTH INFORMATION
Your Authorization Except as outlined below, we will not use
or disclose your personal 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
And Disclosures For Treatment
We will make uses and disclosures of your personal health
information as necessary for your treatment. For instance,
doctors and nurses and other professionals involved in your
care will use information in your medical record and
information that you provide about your symptoms and reactions
to plan a course of treatment that may include procedures,
medications, tests, etc. We may also release your personal
health information to another healthcare facility or
professional who is not affiliated with our organization, but
who is or will be providing treatment to you. For instance,
if, after you leave the hospital, you are going to receive
home health care, we may release your personal health
information to that home health care agency so that a plan of
care can be prepared for you.
Uses
And Disclosures For Payment.
We will make uses and disclosures of
your personal 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 And
Disclosures For Healthcare Operations
We will use and disclose your personal health information as
necessary, and as permitted by law, for our healthcare
operations which include clinical improvement, professional
peer review, business management, accreditation and licensing,
etc. For instance, we may use and disclose your personal
health information for purposes of improving the clinical
treatment and care of our patients. We may also disclose your
personal health information to another healthcare facility,
healthcare 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.
Our Facility
Directory
We maintain a facility directory listing the name, room
number, 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 also be provided to members of the
clergy. You have the right during registration to have your
information excluded from this directory.
Family
And Friends Involved In Your Care
With your approval, we may from time
to time disclose your personal 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 personal health
information with such individuals without your approval. We
may also disclose limited personal 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.
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 personal health
information to one or more of these outside persons or
organizations who assist us with our healthcare operations. In
all cases, we require these business associates to
appropriately safeguard the privacy of your information.
Appointments
And Services
We may contact you to provide appointment reminders or test
results. You have the right to request, and we will
accommodate reasonable requests by you, to receive
communications regarding your personal health information from
us by alternative means or at alternative locations. For
instance, if you wish appointment reminders to not be left on
voice mail or sent to a particular address, we will
accommodate reasonable requests. You may request such
confidential communication in writing and may send your
request to the hospital’s Privacy Officer. (See "For
Further Information.")
Health
Products And Services
We may from time to
time use your personal 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.
Other
Uses And Disclosures
We are, permitted or required by,
law to make certain other uses and disclosures of your
personal health information without your consent or
authorization.
We may
release your personal health information:
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for any
purpose required by law;
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for public
health activities, such as required reporting of disease,
injury, and birth and death, and for required public
health investigations;
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as required
by law if we suspect child abuse or neglect; we may also
release your personal health information as required by
law if we believe you to be a victim of abuse, neglect,
or
domestic violence;
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to the Food
and Drug Administration, if necessary, to report adverse
events, product defects, or to participate in product
recalls;
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to your
employer when we have provided healthcare to you at the
request of your employer to determine workplace-related
ill-ness or injury; in most cases you will receive notice
that information is disclosed to your employer;
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if required
by law to a government oversight agency conducting audits,
investigations, or civil or criminal proceedings;
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if required
to do so by subpoena or discovery request; in some cases
you will have notice of such release;
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to law
enforcement officials as required by law to report wounds
and injuries and crimes;
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to coroners
and/or funeral directors consistent with law;
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if necessary
to arrange an organ or tissue donation from you or a
transplant for you;
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if in
limited instances we suspect a serious threat to health or
safety;
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if you are a
member of the military as required by armed forces
services; we may also release your personal health
information if necessary for national security or
intelligence activities; and
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to workers'
compensation agencies if necessary
for your workers' compensation benefit determination.
Ohio law
requires that we obtain a consent from you before disclosing
your personal health information to the Long Term Care
Ombudsman regarding your stay in our long-term care facility;
or disclosing the performance or results of an HIV test or
diagnoses of AIDS or an AIDS-related condition.
RIGHTS THAT
YOU HAVE
Access To
Your Personal Health Information.
You have the right to copy and/or inspect much of the personal
health information that we retain on your behalf. All requests
for access must be made in writing and signed by you or your
legal representative. We will charge you per page, as set
forth by Ohio law, if you request a copy of the information.
We will also charge for postage if you request a mailed copy
and will charge for preparing a summary of the requested
information if you request such summary. You may obtain a copy
of our fee schedule as well as an Authorization To Release
Medical Information form from the Health Information
Management Department.
Corrections To Your Personal Health Information.
You have the right to request in writing that personal health
information that we maintain about you be amended or
corrected. We are not obligated to make all requested
amendments, but will give each request careful consideration.
All amendment requests, in order to be considered by us, must
be in writing, signed by you or your legal representative, and
must state the reasons for the amendment/correction request.
If an amendment or correction you request is made by us, we
may also notify others who work with us and have copies of the
uncorrected record if we believe that such notification is
necessary. You may obtain an amendment request form from the
Health Information Management Department.
Accounting
For Disclosures Of Your Personal Health Information.
You have the right to receive an accounting of certain
disclosures made by us of your personal health information
after April 14, 2003. Requests must be made in writing and
signed by you or your legal representative. Accounting request
forms are available from the Health Information Management
Department. The first accounting in any 12-month period is
free; you will be charged a fee, as set forth by Ohio law, for
each subsequent accounting you request within the same
12-month period.
Restrictions
On Use And Disclosure Of Your Personal Health
Information.
You have the right to
request restrictions on certain uses and disclosures of your
personal health information for treatment, payment, or
healthcare operations. A restriction request form can be
obtained from the Health Information Management Department. We
are not required to agree to your restriction request, but
will attempt to accommodate reasonable requests when
appropriate. 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 by sending such
termination notice to the Health Information Management
Department.
Complaints.
If you believe your privacy rights have been violated, you can
file a complaint with the hospital’s Risk Manager. You may
also file a complaint with the Secretary of the U.S.
Department of Health and man Services in Washington D.C. in
writing within 180 days of a violation of your rights. There
will be no retaliation for filing a complaint.
Acknowledgment
Of Receipt Of Notice.
You will be asked to sign an acknowledgment form that you
received this Notice of Privacy Practices.
FOR
FURTHER INFORMATION
If you have questions or need further assistance regarding
this Notice, you may contact the following:
Morrow County
Hospital
651 W. Marion Rd.
Mt. Gilead, OH 43338
(419) 946-5015
Privacy Officer- (419) 949-3046
Risk Manager- (419) 949-3183
As a patient you
retain the right to obtain a paper copy of this Notice of
Privacy Practices, even if you have requested such copy by
e-mail or other electronic means.
EFFECTIVE
DATE
This Notice of Privacy Practices is effective August 1, 2004.
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