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Starr County Memorial Hospital NOTICE
OF PRIVACY PRACTICES
Effective Date: APRIL 14, 2003 (revised August 18, 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.
WHO
WILL FOLLOW THIS NOTICE.
This notice
describes Starr
County Memorial Hospital’s practices
and that of:
·
Any health care professional authorized to enter information into your
chart.
·
All departments and units of Starr
County Memorial Hospital.
·
Any member of a volunteer group we allow to help you while you are in the
care of Starr
County Memorial Hospital.
·
All employees, staff and other Starr
County Memorial Hospital personnel.
·
Starr County Memorial Hospital Rural Health Clinics.
All these entities, sites and locations follow the terms of
this notice. In
addition, these entities, sites and locations may share
medical information with each other for treatment,
payment or Starr
County Memorial Hospital operations purposes
described in this notice.
OUR
PLEDGE REGARDING MEDICAL INFORMATION:
Law requires us
to:
1.
Make sure that medical information that
identifies you is kept private;
2.
Give you this notice of our legal duties and
privacy practices with respect to medical information
about you; and
3.
Follow the terms of the notice that is currently
in effect.
Joint
Notice of Privacy
This
Joint Notice applies to the privacy practices of Starr
County Memorial Hospital its professional staff,
employees, volunteers, and medical staff.
The
physicians who provide medical services at Starr County Memorial Hospital are
self-employed independent contractors, and are not the
agents, servants or employees of Starr County Memorial
Hospital. If you receive services by your physician or a health care
provider at different location, there may be different
health information privacy policies or notices, and
there will be different contact information.
This Notice does not apply to your information in
the custody of or the information practices of your
physician in his or her private office
HOW
WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU.
1.
For
Treatment.
We may use medical information about you to
provide you with medical treatment or services. We may disclose medical information about you to doctors,
nurses, technicians, medical students, or other hospital
personnel who are involved in taking care of you.
We also may disclose medical information about
you to people outside the hospital who may be involved
in your medical care after you leave the hospital, such
as family members, clergy or others we use to provide
services that are part of your care.
2.
For
Payment.
We may use and disclose medical information about
you so that the treatment and services you receive at Starr
County Memorial Hospital may be billed to and
payment may be collected from you, an insurance company
or a third party. We
may also tell your health plan about a treatment or
service you are going to receive to obtain prior
approval or to determine whether your plan will cover
the treatment.
3.
For
Health Care Operations. We may use and disclose
medical information about you for Starr
County Memorial Hospital operations.
These uses and disclosures are necessary to run Starr
County Memorial Hospital and make sure that all of
our patients receive quality care.
We may also combine medical information about
many patients to decide what additional services the Starr
County Memorial Hospital should offer, what services
are not needed, and whether certain new treatments are
effective. We
may also disclose information to doctors, nurses,
technicians, medical students, and other Starr
County Memorial Hospital personnel for review and
learning purposes.
We may also combine the medical information we
have with medical information from other health
providers to compare how we are doing and see where we
can make improvements in the care and services we offer.
We may remove information that identifies you
from this set of medical information so others may use
it to study health care and health care delivery without
learning who the specific patients are.
4.
Appointment
Reminders.
We may use and disclose medical information to
contact you as a reminder that you have an appointment
for medical care.
5.
Treatment
Alternatives.
We may use and disclose medical information to
tell you about or recommend possible treatment options
or alternatives that may be of interest to you.
6.
Health-Related
Benefits and Services. We may use
and disclose medical information to tell you about
health-related benefits or services that may be of
interest to you.
7.
Fundraising
Activities.
We may use medical information about you to
contact you in an effort to raise money for Starr County Memorial Hospital and its operations.
If you do not want the Starr County Memorial Hospital to contact you for fundraising
efforts, you must notify the
Medical Records Director in writing.
8.
Individuals
Involved in Your Care or Payment for Your Care.
We may release medical information about you to a
friend or family member who is involved in your medical
care. We
may also give information to someone who helps pay for
your care. In
addition, we may disclose medical 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.
9.
Research.
Under certain circumstances, we may use and
disclose medical information about you for research
purposes. Before
we use or disclose medical information for research, the
project will have been approved through this research
approval process, but we may, however, disclose medical
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
medical information they review does not leave the Starr
County Memorial 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 with Starr
County Memorial Hospital.
10.As Required By Law.
We will disclose medical information about you
when required to do so by federal, state or local law.
11.To Avert a Serious Threat to Health or Safety.
We may use and disclose medical information about
you when necessary to prevent a serious threat to your
health and safety or the health and safety of the public
or another person.
Any disclosure, however, would only be to someone
able to help prevent the threat.
SPECIAL
SITUATIONS
12.Organ and Tissue Donation.
If you are an organ donor, we may release medical
information to organizations that handle organ
procurement or organ, eye or tissue transplantation or
to an organ donation bank, as necessary to facilitate
organ or tissue donation and transplantation.
13.Workers' Compensation.
We may release medical information about you for
workers' compensation or similar programs.
These programs provide benefits for work-related
injuries or illness.
14.Public Health Risks.
We may disclose medical information about you for
public health activities.
These activities generally include the following:
a.
To prevent or control disease, injury or
disability;
b.
To report births and deaths;
c.
To report child abuse or neglect;
d.
To report reactions to medications or problems
with products;
e.
To notify people of recalls of products they may
be using;
f.
To notify a person who may have been exposed to a
disease or may be at risk for contracting or spreading a
disease or condition;
to
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.
15.Health Oversight Activities.
We may disclose medical 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.
16.Lawsuits and Disputes.
If you are involved in a lawsuit or a dispute, we
may disclose medical information about you in response
to a court or administrative order.
We may also disclose medical 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 or to obtain an order protecting the
information requested.
17.Law Enforcement.
We may release medical information if asked to do
so by a law enforcement official:
a.
In response to a court order, subpoena, warrant,
summons or similar process;
b.
To identify or locate a suspect, fugitive,
material witness, or missing person;
c.
About the victim of a crime if, under certain
limited circumstances, we are unable to obtain the
person's agreement;
d.
About a death we believe may be the result of
criminal conduct;
e.
About criminal conduct at Starr
County Memorial Hospital; and
f.
In emergency circumstances to report a crime; the
location of the crime or victims; or the identity,
description or location of the person who committed the
crime.
18.Coroners, Medical Examiners and Funeral Directors.
We may release medical information to a coroner
or medical examiner.
This may be necessary, for example, to identify a
deceased person or determine the cause of death.
19.National Security and Intelligence Activities.
We may release medical information about you to
authorized federal officials for intelligence,
counterintelligence, and other national security
activities authorized by law.
20.Protective Services for the President and Others.
We may disclose medical information about you to
authorized federal officials so they may provide
protection to the President, other authorized persons or
foreign heads of state or conduct special
investigations.
21.Inmates. If you are an
inmate of a correctional institution or under the
custody of a law enforcement official, we may release
medical information about you to the correctional
institution or law enforcement official.
This release 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.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU.
You
have the following rights regarding medical information
we maintain about you:
22.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. Usually,
this includes medical and billing records, but does not
include psychotherapy notes.
To
inspect and copy medical information that may be used to
make decisions about you, you must submit your request
in writing to the Medical Records Director.
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.
We
may deny your request to inspect and copy in certain
very limited circumstances.
If you are denied access to medical information,
you may request that the denial be reviewed.
Another licensed health care professional chosen
by Starr County
Memorial 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.
23.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.
You have the right to request an amendment for as
long as the information is kept by or for the Starr
County Memorial Hospital.
To request an amendment, your request must be
made in writing and submitted to the Medical Records
Director. 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:
a.
Was not created by us, unless the person or
entity that created the information is no longer
available to make the amendment;
b.
Is not part of the medical information kept by or
for the Starr County Memorial Hospital;
c.
Is not part of the information which you would be
permitted to inspect and copy; or
d.
Is accurate and complete.
24.Right to an Accounting of Disclosures.
You have the right to request an "accounting
of disclosures."
This is a list of the disclosures we made of
medical information about you.
To
request this list or accounting of disclosures, you must
submit your request in writing to Medical Records
Director. Your
request must state a time period, which may not be
longer than six years and may not include dates before
April 14, 2003. Your
request should indicate in what form you want the list
(for example, on paper, electronically).
The first list you request within a 12-month
period will be free.
For additional lists, 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.
25.Right to Request Restrictions.
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 your care, like
a family member or friend.
For example, you could ask that we not use or
disclose information about care you had.
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 restrictions, you must make your request
in writing to Medical Records Director.
In your request, you must tell us (1) what
information you want to limit; (2) whether you want to
limit our use, disclosure or both; and (3) to whom you
want the limits to apply, for example, disclosures to
your spouse.
26.Right
to Request Confidential Communications. You have the right to
request that we communicate with you about medical
matters in a certain way or at a certain location.
For example, you can ask that we only contact you
at work or by mail. To request confidential communications, you must make your
request in writing to the Medical Records Director. We will not ask you the reason for your request.
We will accommodate all reasonable requests.
Your request must specify how or where you wish
to be contacted.
27.Right
to a Paper Copy of This Notice.
You have the right to a paper copy of this
notice. To obtain a paper copy of this notice, you may
ask the
admitting clerk for one.
CHANGES TO THIS NOTICE
28.
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
waiting room. In addition, each time you register at the
front desk for treatment or health care services as an
inpatient or outpatient, we will offer you a copy of the
current notice in effect.
COMPLAINTS
If
you believe your privacy rights have been violated, you
may file a complaint with the Starr County Memorial Hospital or with the Secretary of the Department of Health and Human Services(800-368-1019).
To file a complaint with the Starr
County Memorial Hospital, contact:
Privacy
Officer, Starr County Memorial Hospital, PO Box 78, Rio
Grande City, Texas 78582, 956-487-5561 phone,
956-487-0332 fax
You will not be penalized for filing a complaint.
OTHER USES OF
MEDICAL INFORMATION.
Other
uses and disclosures of medical information not covered
by this notice or the laws that apply to us will be made
only with your written permission. If you provide us permission to use or disclose medical
information about you, you may revoke that permission,
in writing, at any time.
If you revoke your permission, we will no longer
use or disclose medical information about you for the
reasons covered by your written authorization. You
understand that we are unable to take back any
disclosures we have already made with your permission,
and that we are required to retain our records of the
care that we provided to you.
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