THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT
YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
Upper Chesapeake Health (UCH) and the physicians
who participate in your care here are committed to your personal well
being. Protecting the privacy and security of the information you share
with us is included in this commitment. While we do not sell or trade
any information to third parties, we do share information with entities
such as your insurance company and quality review organizations as part
of our routine and necessary business operations. We do this with the
utmost care and sensibility.
This Notice is being provided to you to explain how
your personal healthcare information is used, and to explain your right
to review, amend and/or request limitations on the disclosure of your
|| Disclosure means the release,
transfer, provision of access to, or divulging in any other manner
information outside the entity holding the information.
||Healthcare means care or service related
to the health of an individual. Healthcare includes, but is
not limited to, diagnostic, therapeutic, rehabilitative care and/or the sale
or dispensing of a drug, equipment, or other item in accordance with a prescription.
||Protected Health Information means any individually identifiable health information, whether
or recorded in any form, that is created and relates to the past, present, or
future physical or mental health, condition or care of an individual.
Your Rights to Privacy and Disclosure
|You have the right to
request restriction of uses and disclosures of your Protected Health
as outlined below. However, there are some instances where UCH is
not required to agree to a requested restriction.
||At the time you
initially receive service at UCH, you may request that UCH restrict
the use or disclosure of your protected health information to carry
out treatment, payment, or healthcare operations. To
request a restriction on the use or disclosure of your information,
contact our Medical Records Department and say that you want to
restrict the release of all or part of your information.
request to receive confidential communications concerning your
receive your information confidentially, contact our Medical Records
Department and direct them to how and where you wish to receive
||You can inspect and obtain
a copy of your protected health information/medical record, unless
otherwise protected by law. Contact our Medical Records Department to make the request.
obtain a copy of this Notice at any time. You will receive one at the time of service.
can request an amendment to your protected health information by
contacting our Medical Records Department. We cannot destroy or otherwise remove
the original information, but you may add/amend information in your
record pursuant to UCH's policy.
|| You can request an accounting of
our disclosures of your protected health information, unless protected
by law, by contacting the UCH Medical Records Department.
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|II. Permitted Disclosures
|UCH and/or your physician may not use
or disclose protected health information, except as permitted or
required by law. The following are permitted uses and disclosures
under current laws. We can release information to the following unless
otherwise restricted by law:
|| To the patient the information pertains
to or his/her representative;
||To UCH business associates or other
healthcare providers, to carry out treatment payment, or healthcare
||To anyone in compliance
with an authorization completed by the patient or patient's representative,
such as that from a healthcare provider regarding psychotherapy notes;
||To others as permitted
by and in compliance with some other law or regulation such as those
that require us to make certain reports to health oversight agencies,
Department of Health and Mental Hygiene.
health information is frequently shared with the following types
of entities for purposes related to the function and operation of
a healthcare facility or physician practice:
|• Managed care
||• Home Health Care
||• Clinical laboratories
||• Health benefit
information is released for the purposes of ensuring continuity
of care, billing, quality assessment and improvement activities,
and reviewing the competence or qualifications of healthcare professionals.
may also use information to contact you and provide appointment
reminders and information about treatment alternatives or other
health related benefits and services. We may contact you to request
funds for UCH's programs and services.
Federal Health Insurance Portability and Accountability Act (HIPAA)
established federal guidelines that require UCH to maintain the
privacy of your protected health information. It also requires
UCH to provide you with this Notice of our legal duties and privacy
practices with respect to your health information. Further, UCH
and the physicians participating in your care at UCH are required
to abide by the terms of this Notice. UCH does, however, have the
right to change the terms of this Notice and to make the new Notice
provisions effective for all protected health information that
we maintain. In the event we make changes to this Notice, we will
make the changes apparent in the new document, post the changes
in a prominent place within the UCH facilities and include them
on the UCH website. We will not individually notify every past
patient, but will attempt to abide by the requirements of the Notice
in effect at the time of your healthcare.
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|IV. Health Information Exchange
Health System participates in the Chesapeake Regional Information
System for our Patients, Inc. (CRISP). This system is a statewide,
internet-based health information exchange. As a participant in CRISP,
we share information that we obtain or create about you with health
care providers for treatment and public health purposes, as permitted
by law. Exchange of your health information can provide faster access,
better coordination of care and assist providers and public health
officials in making more informed treatment decisions. You may opt-out
of CRISP and prevent providers from being able to search for your
information through the exchange. However, even if you opt-out of
CRISP, a certain amount of your information will be retained by the
exchange. Your ordering or referring physicians, if participating
in CRISP, may access diagnostic information about you, such as reports
of imaging and lab results. Also, your physicians, if participating
in CRISP, still may use CRISP's secure messaging services. You may
prevent searching of your health information through CRISP by calling
1-877-952-7477 or completing and submitting an Opt-Out form to CRISP
by mail, fax or through their website at www.crisphealth.org.
|If you should have any questions
regarding CRISP, please contact the Privacy Coordinator, Chrissy
Kyak, at 443-643-2466 at Upper Chesapeake Medical Center or 443-843-5828
at Harford Memorial Hospital.
|V. Questions, Concerns or
|Should you have any questions
about this Notice, please contact our Privacy Coordinator:
|You may lodge a complaint/grievance
relevant to any portion of the Notice provisions. It will be reviewed
under the terms and parameters of our grievance process. At no time
will you be subject to retaliation for filing a complaint. You may
also forward your complaint to the Secretary of Health and Human
Services in Washington, D.C.
|To file a complaint/grievance
with UCH, please contact our Privacy Coordinator.
date: The provisions set forth in this Notice will take effect
on March 1, 2003.
is provided to you on behalf of:
Harford Memorial Hospital, Inc.
Upper Chesapeake Medical Center, Inc.
The Upper Chesapeake Health Medical Staff
request and receive medically appropriate treatment and services
within the organization's capacity and its mission.
- To request and receive care which respects your individual
cultural, spiritual and social values.
- To receive care which promotes your dignity, privacy, safety
and comfort, and which promotes optimal management of pain.
- To receive care without discrimination based on race, religion,
national origin, sex, age, handicap, marital status, sexual preference
or source of payment.
- To be informed of the nature of your illness and treatment
options, including potential risks, benefits, alternatives and
costs, and to participate fully in your health care decisions.
- To refuse recommended tests or treatments to the extent permitted
by law and to be informed of the possible consequences of your
- To formulate Advance Directives, such as a living will or
appointment of a health care agent, and to expect that your Advance
Directives will be followed when applicable.
- To expect that appropriate, surrogate decision-makers will
be sought in the event you lack decision-making ability and have
no Advance Directives.
- To raise ethical issues concerning your care with your care
providers and/or the ethics committee, and to participate in the
resolution of those issues.
- To be informed of any proposed research or experimental treatment
that may be considered in your care, and to consent or refuse to
- To be provided with continuous, coordinated and appropriate
care during and after your hospitalization.
- To be assured that medical and personal information will
be handled in a confidential manner.
- To receive a prompt and courteous response to your complaints
concerning the quality of care or service.
- To request and receive information regarding the charges
for any treatment and to receive an explanation of your bill upon
- To receive a plan of care specifically related to your chronological
and developmental age.
- To have a plan of care developed that
reflects a child's
need to grow, play and learn.
- To have your family treated with dignity, respect and emotional
- To receive care in an environment free of all forms of abuse
- To have a family member and/or your physician notified promptly
(if you wish) of your admission to the hospital.
|At Upper Chesapeake Health,
we are dedicated to creating a healing and compassionate environment
by providing the finest in care, courtesy and service to all our
patients. In order for us to provide the quality care that is appropriate
for your needs, it is important that you understand your rights,
responsibilities and the role you play in your recovery. By working
together, we can achieve the best possible outcome for you.
- To provide complete
personal and family health information needed to provide you with
- To participate to the best of your ability in making decisions
about your medical treatment and to comply with the agreed upon
plan of care.
- To ask questions of your physician or other care providers
when you do not understand any information or instruction.
- To inform your physician or other care providers if you desire
a transfer of care to another physician, caregiver or facility.
- To be considerate of others receiving and providing care.
- To observe facility policies and procedures, including those
regarding smoking, noise, and number of visitors.
- To respect the privacy, confidentiality, and dignity of fellow
patients and their families within our health care system.
|Please refer any concerns
you have during your hospital stay or questions regarding your rights
and responsibilities to our Guest Services Department. At Upper Chesapeake
Medical Center, call 443-643-2400, and at Harford Memorial Hospital,