Upper Chesapeake Health

Notice of Privacy Protection

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.

PLEASE REVIEW THIS INFORMATION CAREFULLY

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 medical information.

Definitions

Disclosure means the release, transfer, provision of access to, or divulging in any other manner of
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 oral
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.

I. Your Rights to Privacy and Disclosure

You have the right to request restriction of uses and disclosures of your Protected Health Information ("PHI") 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.

You can request to receive confidential communications concerning your health information.To receive your information confidentially, contact our Medical Records Department and direct them to how and where you wish to receive your information.

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.

You can obtain a copy of this Notice at any time. You will receive one at the time of service.

You 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.

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 operations purposes;

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, like Maryland's Department of Health and Mental Hygiene.

Individually identifiable 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:

• Consulting Physicians	• Health insurance companies	• State/Federal agencies
• Managed care organizations	• Home Health Care	• Clinical laboratories
	• Health benefit managers

This 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.

We 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.

The 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.

IV. Health Information Exchange

Upper Chesapeake 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 "opt-out" and 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 Complaints

Should you have any questions about this Notice, please contact our Privacy Coordinator:

Chrissy Kyak
443-643-2466 (UCMC)
443-843-5828 (HMH)
ckyak@uchs.org

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.

Effective date: The provisions set forth in this Notice will take effect on March 1, 2003.

This notice is provided to you on behalf of:
Harford Memorial Hospital, Inc.
Upper Chesapeake Medical Center, Inc.
The Upper Chesapeake Health Medical Staff

Patient Rights

To 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 actions.
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 participate.
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 request.
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 support.
To receive care in an environment free of all forms of abuse and harassment.
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.

Patient Responsibilities

To provide complete personal and family health information needed to provide you with appropriate care.
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, call 443-843-5618.

Upper Chesapeake Medical Center 443-643-1000 • Harford Memorial Hospital 443-843-5000