|Notice of Privacy Protection
EFFECTIVE MARCH 26, 2013
THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO YOUR MEDICAL INFORMATION.
REVIEW THIS INFORMATION CAREFULLY
If you have any questions about this Notice, please contact our Privacy Officer at the address, phone number or email listed on the bottom of this Notice.
Upper Chesapeake Health Services (UCHS) and the physicians who participate in your care are committed to protecting the privacy and confidentiality of your medical information. This Notice applies to all medical records that we maintain on your behalf, which contain your protected health information (PHI). PHI is medical information that identifies you or may provide a basis for identifying you. Your personal doctor may have different policies or notices regarding the doctor's use and disclosure of your health information created in the doctor's 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 your medical information. We are required by law to provide you with this Notice, and we are required to follow the terms of the Notice that is currently in effect.
Who Will Follow This Notice
This notice describes the privacy practices of those individuals or entities listed below:
- Upper Chesapeake Medical Center, Inc
- Harford Memorial Hospital, Inc.
- Upper Chesapeake Health Medical Services
These entities may share PHI with each other as it relates to your treatment, payment or any health care operations described in this Notice.
Changes to This Notice
We reserve the right to change this Notice. The changes will apply to PHI we already have as well as new information we receive. Before we make a change that may impact your understanding of our current privacy practices, we will change our Notice to reflect our current practice of protecting your PHI. We will post a copy of the current Notice in the hospital. The effective date of this Notice is March 26, 2013.
The Notice is available on our website at www.uchs.org. We will also make a copy of our Notice available to you every time you register at any UCHS facility for treatment. You will be asked to acknowledge in writing your receipt of this Notice.
How We May Use and Disclose Medical Information
Treatment – We may use medical information about you to provide you with treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other hospital personnel who are involved directly or indirectly with your care. For example, we may use and disclose your PHI for treatment purposes if we need to request the services of an outside laboratory to perform blood tests that are more extensive than those that would be performed by our in-house pathology department. We also may disclose medical information about you to healthcare entities outside of UCHS who may be involved in your continuing medical care after you leave UCHS, such as other health care providers, transport companies, community agencies and family members.
Payment – We may use and disclose your PHI for payment purposes. We will bill and collect payment for the treatment and services we provide to you. We may send your PHI to an insurance company or third party for payment purposes, including a collection service. For example, we may tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. We may also give information to other third parties or individuals who are responsible for payment of your health care. For example, the owner of a health insurance policy will receive an explanation of benefits (EOB) for all beneficiaries who are covered under their health plan.
Health Care Operations – We may use and disclose your PHI for health care operations. These uses and disclosures are necessary to make sure that you receive competent, quality health care and to maintain and improve the quality of health care we provide. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff when caring for you. We may disclose information to doctors, nurses, technicians, medical students, and other hospital personnel for review and learning purposes.
Permitted Use of Your PHI Without Prior Authorization – We may use or disclose your protected health information without your prior authorization for other reasons. Subject to certain requirements, we may give out health information about you without prior authorization for public health purposes, abuse or neglect reporting, health oversight audits or inspections, research studies (chart reviews), funeral arrangements, organ donation and worker's compensation purposes. We may also disclose health information about you when required by federal, state or local law, or in response to valid judicial or administrative orders.
Appointment Reminders, Treatment Alternatives, Health-Related Bents and Services – We may use and disclose your PHI to provide appointment reminders. Additionally, we may use you PHI to tell you about or recommend possible treatment alternatives or health-related benefits or services that may be of interest to you.
Fundraising & Marketing Activities – We may use medical information about you to contact you in an effort to raise money for the UCHS hospitals and its operations or to market services or treatments available at UCHS that may be beneficial to you as a patient. We may disclose medical information to our related foundation so the foundation may contact you in raising money for the hospitals. We may also disclose medical information to our Marketing Department in order to contact you regarding new or related services available to you at UCHS. If you do not want to be contacted for fundraising or marketing purposes, you must notify us, in writing, at the appropriate address that is listed at the end of this Notice.
Hospital Directory – We may include certain limited information about you in the hospital directory (the list of patients currently hospitalized) while you are a patient. This information may include your name, location in the hospital, your general condition (e.g., fair, stable, etc.), and your religious affiliation. Unless there is a specific written request from you to the contrary, this directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they don't ask for you by name. This information is released so your family, friends and clergy can visit you in the hospital and generally know how you are doing.
Confidential patients: If you do not want to be identified on the facility directory while you are a patient at UCHS, you must tell UCHS caregivers or registration personnel that you wish to be confidential while a patient at any UCHS facility. If you choose to be confidential, we will not tell the public, florists, other service persons and organizations, or your family and friends that you are a patient at UCHS or give out information regarding your general condition.
Individuals Involved in Your Care – We may release PHI about you to a family member, other relative or any other person identified by you who is involved in your health care with your permission. We may also tell your family, friends, personal representative or other person responsible for your health care your condition while you are at the hospital. In addition, we may disclose PHI about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
To Avert a Serious Threat to Health or Safety – We may use and disclose PHI about you when necessary to prevent a serious threat to your health and safety or to the public or another person. Any disclosure would only be to someone able to help prevent the threat.
Military – If you are a member of the armed forces (domestic or foreign), we may release PHI about you, as required, by domestic military command authorities for domestic armed forces and by foreign military authority for foreign armed forces.
National Security, Protective Services and Intelligence Activities – We may release PHI about you to authorized federal officials for intelligence, counterintelligence, protection of U.S. or foreign leaders and other security related activities authorized by law.
Law Enforcement – If asked to do so by law enforcement and as authorized or required by law, we may release your PHI to law enforcement. For example, we may disclose PHI about a victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement. We may release PHI to a law enforcement official about criminal conduct at the hospital. We may also release information to law enforcement, when requested, in the event that they are trying to identify the location of an individual who has outstanding warrants or is being sought by law enforcement for questioning.
Inmates – If you are an inmate of a correctional institution or under the custody of law enforcement officials, we may release PHI about you to the correctional institution as authorized or required by law.
Your Rights Regarding Medical Information About You
All request forms relating to your rights as mentioned below may be obtained from the Quality and Health Information Management medical records department at the particular facility from where you have or had received treatment.
You have the following rights regarding medical information we maintain about you:
Right to Inspect and Copy – You have the right to obtain and review a copy of your medical information that may be used to make decisions about your care. To review and obtain a copy of your medical information, you must make your request in writing to the hospital's Quality and Health Information Management department. 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. You also have the right to request that your medical record be given to you in a readable, electronic format as long as we can reasonably accommodate your request.
Right to Amend – If you feel that medical information we have about you is incorrect or incomplete, you have the right to request an amendment to your medical information. You have the right to request an amendment for as long as the information is kept by the hospital. You must submit your request in writing to the Quality and Health Information Management department with a reason that supports your requested change/s. After reviewing your request for an amendment, we will notify you in writing of our decision to deny or approve your request. 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 UCHS
- Is not part of the information which you would be permitted to inspect and copy
- Is accurate and complete
Right to an Accounting of Disclosures – You have the right to a list of disclosures of your health information, other than our own uses for treatment, payment and health care operations, as those functions are described above. To request an accounting of disclosures, you must submit your request in writing to the hospital's Quality and Health Information Management department.
Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. 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 lists. 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.
Right to Request Confidential Communications – You have the right to request that we communicate with you regarding your medical care in a certain way or at a certain location. For example, you can ask that we contact you at work or by mail. To request confidential communications, you must make your request in writing to the Quality and Health Information Management department. We will not ask you the reason for your request. We will accommodate all reasonable requests, and you must specify how or where you wish to be contacted. If we are unable to contact you using the requested way or location, we may contact you using any information we have.
Right to Request Restrictions – You have the right to request that we do not use or disclose PHI about you for treatment, payment or health care operations. You also have the right to request a limit on the PHI we disclose about you to someone who is involved in your care, like a family member or friend. You have a right to limit disclosures regarding any genetic information or genetic testing that is contained in your medical record. You have the right to restrict disclosure of any medical records pertaining to psychotherapy or psychiatric care.
You have a right to request restrictions to any treatment that you receive at any UCHS facility that was paid for out-of-pocket. For example, if you were seen in the emergency department, and you pay the bill for this date of service, you have the right to restrict who we disclose information to regarding that date of service. To request restrictions, you must make your request in writing to the hospital's Quality and Health Information Management department.
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.uchs.org.
Right to Receive Notification in the Event of a Breach – In the event that there is a breach of your confidential patient information, whether paper or electronic, we are required by law to notify you in writing regarding the circumstances of the breach, what information was disclosed, and what efforts were taken to correct the breach of your patient information.
If you believe that we have not complied with this Notice, you may file a complaint with our Privacy Coordinator. You also have a right to contact the Secretary of Office for Civil Rights/Department of Health and Human Services. To file a complaint with the appropriate hospital contact:
Upper Chesapeake Medical Center
500 Upper Chesapeake Drive
Bel Air, MD 21014
Phone: 443 643-2466
Harford Memorial Hospital
501 South Union Avenue
Havre de Grace, MD 21078
Phone: 443 843-5828
You will not be penalized for filing a complaint.
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