Deaconess
Billings Clinic - Notice Of Privacy Practices
Effective Date: April 14, 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 THIS NOTICE CAREFULLY.
If you have any questions about this notice, please contact the
DBC Privacy Officer
Box 37000
Billings, Montana 59107
Phone: 406-657-4229
This notice applies to the following entities:
Deaconess Billings Clinic (“DBC”) and
the Medical Staff of Deaconess Hospital
Deaconess Billings Clinic is a charitable health care corporation
that owns and operates a wide range of health care facilities and
services in Montana and Wyoming, including Deaconess Hospital,
Billings Clinic, regional DBC clinic sites, Aspen Meadows Retirement
Community, and other services. This notice applies to all members
of DBC’s workforce and all protected health care information
maintained by DBC.
This notice also applies to members of the medical staff of DBC’s
Deaconess Hospital, including physicians, dentists, podiatrists
and other independent health care providers accorded privileges
to practice at Deaconess Hospital. Everyone on the Medical Staff
of Deaconess Hospital has agreed to abide by the terms of the current
DBC Notice of Privacy Practices for services provided at Deaconess
Hospital, and to share information as necessary to carry out treatment,
payment or health care operations related to the Hospital.
OUR PLEDGE REGARDING MEDICAL INFORMATION
We understand that medical information about you and your health
is personal. At DBC, we are committed to protecting the confidentiality
of that information, wherever generated or used. For that reason,
in most cases, your health care information may not be disclosed
without your written authorization or permission. There are, however,
reasons DBC may use or disclose information about you, without
your authorization, but in ways that protect your privacy and are
required by state or federal law. We want you to understand these
practices. This notice tells you about the ways in which we may
use and disclose “protected health information” about
you. We also describe your rights and certain obligations we have
regarding the use and disclosure of medical information.
“Protected health information” is patient-identifiable
information, whether oral, electronic, or paper, which is created
or received by DBC and relates to a patient’s health care
or payment for the provision of health care. In this notice, we
will also refer to “protected health information” as “medical
information” or simply “information.”
We are required by law to:
- Maintain the privacy of your protected health information;
- Give
you notice of our legal duties and privacy practices with respect
to protected health information; and
- Abide by the terms of DBC’s
privacy notice currently in effect.
HOW WE MAY USE AND DISCLOSE PROTECTED HEALTH
INFORMATION ABOUT YOU
The following categories describe different ways that we use and
disclose protected health information, with an explanation and
examples, in some cases. Not every use or disclosure in a category
will be listed. However, all of the ways we are permitted to use
and disclose information will fall within one of the categories.
For Treatment. We may use medical information about you to provide,
coordinate, or manage your health care and related services, including
coordination or management with a third party, consultation between
health care providers, and the referral of patients both within
and outside of DBC. At DBC, we maintain an integrated medical record
for many of our patients. Portions of this record are maintained
electronically, and are accessible from computer workstations to
assist health care professionals throughout DBC in caring for you.
We may disclose information about you to doctors, nurses, technicians,
medical students, or other personnel who are involved in taking
care of you. For example, your internal medicine physician may
share information regarding your diabetes with the orthopedic surgeon
treating you for a broken leg because diabetes may slow the healing
process. You may also be referred for rehabilitation either within
or outside of DBC, and information will be shared to facilitate
that referral.
For Payment. We may use and disclose medical information about
you related to obtaining payment for the provision of health care.
For example, we may need to give your health plan or other third
party payor information about surgery you received at the hospital
so that health plan or payor will pay us or reimburse you for the
surgery. We may also 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 disclose information
to another health care provider or entity eligible to receive such
information for its own payment activities. For instance, if you
are brought to a hospital by an ambulance, we may share information
with the ambulance company to allow it to bill you or your insurer.
We may also disclose certain limited information to consumer reporting
agencies relating to collection of reimbursement.
For Health Care Operations. We may use and disclose medical information
about you for our organizational operations. As an organization
committed to providing high quality and efficient care, we use
information to conduct quality assessment and improvement activities,
to review the competence or qualifications of health care professionals
and to conduct training and education programs so health care providers
improve their skills and all personnel comply with applicable professional,
licensure, safety, and accreditation standards. We may also use
and disclose information to conduct or arrange for legal services
or for auditing and monitoring, including fraud and abuse detection
and compliance programs. Business planning and development, management
and general administrative activities, grievance resolution, customer
service activities, and grievance and complaint resolution are
all routine operational activities that may require use and disclosure
of certain protected information. We may also use and disclose
medical information as part of any reorganization of operations,
including one that results in a new or reorganized entity that
is subject to privacy protections. Often we track information over
time on patient care issues or combine medical information about
many patients in order to engage in these operational activities.
Use and disclosure of protected health care for health care operations
is limited to the minimum reasonably necessary to achieve that
purpose, subject to reasonable safeguards to assure the security
of such information.
For Research. In most cases, we will seek your
written authorization prior to engaging in research that involves
use or disclosure of
your medical information. For instance, in all research conducted
under the auspices of the DBC Research Division that involves recruiting
people to participate in research on new pharmaceutical products,
prior written authorization is sought. Such research is also subject
to review by an Institutional Review Board (“IRB”),
which is required by law to evaluate research to protect human
subjects. Under limited circumstances, subject to IRB review, we
may use and disclose medical information about you for research
purposes without your authorization. In such situations, the IRB
is required by law to evaluate proposed research projects to assure
that the use or disclosure of protected health information involves
no more than a minimal risk to the privacy of individuals and could
not practically be conducted without a waiver of authorization
and access to protected health information. For instance, research
on chronic conditions, such as asthma or diabetes, may best be
conducted using historical data in medical records. It may not
be practical to get permission from all patients who have been
diagnosed with asthma or diabetes in order to review their historical
medical records as part of research on the progression of the disease.
In addition, use or access to information necessary for research
purposes may be allowed without your authorization, before IRB
approval, to allow a researcher to prepare a research protocol
or for similar purposes, so long as the medical information they
review does not leave the organization.
164.512 (i)
Appointment Reminders. We may use and disclose medical information
to contact you as a reminder that you have an appointment for treatment
or medical care at Deaconess Billings Clinic.
Treatment Alternatives. We may use and disclose medical information
to contact you about possible treatment options or alternatives.
Health-Related Benefits and Services. We may use and disclose
medical information to contact you about health-related products
or services we provide, including communications about health care
provider networks, plans, and benefits.
Fundraising Activities. We may use medical information about you,
or disclose information to DBC Foundation or a business associate,
in an effort to raise funds for Deaconess Billings Clinic. We will
release only contact information, such as your name, address and
phone number and the dates you received treatment or services at
Deaconess Billings Clinic. If you do not want DBC or DBC Foundation
to contact you for fundraising efforts, you may “opt out” of
future fundraising efforts by notifying DBC Foundation or DBC’s
Privacy Officer in writing.
Directory Information. Unless you request that such information
not be released, we may disclose limited “directory information” about
you while you are a patient in the hospital or nursing home. Specifically,
we may disclose your presence and general health condition to people
who ask for you by name. If you authorize it, DBC may also disclose
your religious affiliation to a member of the clergy, such as a
minister, priest or rabbi, even if they do not ask for you by name.
This is so your family, friends and clergy can visit you in the
hospital or nursing home and generally know how you are doing.
Individuals Involved in Your Care or Payment for Your
Care. Unless
you object, we may disclose to a family member, other relative,
or a close personal friend, or any other person you identify, protected
health information directly relevant to that person’s involvement
with your care or payment related to your care. We will also disclose
protected health information to an individual if we reasonably
infer from the circumstances, based on the exercise of professional
judgment, that you do not object to the disclosure. 164.510(b)(1)(2)
Limited Uses When You Are Not Present or Are Incapacitated. If
you are not present or cannot object to disclosure of information
because of incapacity or an emergency circumstance, we will, in
the exercise of professional judgement, disclose protected information
in your best interests. We may use professional judgment and experience
to make reasonable inferences of your best interest in allowing
a person to pick up filled prescriptions, medical supplies, x-rays,
or other similar forms of protected health information on your
behalf. In addition, we may disclose medical information about
you to an entity assisting in a disaster relief effort. 164.510(b)(3)
(4)
As Required By Law. We will disclose medical information about
you when required to do so by federal, state or local law. 164.512(a)(1)
To Avert a Serious Threat to Health or Safety. We may use and
disclose medical information about you when necessary to prevent
or lessen a serious threat to your health and safety or the health
and safety of the public or another person, unless that information
is learned during counseling, therapy or treatment to affect the
propensity to engage in such criminal conduct. Any disclosure,
however, would only be to someone able to help prevent the threat.
164.512(j)
SPECIAL SITUATIONS
Tumor Registry. If you have been diagnosed with cancer we may
release medical information about you to the State Registry. This
information is used to monitor current treatment practices and
develop new protocols to treat cancer.
Military and Veterans. If you are a member of the armed forces,
we may release medical information about you as required by military
command authorities. We may also release protected health information
about foreign military personnel to the appropriate foreign military
authority. 164.512(k)
Workers’ Compensation. We may release protected health information
about you for workers’ compensation or similar programs,
in accordance with state law.
Public Health Risks. We may disclose protected health information
about you for public health activities and purposes described below
- To a public health authority authorized to collect
information for the purpose of preventing or controlling disease,
injury, or
disability, including, but not limited to, the reporting of
disease, injury, vital events such as births and deaths, conducting
public
health surveillance, investigations and interventions, or,
at the direction of a public health authority, disclosing information
to an official of a foreign government agency that is collaborating
with a public health authority;
- To a public health authority
or other appropriate government agency authorized to receive
reports of actual or suspected child
abuse or neglect;
- To a person responsible for federal Food and Drug Administration
activities for purposes related to the quality, safety or effectiveness
of FDA-regulated products or activities;
- To a person who may
have been exposed to a communicable disease or may be at risk
for contracting or spreading a disease or
condition, as authorized by law
- To an employer, when required by federal or state
law, to conduct medical surveillance of the workplace or to
evaluate whether
an individual has a work-related illness or injury.
164.512(b)
Victims of Abuse, Neglect or Domestic
Violence. We may disclose protected health information about an individual
we reasonably believe to be the victim of abuse, neglect or domestic
violence to a person authorized by law to receive such reports.
We will make this disclosure if you agree, or if the disclosure
is required or authorized by law and we believe the disclosure
is necessary to prevent harm to the victim or other potential victims.
Also if the patient is incapacitated, we may disclose information
to a person authorized to receive such reports, if that person
represents that the protected health information is not intended
to be used against the patient and that an immediate enforcement
activity depends upon the disclosure. [164.512(c)]
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 or disciplinary activities; legal proceedings
or actions; or other activities necessary for appropriate oversight
of the health care system, government benefit programs, and compliance
with government regulatory programs or civil rights laws for which
health information is necessary for determining compliance. [164.512(d)]
Judicial and Administrative Proceedings. If you are involved in
a lawsuit or 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 obtain an order protecting the information
requested, in the manner required by state or federal law, whichever
is more stringent under the circumstances. 164.512(e)
Law Enforcement. We may release medical information if asked to
do so by a law enforcement official:
- in response to a court order,
subpoena, warrant, summons or similar process;
- to identify or
locate a suspect, fugitive, material witness, or missing person;
- about
the victim of a crime if, under certain limited circumstances,
we are unable to obtain the person’s agreement;
- about a
death we believe may be the result of criminal conduct;
- about
criminal conduct at our organization; and
- in emergency circumstances
to report a crime; the location of the crime or victims; or
the identify, description or location of
the person who committed the crime.
164.512(f)
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. We may also release medical information about
patients of the hospital or nursing home to funeral directors as
necessary to carry out their duties. 164.512(g)
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.
164.512(h)
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. 164.512(k)(2)
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 to conduct special investigations
authorized by law. 164.512(k)(3)
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 authorities for those facilities,
if the correctional institution or law enforcement official represents
that such information is necessary in order to provide you with
health care; to protect your or other inmate’s health and
safety or the health and safety of others; for law enforcement
on the premises of the correctional institution; or for the safety,
security, and good order of the correctional institution. 164.512(k)(5)
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You have the following rights regarding medical information we
maintain about you:
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, you must submit your
request in writing to Deaconess Billings Clinic Medical Record
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.
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 Deaconess Billings Clinic 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.
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 Deaconess Billings Clinic in any of its locations.
To request an amendment, your request must be made in writing
and submitted to Deaconess Billings Clinic Medical Record 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:
- 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
Deaconess Billings Clinic;
- is not part of the information which
you would be permitted to inspect and copy; or
- is accurate and
complete.
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 for purposes
other than treatment, payment, or health care operations.
To request this list or accounting of disclosures, you must submit
your request in writing to Deaconess Billings Clinic’s Privacy
Officer. Your request must state a time period which may not be
longer than six years and may not include dates before April 14,
2000. 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.
Right to Request Restrictions. You have a right to request a restriction
or limitation on our use or disclosure of your protected health
care information. Such requests must be in writing. Because of
the integrated nature of DBC’s delivery of health care, and
the technical limitations of our electronic medical record, DBC
may not be able to agree to your request. If we do agree to a restriction,
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 Deaconess Billings Clinic Privacy Officer. 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.
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 Deaconess
Billings Clinic’s Privacy Officer. 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.
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.billingsclinic.com.
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