Patient Privacy Act

NOTICE OF HEALTH INFORMATION PRACTICES

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.

Our Legal Responsibility

Paragraph:
As your health care provider; we are legally required to protect the privacy of your health information, and to provide you with this notice about our legal obligations and privacy practices. This requirement applies to all patients served by Marengo Memorial Hospital.

Marengo Memorial Hospital describes the partnership between Marengo Memorial Hospital, the Family Medical Clinic of Iowa River Valley and Iowa County Ambulance Service. This notice applies to health information held by all entities.

Marengo Memorial Hospital is legally required to follow the privacy practices described in this notice. If you have any questions or want more information about this notice, please contact our Privacy Officer listed at the end of this notice.

Your Protected Health Information (PHI)

Throughout this notice, we will refer to your protected health information as PHI. Your PHI includes data that identifies you and reports about the care and services you receive at the Marengo Memorial Hospital and the described partnerships.

This notice applies to all of the records, both electronic and paper, about your care. It includes all information created by Marengo Memorial Hospital staff. This staff includes physicians, other health professionals, students, and other department staff.

This notice about our privacy practices explains how, when, and why we use and share your PHI. We may not use or disclose any more of you PHI than is necessary, with some exceptions. If state law is more protective of your privacy, we will follow state law.

Changes to This Notice

We reserve the right to change the terms of this notice and our privacy policies. Any changes will apply to your past, current and future PHI. When we make an important change to our policies, we will post this notice at the bottom of this page.

You can also request a copy of our current notice at any time from the Marengo Memorial Hospital at the registration desk.

Title: Uses of Protected Health Information

Marengo Memorial Hospital collects health information about you and stores it in a chart and on a computer. This is your medical record. The medical record is the property of Marengo Memorial Hospital, but the information in the medical record belongs to you.

We use and disclose health information for many reasons. The following examples describe some of the categories of our uses and disclosures. Please note that not every use or disclosure in a category is listed.

• Treatment. We may use and disclose medical information about you to physicians, nurses, technicians, physicians in training, or other health care professionals who are involved with your care. For example, if you are being treated for a knee injury, we may disclose you PHI to the Department of Rehabilitations Therapies. Different health care professionals, such as pharmacists and lab technicians, also may share information about you in order to coordinate your care. In addition, we may send information to your physician or practitioner.
• Payment. We may use and disclose your PHI in order to bill and collect payment for the treatment and services we provided to you. For example, we may provide PHI to an insurance company or other third party payer in order to obtain approval for treatment or admission to the hospital.
• Health Care Operations. We may use and disclose your PHI as part or our routine operations. For example, we may use your PHI to evaluate the quality of health services you received or to evaluate the performance of health care professionals who cared for you. We may also disclose information to physicians, nurses, technicians, medical students, nursing and other health professional students, and other hospital personnel as a part of our educational mission.

Appointment reminders and health-related benefits or services.

We may use your PHI to provide appointment reminders or give you information about treatment alternatives or other health care services.

• Public health activities. We report information about births, deaths, and various diseases to government officials in charge of collecting that information about an individual’s death.
• Law enforcement. We may disclose PHI to government agencies and law enforcement personnel when the law requires it. For example, we report about victims of abuse, neglect, domestic violence, and gunshots, or when ordered to do so in judicial or administrative proceedings.
• Health oversight activities. We may disclose PHI to a health oversight agency for audits, investigation, inspections, and licensure, as authorized by law. For example, we may disclose PHI to the Food and Drug Administration, state Medicaid fraud control, or the Department of Health and Human Services Office for Civil Rights.
• Research studies. We may disclose your PHI to help conduct research. Research may involve finding a cure for an illness or helping determine the effectiveness of a treatment. All research studies are subject to approval of the Marengo Memorial Hospital Board of Trustees. The Board of Trustees will evaluate the proposed research study to determine that measures are in place to balance research needs with the need for the privacy of your health information. For some research activities you may be asked to participate in a study, and, if you agree, the researcher will be required to obtain your permission to use your PHI for that study.
• Organ donation. We may use your PHI to notify organ donation organizations, and to assist them in organ, eye, or tissue donation and transplants.
• Workers’ compensation purposes. We may disclose PHI to your employer or your workers’ compensation carrier.
• National security and intelligence activities. We may release PHI to authorized federal officials when required by law. This information may be used to protect the President; other authorized persons or foreign heads of state; to conduct special investigations; for intelligence and other national security activities authorized by law.

Title: Uses and Disclosures for Which You Have the Opportunity to Object.

• Hospital Directory. We will use your name, the location at which you are receiving care, your general condition for directory purposes. All of this information will be disclosed to people who ask for you by name. If you object to this use, we will not include this information in the directory. You will need to express your objection for each inpatient stay. To object, please notify a member of your nursing or hospital registration staff.
• Fundraising. We may use your PHI in efforts to raise money for Marengo Memorial Hospital. We may provide your PHI to the Marengo Memorial Hospital Foundation for this purpose. We would release contact information only, such as your name, address, phone number, the dates the health care was provided to you and your insurance status. If you do not want Marengo Memorial Hospital to contact you for fundraising efforts, you must notify our Privacy Officer in writing at the address listed at the end of this notice.
• Disclosures to family, friends, or others. We may provide your PHI to a family member, friend, or other person you tell us is involved in your care, or involved in the payment of your health care, unless you object in whole or in part. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest.

Except as described above, all other uses and disclosures of your PHI will require your authorization.

Your Rights Regarding PHI

You Have the Right to:

• Request restrictions. You have the right to ask that we limit how we use and disclose your PHI. We will consider your request, but we are not legally required to accept it. If we accept your request, we will honor that request except in emergency situations. You may not limit the uses and disclosures that we are legally required or allowed to make. To request a restriction, contact the Privacy Officer listed at the end of this notice.
• Request confidential communications. You have the right to ask that we send PHI to you at an alternate address. For example, you may wish to have appointment reminders and test results sent to a P.O. Box or an address different from your home address. We will accommodate reasonable request, contact the Privacy Officer listed at the end of this notice.
• Inspect and copy. You have the right to inspect and obtain a copy of medical information that may be used to make decisions about your care. Usually this includes the medical record and billing records. To inspect and obtain a copy of your medical information, you must submit your request in writing to either:

• Health Information Management (for medical information) or
• Business Office (for billing)

We will make every effort to respond to your request within a reasonable period of time. You may be charged a fee to cover the costs of copying, mailing, or other supplies associated with your request.

• Accounting of disclosures. You have the right to obtain a list of instances in which we have disclosed your PHI. Your request must state a time period not longer than six years and your request may not include dates before April 14, 2003. The list will not include uses or disclosures made for treatment, payment, or health care operations. In addition, the list will not include uses or disclosures that you have specifically authorized in writing, such as copies of records to your attorney or to your employer. To request an accounting of disclosures, contact the Privacy Officer listed at the end of this notice.
• Amend. You have the right to request an amendment of your PHI if you think that information is inaccurate or incomplete in your medical record or in a billing record. You may request an amendment for as long as that record is maintained. You may submit a written request for an amendment to either:

• Health Information Management (for amendment to your medical record) or
• The Business Office (for amendment to your billing record).

Marengo Memorial Hospital may deny your request for an amendment if:

• it is not in writing
• it relates to information not created or produced by Marengo Memorial Hospital
• we decide that the information in the record is accurate and complete

• Paper Copy of this Notice. You have the right to request a paper copy of this notice. You may pick one up at any check-in point at the hospital or the clinic or request that a copy be sent to you.

Revocation of Permission

If you provide us with permission to use or disclose medical information about you, you may revoke that permission at any time. To request revocation of permission, contact the Marengo Memorial Hospital Privacy Officer listed at the end of this notice.

If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written revocation. We are unable to take back any disclosures previously made with your permission. Also, we are required to keep all records of the care we provide to you.

Complaints and Questions

If you believe your privacy rights have been violated, you may file a complaint with the MMH Privacy Officer or with the Secretary of the U.S. Department of Health and Human Services.

To file a complaint with the Marengo Memorial Hospital, contact the privacy officer at Marengo Memorial Hospital. The address and phone number are listed at the end of this notice. You will not be penalized for filing a complaint and your care will not be compromised.

Contact Information

Marengo Memorial Hospital
ATTN: Privacy Officer
300 W. May Street
Marengo, IA 52301
319/642-5543

For:

• Confidential communications
• Inspection and copying of your billing records
• Amending your billing records
• Inspection and copying of your medical records
• Amending your medical record
• Revoking your permission to disclose your medical information

If you have questions about this notice, any complaints about our privacy practices, or you would like to have more information, please contact the Privacy Officer listed above.

This notice is in effect April 14, 2003

References

Public Health Service, Department of Health and Human Services. "Confidentiality of Alcohol and Drug Abuse Patient Records."
Code of Federal Regulations, 2000. 42 CFR, Chapter I, Part 2
"Standards for the Privacy of Individually Identifiable Health Information; Final Rule." 45 CFR Parts 160 through 164. Federal Register 65, no. 250 (December 28, 2000). Available at http://aspe.hhs.gov/admnsimp/. P:HIPAA/NoticeHealthInfoPractices.203