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NOTICE OF PRIVACY
PRACTICES
Required by the Health
Insurance Portability and Accountability Act of 1996
(HIPAA)
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.
On the last page of this document is the
name and phone number of the Facility Privacy Officer should you
have questions about your privacy rights. You will also find the
effective date of this document and, in addition to the hospital,
the other healthcare providers that may follow this
notice.
WHO WILL FOLLOW THIS
NOTICE - This notice describes the privacy
practices of Glades General Hospital and the physicians who provide
services to patients at this hospital. It will also apply to any
healthcare professional authorized to provide you with treatment
and/or authorized to enter information into your hospital chart.
MEDICAL
INFORMATION - Each time you visit a
hospital, physician, or other provider of health care, a record is
made of your visit. We need this information to provide you with
quality care and to comply with the law. Although your health record
is the physical property of the healthcare provider that compiles
it, the information belongs to you. We are required by law to
maintain the privacy of your health information and we are committed
to doing so. We will abide by the terms of this notice as required
by Federal law.
HOW WE USE AND DISCLOSE MEDICAL
INFORMATION -
Treatment -
Medical information is used to provide you with medical treatment.
This information may be disclosed to physicians, nurses, technicians
and other individuals who are involved in your care. Departments of
the hospital may share information about you in order to coordinate
the things you need, such as prescription drugs, lab tests and
x-rays. For example, a physician treating you for a broken bone will
need to know if you are diabetic as this may slow the healing
process. The physician may need to tell the dietitian about the
diabetes so appropriate meals can be provided for you. We may
disclose information about you for the treatment activities of
another healthcare provider.
Payment - We may
use and disclose medical information about you so that we can bill
and collect payment. This could include an insurance company or a
third party. If you are covered by health insurance your health plan
may need information from us about a surgery or other procedure you
had, or will have, before they will pay us. We may disclose
information about you for the payment activities of another
healthcare provider.
Health Care
Operations - Your medical information may be used or
disclosed for purposes of our day-to-day operations. These
activities are necessary to operate the hospital and to monitor the
quality of care our patients receive. Examples would include to
assess your satisfaction with our services; remind you of
appointments; to tell you of possible treatment alternatives; to
evaluate the treatment you received by our staff; to work with
health oversight organizations which would include audits,
investigations, inspections and licensure; and to combine
information about you with other patients to determine what
additional services should be provided.
Clergy - In
accordance with the law, we may disclose your name, location in the
facility, religious affiliation and general condition to members of
the clergy, but only if you have not objected to this information
being released.
Individuals Involved in
Care or Payment for Your Care - We may disclose your
medical information to a family member or friend who will be
involved in your care.
Law Enforcement
- Subject to certain restriction, we may disclose information
required by law enforcement officials. Legal Requirements - We
disclose patient information to comply with both state and Federal
laws. For instance, we are required to report to the state any time
a patient has certain diseases, for example, tuberculosis. Other
examples of required reporting would involve cases of abuse, neglect
or domestic violence; Workers Compensation Agents; Food and Drug
Administration; correctional institutions regarding inmates;
compliance with court orders, subpoenas, or other administrative
processes; organ procurement organizations; and, to report to the
state all births and deaths.
Medical Examiners,
Coroners, and Funeral Directors - We may disclose
information to these entities when necessary for them to carry out
their job responsibilities.
Military and
Veterans - If you are, or have been, a member of the
armed forces, we may disclose information about you as required by
military authorities.
National
Security - We may release patient information to
authorized Federal officials for matters related to national
security.
Patient Directory
- You have the opportunity to be included in the patient
directory or you may Aopt out@. If you are in the patient directory
and someone asks about you by name then we may provide verification
that you are a patient, your location in the facility, and your
general condition (for example, fair, stable, etc.). Should you
decide to opt out of the directory, then anyone asking for you will
be given no information.
Serious Threats to Health
or Safety - We may disclose information about you when
necessary to prevent a serious threat to your health and safety as
well as the health and safety of the public.
Public Health
Risks - We disclose information to report reactions to
medications or medical products; to notify people of recalls; to
notify people who may have been exposed to a disease or are at risk
of contracting or spreading a disease; and, to report certain
injuries such as gunshots or knife wounds.
YOUR RIGHTS REGARDING MEDICAL
INFORMATION ABOUT YOU - To
exercise these rights, contact the Privacy Officer or Medical
Records Department for appropriate forms.
To Inspect and
Copy - In most cases you have the right to inspect and to
obtain a copy of the health information that may have been used to
make decisions about your care. A fee may be charged if you obtain a
copy of your records. The law provides that in limited
circumstances, you may be denied access to this information.
To Request an Amendment to
Your Medical Record - If you believe that the information
we have about you is incorrect or is incomplete, you have the right
to request an amendment to the information. You have this right for
as long as we have the information. The law provides that in some
circumstances we may deny your request to amend the record.
To Request
Restrictions - You have the right to request that we
restrict or limit the medical information we use or disclose about
you for treatment, payment, or healthcare operations. The law states
that we are not required to comply with your request.
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
particular location. We will accommodate all reasonable requests;
however, you are not allowed to limit the way we can contact you in
order to avoid your responsibility to pay us for the services
rendered to you.
To Request an Accounting of
Disclosures - You may request a list of instances where
we have disclosed health information about you for reasons other
than treatment, payment, or health care operations. We are not
required to provide for an accounting which took place before April
14, 2003.
OTHER USES OF YOUR MEDICAL
INFORMATION - If we wish to
disclose medical information about you for a reason not covered by
treatment, payment, healthcare operations, legal requirements or
other disclosures as set forth in this notice, we will seek your
written authorization. If you provide us written authorization to
use or disclose medical information about you, you may revoke it at
any time by doing so in writing. If you revoke your authorization,
we will no longer use or disclose medical information about you for
the reasons covered by our written authorization. CHANGES
TO THIS NOTICE - We reserve the right to change this notice and
our policies at any time. If our policies change and we make changes
to our Notice then we will post the new Notice in a public area. You
can request a copy of our Notice at any time.
COMPLAINTS - If you believe your privacy rights have been violated, you
may file a complaint with the Facility Privacy Officer or with the
Secretary of the Department of Health and Human Services in
Washington, D.C. To file a complaint you will need to contact the
Facility Privacy Officer whose name and phone number is listed
below. All complaints must be submitted in writing. You will not be
penalized for filing a complaint. PRIVACY
OFFICER - If you have questions, requests, or complaints, please
contact:
Ms. Terri A. Calsetta
Facility Privacy Officer
Glades General Hospital
1201
South Main Street
Belle Glade, FL 33430
561-996-6571, ext.
444
INDEPENDENT CONTRACTORS - Glades General Hospital and the physicians who
practice at the hospital are independent contractors and do not,
hereby, assume any liability for the services or conduct of each
other.
The Effective Date of this Notice is April 14,
2003.
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