This notice describes how medical information about you may be used and disclosed and how to get access to this information. Please review it carefully.
This notice describes the privacy practices of Redlands Community Hospital (the Hospital), including members of its workforce, the physician members of the medical staff, and allied health professionals who practice at the Hospital. The Hospital and the individual health care providers together are sometimes called us or we in this notice. While we engage in many joint activities and provide services in a clinically integrated care setting, we each are separate legal entities. This notice applies to services furnished to you at 350 Terracina Boulevard, Redlands, California as a Hospital inpatient or outpatient.
Each of us is required by law to maintain the privacy of your health information (Protected Health Information or PHI) and to provide you with this Notice of our legal duties and privacy practices with respect to your Protected Health Information. When we use or disclose your Protected Health Information, we are required to abide by the terms of this notice (or other notice in effect at the time of the use or disclosure).
In certain situations, which we will describe in Section IV, we must obtain your written authorization in order to use and/or disclose your PHI. However, we do not need any type of authorization from you for the following uses and disclosures:
1.
Uses and Disclosures for Treatment Payment and Health Care Operations.
We may use and disclose PHI, but not your 'highly confidential information'
(defined in Section IV.C), in order to treat you, obtain payment for services
provided to you and conduct our health care operations as detailed below:
Treatment
We use and disclose your PHI to provide treatment and other services to you. For example, to diagnose and treat your injury or illness. In addition, we may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. We may also disclose PHI to other providers involved in your treatment.
Payment
We may use and disclose your PHI to obtain payment for services that we provide to you. For example, disclosures to claim and obtain payment from your health insurer, HMO, or other company that arranges or pays the cost of some or all of your health care (your 'Payor') to verify that your payor will pay for health care.
Health Care Operations
We may use and disclose your PHI for our health care operations, which include internal administration and planning and various activities that improve the quality and cost effectiveness of the care that we deliver to you. For example, we may use PHI to evaluate the quality and competence of our physicians, nurses and other health care workers. We may disclose PHI to our Privacy Office Risk Management Officer in order to resolve any complaints you may have and ensure that you have a comfortable visit with us.
We may also disclose PHI to your other health care providers when such PHI is required for them to treat you, receive payment for services they render to you, or conduct certain health care operations, such as quality assessment and improvement activities, reviewing the quality and competence of health care professionals, or for health care fraud and abuse detection or compliance. In addition, we may share PHI with our business associates who perform treatment, payment and health care operations services on our behalf.
2.
Use or Disclosure for Directory of Individuals in the Hospital.
We may include your name, location in the hospital, general health condition
and religious affiliation in a patient directory without obtaining your
authorization unless you object to inclusion in the directory or are located
in a specific ward, wing or unit where the identification of which would
reveal that you are receiving treatment for mental health and developmental
disabilities. Information in the directory may be disclosed to anyone
who asks for you by name or members of the clergy; provided, however,
that religious affiliation will only be disclosed to members of the clergy.
3.
Disclosure to Relatives, Close Friends and Other Caregivers.
We may use or disclose your PHI to a family member, other relative, a close
personal friend or any other person identified by you when you are present
for, or otherwise available prior to, the disclosure, if we
(1) obtain your agreement;
(2) provide you with the opportunity to object to the disclosure and you do
not object; or
(3) reasonably infer that you do not object to the disclosure. If you are
not present, or the opportunity to agree or object to a use or disclosure
cannot practicably be provided because of your incapacity or an emergency
circumstance, we may exercise our professional judgment to determine whether
a disclosure is in your best interests. If we disclose information to
a family member, other relative or a close personal friend, we would disclose
only information that we believe is directly relevant to the person’s
involvement with your health care or payment related to your health care.
We may also disclose your PHI in order to notify (or assist in notifying)
such persons of your location or general condition.
4.
Public Health Activities.
We may disclose your PHI for the following public health activities:
(1) to report health information to public health authorities for the purpose
of preventing or controlling disease, injury or disability;
(2) to report child abuse and neglect to public health authorities or other
government authorities authorized by law to receive such reports;
(3) to report information about products and services under the jurisdiction
of the U.S. Food and Drug Administration;
(4) to alert a person who may have been exposed to a communicable disease
or may otherwise be at risk of contracting or spreading a disease or condition; and
(5) to report information to your employer as required under laws addressing
work-related illnesses and injuries or workplace medical surveillance.
5.
Victims of Abuse, Neglect or Domestic Violence.
If we reasonably believe you are a victim of abuse, neglect or domestic
violence, we may disclose your PHI to a governmental authority, including
a social service or protective services agency, authorized by law to receive
reports of such abuse, neglect, or domestic violence.
6.
Health Oversight Activities.
We may disclose your PHI to a health oversight agency that oversees the
health care system and is charged with responsibility for ensuring compliance
with the rules of government health programs such as Medicare or Medicaid.
7.
Judicial and Administrative Proceedings.
We may disclose your PHI in the course of a judicial or administrative
proceeding in response to a legal order or other lawful process.
8.
Law Enforcement Officials.
We may disclose your PHI to the police or other law enforcement officials
as required or permitted by law or in compliance with a court order or
a grand jury or administrative subpoena.
9.
Decedents.
We may disclose your PHI to a coroner or medical examiner as authorized by law.
10.
Organ and Tissue Procurement.
We may disclose your PHI to organizations that facilitate organ, eye or
tissue procurement, banking or transplantation.
11.
Research.
We may use or disclose your PHI without your consent or authorization if
our Institutional Review Board approves a waiver of authorization for
disclosure.
12.
Health or Safety.
We may use or disclose your PHI to prevent or lessen a serious and imminent
threat to a person’s or the public’s health or safety.
13.
Specialized Government Functions.
We may use and disclose your PHI to units of the government with special
functions, such as the U.S. military or the U.S. Department of State under
certain circumstances.
14.
Workers Compensation.
We may disclose your PHI as authorized by and to the extent necessary to
comply with California law relating to workers compensation or other similar programs.
15.
As Required by Law.
We may use and disclose your PHI when required to do so by any other law
not already referred to in the preceding categories.
1.
Use or Disclosure with Your Authorization.
For any purpose other than the ones described above in Section III, we
only may use or disclose your PHI when you grant us your written authorization
on our authorization form ('Your Authorization'). For instance, you will
need to execute an authorization form before we can send your PHI to your
life insurance company or to the attorney representing the other party
in litigation in which you are involved.
2.
Marketing.
We must also obtain your written authorization ('Your Marketing Authorization')
prior to using your PHI to send you any marketing materials. (We can,
however, provide you with marketing materials in a face-to-face encounter
without obtaining Your Marketing Authorization. We are also permitted
to give you a promotional gift of nominal value, if we so choose, without
obtaining Your Marketing Authorization.) In addition, we may communicate
with you about products or services relating to your treatment, case management
or care coordination, or alternative treatments, therapies, providers
or care settings without Your Marketing Authorization.
3.
Uses and Disclosures of Your Highly Confidential Information.
In addition, federal and state law requires special privacy protections
for certain highly confidential information about you, including the subset
of your PHI that:
(1) is maintained in psychotherapy notes;
(2) is about mental health and developmental disabilities services;
(3) is about alcohol and drug abuse prevention, treatment, and referral;
(4) is about HIV/AIDS testing, diagnosis or treatment;
(5) is about communicable disease(s);
(6) is about genetic testing;
(7) is about child abuse and neglect;
(8) is about domestic and elder abuse or
(9) is about sexual assault. In order for us to disclose your highly confidential
information for a purpose other than those permitted by law, we must obtain
your written authorization. In accordance with federal and California
law, there are specific situations in which highly confidential information
may be released without the patient’s authorization:
1. Substance Abuse Information May Be Released in the Following Situations:
2. Reports of Suspected Child Abuse or Neglect and Information Contained Therein May Be Disclosed Only To:
3. Reports of Elder and Dependent Adult Abuse May Be Disclosed Only in the Following Situations:
4. HIV Test Results May Be Disclosed to the Following Persons Without the Written Authorization of the Subject of the Test:
5. Communicable Diseases:
6. Release of Mental Health and Developmental Disability Information Requires the Written Authorization of the Patient Only to the Persons Listed Below:
1.
For Further Information /Complaints.
If you desire further information about your privacy rights, are concerned
that we have violated your privacy rights or disagree with a decision
that we made about access to your PHI, you may contact our Privacy Office.
You may also file written complaints with the Director, Office for Civil
Rights of the U.S. Department of Health and Human Services. Upon request,
the Privacy Office will provide you with the correct address for the Director.
We will not retaliate against you if you file a complaint with us or the Director.
2.
Right to Request Additional Restrictions.
You may request restrictions on our use and disclosure of your PHI
(1) for treatment, payment and health care operations,
(2) to individuals (such as a family member, other relative, close personal
friend or any other person identified by you) involved with your care
or with payment related to your care, or
(3) to notify or assist in the notification of such individuals regarding
your location and general condition. While we will consider all requests
for additional restrictions carefully, we are not required to agree to
a requested restriction. If you wish to request additional restrictions,
please obtain a request form from the Health Information Management (H.I.M.)
Director and submit the completed form to the H.I.M. Director. We will
send you a written response.
3.
Right to Receive Confidential Communications.
You may request, and we will accommodate, any reasonable written request
for you to receive your PHI by alternative means of communication or at
alternative locations.
4.
Right to Revoke Your Authorization.
You may revoke your authorization, your marketing authorization or any
written authorization obtained in connection with your highly confidential
information, except to the extent that we have taken action in reliance
upon it, by delivering a written revocation statement to the H.I.M. Director
identified below.
5.
Right to Inspect and Copy Your Health Information.
You may request access to your medical record file and billing records
maintained by us in order to inspect and request copies of the records.
Under limited circumstances, we may deny you access to a portion of your
records. You should take note that, if you are a parent or legal guardian
of a minor, certain portions of the minor’s medical record will
not be accessible to you (for example, records pertaining to health care
services for which the minor can lawfully give consent and therefore for
which the minor has the right to inspect or obtain copies of the record
(i.e. abortion or mental health treatment); or the health care provider
determines, in good faith, that access to the patient records requested
by the representative would have a detrimental effect on the provider’s
professional relationship with the minor patient or on the minor’s
physical safety or psychological well-being. If you desire access to your
records, please obtain a record request form from the Medical Records
Office and submit the completed form to the Medical Records Office. If
you request copies, we will charge you twenty-five cents ($0.25) for each
page copied and the actual costs for clerical time and copies of x-rays
and EEG, ECG and EMG tracings. We will also charge you for our postage
costs, if you request that we mail the copies to you.
6.
Right to Amend Your Records.
You have the right to request that we amend Protected Health Information
maintained in your medical record file or billing records. If you desire
to amend your records, please obtain an amendment request form from the
Medical Records Office and submit the completed form to the Medical Records
Office. We will comply with your request unless we believe that the information
that would be amended is accurate and complete or other special circumstances apply.
7.
Right to Receive an Accounting of Disclosures.
Upon request, you may obtain an accounting of certain disclosures of your
PHI made by us during any period of time prior to the date of your request
provided such period does not exceed six years and does not apply to disclosures
that occurred prior to April 14, 2003. If you request an accounting more
than once during a twelve (12) month period, we will charge you the actual
costs of the preparing of the accounting statement for each subsequent request.
8.
Notification of Unlawful or Unauthorized Access, Use, or Disclosure.
In the event of an unlawful or unauthorized access, use or disclosure of
your Protected Health Information in violation of the California Confidentiality
of Medical Information Act and related privacy laws occurs, reasonable
efforts will be undertaken to advise you of the same within five (5) days
of the detection by the Hospital of any such breach of privacy.
9.
Right to Receive Paper Copy of this Notice.
Upon request, you may obtain a paper copy of this Notice, even if you have
agreed to receive such notice electronically.
1.
Effective Date.
This notice is effective on April 14, 2003.
2.
Right to Change Terms of this Notice.
We may change the terms of this notice at any time. If we change this notice,
we may make the new notice terms effective for all Protected Health Information
that we maintain, including any information created or received prior
to issuing the new notice. If we change this notice, we will post the
new notice in waiting areas around the Hospital and on our Internet web
site at www.redlandshospital.org. You also may obtain any new notice by
contacting the Privacy Office.
You may contact the Privacy Officer at:
Privacy Office
Redlands Community Hospital
350 Terracina Boulevard
Redlands CA 92373
Telephone:
909.478.3524
E-mail:
Privacy.Officer@redlandshospital.org