| Notice of Privacy Practices
PURPOSE: This notice describes how medical
information about you may be used and disclosed and how you
can get access to this information.
The terms of this Notice of Privacy Practices apply to Mercer
County Joint Township Community Hospital; Community Hospital
Home Nursing Care; Maternal Care Center; Doctors’ Care;
and the Celina Community Medical Center. The members of this
clinically integrated health care arrangement work and practice
in the Mercer County area with a home base in either Coldwater
or Celina, Ohio. All of the entities and persons listed will
share personal health information of patients as necessary
to carry out treatment, payment, and health care operations
as permitted by law.
We are required by law to maintain the privacy or our patients’
personal health information and to provide patients with notice
of our legal duties and privacy practices with respect to
your personal health information. We are required to abide
by the terms of this Notice so long as it remains in effect.
We reserve the right to change the terms of this Notice of
Privacy Practices as necessary and to make the new Notice
effective for all personal health information maintained by
us. You may receive a copy of any revised notices at Mercer
County Community Hospital or a copy may be obtained by mailing
a request to: Mercer County Community Hospital: ATTN: Public
Relations Dept.; 800 W. Main Street; Coldwater, OH 45828.
Uses and Disclosures of Your Personal
Health Information
Your Authorization and Consent.
Except as outlined below, we will not use or disclose your
personal health information for any purpose unless you have
signed a form consenting to or authorizing the use of disclosure.
You have the right to revoke that consent or authorization
in writing unless we have taken any action in reliance on
the consent or authorization.
Uses and Disclosures for Treatment.
We will make uses and disclosures of your personal health
information as necessary for your treatment. For instance,
doctors and nurses and other professionals involved in your
care will use information in your medical record and information
that you provide about your symptoms and reactions to plan
a course of treatment for you that may include procedures,
medications, tests, etc.
Uses and Disclosures for Payment.
We will make uses and disclosures of your personal health
information as necessary for payment purposes. For instance,
we may forward information regarding your medical procedures
and treatment to your insurance company to arrange payment
for the services provided to you or we may use your information
to prepare a bill to send to you or to the person responsible
for your payment.
Uses and Disclosures for Health Care
Operations. We will use and disclose your personal
health information as necessary, and as permitted by law,
for our health care operation which include clinical improvement,
professional peer review, business management, accreditation
and licensing, etc. For instance, we may use and disclose
your personal health information for purposes of improving
the clinical treatment and care of our patients.
Our Facility Directory. We
maintain a facility directory listing the name, room number,
general condition, and, if you wish, your religious affiliation.
Unless you choose to have your information excluded from this
directory, the information, excluding your religious affiliation,
will be disclosed to anyone who requests it by asking for
you by name. This information, including your religious affiliation,
may also be provided to members of the clergy. You have the
right during registration to have your information excluded
from this directory and also to restrict what information
it provides and/or to whom.
Family and Friends Involved in Your
Care. With your approval, we may from time to time
disclose your personal health information to designated family,
friends, and others who are involved in your care or in payment
of your care in order to facilitate that person’s involvement
in caring for you or paying for your care. If you are unavailable,
incapacitated, or facing an emergency medical situation, and
we determine that a limited disclosure may be in your best
interest, we may share limited personal health information
with such individuals without your approval. We may also disclose
limited personal health information to a public or private
entity that is authorized to assist in disaster relief efforts
in order for that entity to locate a family member or other
persons that may be involved in some aspect of caring for
you.
Business Associates. Certain
aspects and components of our services are performed through
contracts with outside persons or organizations, such as auditing,
accreditation, legal services, etc. At times it may be necessary
for us to provide certain areas of your personal health information
to one or more of these outside persons or organizations who
assist us with our health care operation. In all cases, we
require these business associates to appropriately safeguard
the privacy of your information.
Fundraising. We may contact
you to donate to a fundraising effort for or on our behalf.
You have the right to “opt-out” of receiving fundraising
materials/communications. To do so, send your name and address
with a statement that you do not wish to receive fundraising
materials or communication from us to: Mercer County Community
Hospital; ATTN: Public Relations Dept.: 800 W. Main Street;
Coldwater, OH 45828.
Appointments and Services.
We may contact you to provide appointment reminders of information
about treatment alternatives or other health-related benefits
and services that may be of interest to you. You have the
right to request and we will accommodate reasonable requests
by you to receive communications regarding your personal health
information from us by alternative means or at alternative
locations. For instance, if you wish appointment reminders
to not be left on voice mail or sent to a particular address,
we will accommodate reasonable requests. You may request such
confidential communication in writing and may send your request
to: Mercer County Community Hospital: ATTN. HIPAA Privacy
Officer; 800 West Main Street; Coldwater, OH 45848. You also
have the right to request that we not send you any future
marketing materials, and we will use our best efforts to honor
such request. You may make the request by sending your name
and address to the Public Relations Dept. at the Community
Hospital address with your request to be removed from our
marketing mailing lists.
Other Use and Disclosures.
We are permitted or required by law to make certain other
uses and disclosures of your personal health information without
your consent or authorization.
· We may release your personal health information
for any purpose required by law;
· We may release your personal health information
for public health activities, such as required reporting of
disease, injury, and birth and death, and for requires public
health investigations;
· We may release your personal health information
as required by law if we suspect child abuse or neglect; we
may also release your personal health information as required
by law if we believe you to be a victim of abuse, neglect,
or domestic violence;
· We may release your personal health information
to the Food and Drug Administration if necessary to report
adverse events, product defects, or to participate in product
recalls;
· We may release your personal health information
to your employer when we have provided health care to you
at the request of your employer; in most cases you will receive
notice that information is disclosed to your employer;
· We may release your personal health information
if require by law to a government oversight agency conducting
audits, investigations, or civil or criminal proceedings;
· We may release your personal health information
if require to do so by a court or administrative ordered subpoena
or discovery request; in most cases you will have notice of
such release;
· We may release personal health information to law
enforcement officials as required by law to report wounds
and injuries and crimes;
· We may release personal health information to coroners
and/or funeral directors consistent with law;
· We may release your personal health information
as required by law to arrange an organ or tissue donation
from you or a transplant for you;
· We may release your personal health information
for certain research purposes when such research is approved
by an institutional review board with established rules to
ensure privacy;
· We may release your personal health information
if you are a member of the military as required by armed forces
services; we may also release your personal health information
if necessary for national security or intelligence activities;
and
· We may release your personal health information
to workers’ compensation agencies if necessary for your
workers’ compensation benefit determination.
RIGHTS THAT YOU HAVE
Access to Your Personal Health Information.
You have the right to copy and/or inspect much of the personal
health information that we retain on your behalf. All requests
for access must be made in writing and signed by you or your
representative. We will charge you a fee based upon the legal
limitations outlined. You may obtain an access request form
from our Health Records Department.
Amendments to Your Personal Health
Information. You have the right to request in writing
that personal health information that we maintain about you
be amended or corrected. We are not obligated to make all
requested amendments but will give each request careful consideration.
All amendment requests, in order to be considered by us, must
be in writing, signed by you or your representative, and must
state the reasons for the amendment/correction request. If
an amendment or correction you request is made by us, we may
also notify others who work with us and have copies of the
uncorrected record if we believe that such notification is
necessary. You may obtain an amendment request from our Health
Records Department.
Accounting for Disclosures or Your
Personal Health Information. You have the right to
receive an accounting of certain disclosures made by us of
your personal health information after April 14, 2003. Requests
must be made in writing and signed by you or your representative.
Accounting request forms are available at our Health Records
Department. The first accounting in any 12-month period is
free; you will be charged a fee for each subsequent accounting
you request within the same 12-month period.
Restrictions on Use and Disclosure
of Your Personal Health Information. You have the right
to request restrictions on certain of our uses and disclosures
of your personal health information for treatment, payment,
or health care operations on the consent form you sign when
you become a patient. We are not required to agree to your
restriction request, but will attempt to accommodate reasonable
requests when appropriate. We retain the right to terminate
agreed-to restrictions if we believe such termination is appropriate.
In the event of a termination by us, we will notify you of
such termination. You also have the right to terminate, in
writing or orally, any agreed-to restriction to sending such
termination notice to the Community Hospital address, ATTENTION
HIPAA PRIVACY OFFICER.
Complaints. If you believe
your privacy rights have been violated, you can file a complaint
in writing to: Mercer County Community Hospital; ATTN. HIPAA
Privacy Officer; 800 West Main Street, Coldwater, OH 45828.
You may also file a complaint with the Secretary of the U.S.
Department of Health and Human Services in Washington, D.C.
in writing within 180 days of a violation of your rights.
There will be no retaliation for filing a complaint.
FOR FURTHER INFORMATION
If you have questions or need further assistance regarding
this Notice, you may contact our HIPAA Privacy Officer by
calling 419-678-5146, or by sending a written communication
to: Mercer County Community Hospital; ATTN: HIPAA Privacy
Officer; 800 W. Main St.; Coldwater, OH 45828.
As a patient you retain the right to obtain a paper copy
of the Notice of Privacy Practices, even if you have requested
such copy by e-mail or other electronic means.
Effective Date: This notice of Privacy Practices is effective
April 14, 2003.
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