| NOTICE
OF PRIVACY PRACTICES
For Personal Health Information
Baraga County Memorial Hospital •
Baraga County Family Practice •
Baraga County Home Care & Hospice
• Baraga County Home Helpers •
Baraga County Medical Equipment •
Bayside Village - Dr. Louis and Anne Guy
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 QUESTIONS ABOUT
THIS NOTICE OR PRIVACY POLICIES, YOU
MAY CONTACT THE PRIVACY OFFICER, AT (906)
524-3300.
WHO
WILL FOLLOW THIS NOTICE :
BARAGA COUNTY MEMORIAL HOSPITAL (BCMH)
IS PART OF AN ORGANIZED HEALTH CARE ARRANGEMENT
WITH ITS MEDICAL STAFF AND VARIOUS OTHER
HEALTH CARE PROVIDERS IT OWNS AND OPERATES.
THIS NOTICE WILL BE FOLLOWED BY EMPLOYEES,
MEDICAL STAFF AND OTHER PERSONNEL OF BCMH,
AS WELL AS THOSE PROVIDERS IT OWNS AND
OPERATES. WE MAY ALSO USE BUSINESS ASSOCIATES
TO CARRY OUT SOME OF THE ACTIVITIES DESCRIBED.
WHEN SERVICES ARE CONTRACTED AND WE MUST
DISCLOSE INFORMATION ABOUT YOU TO OUR
BUSINESS ASSOCIATES, WE WILL REQUIRE OUR
BUSINESS ASSOCIATES TO SAFEGUARD YOUR
INFORMATION. THIS NOTICE APPLIES TO ALL
OF THE RECORDS OF YOUR CARE GENERATED
AND MAINTAINED BY BCMH , WHETHER MADE
BY BCMH OR BCMH HEALTH CARE PROVIDER PERSONNEL
OR YOUR PERSONAL DOCTOR. THIS NOTICE DOES
NOT APPLY TO THE RECORDS OF YOUR CARE
MAINTAINED OR GENERATED BY OTHER HEALTH
CARE PROVIDERS AS THEY MAY HAVE DIFFERENT
POLICIES OR NOTICES REGARDING THEIR USE
AND DISCLOSURE OF YOUR MEDICAL INFORMATION.
OUR
PLEDGE REGARDING MEDICAL INFORMATION :
WE UNDERSTAND THAT MEDICAL INFORMATION
ABOUT YOU AND YOUR HEALTH IS PERSONAL.
WE ARE COMMITTED TO PROTECT MEDICAL INFORMATION
ABOUT YOU. WE CREATE A RECORD OF THE CARE
AND SERVICES YOU RECEIVE AT BCMH OR FROM
BCMH HEALTH CARE PROVIDERS. WE NEED THIS
RECORD TO PROVIDE YOU WITH QUALITY CARE
AND TO COMPLY WITH CERTAIN LEGAL REQUIREMENTS.
THIS
NOTICE WILL TELL YOU ABOUT THE WAYS IN
WHICH WE MAY USE AND DISCLOSE MEDICAL
INFORMATION ABOUT YOU. WE ALSO DESCRIBE
YOUR RIGHTS AND CERTAIN OBLIGATIONS WE
HAVE REGARDING THE USE AND DISCLOSURE
OF MEDICAL INFORMATION. WE ARE REQUIRED
BY LAW TO MAKE SURE THAT MEDICAL INFORMATION
THAT IDENTIFIES YOU IS KEPT PRIVATE, TO
MAKE AVAILABLE TO YOU THIS NOTICE OF OUR
LEGAL DUTIES AND PRIVACY PRACTICES WITH
RESPECT TO MEDICAL INFORMATION ABOUT YOU,
AND TO FOLLOW THE TERMS OF THE NOTICE
THAT IS CURRENTLY IN EFFECT.
HOW
WE MAY USE AND DISCLOSE MEDICAL INFORMATION
ABOUT YOU :
THE FOLLOWING CATEGORIES DESCRIBE DIFFERENT
WAYS THAT WE USE AND DISCLOSE MEDICAL
INFORMATION. FOR EACH CATEGORY OF USES
OR DISCLOSURES WE WILL EXPLAIN WHAT WE
MEAN AND TRY TO GIVE SOME EXAMPLES. 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 YOU WITH MEDICAL TREATMENT
OR SERVICES. WE MAY DISCLOSE MEDICAL INFORMATION
ABOUT YOU TO DOCTORS, NURSES, NURSING
ASSISTANTS, TECHNICIANS, HEALTH CARE STUDENTS,
OR OTHER PERSONNEL WHO ARE INVOLVED IN
TAKING CARE OF YOU AT OR ON BEHALF OF
BCMH OR BCMH HEALTH CARE PROVIDERS; AND
TO OTHER HEALTH CARE PROVIDERS THAT MAY
PROVIDE YOU WITH TREATMENT OR SERVICES
IN THEIR FACILITIES. FOR EXAMPLE, A DOCTOR
TREATING YOU FOR A BROKEN LEG MAY NEED
TO KNOW IF YOU HAVE DIABETES BECAUSE DIABETES
MAY SLOW THE HEALING PROCESS. IN ADDITION,
THE DOCTOR MAY NEED TO TELL THE DIETITIAN
IF YOU HAVE DIABETES SO THAT WE CAN ARRANGE
FOR APPROPRIATE MEALS. DIFFERENT DEPARTMENTS
OF BCMH OR BCMH HEALTHCARE PROVIDERS ALSO
MAY SHARE MEDICAL INFORMATION ABOUT YOU
IN ORDER TO COORDINATE THE DIFFERENT THINGS
NEEDED FOR YOUR TREATMENT, SUCH AS PRESCRIPTIONS,
LAB WORK, AND X-RAYS. WE ALSO MAY DISCLOSE
MEDICAL INFORMATION ABOUT YOU TO PEOPLE
OUTSIDE THE HOSPITAL, SUCH AS FAMILY MEMBERS,
CLERGY OR OTHERS WE USE TO PROVIDE SERVICES
THAT ARE PART OF YOUR CARE. PSYCHOTHERAPY
NOTES WILL ONLY BE DISCLOSED WITHOUT YOUR
AUTHORIZATION TO THE PERSON CREATING THOSE
NOTES, TO THOSE INVOLVED IN TRAINING AND
QUALITY ASSURANCE OPERATIONS, AND TO DEFEND
BCMH OR BCMH HEALTH CARE PROVIDERS IN
AN ACTION YOU MIGHT INITIATE.
FOR
PAYMENT :
WE MAY USE AND DISCLOSE MEDICAL
INFORMATION ABOUT YOU SO THAT THE TREATMENT
AND SERVICES YOU RECEIVE AT BCMH OR FROM
BCMH HEALTH CARE PROVIDERS, OR ANOTHER
HEALTH CARE PROVIDER MAY BE BILLED TO
AND PAYMENT MAY BE COLLECTED FROM YOU,
AN INSURANCE COMPANY, OR A THIRD PARTY.
FOR EXAMPLE, WE MAY NEED TO GIVE YOUR
HEALTH PLAN INFORMATION ABOUT TREATMENT
YOU RECEIVED EITHER AT THE HOSPITAL OR
FROM BCMH HEALTH CARE PROVIDERS TO BE
PAID BY YOUR HEALTH PLAN OR TO OBTAIN
PRIOR APPROVAL OR TO DETERMINE WHETHER
YOUR PLAN WILL COVER THE TREATMENT.
FOR
HEALTH CARE OPERATIONS :
WE MAY USE AND DISCLOSE MEDICAL INFORMATION
ABOUT YOU FOR EITHER HOSPITAL OR BCMH
HEALTH CARE PROVIDERS OPERATIONS; AND
FOR OPERATIONS ACTIVITIES OF OTHER HEALTH
CARE PROVIDERS. THESE USES AND DISCLOSURES
ARE NECESSARY TO RUN BCMH AND BCMH HEALTH
CARE PROVIDERS, AND MAKE SURE THAT ALL
OF OUR PATIENTS RECEIVE QUALITY CARE.
FOR EXAMPLE, WE MAY USE MEDICAL INFORMATION
TO CONTACT YOU AS A REMINDER THAT YOU
HAVE AN APPOINTMENT, TO REGISTER YOU FOR
INPATIENT OR OUTPATIENT PROCEDURES, TO
TELL YOU ABOUT OR RECOMMEND POSSIBLE TREATMENT
OPTIONS, ALTERNATIVE CARE, OR HEALTH-RELATED
BENEFITS OR SERVICES; TO REVIEW OUR TREATMENT
AND SERVICES AND TO EVALUATE THE PERFORMANCE
OF OUR STAFF OR THE STAFF OF OTHER PROVIDERS
IN CARING FOR YOU; OR WE MAY SEND YOU
A PATIENT SATISFACTION SURVEY. WE MAY
ALSO COMBINE MEDICAL INFORMATION ABOUT
MANY PATIENTS USING VARIOUS HEALTH CARE
SERVICES TO DECIDE WHAT ADDITIONAL SERVICES
VARIOUS HEALTH CARE PROVIDERS SHOULD OFFER,
WHAT SERVICES ARE NOT NEEDED, AND WHETHER
CERTAIN NEW TREATMENTS ARE EFFECTIVE.
WE MAY ALSO DISCLOSE INFORMATION TO DOCTORS,
NURSES, NURSING ASSISTANTS, TECHNICIANS,
HEALTH CARE STUDENTS, AND OTHER BCMH OR
BCMH HEALTH CARE PROVIDERS PERSONNEL FOR
REVIEW AND LEARNING PURPOSES, AND TO ACCREDITATION
AGENCIES TO CERTIFY THE QUALITY AND SAFETY
OF BCMH AND BCMH HEALTH CARE PROVIDERS.
WE ALSO MAY COMBINE THE MEDICAL INFORMATION
WE HAVE WITH MEDICAL INFORMATION FROM
OTHER PROVIDERS TO COMPARE HOW WE ARE
DOING AND SEE WHERE WE CAN MAKE IMPROVEMENTS
IN THE CARE AND SERVICES WE OFFER. WE
MAY REMOVE INFORMATION THAT IDENTIFIES
YOU FROM THIS SET OF MEDICAL INFORMATION
SO OTHERS MAY USE IT TO STUDY HEALTH CARE
AND HEALTH CARE DELIVERY WITHOUT LEARNING
WHO THE SPECIFIC PATIENTS ARE.
FUND-RAISING
ACTIVITIES :
WE MAY USE INFORMATION ABOUT
YOU IN AN EFFORT TO RAISE MONEY FOR BCMH
AND BCMH HEALTH CARE PROVIDERS AND ITS
OPERATIONS. FOR EXAMPLE, DISCLOSING A
PATIENT’S NAME FOR THE LOVE LIGHT
CEREMONY FOR HOSPICE; OR WE MAY PUT A
NAME ON A PLAQUE AS A SPECIAL DONOR RECOGNITION.
FACILITY
DIRECTORY :
UNLESS YOU SPECIFICALLY REQUEST
OTHERWISE, WE MAY INCLUDE CERTAIN LIMITED
INFORMATION ABOUT YOU IN THE FACILITY
DIRECTORY WHILE YOU ARE A PATIENT AT BCMH/BCMH
HEALTH CARE PROVIDERS. THIS INFORMATION
MAY INCLUDE YOUR NAME, LOCATION IN THE
FACILITY, AND/OR GENERAL CONDITION (E.G.
FAIR, STABLE, ETC.). THE DIRECTORY INFORMATION
MAY BE RELEASED TO PEOPLE WHO ASK FOR
YOU BY NAME SO YOUR FAMILY AND FRIENDS
CAN VISIT YOU IN THE FACILITY, FIND OUT
ABOUT YOUR GENERAL CONDITION, AND TO DELIVER
FLOWERS OR GIFTS THAT MAY BE SENT TO YOU.
IF YOU ARE LISTED IN THE FACILITY
DIRECTORY, WE MAY PROVIDE INFORMATION
TO A MEMBER OF THE CLERGY. WE MAY NOTIFY
CLERGY ABOUT YOUR RELIGIOUS AFFILIATION
AND ADMISSION TO THE FACILITY, EVEN IF
THEY DON’T ASK ABOUT YOU BY NAME.
YOU
HAVE A RIGHT TO REQUEST THAT YOUR INFORMATION
NOT BE INCLUDED IN THE FACILITY DIRECTORY
OR RESTRICTED TO FAMILY MEMBERS, AND SUCH
REQUESTS CAN BE MADE DURING THE REGISTRATION
PROCESS OR ANYTIME DURING YOUR STAY IN
THE FACILITY. WE ARE REQUIRED TO CONFORM
TO YOUR REQUEST. IF YOU MAKE A REQUEST
TO RESTRICT SUCH INFORMATION AFTER THE
REGISTRATION PROCESS, WE ARE UNABLE TO
TAKE BACK ANY DIRECTORY INFORMATION DISCLOSURES
THAT MAY HAVE ALREADY BEEN MADE PRIOR
TO SUCH REQUEST.
INDIVIDUAL INVOLVED IN YOUR CARE
OR PAYMENT FOR YOUR CARE :
WE MAY RELEASE MEDICAL INFORMATION
ABOUT YOU TO A FAMILY MEMBER OR FRIEND
WHO IS INVOLVED IN YOUR MEDICAL CARE.
WE MAY ALSO GIVE INFORMATION TO SOMEONE
WHO HELPS PAY FOR YOUR CARE. WE MAY ALSO
TELL YOUR FAMILY OR FRIENDS YOUR CONDITION
AND THAT YOU ARE IN THE FACILITY. IN ADDITION,
WE MAY DISCLOSE MEDICAL INFORMATION ABOUT
YOU TO AN ENTITY ASSISTING IN A DISASTER
RELIEF EFFORT TO NOTIFY YOUR FAMILY OF
YOUR CONDITION, STATUS, AND LOCATION.
RESEARCH
:
UNDER CERTAIN CIRCUMSTANCES,
WE MAY USE AND DISCLOSE MEDICAL INFORMATION
ABOUT YOU FOR RESEARCH PURPOSES. FOR EXAMPLE,
A RESEARCH PROJECT MAY INVOLVE COMPARING
THE HEALTH AND RECOVERY OF ALL PATIENTS
WHO RECEIVED ONE MEDICATION TO THOSE WHO
RECEIVED ANOTHER, FOR THE SAME CONDITION.
ALL RESEARCH PROJECTS, HOWEVER, ARE SUBJECT
TO A SPECIAL APPROVAL PROCESS THROUGH
THE INSTITUTIONAL REVIEW BOARD (IRB).
THE IRB EVALUATES A PROPOSED RESEARCH
PROJECT AND ITS USE OF MEDICAL INFORMATION,
TRYING TO BALANCE THE RESEARCH NEEDS WITH
PATIENTS’ NEED FOR PRIVACY OF THEIR
MEDICAL INFORMATION. BEFORE WE USE OR
DISCLOSE MEDICAL INFORMATION FOR RESEARCH,
THE PROJECT WILL HAVE BEEN APPROVED THROUGH
THE IRB, BUT WE MAY, HOWEVER, DISCLOSE
MEDICAL INFORMATION ABOUT YOU TO PEOPLE
PREPARING TO CONDUCT A RESEARCH PROJECT,
FOR EXAMPLE, TO HELP THEM LOOK FOR PATIENTS
WITH SPECIFIC MEDICAL NEEDS, SO LONG AS
THE MEDICAL INFORMATION THEY REVIEW DOES
NOT LEAVE THE FACILITY. UNLESS THE IRB
AS PERMITTED BY LAW HAS APPROVED A WAIVER,
WE WILL ASK FOR YOUR SPECIFIC PERMISSION
TO USE AND DISCLOSE YOUR INFORMATION FOR
RESEARCH PURPOSES.
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.
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 MEDICAL
INFORMATION ABOUT FOREIGN MILITARY PERSONNEL
TO THE APPROPRIATE FOREIGN MILITARY AUTHORITY.
WORKERS
COMPENSATION:
WE MAY DISCLOSE MEDICAL INFORMATION ABOUT
YOU FOR WORKERS COMPENSATION OR SIMILAR
PROGRAMS. THESE PROGRAMS PROVIDE BENEFITS
FOR WORK-RELATED INJURIES OR ILLNESS.
LAWSUITS
AND DISPUTES:
IF YOU ARE INVOLVED IN A LAWSUIT OR A
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 TO OBTAIN AN ORDER PROTECTING THE INFORMATION
REQUESTED.
PUBLIC
HEALTH RISKS:
WE MAY DISCLOSE MEDICAL INFORMATION ABOUT
YOU FOR PUBLIC HEALTH ACTIVITIES. THESE
ACTIVITIES GENERALLY INCLUDE THE FOLLOWING:
· > TO PREVENT OR CONTROL DISEASE,
INJURY OR DISABILITY;
· > TO REPORT BIRTHS AND DEATHS;
· > TO REPORT CHILD ABUSE OR
NEGLECT;
· > TO REPORT REACTIONS TO MEDICATIONS
OR PROBLEMS WITH PRODUCTS;
· > TO NOTIFY PEOPLE OF RECALLS
OF PRODUCTS THEY MAY BE USING;
· > TO NOTIFY A PERSON WHO MAY
HAVE BEEN EXPOSED TO A DISEASE OR MAY
BE AT RISK FOR CONTRACTING OR SPREADING
A DISEASE
OR CONDITION;
· > TO AVERT A SERIOUS THREAT
TO HEALTH OR SAFETY; AND
· > TO NOTIFY THE APPROPRIATE
GOVERNMENT AUTHORITY IF WE BELIEVE A PATIENT
HAS BEEN THE VICTIM OF ABUSE, NEGLECT
OR DOMESTIC VIOLENCE. WE WILL ONLY MAKE
THIS DISCLOSURE IF YOU AGREE OR WHEN REQUIRED
OR AUTHORIZED BY LAW.
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. THESE ACTIVITIES
ARE NECESSARY FOR THE GOVERNMENT TO MONITOR
THE HEALTH CARE SYSTEM, GOVERNMENT PROGRAMS,
AND COMPLIANCE WITH CIVIL RIGHTS LAWS.
LAW
ENFORCEMENT:
WE WILL DISCLOSE MEDICAL INFORMATION ABOUT
YOU WHERE REQUIRED TO DO SO BY FEDERAL,
STATE OR LOCAL LAW. SOME POSSIBLE SITUATIONS
ARE:
· > IF WE RECEIVE A COURT ORDER,
SUBPOENA, WARRANT, SUMMONS OR SIMILAR
PROCESS;
· > IF WE MUST HELP IDENTIFY
OR LOCATE A SUSPECT, FUGITIVE, MATERIAL
WITNESS, OR MISSING PERSON;
· > IF WE MUST PROVIDE INFORMATION
ABOUT THE VICTIM OF A CRIME;
· > IF WE BELIEVE A DEATH MAY
BE THE RESULT OF A CRIME;
· > IF THERE IS A CRIME AT ANY
OF OUR FACILITIES; AND
· > IF WE MUST REPORT A CRIME,
THE LOCATION OF THE CRIME OR VICTIMS,
OR THE IDENTITY, DESCRIPTION OR LOCATION
OF THE PERSON
WHO COMMITTED THE CRIME.
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 TO FUNERAL DIRECTORS
AS NECESSARY TO CARRY OUT THEIR DUTIES.
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. WE MAY DISCLOSE MEDICAL INFORMATION
ABOUT YOU TO AUTHORIZED FEDERAL OFFICIALS
IF REQUIRED FOR SPECIAL INVESTIGATIONS.
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 THE CORRECTIONAL
INSTITUTION OR LAW ENFORCEMENT OFFICIAL.
THIS RELEASE WOULD BE NECESSARY (1) FOR
THE INSTITUTION TO PROVIDE YOU WITH HEALTH
CARE; (2) TO PROTECT YOUR HEALTH AND SAFETY
OR THE HEALTH AND SAFETY OF OTHERS; OR
(3) FOR THE SAFETY AND SECURITY OF THE
CORRECTIONAL INSTITUTION.
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 OBTAIN
COPIES OF YOUR 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. IF YOU WISH TO INSPECT
AND OBTAIN COPIES OF MEDICAL INFORMATION
THAT MAY BE USED TO MAKE DECISIONS ABOUT
YOU, YOU MUST SUBMIT YOUR REQUEST IN WRITING
TO THE MEDICAL RECORDS DEPARTMENT OF THE
FACILITY. 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 OBTAIN COPIES 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 BCMH OR BCMH HEALTH CARE PROVIDERS
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 BCMH AND BCMH HEALTH CARE PROVIDERS.
IF YOU WISH TO REQUEST AN AMENDMENT, YOUR
REQUEST MUST BE MADE IN WRITING TO THE
MEDICAL RECORDS DEPARTMENT OF THE FACILITY.
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 THE HOSPITAL OR OTHER HEALTH
CARE PROVIDERS IT OWNS AND
OPERATES;
> 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, AND HEALTH CARE
OPERATIONS AND DISCLOSURES MADE TO YOU
OR REQUESTED BY YOU OR AN AUTHORIZED REPRESENTATIVE
IN A WRITTEN AUTHORIZATION. YOUR REQUEST
MUST BE SUBMITTED IN WRITING TO THE MEDICAL
RECORDS DEPARTMENT OF THE FACILITY AND
STATE A TIME PERIOD THAT MAY NOT BE LONGER
THAN SIX YEARS AND MAY NOT INCLUDE DATES
BEFORE APRIL 14, 2003. 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 COST
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.
WE MAY SUSPEND YOUR RIGHT TO RECEIVE THIS
LIST OF DISCLOSURES IF REQUIRED TO DO
SO BY A HEALTH OVERSIGHT AGENCY OR LAW
ENFORCEMENT OFFICIAL FOR THE PERIOD OF
TIME SPECIFIED BY SUCH AGENCY OR OFFICIAL.
RIGHT
TO REQUEST RESTRICTIONS:
YOU HAVE THE RIGHT TO REQUEST A RESTRICTION
OR LIMITATION ON THE MEDICAL INFORMATION
WE USE OR DISCLOSE ABOUT YOU FOR TREATMENT,
PAYMENT, OR HEALTH CARE OPERATIONS. YOU
ALSO HAVE THE RIGHT TO REQUEST A LIMIT
ON THE MEDICAL INFORMATION WE DISCLOSE
ABOUT YOU TO SOMEONE WHO IS INVOLVED IN
YOUR CARE OR THE PAYMENT FOR YOUR CARE,
LIKE A FAMILY MEMBER OR FRIEND. FOR EXAMPLE,
YOU COULD ASK THAT WE NOT USE OR DISCLOSE
INFORMATION ABOUT A SURGERY THAT YOU HAD.
WE ARE NOT REQUIRED TO AGREE TO YOUR REQUEST
BUT WILL MAKE REASONABLE EFFORTS TO COMPLY
WITH YOUR REQUEST AS LONG AS THE REQUEST
DOES NOT HINDER OUR ABILITY TO PROVIDE
YOU WITH QUALITY CARE OR PREVENTS US FROM
OBTAINING PAYMENT FOR SERVICES PROVIDED
TO YOU BY BCMH OR BCMH HEALTH CARE PROVIDERS.
IF WE DO AGREE, 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 THE
MEDICAL RECORDS DEPARTMENT OF THE FACILITY.
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
LIMIT 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 THE ADMITTING
DEPARTMENT OR THE BUSINESS OFFICE DEPARTMENT
AT THE FACILITY FOR COMMUNICATIONS REGARDING
YOUR BILL AT BCMH OR BCMH HEALTH CARE
PROVIDERS. WE WILL NOT ASK YOU YOUR 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 PAPER COPY OF THIS NOTICE AT ANY TIME.
A COPY WILL NOT BE ISSUED UNLESS YOU REQUEST
ONE. EVEN IF YOU HAVE AGREED TO RECEIVE
THIS NOTICE ELECTRONICALLY, YOU ARE STILL
ENTITLED TO A PAPER COPY OF THIS NOTICE.
YOU MAY ALSO OBTAIN A COPY OF THIS NOTICE
ON OUR WEBSITE AT WWW.BCMH.ORG.
TO
OBTAIN A PAPER COPY OF THIS NOTICE, PLEASE
ASK AT THE REGISTRATION DESK OR CALL (906)
524-3300.
CHANGES
TO THIS NOTICE:
WE RESERVE THE RIGHT TO CHANGE THIS NOTICE.
WE RESERVE THE RIGHT TO MAKE THE REVISED
OR CHANGED NOTICE EFFECTIVE FOR MEDICAL
INFORMATION WE ALREADY HAVE ABOUT YOU
AS WELL AS ANY INFORMATION WE RECEIVE
IN THE FUTURE. WE WILL POST A COPY OF
THE CURRENT NOTICE IN THE HOSPITAL AND
AT OTHER BCMH HEALTH CARE PROVIDER LOCATIONS
AND ON OUR WEBSITE AT WWW.BCMH.ORG.
THE NOTICE WILL CONTAIN ON THE FIRST PAGE,
IN THE BOTTOM RIGHT-HAND CORNER, THE REVISION
DATE. IN ADDITION, EACH TIME YOU REGISTER
AT OR ARE ADMITTED TO BCMH OR OTHER BCMH
HEALTH CARE PROVIDERS FOR TREATMENT OR
HEALTH CARE SERVICES AS AN INPATIENT,
OUTPATIENT, RESIDENT OF LONG TERM CARE
OR CLIENT OF HOME CARE, HOME HELPERS,
OR DURABLE MEDICAL EQUIPMENT, WE WILL
OFFER YOU A COPY OF THE CURRENT NOTICE
IN EFFECT IF THE NOTICE HAS BEEN REVISED
OR CHANGED SINCE THE LAST TIME YOU REVIEWED
OR RECEIVED A COPY OF THIS NOTICE.
COMPLAINTS:
IF YOU BELIEVE YOUR PRIVACY RIGHTS HAVE
BEEN VIOLATED, YOU MAY FILE A COMPLAINT
WITH BCMH OR BCMH HEALTH CARE PROVIDERS
OR WITH THE SECRETARY OF THE DEPARTMENT
OF HEALTH AND HUMAN SERVICES. TO FILE
A COMPLAINT WITH THE BCMH OR BCMH HEALTH
CARE PROVIDERS, CONTACT THE PRIVACY OFFICER,
AT (906) 524-3300. YOU WILL NOT BE PENALIZED
FOR FILING A COMPLAINT.
OTHER
USES OF MEDICAL INFORMATION:
OTHER USES AND DISCLOSURES OF MEDICAL
INFORMATION NOT COVERED BY THIS NOTICE
OR THE LAWS THAT APPLY TO US WILL BE MADE
ONLY WITH WRITTEN AUTHORIZATION FROM YOU
OR AN AUTHORIZED REPRESENTATIVE. IF YOU
PROVIDE US PERMISSION TO USE OR DISCLOSE
MEDICAL INFORMATION ABOUT YOU, YOU MAY
REVOKE THAT PERMISSION, IN WRITING, AT
ANY TIME. IF YOU REVOKE YOUR PERMISSION,
WE WILL NO LONGER USE OR DISCLOSE MEDICAL
INFORMATION ABOUT YOU FOR THE REASONS
COVERED BY YOUR WRITTEN AUTHORIZATION.
YOU UNDERSTAND THAT WE ARE UNABLE TO TAKE
BACK ANY DISCLOSURES WE HAVE ALREADY MADE
WITH YOUR PERMISSION, AND THAT WE ARE
REQUIRED TO RETAIN OUR RECORDS OF THE
CARE THAT WE PROVIDED TO YOU. |
