NOTICE OF PRIVACY PRACTICES
Effective Date: 4/14/03
This
Notice is in effect for all HMA Facilities and Employed Physician
Practices. There may be some differences in a particular states
Privacy law. These provisions have been conveyed and employed with that
particular state’s Privacy Notice for our facilities.
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. THE PRIVACY OF YOUR MEDICAL INFORMATION IS IMPORTANT TO US.
If you have any questions about this notice please contact our privacy officer at: (239) 598-3131
Our Legal Duty.
We
are required by applicable federal and state law to maintain the
privacy of your medical information. We are also required to give you
this notice about our privacy practices, our legal duties, and your
rights concerning your medical information. We must follow the privacy
practices that are described in this notice while it is in effect.
This notice takes effect 04/14/2003, and will remain in effect until we
replace it.
We reserve the right to change our privacy practices
and the terms of this notice at any time, provided such changes are
permitted by applicable law. We reserve the right to make the changes
in our privacy practices and the new terms of our notice effective for
all medical information that we maintain, including medical information
we created or received before we made the changes. Before we make a
significant change in our privacy practices, we will change this notice
and make the new notice available upon request.
You may request a
copy of our notice at any time. For more information about our privacy
practices, or for additional copies of this notice, please contact us
using the information listed at the end of this notice.
Who Will Follow This Notice.
This
notice describes our facility’s practices and those participants listed
below in our organized health care arrangement. As such, we may share
your medical information and the medical information of others we
service with each other as needed for treatment, payment or health care
operations relating to our organized health care arrangement.
This
notice does not imply any joint venture or any other special
association or legal relationship between the facility and its medical
staff. This notice is an administrative tool permitted by federal law
allowing the facility and medical staff to tell you about common
privacy practices.
Along with the facility, the following participate in our organized health care arrangement:
- Members of our medical staff and their employees or workforce who provide services or support to the physician at the hospital.
- Our employed physicians and their office staff.
Uses and Disclosures of Medical Information
We use and disclose medical information about you for treatment, payment, and health care operations. For example:
Treatment
We
may use or disclose your medical information to a physician or other
health care provider in order to provide treatment to you.
Payment
We
may use and disclose your medical information to obtain payment for
services we provide to you. We may disclose your medical information
to another health care provider or entity subject to the federal and
state Privacy Rules so they can obtain payment.
Health Care Operations
We
may use and disclose your medical information in connection with our
health care operations. These uses are necessary to make sure that all
our patients receive quality care.
Some examples are:
- Review of our treatment or services to evaluate the performance of our staff providing your care;
- sending you a satisfaction survey;
- review
of information about many of our patients to determine if additional
services should be added or perhaps are no longer needed;
- information
may be given to our doctors, nurses, medical and health care students,
and other personnel to be used for education and learning purposes;
- we
may remove information that identifies you from the medical information
so others may use it for studies in health care delivery without
learning who the patients are; and
- we may disclose your medical
information to another provider who has a relationship with you and is
subject to the same Privacy rules, for their health care operation
purposes.
On Your Authorization
You may give us
written authorization to use your medical information or to disclose it
to anyone for any purpose. If you give us an authorization, you may
revoke it in writing at any time. Your revocation will not affect any
use or disclosures permitted by your authorization while it was in
effect. Unless you give us a written authorization, we cannot use or
disclose your medical information for any reason except those described
in this notice.
Appointment Reminders
We may use and
disclose medical information to contact you as a reminder that you have
an appointment for treatment or medical care at the facility.
To Your Family and Friends
Unless
you object, we may disclose your medical information to a family
member, friend or other person to the extent necessary to help with
your health care or with payment for your health care.
If you are
not present, or in the event of your incapacity or an emergency, we
will disclose your medical information based on our professional
judgment of whether the disclosure would be in your best interest.
We
will also use our professional judgment and our experience with common
practice to allow a person to pick up filled prescriptions, medical
supplies, x-rays or other similar forms of medical information.
Hospital Directory
We
may use your name, your location in our facility, your general medical
condition, and your religious affiliation in our facility directories.
We will disclose this information to members of the clergy and, except
for religious affiliation, to other persons who ask for you by name.
We will provide you with an opportunity to restrict or prohibit some or
all disclosures for facility directories unless emergency circumstances
prevent your opportunity to object. In addition, we may disclose
medical information about you to an organization assisting in a
disaster relief effort so your family can be notified about your
condition and location.
By Law or Special Circumstances
We
may use or disclose your medical information as authorized by law for
the following purposes deemed to be in the public interest or benefit:
- as required by law;
- for
public health activities, including disease and vital statistic
reporting, child abuse reporting, FDA oversight, and to employers
regarding work-related illness or injury;
- to report adult abuse, neglect, or domestic violence;
- to health oversight agencies;
- In response to court and administrative orders and other lawful processes;
- to
law enforcement officials after receiving subpoenas and other lawful
processes, concerning crime victims, suspicious deaths, crimes on our
premises, reporting crimes in emergencies, and for purposes of
identifying or locating a suspect or other person;
- to coroners, medical examiners, and funeral directors;
- to organ procurement organizations;
- to avert a serious threat to health or safety;
- in connection with certain research activities;
- to the military and to federal officials for lawful intelligence, counterintelligence, and national security activities;
- to correctional institutions regarding inmates; and
- as authorized by state worker’s compensation laws.
Health Related Benefits and Services
We
may use your medical information to contact you with information about
health-related benefits and services or about treatment alternatives
that may be of interest to you. We may disclose your medical
information to a business associate to assist us in these activities.
We
may use or disclose your medical information to encourage you to
purchase or use a product or service by face-to-face communication or
to provide you with promotional gifts.
Use and Disclosure of Certain Types of Medical Information
For
certain types of medical information we may be required to protect your
privacy in ways more strict than we have discussed in this notice. We
must abide by the following rules for our use or disclosure of certain
types of your medical information or purposes of use or disclosure of
your medical information:
Disclosure of Medical Information for Treatment, Payment and Health Care Operations
In
order to disclose your medical information in the ways discussed above
for treatment, payment and health care operations without specific
authorization, we must obtain your general written permission.
HIV Information
We
may not disclose HIV information unless required by law, pursuant to an
authorization or the disclosure is to you or your personal
representative; to agents or employees of health care providers who
participate in the administration or provision of your care or handles
or processes specimens of bodily fluids or tissues, and the agent or
employee has a need to know such information; to health care providers
consulting between themselves or with health care facilities to
determine diagnosis and treatment; to the State for public health
purposes; to a health care provider who processes, procures,
distributes or uses body parts of a deceased person; to health care
provider staff committees for the purposes of conducting program
monitoring, program evaluation, or service reviews; to pursuant to
court order; or, to persons who have been subject to a significant
exposure during the course of medical practice or in the performance of
professional duties.
DNA Information
We may not disclose DNA
information without your specific authorization, except to the
following persons: to your physician; or to other persons as may be
required by law in your state or required by the Federal government.
Alcohol and Drug Abuse Information
We
may not disclose your medical information that contains alcohol and
drug abuse information except to you, your personal representative or
pursuant to an authorization or as may otherwise be allowed by law.
Your Rights Regarding Medical Information About You
Right to Inspect and Copy
You
have the right to look at or get copies of your medical information,
with limited exceptions. You must make a request in writing to obtain
access to your medical information. You may obtain a form to request
access by using the contact information listed at the end of this
notice. You may also request access by sending us a letter to the
address at the end of this notice. If you request copies, we will
charge you a fee for copying and postage if you want the copies mailed
to you. Contact us using the information listed at the end of this
notice for a full explanation of our fee structure.
We may deny
your request to inspect and copy in very limited circumstances as
allowed by law. If you are denied access to your medical information,
you may request that the denial be reviewed. Another licensed health
care professional chosen by the facility 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.
Disclosure Accounting
You
have the right to receive a list of instances in which we or our
business associates disclosed your medical information for purposes
other than treatment, payment, health care operations, as authorized by
you, and for certain other activities, since April 14, 2003. You must
make a request in writing to request a listing of disclosures. You may
obtain a form to request the accounting by using the contact
information at the end of this notice. If you request this accounting
more than once in a 12-month period, we may charge you a reasonable,
cost-based fee for responding to these additional requests. Contact us
using the information listed at the end of this notice for a full
explanation of our fee structure.
Restriction
You have
the right to request that we place certain restrictions on our use or
disclosure of your medical information. We are not required to agree
to these additional restrictions, but if we do, we will abide by our
agreement (except in an emergency). Any agreement to additional
restrictions must be in writing. You may obtain a form to request
additional restrictions on the use or disclosure of your medical
information by using the contact information listed at the end of this
notice. We will not be bound to the restrictions unless our agreement
is signed by you and the appropriate facility representative.
Confidential Communication
You
have the right to request that we communicate with you about your
medical information by alternative means or to alternative locations.
For example, you might request that we contact you at work or by mail.
You must make your request in writing. You may obtain a form to request
alternative communications by using the contact information listed at
the end of this notice. We must accommodate your request if it is
reasonable, specifies the alternative means or location, and provides
satisfactory explanation how payments will be handled under the
alternative means or location you request.
Amendment
If
you feel that medical information we have about you is incorrect or
incomplete, you may ask us to amend the information. Your request must
be in writing, and it must explain why the information should be
amended. You may obtain a form to request an amendment by using the
contact information listed at the end of this notice. We may deny your
request if we did not create the information you want amended and the
individual who provided the information remains available or for
certain other reasons. If we deny your request, we will provide you a
written explanation. You may respond with a statement of disagreement
to be attached to the information you wanted amended. If we accept
your request to amend the information, we will make reasonable efforts
to inform others, including people you name, of the amendment and to
include the changes in any future disclosures of that information.
Electronic Notice
If
you receive this notice on our web site or by electronic mail (e-mail),
you are entitled to receive this notice in written form. Please
contact us using the information listed at the end of this notice to
obtain this notice in written form.
Questions and Complaints
If
you want more information about our privacy practices or have questions
or concerns, please contact us using the information listed at the end
of this notice.
If you are concerned that we may have violated
your privacy rights, or you disagree with a decision we made about
access to your medical information or in response to a request you made
to amend or restrict the use or disclosure of your medical information
or to have us communicate with you by alternative means or at
alternative locations, you may complain to us using the contact
information listed at the end of this notice. You also may submit a
written complaint to the U.S. Department of Health and Human Services.
We will provide you with the address to file your complaint with the
U.S. Department of Health and Human Services upon request.
We
support your right to the privacy of your medical information. We will
not retaliate in any way if you choose to file a complaint with us or
with the U.S. Department of Health and Human Services.
Contact Information
Corporate HIPAA Compliance Manager
P: (239) 598-3131
F: (239) 597-5006
Health Management Associates, Inc.
Attn: Corporate HIPAA Compliance Manager
5811 Pelican Bay Blvd., Suite 500
Naples, FL 33908