Deaconess Associations Incorporated

advancing healthcare solutionssm

 
 

Privacy Statement

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.

This Notice of Privacy Practices applies to the Deaconess Hospital Organized Health Care Arrangement ("arrangement") which is operating as a clinically integrated health care arrangement as that term is defined by the Health Insurance Portability and Accountability Act of 1996. This arrangement consists of the employees, volunteers, agents and trustees of The Deaconess Hospital of Cincinnati, its Laboratory and outpatient clinics, the medical practices owned by Deaconess (Tri-State Internal Medicine, Tri-State Primary Care), and physicians and other credentialed professionals when they are seeing and treating patients at Deaconess Hospital or participating in peer review / quality assurance activities. The services of this arrangement are primarily provided at 311 Straight Street, Cincinnati, Ohio and in the offices of Tri-State Internal Medicine and Tri-State Primary Care located in Cincinnati, Ohio. As an arrangement, all of the entities and categories of persons listed above will share the personal health information of patients as necessary to carry out treatment, payment, and health care operations as permitted by law when participating in the arrangement.

Physicians and other credentialed professionals (including physicians under contract to work in the Emergency Department or as house physicians or as Medical Directors at Deaconess), who are not employees of either Deaconess Hospital or a medical practice owned by Deaconess, are independent contractors. Their own Notice of Privacy Practices will govern any services they provide to you outside of the Deaconess Hospital Organized Health Care Arrangement (for example, services they provide you in their own offices). This arrangement is specific only to the sharing of personal health information as described in this Notice of Privacy Practices. No other liability is expressed, implied or can be inferred from this arrangement with respect to the physicians and other credentialed professionals who are not employees of Deaconess.

It is our policy as well as a legal requirement to maintain the privacy of our patients' personal health information. We are legally required to provide patients with notice of our legal duties and privacy practices with respect to their 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 as necessary and to make the new Notice effective for all personal health information maintained by us. You may obtain a copy of any revised notices at 311 Straight Street, Cincinnati, Ohio. You may also obtain a copy of the current Notice by mailing a request to the Privacy Officer, Deaconess Hospital, 311 Straight Street, Cincinnati, Ohio 45219 or e-mailing the Privacy Officer at privacy@deaconess-cinti.com.

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 authorizing that use or disclosure. You have the right to revoke your authorization to such uses except to the extent that we have already taken action in reliance on your authorization. Such revocations shall be in writing.

Uses and Disclosures for Treatment. We will make uses and discloses of your personal health information as necessary for your treatment. For instance, doctors, 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 your course of treatment which may include procedures, medications, tests, etc. We may also release your personal health information to another health care facility or professional who is not affiliated with our organization but who is or will be providing treatment to you. For instance, if, after you leave the hospital, you are going to receive home health care, we may release your personal health information to that home health care agency so that a plan of care can be prepared for you.

Uses and Disclosures for Payment. We will make uses and disclosures of your personal health information as necessary for the payment purposes of those health professionals and facilities that have treated you or provided services to you. For instance, we may forward information regarding your medical procedures and treatment to your insurance company to arrange payment for the services you receive. We may also use your information to prepare a bill to send to you or to the person responsible for your payment. In addition, we may provide access to your personal health information to your personal physician and physicians in the Emergency, Pathology, Radiology and Anesthesiology Departments to facilitate their billing for any services they provide to you at Deaconess. If you designate a guarantor of payment, that individual may request billing information which may contain personal health information.

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 operations. These operations include clinical improvement, professional peer review, business management, accreditation and licensing, etc. For instance, we may use and disclose your personal health information to accreditation survey team members who are involved with us through a Business Associate agreement. We may also disclose your personal health information to another health care facility, health care professional, or health plan for such things as quality assurance and case management, but only if that facility, professional, or plan also has or had a patient relationship with you.

Our Facility Directory. For hospital inpatients, we maintain a facility directory listing the name, room number, general condition and, if desired, a religious affiliation. Unless you choose to have your information excluded from this directory, this limited 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 religious information excluded from this directory. You may also request that your facility directory information not be made available. Note that electing not to make your facility directory information available means that you will not receive mail, flowers, etc. nor will inquirers be advised of your room or phone number or that you are even a patient at Deaconess.

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 with payment for your care 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 such as the Red Cross that is authorized to assist in disaster relief efforts. This will allow 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. These persons or organizations may provide such services as auditing, accreditation, legal services, etc. At times it may be necessary for one or more of these outside persons or organizations to be given certain of your personal health information to assist us with our health care operations. In all cases, we require these business associates to appropriately safeguard the privacy of your information.

Fundraising. We may use certain information (name, address, telephone number, dates of service, age, and gender) to contact you in the future to raise money for Deaconess Hospital. We may also provide this information to our institutionally related foundation, for the same purpose. The money raised will be used to expand and improve the services and programs we provide the community. If you do not wish to be contacted for fund-raising efforts, you have the right to opt-out by sending your name and address to the Privacy Officer, Deaconess Hospital, 311 Straight Street, Cincinnati, Ohio 45219 together with a statement that you do not wish to receive fundraising materials or communications from us. You may also e-mail this information to the Privacy Officer (privacy@deaconess-cinti.com).

Appointments and Services. We may contact you to provide appointment reminders or test results. 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. Requests for communication by alternative means or at alternative locations must be made in writing. You may send your request to the Privacy Officer, Deaconess Hospital, 311 Straight Street, Cincinnati, Ohio 45219. You may also e-mail this information to the Privacy Officer (privacy@deaconess-cinti.com). 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 a request. You may make this request by sending your name and address to the Privacy Officer, Deaconess Hospital, 311 Straight Street, Cincinnati, Ohio 45219 along with your request to be removed from our marketing mailing lists. You may also e-mail this information to the Privacy Officer (privacy@deaconess-cinti.com).

Health Products and Services. We may from time to time use your personal health information to communicate with you about health products and services necessary for your treatment, to advise you of new products and services we offer, and to provide general health and wellness information.

Research. In limited circumstances, we may use and disclose your personal health information for research purposes. For example, a researcher may wish to review a series of medical records to compare outcomes of all patients that received a particular drug and will need to review a series of medical records. In all cases where your specific authorization is not obtained, your privacy will be protected by strict confidentiality requirements applied by an Institutional Review Board or privacy board which is overseeing that research or by representations of the researchers through a Data Use Agreement that limit their use and disclosure of patient information.

Confidentiality of Alcohol and Drug Abuse Patient Records. The confidentiality of alcohol and drug abuse patient records maintained by Deaconess is protected by federal law and regulations. Generally, we may not say to a person outside the program that you attend a drug or alcohol program, or disclose any information identifying you as an alcohol or drug abuser unless: (1) you consent in writing: (2) the disclosure is allowed by a court order; or (3) the disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit, or program evaluation. Federal law and regulations do not protect any information about a crime committed by you either at Deaconess or against any person who works for Deaconess or about any threat to commit such a crime. Federal laws and regulations do not protect any information about suspected child abuse or neglect from being reported under State law to appropriate State or local authorities.

Elderlife. Elderlife members may be asked to voluntarily provide limited personal health information in order to join the Elderlife program. This information is used to inform members of benefits and opportunities that may be available to them as Elderlife members.

Other Uses 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.

Ohio law requires that we obtain a consent from you in many instances before disclosing the performance or results of an HIV test or diagnoses of AIDS or an AIDS-related condition; before disclosing information about drug or alcohol treatment you have received in a drug or alcohol treatment program; before disclosing information about mental health services you may have received; and before disclosing certain information to the State Long Term Care Ombudsman. For full information on when such consents may be necessary, you can contact the Privacy Officer, Deaconess Hospital, 311 Straight Street, Cincinnati, Ohio 45219.

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 provide the first copy of your personal health information for free during any twelve month period. Thereafter, we may charge you according to the current cost per page rate if you request a copy of the information. We may also charge for postage if you request a mailed copy and will charge for preparing a summary of the requested information if you request such summary. You may obtain a request form to request a copy of your personal health information maintained at Deaconess Hospital either in person at the Medical Records Office at the hospital or by mail from the Privacy Officer, Deaconess Hospital, 311 Straight Street, Cincinnati, Ohio 45219. You may e-mail your request to the Privacy Officer (privacy@deaconess-cinti.com). You may also obtain a request form to request a copy of your personal health information maintained at a Deaconess owned physician practice either in person at the office holding your personal health information or by writing to that office and requesting the form. At any location where you may request a request form, you may also request information about the current cost per page rate to obtain a copy of your personal health information.

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 form from the Privacy Officer, Deaconess Hospital, 311 Straight Street, Cincinnati, Ohio 45219 or by e-mailing your request to the Privacy Officer (privacy@deaconess-cinti.com).

Accounting for Disclosures of 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 from the Privacy Officer, Deaconess Hospital, 311 Straight Street, Cincinnati, Ohio 45219. You may also e-mail the Privacy Officer (privacy@deaconess-cinti.com) to request this form. 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. Upon request, the Privacy Officer will provide information about the fee to obtain subsequent accountings for disclosure of your personal health information during the twelve 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. You may obtain a Restriction Request form at the hospital's Central Registration or Emergency Department Registration desks, the registration area at any physician practice owned by Deaconess or by writing the Privacy Officer at Deaconess Hospital, 311 Straight Street, Cincinnati, Ohio 45219 or e-mailing the Privacy Officer (privacy@deaconess-cinti.com). 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 an agreed-to restriction 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 by sending a termination notice to the Privacy Officer, Deaconess Hospital, 311 Straight Street, Cincinnati, Ohio 45219 or e-mailing the Privacy Officer (privacy@deaconess-cinti.com).

Complaints. If you believe your privacy rights have been violated, you can file a complaint by writing the Privacy Officer, Deaconess Hospital, 311 Straight Street, Cincinnati, Ohio 45219 or e-mailing the Privacy Officer (privacy@deaconess-cinti.com) or calling (513) 559-2100 and asking to speak with the Privacy Officer. 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 the occurrence which you believe was a violation of your rights. There will be no retaliation for filing a complaint.

Acknowledgment of Receipt of Notice. You will be asked to sign an acknowledgment form indicating that you received this Notice of Privacy Practices.

FOR FURTHER INFORMATION

Federal laws and regulations require us to provide you with all of the above information. If you have questions or need further assistance regarding this Notice, you may contact the Privacy Officer, Deaconess Hospital, 311 Straight Street, Cincinnati, Ohio 45219. As a patient you retain the right to obtain a paper copy of this Notice of Privacy Practices, even if you have requested such copy by e-mail or other electronic means.

Effective Date Of This Notice Of Privacy Practices April 14, 2003