NOTICE OF PRIVACY PRACTICES
This notice describes how health information about you may be disclosed and how you can get access to your health information. Please read this notice carefully.
The privacy of your medical information is important to us.
OUR RESPONSIBILITIES TO YOU: Cullman Regional takes the privacy of your health information seriously. We are required by law to maintain your privacy and provide you with this Notice of Privacy Practices.
THIS NOTICE APPLIES TO THE FOLLOWING ENTITIES, SITES AND LOCATIONS:
- Administration Offices
- Medical Staff
- Home Health
- Medical Center Clinics
- Cullman Emergency Medical Services
This Notice describes our hospital’s practices and those of:
- Any healthcare professional authorizes to enter information into or consult your medical record.
- All departments and units of Cullman Regional Medical Center.
- Any member of a volunteer group we allow to help you.
- All employees, staff and other Cullman Regional personnel, resident, student or trainee that have allowed to train at Cullman Regional.
- Cullman Regional Medical Staff and its members.
- The Cullman Regional organized Health Care Arrangement, which if applicable consists of all facilities owned by Cullman Regional.
All of these entities, sites and locations follow the terms of this Notice. In addition, these entities, sites and locations may share health information with each other for purposes of treatment, payment or healthcare operations described in this Notice.
WE ARE REQUIRED BY LAW TO:
- Maintain the confidentiality of your health information in accordance with applicable federal and/or state law.
- Comply with the terms of this Notice until it is replaced with a new Notice.
- Give you this Notice of our legal duties and privacy practices with respect to health information we maintain about you.
To request additional copies of this notice or to receive more information about our privacy practices or your rights, please contact us at the following:
Judicial and Administrative Proceedings: We may disclose your health information in response to a court or administrative order. We may also disclose your health information in response to a subpoena, discovery request, or other lawful process by someone else involved in a dispute, but only if efforts have been made to tell you about the request, and you were given an opportunity to object to the request, or to obtain an order protecting the information requested.
National Security and Intelligence Activities: We may release your health information to authorized federal officials for lawful intelligence, counterintelligence, and other national security activities authorized by law.
Law Enforcement: We may release health information if asked to do so by a law enforcement official, if such disclosure is 1) required by law, 2) in response to Court Order, subpoena, warrant, summons or similar lawful process, 3) to identify or locate a suspect, fugitive, material witness or missing person, 4) about the victim of a crime, it, under certain limited circumstances, we are unable to obtain the person’s agreement 5) about a death we believe may be the result of criminal conduct, 6) about criminal conduct on the premises of CRMC facility, 7) in emergency circumstances to report a crime, the location of a crime or victims or the identity, description of location of the person who committed the crime.
Coroners, Medical Examiners and Funeral Directors: In certain circumstances, we may disclose health information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine a cause of death. We may also release information about an individual to funeral directors as necessary to carry out their duties.
Organ and Tissue Donation: We may disclose your health 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.
Research: Under certain circumstances, we may use or disclose health information about you for research purposes. For example, a research project may involve comparing the health and recovery of all individuals who received one medication to those who received another. All research projects however are subject to a special approval process, including evaluation of a proposed project by balancing the research needs with your need for privacy of your health information.
To Avert a Serious Threat to Health or Safety: We may use and disclose your health information when we believe it is necessary to prevent a serious threat to your health and safety of the public or another person. Any disclosure, however, would be to someone able to help prevent or lessen the threat of to law enforcement authorities in particular circumstances.
Military and Veterans: If you are a member of the armed forces, we may release your health information as required by military command authorities. We may also release health information about foreign military personnel to the appropriate foreign military authority.
Protective Services for the President and Others: We may disclose your health information to authorized federal officers to facilitate protection for the President, other authorized persons or foreign heads of state or for the conduct of special investigations.
Workers Compensation: We may disclose your health information as authorized by and to the extent necessary to comply with workers compensation laws or laws relating to similar programs.
Custodial Situations: If you are an inmate in a correctional facility and if the correctional institution of law enforcement authority makes certain representations to us, we may disclose your health information to a correctional institution or law enforcement official.
Breach Notification: We are required by law to notify the patient of nay breach of his or her unsecured PHI.
Disclosure for self-payment: We are required by law to comply with a request not to disclose health information to a health plan for treatment where the individual has paid in full out-of-pocket for a health care item or service.
Incidental Uses and Disclosures: We may occasionally inadvertently use or disclose your health information when such use or disclosure is incident to another use or disclosure that is permitted or required by law. For example, while we have safeguards in place to protect against others overhearing conversations which take place between doctors, nurses or other personnel, there may be times when such conversations are in fact overheard. Please be assured, however that we have appropriate safeguards in place to avoid such situations, and others, as much as possible.
Disclosure to You: Upon request by you, we may use or disclose your medical information in accordance with our request.
Limited Data Sets: We may use or disclose certain parts of your health information, called “limited data set”, for the purposes of research, public health reasons or for our health care operations. We would disclose a limited data set only to third parties that have provided us with satisfactory assurances that they will use or disclose your health information only for limited purposes.
Disclosure to the Secretary of the U.S. Department of Health and Human Services: We might be required by law to disclose your health information to the Secretary of the U.S. Department of Health and Human Services and his/her designee, (an agency of the federal government) in the case of a compliance review to determine whether we are complying with privacy laws.
De-Identified Information: We may use your health information, or disclose it to a third party whom we have hired, to create information that does not identify you in anyway. Once we have de-identified your information, it can be used or disclosed in any way permitted under the law.
Disclosure by Members of our Workplace: Members of our workforce, including employees, volunteer trainees, or independent contractors, may disclose your health information to health oversight agency, public health authority, health care accreditation organization or attorney hired by the workforce member, to report the workforce member’s belief that we have engaged in unlawful conduct or that our case or services could endanger a patient, workers of the public. In addition, if a workforce member is a crime victim, the member may disclose your health information to a law enforcement official.
For Public Health Purposes: We may disclose your health information for public health activities. Where there may be others, public health activities generally include the following:
- Preventing or controlling disease, injury or disability.
- Reporting births or deaths.
- Reporting defective material devices or problems with medications.
- Notifying people of recalls they may be using.
- Notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading the disease or condition.
As Required By Law: We will disclose your health information when required to do so by federal, state, or local law, regulation or other legal authority.
About Victims of Abuse Neglect or Domestic Violence: We may disclose your health information to notify the appropriate government authority if we believe an individual has been the victim of abuse, neglect or domestic violence. We will make this disclosure only if you agree or when required or authorized by law to do so.
Health Oversight Activities: We may disclose your health information to a health oversight agency for activities and as authorized by law. These oversight activities might include audits, investigations and licensure. These activities are necessary for the government to monitor the health care system; government benefits programs, and c compliance with civil rights laws.
Suspected Abuse or Neglect: If we believe that a person is a victim of child of adult abuse or neglect, we are required by law to report certain information to public authorities.
Communication Regarding Our Services or Products: We may use or disclose your health information to make a communication to you to describe health-related products or services. In addition, we may use or disclose your health information to tell you about products or services related to your treatment, case management or care coordination, or alternative treatments, therapies providers or setting of care for you. We may occasionally tell you about another hospital’s products or services, but will use or disclose your health information for such communications only if they occur in person with you.
We may also use and disclose health information to give you a promotional gift or us that is of minimal value.
USES AND DISCLOSURES FOR WHICH YOU HAVE AN OPPORTUNITY TO AGREE OR OBJECT
You have the following rights regarding health information we maintain about you:
Treatment Alternatives, Anointment reminders, and Health-related Benefits: We may use or disclose your health information to tell you about or recommend possible treatment alternatives or health-related benefits or services that may be of interest to you. Additionally, we may use and disclose your health information to provide appointment reminders. If you do not wish us to contact you about treatment alternatives, health –related benefits or appointment reminders, you must notify us in writing and state which of those activities you wish to be excluded from.
Fundraising Activities: We may use your health information to contact you in an effort to raise money for our hospital and its operations, We may disclose health information to a foundation related to our hospital so that the foundation may contact you to raise money for us. In these cases, we would release only contact information, such as your mane, address and phone number and the dates you were here, If you do not want us to contact your for fundraising efforts you have the right to opt out by providing written notice to the person listed on the last page of this Notice.
Hospital Directory: We may include certain limited information about you in our directory. This information may include your name, location, your general condition. (i.e., fair, stable, etc.) and your religious affiliation. The directory information, except for you religious affiliation, may also be released to people who ask for you by name. Your religious affiliations may be given to a member of the clergy, such as a priest of minister, even if they do not ask for you by name. If you do not wish to be included in the directory, you will be given an opportunity to object at the time of admission.
Individuals Involved in Your Care or Payment for Your Care: We may release health information about you to a family member, relative, and/or other person who is involved in your health care. We may also give information to someone who is involved with or help pay for your care. Additionally, we may tell your friends, family personal representative or other person responsible for your health care, your condition and that you are being served by CRMC.
Disclosure of Records Containing Drug or Alcohol Abuse Information: Because of federal law, we will not release your health information if it contains information about drug or alcohol abuse treatment without your written permission except in very limited situations.
AUTHORIZATION REQUIRED FOR OTHER USES: Other uses and disclosures of health information not covered by this Notice of the laws that apply to us in regard to privacy of your health information will be made only with your written authorization. If you provide an authorization to use or disclose your health information, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose health information about you for the reasons covered by your written authorization. We are unable to take back any uses or disclosers we have already made under your authorization, and we are required to retain our records of the health care that we provided for you.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION: You have the following rights rewarding health information we maintain about you.
- Right to Request Restrictions: You have the right to request a restriction or limitation on the health information we use of disclose about you for treatment, payment, or health care operations. You also have the right to request a limit on the heath information we disclose about you to someone who is involved in your care of the payment of your care. We are not required to agree to your request for restriction. If we agree, we will comply with your request unless the information is needed to provide you emergency treatment. In your request, you must tell us what information you wish to limit, whether you want to limit our use, disclosure or both, and to whom you want this to apply.
- Special Authorization: You must sign a separate special authorization for the following: 1) substance abuse, 2) HIV status, 3) psychotherapy records.
- Marketing and Subsidized Treatment Communications: We are required by law to inform you of disclosures that constitute a sale of PHI and other uses and disclosures not described in the Notice.
- Right to Request Confidential Communications: You have the right to request that we communicate with you and your personal representative about your health care in an alternative way or at a certain location. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
- Right to Inspect and Copy: you have the right to inspect and copy your health information that may be used to make decisions about your care. 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.
- Right to Amend: You have the right to ask us to amend your health and/or billing information for as long as the information is kept by us. In addition, you must provide a reason that supports your request. We may deny your request for 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: 1) was not created by us, unless the person or entity that created the information is no longer available to make the amendment, 2) is not part of the health information kept by or for us, 3) is not part of the information which you would be permitted to inspect or copy, 4) is accurate and complete.
- Right to an Accounting of Disclosure: You have the right to request a list of certain disclosures that we have made of your health information. Your request must state a time period that may not be longer than 6 years and may not include dates before January 1, 2009. Your request should indicate what form you want the list (for example, on paper, electronically, etc.) The first list you request within a twelve month period will be provided to you free of charge. For additional list(s), we will notify you of the cost involved and you may choose to withdraw or modify your request at the time before any costs are incurred.
- Right to File a Complaint: If you believe your privacy rights have been violated, you may file a complaint with CRMC and/or with the Secretary of the U.S. Department of Health and Human Resources. To file a complaint with CRMC, contact the HIPAA privacy officer at 256-737-2659 or email at email@example.com.
You will not be penalized, discriminated against, retaliated against or intimidated for filing a complaint.
CHANGE TO THIS NOTICE: We reserve the right to change the terms of the Notice at any time. We also reserve the right to make the changes apply to any medical information we already have about you. Before we make a material change to this Notice, we promptly post a new notice in a clear ad prominent area at each of our facilities and on our website.
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION:
The following categories describe different ways that we use and disclose your health information:
For Treatment: We may use health information about you to provide you with treatment, healthcare or other related services. We may disclose your health information to doctors, nurses, aides, technicians, therapists or other employees who are involved in taking care of you. We may use or disclose your health information to manage or coordinate your treatment, healthcare or other related services. We may also disclose healthcare providers who are providing treatment to you, whether or not we are involved in your treatment at that time.
For Payment: We may use and disclose health information to:
- Bill and collect for the treatment and services we provide to you.
- Send your health information to an insurance company or third party for payment purposes, including sending the information to a collection service.
- Disclose your health information to another healthcare provider or payer of health care for the payment activities of that entity. For example when you ask for treatment, we will use your information to verify that you have insurance coverage. After you have received the service, a bill which identifies you, your diagnosis and the procedures performed will be send to insurer or to you.
- Disclose information about you to the responsible party of your account. If you are listed as a dependent on another person’s insurance policy, financial information regarding medical care may be mailed to that responsible party.
- Disclose your health information to other health care providers, health plans or health care clearinghouses for their payment activities. For an example, we may provide your health information to an ambulance/transportation company that provided services to you.
For Health Care Operations: We may use and disclose your medical information for:
- Healthcare operations. These uses and disclosures are necessary to operate our hospital, make sure you receive competent quality healthcare, and to maintain and improve the quality of the healthcare we provide.
- To various governmental or accreditation entities to maintain our license (s) and accreditation.
- Disclosure of your health information to another health care provider or payer for certain health care operations activities of the entity, if that entity also has a relationship with you.
Disclosure of your medical information to any entities included in our organized health care arrangement for purposes of health care operations of the organized healthcare arrangement. For example, we may use your health information to review the skills of our health professionals, to conduct training or educational programs, and to perform qualify reviews of treatment protocols.
Single Affiliated Covered Entity: Each of the companies and facilities listed as included within CRMC in this Notice are participants in an affiliated covered entity for purposes of compliance with the requirements of federal privacy regulations. As such, each of the companies and their facilities within CRMC may share your health information with each other as needed for the purposes of treatment, payments and/or healthcare operations (described above).
Business Associates/Third Party: We may disclose your health information to our business associates with whom we contact to perform services on our behalf. Business associates assist us in our delivery of health care and related services such as billing companies, lawyers, accountants and others. Before we disclose your health information to our business associates, we will have a written agreement with each of them to require that they agree to maintain the privacy of your health information.