Health Insurance Portability and Accountability Act
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.
WHO THIS NOTICE APPLIES TO This Notice describes Hillsdale Community Health Center’s privacy practices.
The "Hillsdale Community Health Center Organized Health Care Arrangement" (referred to as an "OHCA") will refer to the Hospital and those health care providers who, while not necessarily legally affiliated with Hillsdale Community Health Center, may provide you with care or treatment at Our facility.
This Notice describes Hillsdale Community Health Center’s privacy practices and those of all medical providers described below (all of whom are part of the OHCA) while providing services at or on Our behalf:
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Any health care professional authorized to enter information into or consult any medical record established and maintained by Hillsdale Community Health Center.
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All departments and units of Hillsdale Community Health Center.
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Any member of a volunteer group we allow to help you.
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All employees, staff and other Hillsdale Community Health Center personnel.
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All healthcare clinics managed and maintained by Hillsdale Community Health Center.
OUR RESPONSIBILITIES Hillsdale Community Health Center ("Covered Entity" or "We" or "Our") takes the privacy of your health information seriously. We are required by law to maintain that privacy and to provide you with this Notice of Privacy Practices. This Notice is provided to tell you about our duties and practices with respect to your information, and how 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 to abide by the terms of this Notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION The following categories describe different ways that we use and disclose your health information without your authorization. For each category, we explain what we mean and give some examples. If we maintain your mental health or substance abuse records, those records may be subject to additional restrictions, which we will comply with, under state law. Also, if you are a minor, certain specific information that relates to mental health, substance abuse, pregnancy, or sexually transmitted diseases may be protected by additional restrictions under state law, which we will comply with. 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.
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For Treatment. We may use health information about you to provide you with treatment, health care, or other related services. We may disclose your health information to doctors, nurses, aids, technicians, or other Hillsdale Community Health Center employees who are involved in taking care of you. Additionally, we may use or disclose your health information to manage or coordinate your treatment, health care, or other related services. 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 Hillsdale Community Health Care departments also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work, x-rays, therapy, or to coordinate a referral. We also may disclose medical information about you to people outside Hillsdale Community Health Center who may be involved in your medical care after hospital care, such as family members, or others we use to provide services that are part of your care. We also may disclose your medical information to another health care provider to whom or to which you are referred or transferred for health care services.
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For Payment. We may use and disclose your health information to bill and collect for the treatment and services we provide to you. We may send your health information to an insurance company or other third party for the payment purposes. For example, we may need to give your health plan information about surgery you received at Hillsdale Community Health Center so your health plan will pay us or reimburse you for the surgery. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. Some providers who render care at Hillsdale Community Health Center bill separately, and we may provide payment related information to them to coordinate the billing process. Another example of Our use and disclosure of medical information about you is attempting to contact you in writing or via telephone for purposes of verifying insurance coverage or gaining more information regarding insurance coverage.
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For Health Care Operations. We may use and disclose your health information for health care operations at Hillsdale Community Health Center. These uses and disclosures are necessary to run Hillsdale Community Health Center, to make sure you receive competent, quality health care, and to maintain and improve the quality of health care we provide. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical information about many patients to decide what additional services Hillsdale Community Health Center should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, medical students, and other hospital personnel, for review and learning purposes. We may also combine the medical information we have, with medical information from other hospitals, to compare how we are doing and see where we can make improvements in the care and services we offer. In these cases, we will 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.
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Incidental Uses and Disclosures. We may occasionally inadvertently use or disclose your medical 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 our conversations that take place between doctors, nurses, or other Hillsdale Community Health Center personnel, there may be times that 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.
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As Required By Law. We will disclose your health information when required to do so by federal, state, or local law.
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For Public Health Purposes. We may disclose your health information for public health activities. While there may be others, public health activities generally include the following:
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Preventing or controlling disease, injury, or disability;
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Reporting births and deaths;
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Reporting defective medical devices or problems with medications;
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Notifying people of recalls of products they may be using; and
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Notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
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About Victims of Abuse. We may disclose your health information to notify the appropriate government authority if we believe you have 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.
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Health Oversight Activities. We may disclose your health information to a health oversight agency for activities authorized by law. These oversight activities might include audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government benefit programs, and compliance with civil rights laws.
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Judicial Purposes. 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 required by a court of law, or with your permission.
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Law Enforcement. We may release health information, if asked to do so, by a law enforcement official, if such disclosure is:
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Required by law;
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In response to a court order, subpoena, warrant, summons, or similar process;
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To identify or locate a suspect, fugitive, material witness, or missing person;
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About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement;
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About a death we believe may be the result of criminal conduct;
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About criminal conduct at Hillsdale Community Health Center; or
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In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description, or location of the person who committed the crime.
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Medical Examiners and Funeral Directors. In certain circumstances, We may disclose health information to a medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release health information about individuals to funeral directors as necessary to carry out their duties.
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Organ and Tissue Donation. We may disclose your health information to organizations that handle organ procurement for organ, eye or tissue transplantation, or to an organ donation bank, as necessary, to facilitate organ or tissue donation and transplantation.
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Research. Under certain circumstances, we may use and 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. This process includes evaluating a proposed research project and its use of health information, and trying to balance the research needs with your need for privacy of your health information. Before we use or disclose health information for research, the project will have been approved through this research approval process. Additionally, when it is necessary for research purposes and so long as the health information does not leave Hillsdale Community Health Center, We may disclose your health information to researchers preparing to conduct a research project, for example, to help the researchers look for individuals with specific health needs. Lastly, if certain criteria are met, We may disclose your health information to researchers after your death when it is necessary for research purposes.
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, or the health and safety of the public, or another person. Any disclosure, however, would only be to someone able to help prevent or lessen the threat, or to law enforcement authorities in particular circumstances.
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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.
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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.
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Protective Services for the President and Others. We may disclose your health information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state, or for the conduct of special investigations.
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Custodial Situations. If a correctional institution or law enforcement authority makes certain representations, We may disclose your health information to a correctional institution or law enforcement official.
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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.
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Treatment Alternatives, Appointment Reminders and Health-Related Benefits. We may use and 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 Hillsdale Community Health Center to contact you about treatment alternatives, health-related benefits or appointment reminders, you must notify in writing, and state which of those activities you wish to be excluded from, the Privacy Officer at Hillsdale Community Health Center.
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Fundraising Activities. We may use your health information to contact you in an effort to raise money for Hillsdale Community Health Center and its operations. We may disclose health information to a foundation related to Hillsdale Community Health Center so that the foundation may contact you to raise money for Hillsdale Community Health Center. In these cases, we would release only contact information, such as your name, address and phone number and the dates you were at the hospital. If you do not want Hillsdale Community Health Center to contact you for fundraising efforts, you must notify, in writing, the Privacy Official at Hillsdale Community Health Center.
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Hospital Directory. We may include certain limited information about you in Hillsdale Community Health Center’s directory. This information may include your name, location in the hospital, your general condition (e.g., fair, stable, etc.) and your religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest or minister, even if they do not ask for you by name. You have a right to request a restriction on the use or disclosure of your information in the hospital directory. To request restrictions, you must tell us during registration. You also have the right to object to the inclusion of your information in the directory by notifying the Privacy Official of that request.
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Individuals Involved in Your Care or Payment for Your Care. We may release health information about you to a family member, other relative, or any other person identified by you, who is involved in your health care. We may also give information to someone who helps pay for your care. We may also tell your family, friends, personal representative, or other person responsible for your health care, your general condition and that you are at Hillsdale Community Health Center. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort, so that your family can be notified about your condition, status, and location.
OTHER USES OF HEALTH INFORMATION Other uses and disclosures of health information not covered by this Notice, or the laws that apply to us, will be made only with your written authorization. If you provide us 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. You understand that we are unable to take back any disclosures we have already made under the authorization, and that we are required to retain our records of the care that we provided to you.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION You have the following rights regarding health information we maintain about you:
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Right to Request Restrictions. You have the right to request a restriction or limitation on the health 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 health information we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend.
We are not required to agree to your request in an emergency situation or when disclosure of your information is necessary to transfer you to another health care facility.
To request restrictions, you must make your request in writing to the Privacy Official at Hillsdale Community Health Center. 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 limits to apply.
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Right to Request Confidential Communications. Typically, We communicate with you regarding your health care either through your home phone or through the mail at your home address. You have the right to request that we communicate with you or your responsible party about your health care in an alternative way or at a certain location.
To request confidential communications, you must make your request in writing to the Privacy Official at Hillsdale Community Health Center. 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.
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Right to Inspect and Copy. You have the right to inspect and copy health information that may be used to make decisions about your care.
To inspect and copy health information that may be used to make decisions about you, you can submit your request in writing or orally to the Privacy Official at Hillsdale Community Health Center. 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.
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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 Hillsdale Community Health Center
To request an amendment, your request must be made in writing and submitted to the Privacy Official at Hillsdale Community Health Center. 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:
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Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
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Is not part of the health information kept by or for Hillsdale Community Health Center;
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Is not part of the information which you would be permitted to inspect and copy; or
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Is accurate and complete.
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Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures that we have made of your health information.
To request this list of disclosures, you must submit your request in writing to the Privacy Official at Hillsdale Community Health Center. Your request must state a time period which 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 twelve-month period will be free. For additional lists, during such twelve-month period, we may charge you for the costs 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.
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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 copy of this Notice at any time. Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice.
You may obtain a copy of this Notice at our web site at www.hchc.com.
To obtain a paper copy of this Notice, contact the Privacy Official at Hillsdale Community Health Center.
CHANGES TO THIS NOTICE We reserve the right to change this Notice. We reserve the right to make the revised Notice effective for health 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 a clear and prominent location to which you have access. The Notice is also available to you upon request. The Notice will contain on the first page, in the top right-hand corner, the effective date. In addition, if we revise the Notice, and you are still with Hillsdale Community Health Center, we will offer you a copy of the current Notice in effect.
COMPLAINTS If you believe your privacy rights have been violated, you may file a complaint with Hillsdale Community Health Center or with the Secretary of the Department of Health and Human Services. To file a complaint with Hillsdale Community Health Center, contact the Privacy Official at 517-437-4451. All complaints must be submitted in writing.
You will not be penalized for filing a complaint. If you have any questions about this Notice, please contact:
Privacy Official Hillsdale Community Health Center 168 S. Howell Street Hillsdale, MI 49242
CHECKLIST FOR NOTICE OF PRIVACY PRACTICES
To determine whether a Covered Entity has met all of the requirements of the Regulations in drafting and providing its Notice to Individuals and the public, the Covered Entity must ask the following questions in relation to the contemplated Notice. A negative answer to any of the following may indicate that the Covered Entity must revise its Notice and/or the manner in which the Notice is being provided to Individuals and the public.
Has the Covered Entity prepared a Notice that includes:
(1)
a header as follows: "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";
(2)
a description, including at least one example, of the types of Uses and Disclosures that the Covered Entity is permitted to make for Treatment, Payment, and Health Care Operations;
(3)
a description of each of the other purposes for which the Covered Entity is permitted or required to use or disclose Protected Health Information without the Individual's consent or authorization;
(4)
a statement that other Uses or Disclosures will only be made with the Individual's authorization and that the Individual may revoke such authorization in writing, except to the extent that the Covered Entity has taken action in reliance thereon?
If the Covered Entity plans to engage in the following activities, has the Covered Entity included a separate statement in its Notice, as applicable, that:
(1)
the Covered Entity may contact the Individual to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to the Individual; or
(2)
the Covered Entity may contact the Individual to raise funds for the Covered Entity?
Does the Notice include a statement of the Individual's rights with respect to Protected Health Information and a brief description of how the Individual may exercise those rights including the following:
(1)
the right to request restrictions on Uses or Disclosures;
(2)
the right to request and receive communications of Protected Health Information from the Covered Entity by alternative means or at alternative locations;
(3)
the right to inspect and copy Protected Health Information;
(4)
the right to amend Protected Health Information;
(5)
the right to receive an accounting of Disclosures of Protected Health Information;
(6)
the right of an Individual, including an Individual who has agreed to receive the Notice electronically, to obtain a paper copy of the Notice upon request?
Does the Notice include sufficient detail to place the Individual on notice of the Uses and Disclosures that are permitted or required by the Regulations or other applicable law?
Does the Notice include a statement that:
(1)
the Covered Entity is Required By Law to maintain the privacy of Protected Health Information and to provide Individuals with notice of its legal duties and privacy practices with respect to Protected Health Information;
(2)
the Covered Entity is required to abide by the terms of the Notice currently in effect;
(3)
for the Covered Entity to apply a change in a privacy practice that is described in the Notice to Protected Health Information it created or received prior to issuing a revised Notice, a statement that the Covered Entity reserves the right to change the terms of its Notice and to make the new Notice provisions effective for all Protected Health Information that it maintains; and
(4)
describes how the Covered Entity will provide Individuals with a revised Notice?
Does the Notice state that Individuals may complain to the Covered Entity and the Secretary if they believe their privacy rights have been violated; briefly describe how to file a complaint; and state that the Individual will not be retaliated against for filing a complaint?
Does the Notice contain the name and/or title, and telephone number of a person or office to contact for further information regarding filing complaints or other information provided in the Notice?
Does the Notice contain the date on which the Notice is first in effect, which may not be earlier than the date on which the Notice is printed or otherwise published?
If the Covered Entity elects to limit the Uses or Disclosures that it is permitted to make, does the Notice describe its more limited Uses or Disclosures? (Note: A Covered Entity may not limit Disclosures Required By Law.)
If the Covered Entity materially changes its Uses or Disclosures, the Individual's rights, legal duties or other privacy practices stated in the Notice, has the Covered Entity promptly revised and redistributed the Notice? (Note: A material change may not be implemented prior to the effective date of the Notice in which such material change is reflected.)
Has the Covered Entity made the Notice available upon request to any person, including Individuals, in compliance with the following:
(1)
if a Direct Treatment Relationship exists with an Individual, the Covered Entity must provide the Notice no later than the date of the first service delivery, including service delivered electronically; have the Notice available at the service delivery site for the Individual to request and take with them; and post the Notice in a clear and prominent location where it is reasonable to expect Individuals seeking service to be able to read the Notice; and whenever the Notice is revised, make the revised Notice likewise available as described herein;
(2)
if the Covered Entity maintains a website, the Notice must be prominently posted and made available on the website;
(3)
if the Covered Entity provides Notice via e-mail, the Individual has agreed to electronic Notice; and if the Covered Entity knows that the e-mail transmission has failed, Covered Entity must provide a paper copy of the Notice;
(4)
if the first service delivery is delivered electronically, the Covered Entity must provide electronic Notice automatically and contemporaneously in response to the Individual's first request for service?
If the Covered Entity participates in an Organized Health Care Arrangement and has created a joint Notice, has the Covered Entity complied with the following:
(1)
the Covered Entities participating in the Organized Health Care Arrangement must agree to abide by the terms of the Notice;
(2)
the Notice must include a statement that it covers more than one Covered Entity; must describe the Covered Entities, or class of Covered Entities, with reasonable specificity; must describe with reasonable specificity the service delivery sites, or classes of delivery sites; and, if applicable, state that the Covered Entities will share Protected Health Information as necessary to carry out Treatment, Payment, and Health Care Operations relating to the Organized Health Care Arrangement? (Note: Provision of a joint Notice to an Individual by any one of the Covered Entities included in the joint Notice, will satisfy the Notice requirements of the remaining Covered Entities.)
Has the Covered Entity documented compliance with the Notice requirements by retaining a copy of each Notice issued by the Covered Entity for a period of six (6) years from the date each Notice was created, or the date each Notice was last in effect, whichever is later?
