NOTICE OF PRIVACY PRACTICES
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please read it carefully.
1. The terms of this Notice of Privacy Practices apply to: Lima Memorial Hospital operating as a clinically integrated health care arrangement composed of Lima Memorial Hospital, the physicians and other professionals seeing and treating patients at the hospital. The members of this clinically integrated health care arrangement work and practice at Lima Memorial Hospital. All of the entities and persons listed will share personal health information of patients as necessary to carry out treatment, payment and health care operations as permitted by law.
2. We are required by law to maintain the privacy of our patient and to provide patients with notice of our legal duties and privacy practices with respect to your 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 of Privacy Practices as necessary and to make the new Notice effective for all personal health terms of this Notice of Privacy Practices as necessary and to make the new Notice effective for all personal health information maintained by us. You may receive a copy of any revised notices at Patient Registration or a copy may be obtained by mailing a request to Patient Registration Department, Lima Memorial Hospital, 1001 Bellefontaine Avenue, Lima, Ohio 45804.
II. USES AND DISCLOSURE OF YOUR PERSONAL HEALTH INFORMATION
1. Your Authorization. Except as outlined below, we will not use or disclose your personal health information for any purpose unless you have signed a form authorizing the use or disclosure. You have the right to revoke that authorization in writing unless we have taken any action in reliance on the authorization.
2. Uses and Disclosures for Treatment. We will make uses and disclosures of your personal health information as necessary for your treatment. For instance, doctors and 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 a course of treatment for you that 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.
3. 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 provided to you or we may use your information to prepare a bill to send to you or to the person responsible for your payment.
4. Uses and Disclosure for Health Care Operations. We will use and disclose your personal information as necessary and as permitted by law, for our health care operations which include clinical improvement, professional peer review, business management, accreditation and licensing, etc. For instance, we may use and disclose your personal health information for purposes of improving the clinical treatment and care of our patients. 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.
5. Our Facility Directory. We maintain a facility directory listing the name, room number, general condition and if you wish, your religious affiliation. Unless you choose to have your information excluded from this directory, the information, excluding religious affiliation, will be disclosed to anyone who requests it by asking for you by name. This information, including religious affiliation, may be provided to members of the clergy. You have the right during registration to have your information excluded from this directory and to restrict what information is provided and/or to whom.
6. Family and Friends Involved In Your Care. With your approval, we may disclose your personal health information to designated family, friends and others involved in your care or in the payment of your care in order to facilitate that person’s involvement. 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 disclose limited personal health information to a public or private entity that is authorized to assist in disaster relief efforts in order for that entity to locate a family member or other persons that may be involved in some aspect of caring for you.
7. Business Associates. Certain aspects and components of our services are performed through contracts with outside persons or organizations, such as auditing, accreditation, legal services, etc. At times it may be necessary for us to provide certain portions of your personal health information to one or more of these outside persons or organizations that assist us with our operations. In all cases, we require these business associates to appropriately safeguard the privacy of your information.
8. Fundraising. We may contact you to donate to a fundraising effort for or on our behalf. You have the right to opt-out of receiving fundraising materials / communications and may do so by sending your name and address to Lima Memorial Hospital Foundation with a statement that you do not wish to receive fundraising materials or communications from us.
9. Appointments and Services. We may contact you to provide appointment reminders or test results. You have the right to request communications regarding your personal health information from us by alternative means or at alternative locations. We will accommodate reasonable requests. For instance, if you prefer appointment reminders not be left on voice mail or sent to a particular address. You may request such confidential communications in writing and may send requests to Lima Memorial Hospital’s Patient Registration Department.
10. Health Products and Services. We may use your personal health information to communicate with you about health products and services necessary for treatment, to advise you of new products and services we offer and to provide general health and wellness information.
11. Research. In limited circumstances, we may use and disclose your personal health information for research purposes. For example, a research organization may wish to compare outcomes of patients that received a particular drug and will need to review a series of medical records. In all cases where your authorization has not been obtained, your privacy will be protected by strict confidentiality requirements applied by an Institutional Review Board which oversees the research or by representations of the researchers that limit their use and disclosure of patient information.
12. Other Uses and Disclosures. We are permitted or required by law to make other uses and disclosures of your personal health information without your consent or authorization.
We may release your personal health information for the following reasons:
a. Purposes required by law;
b. Public health activities, such as required reporting of disease, injury, birth and death and for required public health investigations;
c. As required by law if we suspect child abuse or neglect or if we believe you to be a victim of abuse, neglect, or domestic violence;
d. To the Food and Drug Administration if necessary to report adverse events, product defects, or to participate in product recalls;
e. To your employer when we have provided health care to you at the request of your employer to determine workplace-related illness or injury; in most cases you will receive notice that information is disclosed to your employer;
f. If required by law to a government oversight agency conducting audits, investigations, or civil or criminal proceedings;
g. If required to do so by subpoena or discovery request; in some cases you will have notice of such release;
h. To law enforcement officials as required by law to report wounds and injuries and crimes;
i. To coroners and/or funeral directors consistent with law;
j. To arrange an organ or tissue donation from you or a transplant for you;
k. If we suspect a serious threat to health or safety.
l. If you are a member of the military as required by armed forces services; we may also release your personal health information if necessary for national security or intelligence activities;
m. To workers’ compensation benefit determination;
Ohio law requires that we obtain consent from you before disclosing:
- Performance or results of an HIV test or a diagnosis of AIDS or an AIDS-related condition;
- Information about drug or alcohol treatment you have received in a drug or alcohol treatment program;
- Mental health services you may have received;
- Information to the State Long-Term Care Ombudsman.
For full information of when such consents may be necessary, you can contact the Privacy Officer.
III. RIGHTS THAT YOU HAVE
1. Access to Your Personal Health Information. You have the right to copy and/or inspect much of your 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. You may obtain an access request form from the Medical Records Department.
2. 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 / 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 Medical Records Department.
3. Accounting for Disclosure 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 Lima Memorial Hospital-Medical Records. Patients may receive a copy of their medical records at no charge for the initial request. Duplicate copies will be charged at the rates set by the state of Ohio for photocopying of medical records.
4. Restrictions on Use and Disclosure of Your Personal Health Information. You have the right to request restrictions of our uses and disclosure of your personal health information for treatment, payment, or health care operations. We are not required to agree to your restriction request, but will attempt to accommodate reasonable requests when appropriate and 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 to sending such termination notice to Lima Memorial Hospital’s Patient Registration or Medical Records Department.
5. Complaints. If you believe your privacy rights have been violated, you can file a complaint with Lima Memorial Hospital’s Privacy Hotline at 419-998-4499. You may also file a complaint with the Secretary of the US Department of Health and Human Services in Washington, DC in writing within 180 days of a violation of your rights. There will be no retaliation for filing a complaint.
6. Acknowledgment of Receipt of Notice. You will be asked to sign an acknowledgment statement that you received this Notice of Privacy Practices.
IV. FOR FURTHER INFORMATION
1. If you have questions or need further assistance regarding this Notice contact Anita Good or Lenny Wannemacher, Privacy and Security Officers, Lima Memorial Hospital, 1001 Bellefontaine Avenue, Lima, Ohio 45804.
2. As a patient you have 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.
V. EFFECTIVE DATE
This notice of Privacy Practice is effective April 14, 2003.
VI. ELECTRONIC HEALTH RECORDS: (AMENDED SEPTEMBER 2009) (EFFECTIVE FEBRUARY 17, 2010)
a) You have the right to obtain an electronic copy of your health information that exists in an electronic format and you may direct that the copy be transmitted directly to an entity or person designated by you, provided that any such designation is clear, conspicuous and specific with complete name and mailing address or other identifying information.
b) When you request an accounting of disclosures of your electronic health record, the accounting will be for three years prior to the date of the request. The accounting will include, in addition to all types of disclosures listed in the general policy, disclosures for treatment, payment and health care operations. [For electronic health records acquired as of January 1, 2009, these requirements will apply to disclosures made by the organization from such a record on and after January 1, 2014. For electronic health records acquired after January 1, 2009, these requirements will apply to disclosures made by the organization from such a record on and after January 1, 2011 or the date that it acquires an electronic health record.]