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
Crown Medical Center understands how important your
personal medical information is to you. We know you are concerned with
how that information might be used, the way in which it is disclosed and
how you can access that information. That�s why the Health Insurance
Portability and Accountability Act (HIPAA) Privacy Practices outlined
here are so important, and why we pledge our commitment to respect your
personal medical information.
Our pledge to you
We understand that your medical information is
personal and confidential. We create a medical record of the care you
receive because it�s our legal obligation, but more important because we
want to provide you with quality care. Please know we are committed to
protecting your personal medical information from any use for which it
was not intended.
In short, the law requires us to:
-
Keep your medical information private
-
Notify you of our legal duties and privacy
practices with respect to your medical information
-
Follow the terms of the most current notice
What this notice is all about
The information in this document applies to all of
your medical records whether created by our facility staff or your
personal doctor. Please understand that your personal doctor may have
different policies or notices regarding the use and disclosure of the
medical information created in his or her office. This notice will tell
you about the specific ways Crown Medical Center and our facilities may
use and disclose your medical information. This notice also describes
your rights and the duties we have regarding the use and disclosure of
your medical information.
Entities adhering to these privacy practices
The Department of Health and Human Services sponsored
the Health Insurance Portability Accountability Act (HIPAA). HIPAA
dictates the medical information privacy practices that health care
organizations and their partners are obligated to follow. Crown Medical
Center provides health care to our patients, and clients in partnership
with many physicians and other professionals and organizations. We want
you to know that all of these entities will be following the same
privacy practices we do, and that these practices are specifically
designed to keep your medical information confidential. The medical
information privacy practices in this notice will be adhered to by:
-
Any health care professional who treats you at
any of our locations.
-
Members of Crown Medical Center�s Organized
Health Care Arrangement.*
-
All departments and units of our organization.
-
All employed associates, staff or volunteers of
our organization. This includes staff at our sponsor organizations
with which we may share information.
-
Any business associate or partner with
whom we share health information.
*Crown Medical Center, the members of
its medical staff, and other health care providers affiliated with
Crown Medical Center have agreed to participate in a local Organized
Health Care Arrangement (OHCA). Participation in an OHCA allows
covered entities, among other things, to exchange protected health
information with other OHCA participants to provide patient care in
a more effective and efficient manner.
Be assured that all these individuals and
organizations understand that the privacy of your medical information is
important, and will be following HIPAA guidelines to ensure that your
information is used only as it is intended.
How your personal medical information may be used
and disclosed
The following is a list of ways in which your
personal medical information may be used and disclosed as allowed under
HIPAA provisions. Be assured that we will use your information in the
most discreet manner.
Disclosure for health care related purposes
We may use and disclose your medical information for
health care related purposes including:
-
Treatment, such as sending your medical
information to a specialist as part of a referral.
-
Obtaining payment for treatment, such as sending
billing information to your insurance company or Medicare.
-
Supporting our health care operations, such as
comparing patient data to improve treatment methods.
-
Communication with business partners so they may
help us to do our jobs. These business partners are required by
contract and by law to comply with the provisions of HIPAA and
protect your rights as we do.
Disclosure to other organizations
Subject to certain requirements, we may give out your
medical information to other organizations without prior authorization
for:
-
Public health purposes
-
Abuse or neglect reporting
-
Health oversight audits
-
Research studies or inspections
-
Funeral arrangements
-
Organ donation
-
Workers� compensation purposes
-
Emergencies
Disclosure to legal agencies
We also disclose medical information when required by
law in response to:
-
Requests from law enforcement agencies in
specific circumstances
-
Valid judicial or administrative orders
-
The government, if you are in the military or a
veteran
-
National security and intelligence activities
-
Protective services for the President and others
Disclosure for contact with you
We also may use your medical information for contact
with you, for:
Disclosure for fundraising purposes
We may use your name, address, age, gender and dates
of service:
-
To raise funds for Crown Medical Center, Crown
Medical Support Services or one of our facilities
-
To raise funds for one of our institutionally
related foundations
Please know that our institutionally related
foundations are required by law to comply with HIPAA regulations and
state confidentiality laws. If you do not wish to be contacted for these
efforts please notify the facility in writing.
Disclosure when you are a patient or resident
If admitted as a patient or resident, unless you tell
us otherwise, we may list the following information in our facility
directory:
-
Your name
-
Your location in the facility
-
Your general condition (good, fair, etc.)
-
Your religious affiliation
We will release all but your religious affiliation to
anyone who asks about you by name. Your religious affiliation may be
disclosed only to a clergy member, even if they do not ask for you by
name.
Disclosure to friends, family and others
We may disclose medical information about you to:
-
A friend or family member who is involved in
your medical care
-
Someone who helps pay for your care
-
Disaster relief authorities to notify your
family of your location and condition
Disclosure in special circumstances
In any other situation not covered by this notice, we
will ask for your written authorization before using or disclosing your
medical information. If you chose to authorize use or disclosure you can
later revoke that authorization by notifying us in writing of your
decision.
Your Rights
Can you see a copy of your medical information?
In most cases, you have the right to review and
obtain a copy of the medical information we use to make decisions about
your care by submitting a written request. If you request copies, we may
charge a fee for the cost of copying, mailing or other related supplies.
If we deny your request to review or obtain a copy you may submit a
written request for a review of that decision.
What if your medical records are inaccurate?
If you believe that information in your record is
incorrect or if important information is missing, you have the right to
request correction of the records by submitting a request in writing
along with your reason for requesting the amendment. We could deny your
request to amend a record if the information was not created by us; if
it is not part of the medical information we maintained; if it is not
part of the information you would be permitted to review or copy; or if
we determine that the record is accurate. You may appeal, in writing, a
decision by us not to amend a record.
Can you know with whom we�ve shared your records?
You have the right to a list of those instances
where we have disclosed your medical information, other than for
treatment, payment, health care operations or where you specifically
authorized a disclosure, by submitting a written request. The request
must state the time period desired for the accounting, which must be
less than a 6-year period and start after April 14, 2003. You may
receive the list in paper or electronic form. The first disclosure list
request in a 12-month period is free; other requests will be charged
according to our production cost. We will inform you of the cost before
you incur any expenses.
Can you specify the way in which we communicate your
medical records to you?
You have the right to request that your medical
information be communicated to you in a confidential manner, such as
sending mail to an address other than your home. Your request must
specify how or where you wish to be contacted. We will attempt to honor
all reasonable requests.
Can you request your medical information only be
released with your permission?
You may request in writing that
we not use or disclose your medical information for treatment, payment
and health care operations, or to persons involved in your care
except when specifically authorized by you, when
required by law or in an emergency. We will consider your
request but are not legally required to accept it. We will inform you of
our decision on your request. All written requests must tell us (1) what
information you want to limit; (2) whether you want to limit our use or
disclosure; and (3) to whom you want the limits to apply.
If you�ve received this notice electronically, can
you receive a paper copy?
If this notice was sent to you electronically you
have the right to a paper copy of this notice.
Where can you express a concern?
If you are concerned that your privacy rights may
have been violated or disagree with a decision we made about access to
your records, you may contact the Crown Medical Center at 612-978-3783.
You also may send a written complaint to the U.S. Department of Health
and Human Services Office of Civil Rights. Under no circumstance will
you be penalized or retaliated against for filing a complaint.
Will the policies in this notice change?
We may change our policies at any time. Changes
will apply to medical information we already hold, as well as new
information after the change occurs. When we make a significant change
to our policies, we will change our notice and post the new notice in
our facility and on our Web site at www.crownmedicalcenter.org. You can
receive a copy of the current notice at any time. The effective date is
listed with the title. You will be offered a copy of the current notice
each time you register at our facility for treatment or at a minimum,
whenever there is significant content change. You also will be asked to
acknowledge in writing your receipt of this notice.
If you have an questions regarding the contents of
this Notice of Privacy, please contact the facility main number, ask for
the facility privacy officer or call the Crown Medical Center
at 612-978-3783.