Notice of Patient 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 REVIEW IT CAREFULLY.
Effective Date: June 1, 2004
If you have any questions about this notice, please contact VCU Health Community Memorial Hospital’s Privacy Officer at (434) 774-2400.
WHO WILL FOLLOW THIS NOTICE
This Notice describes VCU Health Community Memorial Hospital’s practices and those considered part of an organized health care arrangement as follows:
- All employees, staff, students, volunteers and other personnel whose work is under the direct control of VCU Health Community Memorial Hospital.
- Hospital, as used in this Notice, includes VCU Health Community Memorial Hospital and all of its service delivery locations including Clarksville Primary Care Center and Chase City Primary Care Center.
- All members of the VCU Health Community Memorial Hospital Medical Staff.
- All these persons, entities, sites, and locations follow the terms of this Notice. In addition, these persons, entities, sites, and locations may share medical information with each other for treatment, payment, or hospital operations purposes as described in this Notice.
OUR PLEDGE REGARDING MEDICAL INFORMATION
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at the hospital. We need this record to provide you with quality care and to comply with certain legal requirements. This Notice applies to all of the records of your care generated by the hospital, whether made by hospital personnel or your personal doctor while on-site. Your personal doctor may have different policies or notices regarding use and disclosure of your medical information when created in the doctor’s office or clinic.
This Notice will tell you about the ways in which 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 by law to:
- Make sure that medical information that identifies you is kept private;
- Give you this notice of our legal duties and privacy practices with respect to medical information about you; and
- Follow the terms of the Notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following categories describe different ways that we use and disclose medical information. Not every use or disclosure in a category will be listed.
- For Treatment. We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you at the hospital. For example, a doctor treating you for a broken hip 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. We also may disclose medical information about you to people outside the hospital who may be involved in your medical care after you leave the hospital, such as family members, clergy, or others we use to provide services that are part of your care, such as therapists or physicians.
- For Payment. We may use and disclose medical information about you so that the treatment and services you receive at the hospital may be billed to and payment may be collected from you, an insurance company, or a third party. For example, we may need to give your health plan information about treatment you received at the hospital so your health plan will pay us or reimburse you for the treatment. We also may disclose information about you to another health care provider, such as another hospital, for their payment activities concerning you.
- For Healthcare Operations. We may use and disclose medical information about you for hospital operations. These uses and disclosures are necessary to run the hospital and make sure that all of our patients receive quality care. For example, we may combine medical information about many hospital patients to decide what additional services the hospital should offer, what services are not needed, and whether certain new treatments are effective.
- Health-Related Benefits, Services and Treatment Alternatives. We may use and disclose medical information to provide appointment reminders or to tell you about health-related benefits, services or treatment alternatives that may be of interest to you.
- Fundraising Activities. We may contact you, by using a business associate or Foundation in an effort to raise money for the hospital and its operations.
- Hospital Directory. Unless you tell us otherwise, we may include certain limited information about you in the hospital directory while you are a patient at the hospital. 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 minister or priest, even if they don’t ask for you by name.
If you do not want to be listed in the hospital directory, you may state so when completing the Notice of Privacy Practices acknowledgement form.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You have the following rights regarding medical information we maintain about you:
- Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes and other mental health records under certain circumstances. You must make your request in writing and be subject to reasonable charges. We will respond to your request within 15 days. We may deny you access to certain information, if we do we will give you the reason in writing, and explain how to appeal such a decision.
- Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to correct or change the information. You have the right to request an amendment for as long as the information is kept by or for the hospital. You must make the request in writing and include the reason for your request. We may deny your request if we did not create the information, if it is not part of the records we use to make decisions about you, if the information is something you would not be permitted to inspect or copy, or if it is complete and accurate as it stands.
- Right to an Accounting of Disclosures. You have the right to request an accounting of disclosures. This is a list of some of the disclosures we made of medical information about you that were not specifically authorized by you in advance.
Your request must state a time period that may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12-month period will be free. For additional lists, 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.
- Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or healthcare operations. You also have the right to request a limitation on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. You must make this request in writing.
We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
- Right to Confidential Communications. You have the right to request to receive communications from us on a confidential basis by using alternative means for receipt of information or by receiving the information at alternative locations. For example, you can ask that we only contact you at work or by mail, or at another mailing address, besides your home address. We will agree to all reasonable requests.
- Right to a Paper Copy of This Notice. You have the right to a paper copy of this notice.
CHANGES TO THIS NOTICE
We reserve the right to change this Notice. We reserve the right to make the revised or changed Notice effective for medical 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 the hospital and all of the service delivery locations.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with the Hospital Privacy Officer or with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing.
You will not be penalized for filing a complaint.
OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of medical information not covered by this Notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical 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 with your permission and that we are required to retain our records of the care that we provided to you.
To ask a question about this Notice, exercise your privacy rights, file a complaint, or receive an additional copy of this Notice – please contact the Privacy Officer listed at the beginning of this document.