Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
T. J. Regional Health ("TJRH") is dedicated to protecting your protected health information ("PHI"). We are required by law to maintain the privacy of protected health information and to provide you with this Notice of our legal duties and privacy practices with respect to protected health information. TJRH is required by law to abide by the terms of the Notice that is currently in effect. The effective date of this Notice of Privacy Practices is September 23, 2013.
ORGANIZED HEALTH CARE ARRANGEMENT:
TJRH participates in a clinically integrated care setting in which patients typically receive health care from more than one health care provider. This arrangement is called an Organized Health Care Arrangement or OHCA under the federal laws governing the privacy of patient health information. This means that when you receive services at TJRH, you will receive certain professional services from physicians on our Medical Staff, residents, and/ or medical students who are independent practitioners and not employees or agents of TJRH. These independent practitioners have agreed to abide by the terms of this Notice when providing services at TJRH. Therefore, this Notice applies to all of your health information that is created or received as a result of being a patient at TJRH. However, this Notice does not apply to the independent practitioners in their private offices. As a result, you will also receive Notices of Privacy Practices from these independent practitioners when they provide services in their private offices.
This Notice applies to all health care professionals who treat you at any of our locations. This Notice also applies to all of TJRH's departments and clinics whether they are located off-campus or on our campus.
HOW YOUR PROTECTED HEALTH INFORMATION WILL BE USED AND DISCLOSED:
TJRH will ask you to sign a consent form that allows TJRH to use and disclose your PHI for treatment, payment and health care operations. You will also be asked to acknowledge receipt of this Notice.
Treatment: We may use and disclose your PHI for treatment purposes to doctors, nurses, technicians, and other caregivers. Your PHI may be used to order diagnostic tests, choose appropriate drugs and determine your treatment plan. If permitted to so do, we may also disclose your PHI to individuals or facilities that will be involved with your care after you leave TJRH and for other treatment reasons. Your PHI may also be used in an emergency situation.
Payment: We may use and disclose your PHI so that the services we provide may be billed and payment be collected from you, an insurance company or a third party. This includes cellular, home and work phone numbers. For example, if a patient is admitted to our facility for chest pain, we will disclose the patient's medical condition to the patient's health plan so that the health plan will pay us or reimburse the patient for the services provided. We may also tell a patient's health plan about a scheduled procedure in order to obtain prior approval or to determine whether the patient's plan will cover the procedure.
Health Care Operations: We may use and disclose your PHI to support our health care operations. For example, we may use or disclose your medical information in order for us to review the quality of our services, to evaluate our staff's performance or to perform general administrative activities of TJRH.
We may also use and/or disclose your PHI in accordance with federal and state laws for the following purposes:
Business Associates: There may be some services provided by our business associates, such as a transcription company, legal counsel, or billing company. TJRH may disclose your PHI to our business associate so that they can perform the job we have contracted with them to do. To protect your PHI, we require our business associates to enter into a written contract that requires them to appropriately use and safeguard your PHI.
Appointment Reminders: We may use and disclose PHI to contact you as a reminder that you have an appointment at TJRH. This includes your home, cellular and work phone numbers and your email address.
Treatment options: We may contact you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Fundraising Activities: We may use information about you to contact you in an effort to raise money for TJRH and its operations. The information to be released will be limited to your contact information, such as your name, address, telephone number, email address and the dates you received treatment or services at TJRH. A description of how to opt out of receiving any further fundraising communications will be included with any fundraising materials you receive from TJRH. If you request that your PHI not be used or disclosed for fundraising purposes, we will make sure that you do not receive future fundraising communications.
Facility Directory: Unless you object, we will include your name, location in the hospital and your religious affiliation in our directory of individuals. The directory information, except for your religious affiliation will be released to people who ask for you by name. Your religious affiliation may be given out to members of the clergy, even if they do not ask for you by name, unless you object. If you do not wish to be included in the facility directory, you may opt out. Visitors, phone calls, flower and mail delivery will not be directed to your room if you are not included in the facility directory.
Family and Friends: We may disclose your PHI to family members, other relatives or close friends when the medical information is directly relevant to that person's involvement with your care or payment for care. We ask if there is a particular member of your family or close friend that you wish to serve as your personal representative, you will inform us as early in your visit as possible. Likewise, if there should be anyone in particular that you do not want included in your medical treatment plan, that you will let us know that information as well. If you are unable to agree or object to such a disclosure, TJRH may disclose your PHI if it is determined that it is in your best interest based on your health care provider's professional judgment or if TJRH may reasonably infer that you would not object.
Notification: TJRH may use or disclose your PHI to notify a family member, a personal representative, or another person responsible for your care, of your location, general condition or death.
Public Health Activities: TJRH may disclose your PHI to a public health authority that is authorized by law to collect or receive information for purposes such as preventing or controlling disease, injury or disability; reporting births, deaths or other vital statistics; reporting child abuse or neglect; notifying individuals of recalls of products they may be using; or notifying a person who may have been exposed to a disease or may be at risk of contracting or spreading a disease or condition.
Disaster Relief: TJRH may disclose your PHI to a public or private entity, such as the American Red Cross, for the purpose of coordinating with that entity to assist in disaster relief efforts. If you are unable to agree or object to such as disclosure, TJRH may disclose such information if it is determined that it is in your best interest based on our professional judgment or we can reasonably infer that you would not object.
Health Oversight Activities: TJRH may disclose your PHI to a health oversight agency for oversight activities authorized by law including audits, investigations, inspections, licensure or disciplinary actions, administrative and/or legal proceedings.
Military and National Security Activities: TJRH may release your medical information to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law. If you are a member of the armed forces, if required by law, TJRH may use and disclose your PHI as required by military command authorities of the Department of Veterans Affairs.
Judicial and Administrative Proceedings: If you are involved in a lawsuit or dispute, TJRH may disclose your PHI in response to your authorization or a court or administrative order. TJRH may also disclose your PHI in response to a subpoena, discovery request or other lawful process if such disclosure is permitted by law.
Law Enforcement: We may disclose your PHI for certain law enforcement purposes if permitted or required by law. Examples include: to report gunshot wounds, to report emergencies or suspicious deaths, to comply with a court order warrant or similar legal process, or to answer certain requests for information concerning crimes.
Coroners, Medical Examiners and Funeral Directors: We may disclose your PHI to a coroner, medical examiner or a funeral director.
Organ Donation: If you are an organ donor, TJRH may disclose your PHI to an organ donation and procurement organization.
Research: We may disclose your PHI to researchers when authorized by law, for example, if their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your PHI or you provide authorization.
Public Safety: TJRH may use or disclose your PHI to prevent or lessen a serious threat to your health and safety or the health or safety of another person or to the public. Any disclosure, however, would be to someone able to help prevent the threat.
Worker's Compensation: TJRH may disclose your PHI as authorized by law relating to worker's compensation or similar programs.
Special Rules Regarding Disclosure of Psychiatric, Substance Abuse and HIV Related Information: For disclosures concerning PHI relating to care for psychiatric conditions, substance abuse or HIV related testing and treatment, special restrictions may apply. Certain mental health information and HIV related information may be protected by state law.
Minors: State law may provide for special use and disclosure rules for minors, especially with respect to certain treatments such as mental health, sexually transmitted diseases and reproductive services.
Abuse and Neglect: Federal laws and regulations do not protect any information about suspected abuse or neglect from being reported under state law to appropriate state or local authorities.
As Required by Law: We may disclose medical information about you when required to do so by federal, state or local law.
AUTHORIZATION: We will not use or disclose your medical information for any other purpose not covered by this Notice without your written authorization. Once given, you may revoke your authorization in writing at any time. To request a Revocation of Authorization form, you may contact:
T.J. Regional Health Information Management Department
1301 North Race Street
Glasgow, KY 42141
270.651.4447
Psychotherapy Notes: A signed authorization or court order is required for any use or disclosure of psychotherapy notes except to carry out certain treatment, payment or health care operations and for use by TJRH in defense of a legal action.
Marketing: A signed authorization is required for the use or disclosure of your PHI for a purpose that encourages you to purchase or use a product or service except for certain limited circumstances.
YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION:
You have the following rights with respect to your medical information:
- RIGHT TO ACCESS, INSPECT AND COPY: You have the right to access, inspect and receive copies of your PHI that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. To request a copy of your medical record, please contact the HIM Department at 270.651.4447 or at the T.J. Health Pavilion at 270.659.5533. We will respond to your request within thirty (30) days of the request or sixty (60) days if your medical information is not available on site. We shall be granted a thirty (30) day extension upon written notice to you providing the reason for the extension of time.
- Fees. There may be a fee for copies of your record; you will be notified before any charges are applied. The patient's first requested copy is free; there will be a charge of $1.00 per page for subsequent copies.
- Denials. We may deny your request to inspect and/or receive copies of your medical information if it is not in writing and in other, very limited circumstances. You will receive a written notice of denial containing the reason for denial and the procedure for review. In some circumstances, another licensed health care professional chosen by TJRH may review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review. You may also have the right to request a review of our denial of access through a court of law. All requirements, court costs and attorneys' fees associated with a review of a denial by a court are your responsibility. You should seek legal advice if you are interested in pursuing such rights.
- RIGHT TO AMEND: If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by, or for, TJRH. In your written request, you must provide a reason that supports your request for amendment. If we approve your request, we shall make the amendment to your medical information, inform you that we have made the amendment, and make a reasonable effort to tell others that need to know about the change to your medical information.
- Send request to: Compliance Officer at TJRH, 1301 North Race Street, Glasgow, KY 42141
- Denials. 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:
- Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
- Is not part of the medical information kept for or by TJRH;
- Is not part of the information which you would be permitted to inspect and copy; or
- Is accurate and complete.
- RIGHT TO AN ACCOUNTING OF DISCLOSURES: You have the right to request an "accounting of disclosures". This is a list of the disclosures we made regarding medical information about you.
- Exclusions. The list will not include: disclosures made for treatment, payment, or health care operations; disclosures made directly to you; disclosures authorized by you pursuant to a signed authorization; disclosures made for national security or intelligence purposes; and disclosures to correctional institutions and for other law enforcement purposes. This list also will not include disclosures made before April 14, 2003. Your request must include a time period, which may not exceed six (6) years prior to the date of the request and may not include any dates prior to April 14, 2003. Your request should also indicate in what form, i.e., electronic or paper, you would like your request to be processed. We will provide the first list to you at no charge; however if you make more than one request in the same year, we may charge you up to $1.00 per page for each additional request. 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.
- Electronic Health Record. An accounting of disclosures from the electronic health record related to treatment, payment or health care operations will be made only for the six (6) year period preceding the request.
- RIGHT TO REQUEST RESTRICTIONS: You have the right to request a restriction or limitation on the PHI we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had. You may request a restriction or revise a restriction of your PHI by providing a written request stating the specific restriction required. However, we are not required to grant your request unless it involves the disclosure of PHI to a health plan for purposes of carrying out payment or health care operations that pertains solely to a health care item or service for which TJRH has been paid out of pocket in full. If we do grant your request, we will comply with your request unless the information is needed to provide you emergency medical treatment. If restricted PHI is disclosed to a health care provider for emergency treatment, we will request that such health care provider not further use or disclose the information. In addition, you and/or TJRH may terminate the restriction if the other party is notified in writing of the termination. Unless you agree, the termination of the restriction is only effective with respect to PHI created or received after you have been informed of the termination.
- RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS: You have the right to request that we communicate with you about medical matters in a certain way or at a certain locations. For example, you may request that we only contact you at work or by mail. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your written request must specify how or where you wish to be contacted.
- RIGHT TO PAPER COPY OF THIS NOTICE: You may request a paper copy of this Notice at any time. You may also obtain a copy of this notice on our website, www.tjsamson.org. If you would like to inspect, amend or copy your medical information, receive an accounting of disclosures of your medical information, or to request a restriction on your medical information, please submit your request and reason in writing.
T.J. Regional Health
Compliance Officer
1301 North Race Street
Glasgow, KY 42141
270.651.4444
COMPLAINTS: You have the right to complain to us and/or the United States Department of Health and Human Services if you believe that we have violated your right to privacy. If you choose to file a complaint, you will not be retaliated against in any way. To complain to us or to contact us for additional information about this Notice or our privacy practices, please contact:
T. J. Regional Health
Patient Advocate Office
1301 North Race Street
Glasgow, KY 42141
270.651.4444
REVISION OF NOTICE OF PRIVACY PRACTICES: We reserve the right to change the terms of this Notice, making any revision applicable to all the protected health information we maintain. If we revise the terms of this Notice, we will post a revised notice on our website and we will make paper copies of the revised Notice of Privacy Practices available upon request.
Rev. 01-18