Privacy Policy

JOINT 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.

Spanish Version

Please Review It Carefully.

This notice describes the privacy practices of Tri-County Area Hospital and all of its programs and departments. This includes:

Any health care professional authorized to enter information into your medical record.
Any member of a volunteer group or health care students we allow to help you while you are receiving care from this hospital.
All employees, staff and other hospital personnel, including Home Care Services.

All the above will follow the terms of this notice. In addition, they may share medical information with each other for treatment, payment or hospital operations as described in this notice.

This notice also describes the privacy practices of an “organized health care arrangement” or “OHCA” between the Hospital and eligible providers on our Medical Staff. Because the Hospital is a clinically-integrated care setting, our patients receive care from Hospital staff and from independent practitioners on the Medical Staff. The Hospital and our Medical Staff must be able to share your medical information freely for treatment, payment and health care operations as described in this notice. Because of this, the Hospital and all eligible providers on the Hospital’s Medical Staff have entered into the OHCA under which the Hospital and the eligible providers will:

Use this Notice as a joint notice of privacy practices for all inpatient and outpatient visits and follow all information practices described in this Notice:
Obtain a single signed acknowledgement of receipt; and
Share medical information from inpatient and outpatient hospital visits with eligible providers so that they can help the Hospital with its health care operations.

The OHCA does not cover the information practices of practitioners in their private offices or at other practice locations.

UNDERSTANDING YOUR MEDICAL RECORD INFORMATION:

Each time you visit Tri-County Area Hospital a record of your visit is made.

Typically, this record describes your symptoms, examination, test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record or designated record set, also includes your financial record and may be in paper or electronic form and serves as a:

basis for planning your care and treatment;
means of communication among the many health care professionals who help with your care;
legal documents describing the care you received;
means by which you or a third party payer, such as your insurance company, can verify that services billed were actually provided;
a tool in educating health professionals;
a source of data for medical research;
a source of information for public health officials who work to improve the health of the nation;
a source of data for facility planning and marketing;
a tool with which we can use to continually work to improve our patient care and the outcomes.

Understanding what is in your record and how it is used will help you to:

make certain it is accurate;
better understand who, what, when, where and why others may access your health information;
make a more informed decision when giving your permission for your health information to be sent or released to others.

YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION:

Although your medical record is the physical property of Tri-County Area Hospital, the information belongs to you. Tri-County Area Hospital has developed procedures as described in the federal law that allows you several rights.

Right To See And Get Copies Of Your Medical Information

In most cases, you have the right to look at or get copies of your medical information that we have, but you must make the request, preferably in writing. If we don’t have your information but we know who does, we will tell you how to get it. We will respond to you within 30 days after receiving your request. In certain situations, we may deny your request. If we do, we will tell you in writing our reasons for the denial and how you can have the denial reviewed.

If you request copies of your medical information, we may charge a fee for the costs of the copying, mailing, or other supplies associated with your request.

Right To Correct Or Update Your Medical Information

If you believe that there is a mistake in your medical information or that a piece of information is missing, you have the right to request that we correct the existing information or add the missing information. That request must be made in writing and you must provide a reason for the change. We will respond within 60 days of receiving your request. We may deny your request if it is not in writing or does not include a reason to support the request. Also, we may deny our request if the medical information is:

correct and complete;
not created by us;
not allowed to be looked at and copied for you; or
not part of our records.

Our written denial will tell you the reasons for the denial and will tell you how to file a written statement of disagreement with the denial.

Right To Get A List Of The Disclosures We Have Made

You have the right to get a list of certain circumstances in which we or our Business Associates have disclosed your medical information after April 14, 2003. This list will not include uses or disclosures that you have already consented to, such as those made for treatment, payment, or health care operations, directly to you, to your family, or in our facility directory. We will respond within 60 days of receiving your written request and will include disclosures made in the last six years, but not before the effective date of this notice, unless you request a shorter time. We will provide the list to you at no charge, but if you make more than one request in the same 12-month period, we will charge you a fee for each additional request. We will notify you of the cost involved and you may choose to withdraw or change your request at that time.

Right To Request Limits On Uses And Disclosures Of Your Medical Information

You have the right to ask that we limit how we use and disclose your medical information. We will consider your written request but are not legally required to accept it. If we accept your request, we will abide by them except in emergency situations. You may not limit the uses and disclosures that we are legally required or allowed to make.

Right To Choose How We Send Medical Information To You

You have the right to ask that we send information to you at an alternate address or by alternate means. We must agree to your written request so long as we can easily provide it in the format you requested.

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. You may also obtain a copy of this notice at our website, www.tricountyhospital.com.

Right To Withdraw Your Authorization To Use Or Disclose Your Medical Information

If you give us permission to use or disclose your medical information, you may withdraw or cancel that permission, in writing, at any time. If you withdraw 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.

All requests to exercise these rights must be in writing.

OUR RESPONSIBILITES:

Tri-County Area Hospital is required by law to:

maintain the privacy of your medical information;
provide you with a paper copy of this notice as to our legal duties and privacy practices concerning the medical information we collect and maintain about you;
abide by the terms of the Notice currently in effect;
notify you if we are unable to agree to a requested limit or restriction;
follow reasonable requests you may have to communicate your medical information at an alternate address or by an alternate means.

We reserve the right to or may be required by law to change our privacy practices, which may result in changes in this notice. We further reserve the right to make the revised or changed privacy practices 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 on our website, www.tricountyhospital.com. The notice’s effective date will be in the bottom right-hand corner of the last page. In addition, each time you register at or are admitted for treatment or health care services as an inpatient or outpatient, we will offer you a copy of the current notice in effect. We will not use or disclose your health information without your permission or authorization, except as described in this notice.

EXAMPLES OF DISCLOSURES FOR TREATMENT, PAYMENT AND HEALTH OPERATIONS:

The following are the types of uses and disclosures we may make of your medical information without your permission. We will use and disclose your information as required by federal, State or local law. Also where State or federal law restricts one of the described disclosures, we will follow the requirements of such law. Not every use or disclosure in a category is listed. However, all the ways we are permitted to use and disclose your medical information will fall within one of the categories.

We will use your medical information for treatment. For example, medical information obtained by a nurse, doctor or other health care workers will be recorded in your record and used to decide the treatment that should work best for you. Members of your healthcare team will then record the actions they took and their observations. In that way, the doctor will know how you are responding to treatment. We may also disclose that information about you to other doctors, nurses, technicians, hospital personnel, medical students, health care volunteers and health care students who are involved in taking care of you.

We will also provide your physician or another healthcare provider or facility with information which may include copies that should assist them in treating you once you are discharged. For example, if you are transferred to a nursing facility, we will send medical information about you to the nursing facility.

We will use your medical information for payment. For example, a bill may be sent to you or a third-party payer, such as your insurance company. The information on or sent with the bill may include your identity, diagnoses, procedures performed, and supplies used. We may also provide necessary information to other healthcare providers for their billing purposes in services they provided you. For example, if you are transferred to another facility by ambulance, the information collected will be given to the ambulance company for its billing purposes. However, as State Law requires for Home Health Agencies and Hospices, we will obtain your permission prior to disclosing your medical information to other providers or health insurance companies for payment purposes.

We may tell your health plan about treatment you are receiving. This may be done to obtain prior approval or to determine whether your health plan will cover the treatment and/or hospital stay.

We will use your health information for regular hospital operations. For example, members of the Medical Staff and quality management teams may use your medical information to review the care and outcomes of your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and services we provide, including if we need to offer additional services. We may also disclose your medical information to medical students and other healthcare students for review and learning purposes.

In some cases, we will furnish other qualified parties with your medical information for their health care operations. For example, an ambulance company may also want to know whether they did an effective job of providing care to you. However, again as per State Law for Home Health Agencies and Hospices, disclosures for health care operations of another health care provider will only be made with your consent.

We may allow our business associates to use your medical information if necessary. For example, there are some services provided in our organization through contracts with other persons or organizations, known as business associates. Our radiology or x-ray films are read by physicians not employed by us and another organization performs the pathology services. To protect your medical information, however, we require the business associates to appropriately protect your medical information.

We will provide your information for the facility directory. For example, unless you object, we will use your name, your location in our hospital, your condition described in general terms, and religious preferences for directory purposes. This directory information may be released to people who contact the hospital and ask for you by name. The information provided to members of the clergy will be released by religious affiliation.

We may provide notification as well as communication with your family about your medical information. For example, using their best professional judgment that it would be in your best interest, our health care professionals may release medical information about you to a family member or close personal friend who is involved in your medical care or payment for care and may tell your family or friends your general condition and that you are in the hospital. We will only release this information if you agree, are given the opportunity to object, and do not. In addition, we may tell your medical information to an organization helping in a disaster relief effort so that your family can be notified about your condition, status, and location.

We may release your medical information for research, subject to certain safeguards. For example, we may disclose information to researchers when their research has been approved by a special committee that has reviewed the research proposal and established protocols to ensure the privacy of your medical information. We may disclose medical information about you to people preparing to conduct a research project, but the information will stay on site.

We will provide your health information to coroners, medical examiners and funeral directors. For example, we may release medical information to a coroner or medical examiner to identify a deceased person or to determine the cause of death. We may also release medical information about our patients to funeral directors as necessary to carry out their duties.

We will use your medical information for organ and tissue donation. For example, according to law, we will provide medical information to organ donation organizations or other organizations involved in the obtaining of organs or tissue, the banking of the organs, or the transplantation of the same.

We may use your information for appropriate reminders. For example, we may contact you to remind you of appointments for diagnostic testing or treatment or other health-related benefits and services that may be of interest to you, including educational opportunities.

We may use your medical information for fundraising activities. For example, we may contact you in an effort to raise money for the hospital and its operations. We may disclose medical information to a foundation related to the hospital so that they may contact you in raising money for the hospital. We would only release your name, address, phone number, and dates you received services at the hospital. If you do not want the hospital to contact you for fundraising purposes, you must notify the Tri-County Area Hospital Administrator in writing.

We will use your medical information for public health purposes. For example, we may disclose medical information about you for public health activities or as authorized by law. These activities generally include the following examples:

to prevent or control disease, injury, or disability;
to report births or deaths;
to report reactions to medications or problems with products to FDA-regulated entities;
to notify people of recalls of products they may be using;
to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
to notify the appropriate government authority if we believe a patient has been the victim of abuse, the victim of neglect, or the victim of violence resulting in certain wounds and physical injuries.

We may use your medical information for Workers’ Compensation. For example, we may release, as authorized by law, medical information about you for workers’ compensation or similar problems. These programs provide benefits for work-related injuries or illness.

We may use your medical information for the correctional institution. For example, if you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release your medical information to the correctional institution or law enforcement official. This release would be necessary for the institution to provide you with health care, to protect your health and safety or the health and safety of others, or for the safety and security of the correctional institution.

We may use your medical information for law enforcement. For example, we may release medical information if asked to do so by a law enforcement official:

in response to a court order, subpoena, warrant, summons or similar process;
to identify or locate a suspect, fugitive, material witness or missing person;
about the victim of a crime if, under certain circumstances, we are unable to obtain the victim’s agreement;
about a death we believe may be the result of criminal conduct;
about criminal conduct at the hospital;
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.

Where limited by State or federal law, we will use and disclose your medical information within the limits of the law.

We may use your medical information for judicial and administrative proceedings. For example, if you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute, but only if reasonable efforts have been made to notify you of the request or to obtain an order from the court protecting the information requested.

We may use your medical information for health oversight activities. For example, we may disclose medical information to a health oversight agency for activities authorized by law. This may include audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.

We may use your medical information to prevent a threat of harm to others. We will only do this if we, in good faith, believe it is necessary to prevent or lessen the threat and is to a person reasonably able to prevent or lessen the threat (including the target) or is necessary for law enforcement authorities to identify or apprehend an individual involved in a crime.

We may use your medical information for national security and intelligence activities as authorized by law or for protective services of the President. If you are a military member, we may disclose to military authorities under certain circumstances.

There may be certain incidental uses or disclosures of your information that occur while we are providing service to you or conduct our business. For example, after surgery the nurse or doctor may need to use your name to identify family members that may be waiting for you in our waiting rooms. Other individuals waiting in the same area may hear your name called. We will make reasonable efforts to limit these incidental uses and disclosures.

FOR MORE INFORMATION OR TO REPORT A CONCERN:

If you have questions about this notice and would like additional information, you may contact the Privacy Officer at Tri-County Area Hospital (308)324-5651. All complaints/requests must be submitted in writing to the Privacy Officer also at P.O. Box 980, Lexington, NE 68850.

If you believe your privacy rights have been violated and not addressed by Tri-County Area Hospital, you have the right to file a complaint with the Secretary of Health and Human Services. You will not be penalized or retaliated against for filing a complaint.

Effective Date: April 14, 2003

Version #1

Tri-County Hospital