HIPAA Notice of Privacy Practices



Effective:  April 14, 2003
Revised:  June 2012  

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.

Our Privacy Obligations


Memorial Hospital of Sweetwater County has long been committed to protecting patient privacy. As part of this commitment, we follow federal and state laws which require us to maintain the privacy of your health information and to provide you with this Notice of our privacy practices. When we use or disclose your health information, we are required to follow the privacy practices described in this Notice (or other notice in effect at the time of the use or disclosure). We must follow either federal or state law, whichever is more protective of your privacy rights. For example, if federal law allows certain disclosures of your health information without your written authorization but state law does require your written authorization for such disclosures, we must follow state law.  We reserve the right to change the privacy practices described in this Notice at any time. Changes to our privacy practices would apply to all health information we maintain. If we change our privacy practices, we will make it available to you. 

Who Will Follow This Notice?


The privacy practices in this notice will be followed by any health care professional that treats you, by all departments and units of our organization and by all employed associates, staff and volunteers of our organization. Memorial Hospital of Sweetwater County participates in a clinically integrated care setting in which patients typically receive health care from more than on 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 and Memorial Hospital of Sweetwater County, you may receive certain professional services from physicians on our Medical Staff or from independent practitioners who are not employees or agents of Memorial Hospital of Sweetwater County.  These independent practitioners have agreed to abide by the terms of this Notice when providing services at Memorial Hospital of Sweetwater County. Therefore, this Notice applies to all of your health information that is created or received as a result of being a patient at Memorial Hospital of Sweetwater County.    However,   this   Notice   does  not  apply  to   the   independent practioners in their private offices.  You will also receive Notices of Privacy Practices from these independent practitioners when they provide services in their private offices.


Our Pledge To You


We understand that medical information about you is personal. We are committed to protecting your medical information. We create a record of the care and services you receive to provide quality care and to comply with legal requirements. This notice applies to all of your care records that we maintain, whether created by facility staff or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your medical information created in the doctor’s office.

When We May Use and Disclose Your Health Information With Your Written Authorization


Use or Disclosure with Your Authorization. For any purpose other than the ones described below, we may only use or disclose your health information when you give us your written authorization to do so. For example, you will need to sign an authorization form before we can send your health information to your life insurance company.

Marketing. We must also obtain your written authorization before using your health information to send you any marketing materials. The only exceptions to this requirement are that (1) we can provide you with marketing materials in a face-to-face encounter or a promotional gift of very small value, if we so choose, and (2) we may communicate with you about products or services relating to your treatment, to coordinate or manage your care, or provide you with information about different treatments, providers or care settings.

Uses and Disclosures of Your Highly Confidential Information. Federal and state law require special privacy protections for certain highly confidential information about you, including the part of your health information that: (1) is maintained in psychotherapy notes; (2) is about treatment of mental illness or developmental disability; (3) is about the identity, diagnosis, prognosis, or treatment for alcohol or drug dependency; (4) is about HIV test results; or (5) is about child abuse or neglect.  The only exception to this is if we are allowed by law to disclose your Highly Confidential Information for certain purposes without your written authorization. For example, we are allowed to disclose information about treatment of mental illness or developmental disability for program monitoring and evaluation or to a physician in a medical emergency.

When We May Use and Disclose Your Health Information Without Your Written Authorization


Treatment. We may use and disclose your health information to provide treatment and other services to you. For example, a doctor may use the information in your medical record to diagnose your injury or illness and determine which treatment option, such as medication or surgery, best addresses your health needs. In addition, we may use your health information for appointment reminders or to send you information about treatment alternatives or other health-related benefits and services that may be of interest to you. We may disclose your health information to other health care providers involved in your treatment.

Payment. We may use and disclose your health information to obtain payment for services that we provide to you. For example, in order for an insurance company to pay for your treatment, we must submit a bill that identifies you, your diagnosis, and the treatment provided to you. As a result, we will give such health information to an insurer to obtain payment for your medical bills. We may also disclose your health information to another health care provider or health plan for its payment activities – for example, for the health plan to determine your eligibility or coverage.

Health Care Operations. We may need to use your health information to improve the quality or cost of care we deliver. These quality and cost improvement activities may include using your health information to evaluate the quality of our health care services.   We may also disclose your health information to another health care provider or health plan that has or had a relationship with you for their health care operational activities such as for the other health care provider or health plan to evaluate the performance of your doctors, nurses and other health care professionals.

Disclosures to Business Associates. In order for us to carry out treatment, payment or health care operations, we may disclose your health information to persons or organizations who perform a service for or on our behalf that requires the use or disclosure of individually identifiable health information. Such persons or organizations are our business associates. For example, we may disclose your health information to an agency that accredits health care organizations or to a collection agency to collect payment of medical bills.

Disclosure to Relatives, Close Friends and Other Caregivers. In certain limited situations, we may disclose important health information to people such as family members, relatives, or close friends who are helping care for you or helping you pay your medical bills. The information disclosed may include the information that we believe is directly relevant to their involvement in your care or payment for your medical bills, and may include your location, general condition or death. We will ask you if you agree to such a disclosure, unless you are unable to function or there is an emergency. If you are unable to function or there is an emergency, we will disclose your health information if we determine it would be in your best interest. In addition, we may disclose your health information to organizations authorized to handle disaster relief efforts so those who care for you can receive information about your location or health status.

Fundraising Communications.  We may contact you to request a tax-deductible contribution to support our activities.  If we do fundraising, we may share demographic information about you (such as your name, address and phone number) and dates on which we provided health care to you with our fundraising staff without your written authorization.

Public Health Activities.  If required or allowed by law, we may disclose your health information for the following public health activities:  1) to report health information to public health authorities for the purpose of preventing or controlling disease, injury or disability; 2) to report information about products and services under the jurisdiction of the U.S. Food and Drug Administration; 3) to alert a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition; and 4) to report information to your employer as required by laws addressing work-related illnesses and injuries or workplace safety.

Victims of Abuse, Neglect or Domestic Violence. If we reasonably believe you are a victim of abuse, neglect or domestic violence and the reporting of such information is required or allowed by law, we may disclose your health information to a governmental authority, including a social service or protective services agency.

Health Oversight Activities. As required or allowed by law, we may disclose your health information to a government agency that is legally responsible for overseeing the health care system and is responsible for ensuring compliance with the rules of government health programs such as Medicare or Medicaid.

Judicial and Administrative Proceedings. We may disclose your health information in the course of a judicial or administrative proceeding in response to a legal order or other lawful process.

Law Enforcement Officials. We may disclose your health information to the police or other law enforcement officials as required/allowed by law.

Coroners, Medical Examiners and Funeral Directors. We may disclose your health information to a coroner, medical examiner or funeral director as required or allowed by law.

Organ and Tissue Donation. We may disclose your health information to organizations that facilitate organ, eye or tissue donation, banking or transplantation.

Research. There are situations when researchers and research staff may use or disclose your health information for research purposes without your authorization. Researchers may conduct research that simply involves reviewing your health information and the health information of others with similar conditions or diseases. In such situations, researchers will not contact you for your authorization, but must obtain permission from a board (called the Institutional Review Board) that is set up to ensure that the welfare and privacy of research participants is protected as required by law. Researchers may also review your health information to determine if there are enough patients with a specific disease or condition to conduct a study or determine whether you would be a good candidate for a study that will involve interaction with you. In this situation, they may contact you to ask you if would like to participate in a study.

Health or Safety. We may use or disclose your health information to prevent or lessen a serious and imminent threat to the health or safety of a person or the general public.

Specialized Government Functions. We may use and disclose your health information for authorized national security activities or to units of the government with special functions, such as the U.S. military or the U.S. Department of State under certain circumstances.

Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose your health information to the correctional institution or law enforcement official for certain purposes. For example, we may disclose your health information to a correctional institution to provide you with health care.

Workers’ Compensation. We may disclose your health information to the extent necessary to comply with workers' compensation law or similar laws.

To Comply With the Law. We may use and disclose your health information when required to do so by any other law not already referred to in this section.

Your Rights Regarding Your Health Information


Right to Request Restrictions on Certain Uses and Disclosures of Your Health Information. You may ask for restrictions on how your health information is used or to whom your health information is disclosed (1) for treatment, payment and health care operations, (2) to family or friends involved in your care or payment of medical bills, or (3) to authorities involved in disaster relief efforts. While we will consider all requests for restrictions, we are not required to agree to your request. To request restrictions on how we use and disclose your health information for the purposes described above, you must obtain a restriction request form from our Health Information Management staff and submit the completed form to them. We will send you a written response.

Right to Receive Confidential Communications of Your Health Information. We will accommodate any reasonable request that we communicate your health information in different ways or places. For example, you may wish to receive your billing statement at a P.O. Box instead of a street address. We may ask you to put your request in writing.

Right to Cancel Authorization to Use or Disclose Your Health Information. You may cancel an authorization you have provided to us except if we have already relied on it. To cancel an authorization, you must obtain a cancellation form from our Health Information Management staff and submit the completed form to them.

Right to Inspect and Copy Your Health Information.  You may request access to your health information in order to review or request copies of such information. In certain situations, we may deny you access to a portion of your health information (for example, mental health records or information gathered for judicial proceedings) as allowed by law. To review or obtain copies of your health information, you must obtain an access request form from our Health Information Management staff and submit the completed form to them.  We will respond to you within 30 days after receiving your written request. We will charge you a reasonable fee for copies of your health information, which may include the cost of copying (including cost of supplies and labor), postage and preparing an explanation or summary of your health information. You should note that, if you are a parent or legal guardian of a minor (child under age 18), certain portions of the minor’s health information may not be accessible to you (for example, records relating to alcohol and other drug abuse treatment, HIV test results, or if the minor is emancipated)

Right to Request to Correct Your Health Information. You may ask us to correct your health information. While we will consider all requests for corrections, we may deny your request for legitimate reasons (for example, if your health information is accurate and complete or we did not create the health information you believe is incorrect). To request a correction to your health information, you must obtain an amendment request form from our Health Information Management staff and submit the completed form to them. The completed form must include the reason for your request.

Right to Receive a Record of Disclosures of Your Health Information. You may ask for a list of certain disclosures of your health information made by us, on or after April 14, 2003. This list must include the date of each disclosure, who received the health information disclosed, a brief description of the health information disclosed, and why the disclosure was made. This list will not include disclosures made to you, or for purposes of treatment, payment, health care operations, or for certain other purposes. To request a list of such disclosures, you must obtain an accounting request form from our Health Information Management staff and submit the completed form to them. If you request a list of such disclosures more than once during a twelve (12) month period, we may charge you a reasonable fee.

Right to Receive Paper Copy of this Notice. You may request a paper copy of this Notice at any time, even if you earlier agreed to receive this notice electronically.

Right to Your Own Billing Account. If you share a multiple adult account (that is, an account with two or more adults where the adults receive the bill for all individuals in this account), you have the right to request your own account. If you want to stay in the multiple adult account, you will need to sign an authorization form to allow the disclosure of your health information on the bill to other adults in your account. If you want your own account, you may ask our Customer Service staff in Patient Financial Services to set up this account. Establishing a new account for you, separate from that of your spouse and children, means that you may receive multiple bills and will need to write separate checks for each bill. If you have questions regarding these options, call 1-307-362-3711

Complaints


If you believe your privacy rights have been violated, you may file a complaint with the Federal Department of Health and Human Services and us. We will not retaliate against you for filing such a complaint. To file a complaint, please contact us.

Questions


If you have any questions about your privacy rights or the information in this Notice, you may contact us:

Health Information Management Director
1200 College Drive Rock Springs, WY  82901
1-307-352-8308