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We understand that health information is personal and
we are committed to fulfilling our legal obligation to protect the privacy of
your health information. This Notice describes our legal duties and privacy
practices concerning your health information. We must follow the privacy practices
described in this Notice or a notice then in effect.
We reserve the right to change the privacy practices
described in this notice, in accordance with the law. Changes to our privacy
practices would apply to all health information we maintain. If we change our
privacy practices, a revised copy of the privacy notice is posted on the Sacred
Heart Hospital website at www.sacredhearteauclaire.org and in designated
patient areas in the hospital.
Who follows
this Notice and where does it apply? This Notice applies only to your health information
created or obtained in connection with care provided to you at Sacred Heart
Hospital, 900 West Clairemont Avenue, Eau Claire, WI by the hospital,
physicians and allied health professionals on the hospital’s Medical Staff and
members of the hospital’s workforce (collectively, “we” or “us”). It also
applies to your medical information, including your medical record, for all
services provided to you in our clinically integrated care setting at the
hospital and other Sacred Heart physician offices and clinics. It does not
apply to services provided at your physician’s office or the office or facility
of any other health care providers. These other providers should provide you
with a notice of privacy practices describing their privacy practices.
Use and
disclosure of your health information without your written authorization.
The following items describe different categories of
uses and disclosures of your health information that we may make without your
written authorization. We have provided an example for each category, but have
not listed every kind of use or disclosure within the category. We will ask for
your written authorization for certain other categories of uses and disclosures
of your health information, which are described under the section entitled “Other Uses and Disclosures of Health Information.”
- Treatment. For example, the hospital may disclose the information in
your medical record to your doctors, nurses and others involved in your care so
they can determine which treatment option, such as a drug or surgery, best
addresses your health needs. The treatment selected will be documented in your
medical record, so that other health care professionals can make informed
decisions about your care. In addition, we may want to use your health
information to contact your pre or post-admission, such as for appointment
reminders or to discuss possible treatment options, alternatives or services
that may be of interest to you.
- Payment. In order for an insurance company, Medicare or another government
health care program to pay for your treatment, the hospital submits a bill that
identifies you, your diagnosis, and the treatment provided to you. As a result,
we will pass such health information on to an insurer or government program in
order to receive payment for your hospital bills.
- Health Care Operations. We may need your diagnosis, treatment, and
outcome information in order to improve the quality or cost of care we deliver
or to perform administrative and other hospital operational activities. The
quality and cost improvement activities may include evaluating the performance
of your doctors, nurses and other health care professionals, or examining the
effectiveness of the treatment provided to you when compared to patients in similar
situations.
- Legal Representatives. We may disclose your health information to your
legal representatives, such as your parents if you are a minor.
- Those Involved With Your Care or Payment of Your Care. If people such as
family members, relatives, or close personal friends are involved in your care
or helping you pay your hospital bills, we may release your health information
to those people if the disclosure is related to their involvement. You have the
right to object to such disclosure, unless you are unable to function, there is
an emergency, or you are otherwise unable to object and we believe that the
disclosure is in your best interests.
- Sacred Heart Hospital Patient Directory. Unless you object, we may use
your health information, such as your name, location in our facility and your
religious affiliation for our hospital patient directory. The information about
you contained in our Hospital patient directory will be released to people who
ask for you by name. However, the information about your
religious affiliation will only be disclosed to clergy members.
- Business Associates. From time to time, in order to carry out payment
and health care operations activities, we may disclose your health information
to a vendor, known as a “business associate”, to assist us with activities
involving health information such as quality improvement, billing, hospital management, legal
services or accounting. Business associates will sign a contract under which
they agree to use or disclose health information only as permitted by the
agreement or as permitted by law.
- Fundraising. We may use and disclose limited information about you
(including your name, address, phone number and dates on which you received
care from us.) If you do not wish to be contacted for fundraising purposes, send a written request to
Sacred Heart Hospital, Privacy Officer, 900 West Clairemont Avenue, Eau Claire,
WI 54701.
- Required or Permitted by Law. Sometimes we must report some of your
health information to legal authorities, such as law enforcement officials or
government agencies to comply with a federal, state or local law
- Law Enforcement. We may disclose your health information to the police
or other law enforcement official for law enforcement purposes required or
authorized by law, such as alerting law enforcement to a death that we believe
may be the result of criminal conduct.
- Lawsuits and Disputes. We may disclose your health information in
connection with a lawsuit or administrative proceeding to respond to a court or
administrative order, a subpoena or other similar request for information
authorized by law.
- Public Health Activities. We may be required to report your health
information to authorities to help prevent or control disease, injury, or
disability. This may include using your medical record to report certain
diseases, injuries, birth or death information, information of concern to the
Food and Drug Administration, or information related to child abuse or neglect.
We may also have to report to your employer certain work-related illnesses and
injuries so that your workplace can be monitored for safety.
- Health Oversight Activities. We may disclose your health information to
authorities so they can monitor, investigate, inspect, discipline or license
those who work in the health care system or for government benefit programs.
- Activities Related to Death. We may disclose your health information to
coroners, medical examiners and funeral directors so they can carry out their
duties related to your death, such as identifying the body, determining cause
of death, or in the case of funeral directors, to carry out funeral preparation
activities.
- Organ, Eye or Tissue Donation. We may disclose your health information
to people involved with obtaining, storing or transplanting organs, eyes or
tissue of cadavers for donation purposes.
- Research. Under certain circumstances, and only after approval by our
research committee, we may use and disclose your health information to conduct
research. Such research might try to find out whether a certain treatment is
effective in curing an illness.
- Avoid a Serious Threat to Health or Safety. As required by law and
standards of ethical conduct, we may release your health information to the
proper authorities if we believe, in good faith, that such release is necessary
to prevent or minimize a serious and approaching threat to your or the public’s
health or safety.
- Military, National Security, or Incarceration/Law Enforcement Custody.
If you are involved with the military, national security, protective services
for the President of the United States, or intelligence activities or you are
in the custody of law enforcement officials or an inmate in a correctional institution,
we may release your health information to the proper authorities so they may
carry out their duties under the law.
- Workers’ Compensation. We may disclose your health information to the
appropriate persons in order to comply with the laws related to worker’s
compensation or other similar programs. These programs may provide benefits for
work-related injuries or illness.
- Disaster Relief Efforts. In addition, we may release your health
information to organizations authorized to handle disaster relief efforts so
those who care for you can receive information
Uses and
Disclosures with Your Written Authorization.
Except for
the situations previously listed or as permitted by law, any other use or
disclosure of your health information requires us to obtain your written
authorization. You may withdraw your authorization at any time, as long as your
withdrawal is in writing. If you wish to withdraw your authorization, please
submit your written withdrawal to Sacred Heart Hospital, Privacy Officer, 900
West Clairemont Avenue, Eau Claire WI 54701. Your withdrawal will be effective
except to the extent that we have already acted upon it. For instance, we will
obtain your written authorization for the following categories of use and
disclosure of your health information.
- Highly Sensitive Information. Federal and state law may
require us to obtain your written authorization to disclose highly sensitive
health information under certain circumstances. Highly sensitive health
information includes health information that is: (1) in a therapist’s
psychotherapy notes; (2) about mental illness or developmental disabilities;
(3) in alcohol and drug abuse treatment program records; (4) in HIV/AIDS test
results; or (5) about genetic testing.
- Fundraising. If we choose to use information found in
your medical record, other than your name, address, phone number and treatment
date, for fund-raising purposes we will obtain your authorization before doing
so. If you do not wish to be contacted for fundraising purposes, send a written
request to Sacred Heart Hospital, Privacy Officer, 900 West Clairemont Avenue,
Eau Claire, WI 54701.
- Marketing. We will obtain your written authorization
before using your health information to send you any marketing materials.
However, we may provide you with marketing materials in a face-to-face
encounter or give you a promotional gift of minimal value without your
authorization. We may also communicate with you about products or services
relating to your treatment, care settings or alternative therapies without your
written authorization.
- Research. If required by law or our committee which
oversees our research activities, we will obtain your written authorization
before using or disclosing your health information for research purposes.
Your Health
Information Rights
You have
several rights with regard to your health information. If you wish to exercise
any of the following rights, please send a written request to Sacred Heart
Hospital, Privacy Officer, 900 West Clairemont Avenue, Eau Claire, WI 54701 or
call 715-717-3755. Specifically, you have the right to:
- Inspect and copy your health information. With a few
exceptions, you have the right to inspect and obtain a copy of your medical
records, billing records and other records used to make treatment or billing
decisions about you. For instance, this right does not apply to psychotherapy
notes or information gathered for judicial proceedings. In addition, we may
charge you a reasonable fee if you want a copy of your health information.
- Request to correct your health information. If you
believe any of your health information contained in medical records, billing
records and other records used to make treatment or billing decisions is
incorrect, you may request that we correct the information. You may be asked to
make such requests in writing and give a reason as to why your health
information should be changed. However, if we did not create the health
information that you believe is incorrect, or if we disagree with you and
believe your health information is correct, we may deny your request.
- Request restrictions on certain uses and disclosures.
You have the right to ask for restrictions on how your health information is
used or to whom your information is disclosed, for your treatment or our
payment or health care operation activities. You may also request that the
hospital limit the health information provided to family or friends involved
in your care or payment for your hospital bills. You may also request that the
hospital limit the health information provided to authorities involved with
disaster relief efforts. However, we are not required to agree to your
requested restriction.
- As applicable, receive confidential communication of
health information. You have the right to ask that we communicate your health
information to you in a certain way or place. For example, you may wish to
receive information at your office rather than at home. We will accommodate
reasonable requests.
- Receive a record of disclosures of your health
information. You have the right to ask for a list of certain disclosures of
your health information that we have made during the previous six years. This
list must include the date of each disclosure, who received the disclosed
health information, a brief description of the health information disclosed,
and why the disclosure was made. We may not charge you for the list, unless you
request such list more than once per year.
- Obtain a paper copy of this Notice. Upon your request,
you may at any time receive a paper copy of this notice, even if you earlier
agreed to receive this notice electronically.
- Right to make a complaint. If you believe your privacy
rights have been violated, you may file a complaint with us and/or with the
United States Department of Health and Human Services Office of Civil Rights.
We will not retaliate against you for filing such a complaint. To file a
complaint with us please contact Sacred Heart Hospital’s Privacy Officer in writing
at 900 West Clairemont, Ave, Eau Claire, WI 54701 or call at 715.717.3755.
To file a
complaint with the Regional Office of Civil Rights please contact:
Regional
Manager
Office for
Civil Rights
U.S.
Department of Health and Human Services
233 N.
Michigan Ave., Suite 240
Chicago,
IL 60601
Voice
Phone (312)886-2359
FAX
(312)886-1807
TDD
(312)353-5693
This Notice
of Medical Information Privacy is Effective September 1, 2011. Publication
Date: September 1, 2011. |
