Saint Francis Hospital Notice of Privacy Practices

Saint Francis Hospital has adopted the following policies and procedures for protection of the privacy of the people we serve. We respect your privacy. This is part of our code of ethics. We are required by law to maintain the privacy of "protected health information" (PHI) about you, to notify you of our legal duties and your legal rights, and to follow the privacy policies described in this notice. "Protected health information" means any information that we create or receive that identifies you and relates to your health or payment for services to you. This notice describes our hospital's practices at on-site and off-site departments or units and the practices of our employees, staff, volunteers and any health care professional authorized to enter information in your medical record.

After reading this notice, please direct any questions about our policies and procedures, requests to exercise individual rights, and concerns to our HIPAA Helpline at (845)483-5145.

Use and Disclosure of Information about You for Treatment, Payment or Hospital Operations Treatment. We will use your protected health information and disclose it to others as necessary to provide treatment to you. We will provide only the minimum necessary information. Here are some examples:

Various members of our staff may see your clinical record in the course of our care for you. This includes clinical assistants, nurses, physicians and other therapists.
It may be necessary to send blood or tissue samples to a laboratory for analysis to help us evaluate your medical condition.
We may provide information to your health plan or another treatment provider in order to arrange for a referral or clinical consultation.
We may contact you to remind you of appointments.
We may contact you to tell you about treatment services that might be of benefit to you.

Payment
We will use or disclose your protected health information as needed to arrange for payment. For example, information about your diagnosis and the service we render is included in the bills that we submit to your health insurance plan. Your health plan may require health information in order to confirm that the service rendered is covered by your health plan and medically necessary. A health care provider that delivers service to you, such as a clinical laboratory, may need information about you in order to arrange for payment for its services.

Health Care Operations
It may also be necessary to use or disclose protected health information for our health care operations or those of other organizations that have a relationship with you. For example, our quality assurance staff reviews records to ensure we deliver appropriate treatment. Your health plan may wish to review your records to be sure that we meet national standards for quality of care.

Other Uses and Disclosures of Protected Health Information

Emergencies
If there is an emergency, we will disclose your protected health information as needed to enable people to care for you.

Disclosure to your family and friends and personal representatives
If you are an adult, you have the right to control disclosure of information about you to any other person, including family members or friends. If you ask us to keep your information confidential, we will respect your wishes. But if you don't object, we will share information with family members, friends or a personal representative involved in your care to enable them to help you.

Fundraising Activities
We may use information about you to contact you in an effort to raise money for the Hospital, and may disclose the information to the charitable foundation that raises money for the Hospital. This information would be limited to contact information, such as your name, address and the dates you received services at the Hospital. If you do not wish to be contacted for fundraising you may call the HIPAA Helpline at (845)483-5145.

Hospital Directory Listing
Unless you request that we do not do so, we will disclose certain limited information about you in the Hospital Directory. This may include your name, location, general condition (e.g., fair, stable) and religious affiliation. This information (except for your religious affiliation) will be released to people who ask for you by name. This will allow your friends and family to visit you and generally know how you are doing. We do not disclose any information about patients on our mental health/chemical dependency units. Your religious affiliation and name may be given to a member of the clergy, even if they do not ask for you by name.

Disclosure to health oversight agencies
We are legally obligated to disclose protected health information to certain government agencies, including the Federal Department of Health and Human Services.

Disclosures to child protection agencies
We are legally obligated to disclose protected health information as needed to comply with state law requiring reports of suspected incidents of child abuse or neglect.

Other disclosures
We will disclose information to organ procurement and transplant personnel, to workers' compensation programs in connection with a claim for a work-related injury; and to researchers involved in approved research projects.

Disclosures without written permission
Generally, we do not disclose any information about patients receiving mental health services and chemical dependency services. There are other circumstances in which we may be required by law to disclose PHI on any patient without their permission. They include disclosures made:

Pursuant to court order;
To public health authorities;
To law enforcement officials in some circumstances;
To correctional institutions regarding inmates;
To federal officials for lawful military or intelligence activities;
To coroners, medical examiners and funeral directors; and
As otherwise required by law.

Disclosures with your permission
No other disclosure of protected health information will be made unless you give written authorization for the specific disclosure.

Your Legal Rights
Right to request confidential communications
You may request that communications to you, such as appointment reminders, bills, or explanations of health benefits be made in a confidential manner. We will accommodate any such request, as long as you provide a means for us to process payment transactions.

Right to request restrictions on use and disclosure of your information
You have the right to request restrictions on our use of your protected health information for particular purposes, or our disclosure of that information to certain third parties. We are not obligated to agree to a requested restriction, but we will consider your request. Any such request must be addressed to the Privacy Officer c/o Saint Francis Hospital.

Right to revoke a Consent or Authorization
You may revoke a written Consent or Authorization for us to use or disclose your protected health information. The revocation will not affect any previous use or disclosure of your information. Such request must be addressed to the Privacy Officer c/o Saint Francis Hospital.

Right to review and copy record
Except in limited circumstances, you have the right to see records used to make decisions about you. At your request, we will make a copy of your record for you. We will charge a reasonable fee for this service. We will allow you to review your record unless a clinical professional determines that it would create a substantial risk of physical harm to you or someone else. If we deny your request we will provide you with information as to how you may appeal that decision in accordance with applicable law. Psychotherapy notes kept separately from the rest of the record will not be released to you. If another person provided information about you to our clinical staff in confidence, that information may be removed from the record before it is shared with you. We will also delete any protected health information about other people. There may be other specific Federal or State laws and regulations that may require us to refuse your request to inspect and copy your medical and billing records.

Right to "amend" record
If you believe your records contain an incorrect/incomplete statement, you may ask us to amend it. A note will be entered in the record to correct the error. In certain circumstances we may deny your request. If we deny your request, you will be allowed the opportunity to add a short statement to the record explaining why you believe the record is inaccurate. This information will be included as part of the total record and shared with others if it might affect decisions they make about your care.

Right to an accounting
You have the right to an accounting of some disclosures of your protected health information to third parties. This does not include disclosures that you authorize, certain disclosures as part of a criminal investigation, disclosures that occur in the context of treatment, payment or health care operations, or disclosures made prior to April 14, 2003. Going forward, we will provide an accounting of other disclosures made in the preceding six years.

How to Exercise Your Rights
In order to exercise your legal rights or voice any concerns about our privacy policies or practices, please contact the HIPAA Helpline at (845)483-5145. If you wish, you can also submit a complaint to the United States Department of Health and Human Services. Send your complaint to:

Office for Civil Rights
U.S. Department of Health and
Human Services
200 Independence Avenue, S.W.
Room 509F, HHH Building
Washington, D.C. 20201
OCR Hotlines-Voice: (800)368-1019

Patients as Partners
YOU ARE THE CENTER OF EVERYTHING WE DO.
WE APPRECIATE THE OPPORTUNITY TO SERVE YOU.

Be our partner in your care:

Wear hospital bracelet at all times. This is how we check to make sure you are you!
Anyone who gives you medicine, a treatment or a test should always check your bracelet first. If they forget, don’t be embarrassed to remind them.
It is our policy that employees wear ID badges and introduce themselves to you. You have the right to know the name of everyone who takes care of you.
If you are having surgery, our policy is that the surgeon is supposed to mark the site after confirming it with you just before you enter the operating room. It's okay for you to make sure he or she does this.
If you have questions or concerns just ask. If someone brings you medicine that is not familiar to you, go ahead and ask about it. Be sure you are aware of any side effects to watch for. And be sure to tell us about any allergies you have.
Check with your nurse before letting anyone bring you any food from outside the hospital; some foods have interactions with some medications.
Hand washing is the most important way to prevent the spread of infection. Everyone (doctors, nurses, therapists, x-ray techs, etc.) should wash their hands before they care for you. If you have any concern that they have not, ask them.
If you have a concern about safety, ask to speak with our Patient Representative or call (845) 431-8114 or ext. 18114. If the Patient Representative is unavailable, ask for the Clinical Administrator.
Most of all, we want you to feel comfortable participating in all aspects of your care. No question is unimportant and no concern is too small. Ask us about anything that concerns you. We won’t be offended. Be our partner in making your stay a safe and comfortable one!

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