DELTA COUNTY MEMORIAL HOSPITAL 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. PLEASE REVIEW IT CAREFULLY.


WE HAVE A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION (PHI).

We are legally required to protect the privacy of your health information. We call this information "protected health information," or "PHI" for short, and it includes information that can be used to identify you that we have created or received about your past, present, or future health or condition, the provision of health care to you, or the payment of this health care. We must provide you with this notice about our privacy practices that explains how, when, and why we use and disclose your PHI. With some exceptions, we may not use or disclose any more of your PHI than is necessary to accomplish the purpose of the use or disclosure. We are legally required to follow the privacy practices that are described in this notice.

However, we reserve the right to change the terms of this notice and our privacy policies at any time. Any changes will apply to the PHI we already have. Before we make an important change to our policies, we will promptly change this notice and post a new notice in the hospital admissions area. You can also request a copy of this notice from the contact person listed in Section IV below at any time and can view a copy of the notice on our Web site at www.deltahospital.org.

HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION

We use and disclose health information for many different reasons. For some of these uses or disclosures, we need your prior consent or specific authorization. Below, we describe the different categories of our uses and disclosures and give you some examples of each category.

Uses and Disclosures Related to Treatment, Payment or Health Care Operations Require Your Prior Written Consent. We may use and disclose your PHI with your consent for the following reasons:

For treatment. We may disclose your PHI to physicians, nurses, health care students, and other health care personnel who provide you with health care services or are involved in your care. For example, if you are being treated for a knee injury, we may disclose your PHI to the physical rehabilitation department in order to coordinate your care.

To obtain payment for treatment. We may use and disclose you PHI in order to bill and collect payment for the treatment and services provided to you. For example, we may provide portions of your PHI to our billing department and your health plan to get paid for the health care services we provided to you. We may also provide your PHI to our business associates, such as billing companies, claims processing companies, and others that process our health care claims.

For health care operations. We may disclose your PHI in order to operate this hospital. For example, we may use your PHI in order to evaluate the quality of health care services that you received or to evaluate the performance of the health care professionals who provided the health care services to you. We may also provide your PHI to our accountants, attorneys, consultants, and others in order to make sure we are complying with the laws that affect us.

Exceptions to consent requirement for treatment, payment, and health care operations. Although your consent is required for numbers 1-3 of this section above, we may disclose your PHI to others without your consent in certain situations. For example, your consent is not required if you need emergency treatment, as long as we try to get your consent after treatment or we try to get your consent but you are unable to communicate with us (for example, if you are unconscious or in severe pain) and we think you would consent if you were able to do so.

Certain Uses and Disclosures Do Not Require Your Consent. We may use and disclose your PHI without your consent or authorization for the following reasons:

When a disclosure is required by federal, state or local law, judicial or administrative proceedings, or law enforcement. For example, we make disclosures when a law requires that we report information to government agencies and law enforcement personnel about victims of abuse, neglect, or domestic violence; when dealing with gunshot and other wounds; or when ordered in a judicial or administrative proceeding.

For public health activities. For example, we report information about births, deaths, and various diseases, to government officials in charge of collecting that information, and we provide coroners, medical examiners, and funeral directors necessary information relating to an individual's death.

For health oversight activities. For example, we will provide information to assist the government when it conducts an investigation or inspection of a health care provider or organization.

For purposes of organ donation. We may notify organ procurement organizations to assist them in organ, eye, or tissue donation and transplants.

For research purposes. In certain circumstances, we may provide PHI in order to conduct medical research.
To avoid harm. In order to avoid a serious threat to the health or safety of a person or the public, we may provide PHI to law enforcement personnel or persons able to prevent or lessen such harm.

For specific government function. We may disclose PHI of military personnel and veterans in certain situations. And we may disclose PHI for national security purposes, such as protecting the president of the United States or conducting intelligence operations.

For worker's compensation purposes. We may provide PHI in order to comply with worker's compensation laws.

Appointment reminders and health-related benefits or services. We may use PHI to provide appointment reminders or give you information about treatment alternatives, or other health care services or benefits we offer.

Fundraising activities. We may use certain information (name, address, telephone number or e-mail information, age, date of birth, gender, health insurance status, dates of service, department of service information, treating physician information or outcome information) to contact you for the purpose of raising money for Delta County Memorial Hospital and you will have the right to opt out of receiving such communications with each solicitation. For the same purpose, we may provide your name to our institutionally related foundation. The money raised will be used to expand and improve the services and programs we provide the community. You are free to opt out of fundraising solicitation, and your decision will have no impact on your treatment or payment for services at Delta County Memorial Hospital. If you do not want to receive future fundraising requests supporting Delta County Memorial Hospital, please contact Patti Kalahar at 970-874-2291 or pkalahar@deltahospital.org. You may also submit your request in writing and send it to Patti Kalahar, Delta County Memorial Hospital. P.O. Box 10100, Delta CO 81416. Please include your name and date of birth and state that you do not want to receive fundraising requests for a specific campaign or for all campaigns.

There is no requirement that you agree to accept fundraising communication from us and we will honor your request not to receive fundraising communications from us after the date we receive your decision.

Two Uses and Disclosures Require You to Have the Opportunity to Object Patient directories. We may include your name, location in this facility, and religious affiliation, in our patient directory for use by clergy and visitors who ask for you by name, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

Disclosures to family, friends, or others. We may provide your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part. The opportunity to consent may be obtained retroactively in emergency situations.

All Other Uses and Disclosures Require Your Prior Written Authorization. In any other situation not described in sections IA, B, and C above, we will ask for your written authorization before using or disclosing any of your PHI. If you choose to sign an authorization to disclose your PHI, you can later revoke that authorization in writing to stop any future uses and disclosures (to the extent that we have not taken any action relying on the authorization.)

WHAT RIGHT YOU HAVE REGARDING YOUR PHI:

You have the following rights with respect to your PHI:
The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask that we limit how we use and disclose your PHI. We will consider your request but are not legally required to accept it. If we accept your request, we will put any limits in writing and abide by them except in emergency situations. If you request that we restrict the use or disclosure of your PHI (protected health information) for treatment, payment or health care operation purposes, we will comply with your request; if the request is not otherwise required by law; and if the PHI at issue pertains solely to a health care item or service for which payment has been made in full by the individual or a third party other than the health plan. You may not limit the uses and disclosures that we are legally required or allowed to make.

The Right to Choose How We Send PHI to You. You have the right to ask that we send information to you to an alternate address (for example, sending information to your work address rather than your home address) or by alternate means (for example, e-mail instead of regular mail). You have the right to obtain a copy of your PHI in electronic format. We will supply you a copy of your PHI in a form and format that you request if we have that form available. If we cannot supply you a copy in the form you request, we will supply a hard copy of your PHI. Unencrypted e-mail may be used to deliver your PHI at your request; however, you must understand the risk involved and agree to accept that risk. We will also, at your request, transmit a copy of your PHI directly to a third party specified by you.

The Right to See and Get Copies of Your PHI. In most cases, you have the right to look at or get copies of your PHI that we have, but you must make the request in writing. If we do not have your PHI but we know who does, we will tell you how to get it. We will respond to you within 30 days (for records on site) and within 60 days (for records off site) after receiving your written request. In certain situations, we may deny your request. If we do, we will tell you, in writing, our reasons for the denial and explain your right to have the denial reviewed.

The Right to Get a List of the Disclosures We Have Made. You have the right to get a list of instances in which we have disclosed your PHI. The 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. The list also will not include uses and disclosures made for national security purposes, to corrections or law enforcement personnel, or before April 14, 2003. We will respond within 60 days of receiving your request. The list we will give you will include disclosures made in the last six years unless you request a shorter time. The list will include the date of the disclosure, to whom PHI was disclosed (including their address, if known), a description of the information disclosed, and the reason for the disclosure. We will provide the list to you at no charge, but if you make more than one request in the same year, we will charge you $5.00 for each additional request.

The Right to Correct or Update Your PHI. If you believe that there is a mistake in your PHI or that a piece of important information is missing, you have the right to request that we correct the existing information or add the missing information. You must provide the request and your reason for the request in writing. We will respond within 60 days of receiving your request. We may deny your request in writing if the PHI is (i) correct and complete, (ii) not created by us, (iii) not allowed to be disclosed, or (iv) not part of our records. Our written denial will state the reasons for the denial and explain your right to file a written statement of disagreement with the denial. If you do not file one, you have the right to request that your request and our denial be attached to all future disclosures of your PHI. If we approve your request, we will make the change to your PHI, tell you that we have done it, and tell others that need to know about the change in your PHI.

The Right to Get This Notice by E-Mail. You have the right to get a copy of this notice by e-mail. Even if you have agreed to receive notice via e-mail, you also have the right to request a paper copy of this notice.

Notification of Breach. We are required to notify you of any acquisition, access, use or disclosure of PHI not permitted under the HIPAA Privacy Rule unless Delta County Memorial Hospital or their business associates can demonstrate that there is low probability that the PHI has been compromised based on a risk assessment. The risk assessment must include consideration of the following four factors: 1. The nature and extent of the PHI involved, including the types of identifiers and the likelihood of re-identification; 2. The unauthorized person who used the PHI or to whom the disclosure was made; 3. Whether the PHI was actually acquired or viewed; 4. The extent to which the risk to the PHI has been mitigated.

HOW TO COMPLAIN ABOUT OUR PRIVACY PRACTICES

If you think that we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a complaint with the person listed in Section IV below. You also may send a written complaint to the Secretary of the Department of Health and Human Services at 200 Independence Avenue SW, Washington D.C. 20201. We will take no retaliatory action against you if you file a complaint about our privacy practices.

PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR TO COMPLAIN ABOUT OUR PRIVACY PRACTICES

If you have any questions about this notice or any complaints about our privacy practices, or would like to know how to file a complaint with the Secretary of the Department of Health and Human Services, please contact: Privacy Officer, P.O. Box 10100, Delta, Colorado 81416, 970/874-2245, privacy@deltahospital.org.

EFFECTIVE DATE OF THIS NOTICE

This notice went into effect on September 23, 2013.