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THIS JOINT
NOTICE IS BEING PROVIDED TO YOU ON BEHALF OF ST. BARNABAS
HOSPITAL AND ITS MEDICAL STAFF WITH RESPECT TO SERVICES
PROVIDED AT THE HOSPITAL FACILITIES. IT DESCRIBES HOW MEDICAL
INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU
CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT
CAREFULLY.
INTRODUCTION
St. Barnabas Hospital and its medical staff
understand that your medical information is private and
confidential. Further, we are required by law to maintain
the privacy of “protected health information.” “Protected
health information” includes any individually identifiable
information that we obtain from you or others that relates to
your past, present or future physical or mental health, the
health care you have received, or payment for your health
care.
As required by law, this notice provides you
with information about your rights and our legal duties and
privacy practices with respect to the privacy of protected
health information. This notice also discusses the uses and
disclosures we will make of your protected health
information. We must comply with the provisions of this
notice as currently in effect, although we reserve the right
to change the terms of this notice from time to time and to
make the revised notice effective for all protected health
information we maintain. You can always request a written
copy of our most current privacy notice from the Hospital or
you can access it on our website at
www.stbarnabashopsital.org.
PERMITTED USES AND DISCLOSURES
We can use or disclose your protected health
information for purposes of treatment, payment and health
care operations. For each of these categories of uses
and disclosures, we have provided a description and an example
below. However, not every particular use or disclosure in
every category will be listed.
1. Treatment means
the provision, coordination or management of your health care,
including consultations between health care providers relating
to your care and referrals for health care from one health
care provider to another. For example, a doctor treating you
for a broken leg may need to know if you have diabetes because
diabetes may slow the healing process. In addition, the
doctor may need to contact a physical therapist to create the
exercise regimen appropriate for your treatment.
2. Payment means
the activities we undertake to obtain reimbursement for the
health care provided to you, including billing, collections,
claims management, determinations of eligibility and coverage
and other utilization review activities. For example, prior
to providing health care services, we may need to provide
information to your Third Party Payor about your medical
condition to determine whether the proposed course of
treatment will be covered. When we subsequently bill the
Third Party Payor for the services rendered to you, we can
provide the Third Party Payor with information regarding your
care if necessary to obtain payment. Federal or State law may
require us to obtain a written release from you prior to
disclosing certain specially protected health information for
payment purposes, and we will ask you to sign a release when
necessary under applicable law.
3. Health care
operations means the support functions of the Hospital,
related to treatment and payment, such as quality assurance
activities, case management, receiving and responding to
patient comments and complaints, physician reviews, compliance
programs, audits, business planning, development, management
and administrative activities. For example, we may use your
protected health information to evaluate the performance of
our staff when caring for you. We may also combine health
information about many patients to decide what additional
services we should offer, what services are not needed, and
whether certain new treatments are effective. We may also
disclose information to doctors, nurses, technicians, medical
students and others for review and learning purposes. In
addition, we may remove information that identifies you from
your patient information so that others can use the
de-identified information to study health care and health care
delivery without learning who you are.
OTHER USES AND DISCLOSURES OF PROTECTED
HEALTH INFORMATION
In addition to using and disclosing your
information for treatment, payment and health care operations,
we may use your protected health information in the following
ways:
1. We may contact you to provide appointment
reminders for treatment or medical care.
2. We may contact you to tell you about or
recommend possible treatment alternatives or other
health-related benefits and services that may be of interest
to you.
3. We may disclose to your family or friends or
any other individual identified by you protected health
information directly related to such person’s involvement in
your care or the payment for your care. We may use or
disclose your protected health information to notify, or
assist in the notification of, a family member, a personal
representative, or another person responsible for your care,
of your location, general condition or death. If you are
present or otherwise available, we will give you an
opportunity to object to these disclosures, and we will not
make these disclosures if you object. If you are not present
or otherwise available, we will determine whether a disclosure
to your family or friends is in your best interest, taking
into account the circumstances and based upon our professional
judgment.
4. We may include certain limited information
about you in the hospital directory while you are a patient at
the Hospital. This information may include your name,
location in the Hospital, your general condition (e.g., fair,
stable, etc.) and your religious affiliation. The directory
information, except for your religious affiliation, may be
released to people who ask for you by name. Your religious
affiliation may be given to a member of the clergy, such as a
priest or rabbi, even if they do not ask for you by name.
This will allow your family, friends, and clergy to visit you
in the Hospital and generally know how you are doing. You
will have the opportunity to request that your information not
be listed in the directory.
5. When permitted by law, we may coordinate our
uses and disclosures of protected health information with
public or private entities authorized by law or by charter to
assist in disaster relief efforts.
6. We will allow your family and friends to act
on your behalf to pick-up filled prescriptions, medical
supplies, X-rays, and similar forms of protected health
information, when we determine, in our professional judgment,
that it is in your best interest to make such disclosures.
7. Subject to applicable law, we may make
incidental uses and disclosures of protected health
information. Incidental uses and disclosures are by-products
of otherwise permitted uses or disclosures which are limited
in nature and cannot be reasonably prevented.
8. We may contact you as part of our
fund-raising and marketing efforts as permitted by applicable
law.
9. We may use or disclose your protected health
information for research purposes, subject to the requirements
of applicable law. For example, a research project may
involve comparisons of the health and recovery of all patients
who received a particular medication. All research projects
are subject to a special approval process which balances
research needs with a patient’s need for privacy. When
required, we will obtain a written authorization from you
prior to using your health information for research.
10. We will use or disclose protected health
information about you when required to do so by applicable
law.
Note: In
accordance with applicable law, we may disclose your protected
health information to your employer if we are retained to
conduct an evaluation relating to medical surveillance of your
workplace or to evaluate whether you have a work-related
illness or injury. You will be notified of these disclosures
by your employer or the Hospital is required by applicable
law.
SPECIAL SITUATIONS
Subject to the requirements of applicable law,
we will make the following uses and disclosures of your
protected health information:
1. Organ and Tissue Donation. If you
are an organ donor, we may release health information to
organizations that handle organ procurement or organ, eye or
tissue transplantation or to an organ donation bank, as
necessary to facilitate organ or tissue donation and
transplantation.
2. Military and Veterans. If you are a
member of the Armed Forces, we may release health information
about you as required by military command authorities. We may
also release health information about foreign military
personnel to the appropriate foreign military authority.
3. Worker’s Compensation. We may
release health information about you for programs that provide
benefits for work-related injuries or illnesses.
4. Public Health Activities. We may
disclose health information about you for public health
activities, including disclosures:
(a) to prevent or control disease, injury or
disability;
(b) to report births and deaths;
(c) to report child abuse or neglect;
(d) to persons subject to the jurisdiction of
the Food and Drug Administration (FDA) for activities related
to the quality, safety, or effectiveness of FDA-regulated
products or services and to report reactions to medications or
problems with products;
(e) 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;
(f) to notify the appropriate government
authority if we believe that an adult patient has been the
victim of abuse, neglect or domestic violence. We will only
make this disclosure if the patient agrees or when required or
authorized by law.
5. Health Oversight Activities. We may
disclose health information to Federal or State agencies that
oversee our activities. These activities are necessary for
the government to monitor the health care system, government
benefit programs, and compliance with civil rights laws or
regulatory program standards.
6. Lawsuits and Disputes. If you are
involved in a lawsuit or a dispute, we may disclose health
information about you in response to a court or administrative
order. We may also disclose health information about you in
response to a subpoena, discovery request, or other lawful
process by someone else involved in the dispute, but only if
the Hospital is given assurances that efforts have been made
by the person making the request to tell you about the request
or to obtain an order protecting the information requested.
7. Law Enforcement. We may release
health information if asked to do so by a law enforcement
official:
(a) In response to a court order, subpoena,
warrant, summons or similar process;
(b) To identify or locate a suspect, fugitive,
material witness, or missing person;
(c) About the victim of a crime under certain
limited circumstances;
(d) About a death we believe may be the result
of criminal conduct;
(e) About criminal conduct on our premises;
and
(f) In emergency circumstances, to report a
crime, the location of the crime or the victims, or the
identity, description or location of the person who committed
the crime.
8. Coroners, Medical Examiners and Funeral
Directors. We may release health information to a coroner
or medical examiner. Such disclosures may be necessary, for
example, to identify a deceased person or determine the cause
of death. We may also release health information about
patients to funeral directors as necessary to carry out their
duties.
9. National Security and Intelligence
Activities. We may release health information about you
to authorized Federal officials for intelligence,
counterintelligence, or other national security activities
authorized by law.
10. Protective Services for the President
and Others. We may disclose health information about you
to authorized Federal officials so they may provide protection
to the President or other authorized persons or foreign heads
of state or may conduct special investigations.
11. Inmates. If you are an inmate of a
correctional institution or under the custody of a law
enforcement official, we may release health information about
you to the correctional institution or law enforcement
official. This release would be necessary (1) for the
institution to provide you with health care; (2) to protect
your health and safety or the health and safety of others; or
(3) for the safety and security of the correctional
institution.
12. Serious Threats. As permitted by
applicable law and standards of ethical conduct, we may use
and disclose protected health information if we, in good
faith, believe that the use or disclosure is necessary to
prevent or lessen a serious and imminent threat to the health
or safety of a person or the public or is necessary for law
enforcement authorities to identify or apprehend an
individual.
Note:
HIV-related information, genetic information, alcohol and/or
substance abuse records, mental health records and other
specially protected health information may enjoy certain
special confidentiality protections under applicable State and
Federal law. Any disclosures of these types of records will
be subject to these special protections.
OTHER USES OF YOUR HEALTH INFORMATION
Other uses and disclosures of protected health
information not covered by this notice or the laws that apply
to us will be made only with your permission in a written
authorization. You have the right to revoke that
authorization at any time, provided that the revocation is in
writing, except to the extent that we already have taken
action in reliance on your authorization.
YOUR RIGHTS
1. You have the right to request restrictions
on our uses and disclosures of protected health information
for treatment, payment and health care operations. However,
we are not required to agree to your request. To request a
restriction, you must make your request in writing to
Department of Medical Records.
2. You have the right to reasonably request to
receive confidential communications of protected health
information by alternative means or at alternative locations.
To make such a request, you must submit your request in
writing to Department of Medical Records.
3. You have the right to inspect and copy the
protected health information contained in your medical and
billing records and in any other Hospital records used by us
to make decisions about you, except:
(a) for psychotherapy notes, which are notes
that have been recorded by a mental health professional
documenting or analyzing the contents of conversations during
a private counseling session or a group, joint or family
counseling session and that have been separated from
the rest of your medical record;
(b) for information compiled in reasonable
anticipation of, or for use in, a civil, criminal, or
administrative action or proceeding;
(c) for protected health information
involving laboratory tests when your access is restricted by
law;
(d) if you are a prison inmate, obtaining a
copy of your information may be restricted if it would
jeopardize your health, safety, security, custody, or
rehabilitation or that of other inmates, or the safety of any
officer, employee, or other person at the correctional
institution or person responsible for transporting you;
(e) if we obtained or created protected
health information as part of a research study, your access to
the health information may be restricted for as long as the
research is in progress, provided that you agreed to the
temporary denial of access when consenting to participate in
the research;
(f) for protected health information
contained in records kept by a Federal agency or contractor
when your access is restricted by law; and
(g) for protected health information obtained
from someone other than us under a promise of confidentiality
when the access requested would be reasonably likely to reveal
the source of the information.
In order to inspect and copy your health
information, you must submit your request in writing to
Department of Medical Records at our Hospital. If you request
a copy of your health information, we may charge you a fee for
the costs of copying and mailing your records, as well as
other costs associated with your request.
We may also deny a request for access to
protected health information if:
(i) a licensed health care professional has
determined, in the exercise of professional judgment, that the
access requested is reasonably likely to endanger your life or
physical safety or that of another person;
(ii) the protected health information makes
reference to another person (unless such other person is a
health care provider) and a licensed health care professional
has determined, in the exercise of professional judgment, that
the access requested is reasonably likely to cause substantial
harm to such other person; or
(iii) the request for access is made by the
individual’s personal representative and a licensed health
care professional has determined, in the exercise of
professional judgment, that the provision of access to such
personal representative is reasonably likely to cause
substantial harm to you or another person.
If we deny a request for access for any of the
three reasons described above, then you have the right to have
our denial reviewed in accordance with the requirements of
applicable law.
4. You have the right to request an amendment
to your protected health information, but we may deny your
request for amendment, if we determine that the protected
health information or record that is the subject of the
request:
(a) was not created by us, unless you provide
a reasonable basis to believe that the originator of protected
health information is no longer available to act on the
requested amendment;
(b) is not part of your medical or billing
records or other records used to make decisions about you;
(c) is not available for inspection as set
forth above; or
(d) is accurate and complete.
In any event, any agreed upon amendment will be
included as an addition to, and not a replacement of, already
existing records. In order to request an amendment to your
health information, you must submit your request in writing to
Department of Medical Records at our Hospital, along with a
description of the reason for your request.
5. You have the right to receive an accounting
of disclosures of protected health information made by us to
individuals or entities other than to you for the six prior
years prior to your request, except for disclosures:
(a) to carry out treatment, payment and
health care operations as provided above;
(b) incident to a use or disclosure otherwise
permitted or required by applicable law;
(c) pursuant to a written authorization
obtained from you;
(d) for the Hospital’s directory or to persons
involved in your care or for other notification purposes as
provided by law;
(e) for national security or intelligence
purposes as provided by law;
(f) to correctional institutions or law
enforcement officials as provided by law;
(g) as part of a limited data set as provided
by law; or
(h) that occurred prior to April 14, 2003.
To request an accounting of disclosures of your
health information, you must submit your request in writing to
Department of Medical Records at our Hospital. Your request
must state a specific time period for the accounting (e.g.,
the past three months). The first accounting you request
within a twelve (12) month period will be free. For
additional accountings, we may charge you for the costs of
providing the list. We will notify you of the costs involved,
and you may choose to withdraw or modify your request at that
time before any costs are incurred.
COMPLAINTS
If you believe that your privacy rights have
been violated, you should immediately contact the HIPAA
Privacy Officer at the Hospital at (718) 960-5577. We
will not take action against you for filing a complaint. You
also may file a complaint with the Secretary of Health and
Human Services.
CONTACT PERSON
If you have any questions or would like further
information about this notice, please contact HIPAA
Information Officer, Department of Medical Records, (718)
960-6255.
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