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.
If you have questions about this notice, please contact Harrison's Privacy Officer at 360-792-6603.
ABOUT THIS NOTICE
It covers services provided to you by Harrison Hospital, Harrison Home Health, and the members of Harrison's medical staff. It applies to your medical record of services provided by the hospital, whether by hospital employees, agents or contractors, or by independent members of our medical staff.
OUR COMMITMENT TO PROTECT YOUR MEDICAL INFORMATION
We understand that your medical information is personal, and we are committed to protecting this information. The record we create of the care and services you receive at the hospital is necessary to ensure quality care and to comply with certain legal requirements.
This notice applies to all of the records of your care generated by the hospital, whether by hospital personnel or your personal doctor. (Your personal doctor may have different policies or notices regarding the use and disclosure of your medical information created in the doctor's office or clinic; see them for guidelines.)
As a hospital, the law requires us to:
- Insure that medical information that identifies you is kept private;
- Provide you with notice of our legal duties and privacy practices regarding your medical information; and
- Follow the terms of this notice.
YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION
You have the following rights regarding your medical information maintained at Harrison:
HOSPITAL'S PUBLIC LIST OF CURRENT PATIENTS (HOSPITAL DIRECTORY). We may include certain limited information about you in the hospital's public list of current patients while you are at the hospital. This information will only include your name, location in the hospital, a one-word description of your general condition (i.e., good, fair, serious, critical) and your religious affiliation. This information, except for your religious affiliation, may also be released to people who ask for you by name. This information may be given to a member of the clergy, such as a pastor, priest or rabbi, even if that person doesn't ask for you by name. This is so family, friends and the clergy can visit you in the hospital and generally know how you are doing. You have the right to be excluded from the hospital's public list of current patients. If you choose to exercise this right, the hospital will not acknowledge that you are a patient here to any callers and visitors, including friends and family members. If you wish to exercise this right, please tell the registration specialist or the nurse or other practitioner caring for you.
INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE. We may release your medical information to a friend or family member you have identified as involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family or friends your condition and that you are in the hospital if you are listed in the hospital's public list of current patients (hospital directory).
In addition, we may disclose your medical information to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location. You have the right to not be included in the hospital's public list of current patients. If you choose to exercise this right, the hospital will not acknowledge you are a patient here to any callers and visitors, including friends and family members. If you wish to exercise this right, please tell your registration specialist or the nurse or other practitioner caring for you.
MEDIA REQUESTS FOR INFORMATION. We may respond to media calls about you with a one-word condition report (good, fair, serious, critical) while you are an inpatient, outpatient, or patient in our Emergency Department, unless you have been excluded from the hospital's public list of current patients. Otherwise, information about your condition will be released only if the inquiry specifically contains your name.
RIGHT TO INSPECT AND COPY. You have the right to inspect and obtain copies of your medical and billing information. To do so, you must submit your request in writing to Harrison's Medical Records Department. We are permitted by law to charge fees for the costs of copying and mailing or other supplies associated with your request. To obtain copies of your billing information, please submit your request to Harrison's Patient Accounts Department.
Your request to inspect and obtain copies may be denied in very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another physician chosen by the hospital will review your request and the denial. The physician conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
RIGHT TO AMEND. If you feel that your medical information is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by the hospital. Your request must be submitted to Harrison's Medical Records Department. We may deny your request to amend information that:
- Was not created by us, unless we hold medical information created by another who is no longer available to make the amendment;
- Is not part of the medical information kept by or for the hospital;
- Is not part of the information which you would be permitted to inspect and copy.
RIGHT TO AN ACCOUNTING OF DISCLOSURES. You have the right to request an accounting of disclosures. This is a list of the disclosures we made of your medical information. You must submit your request in writing to Harrison's Medical Records Department. Your request must state a time period of care that took place not more than six years prior and not before April 14, 2003. The first list you request within a 12-month period will be free. For additional lists, we will charge you for the costs of providing the list. We will notify you of the cost involved, and you may choose to withdraw or modify your request at that time before any costs are incurred.
RIGHT TO REQUEST RESTRICTIONS. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or administrative functions. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, such as a family member or friend. For example, you could ask that we not use or disclose information about a procedure that you had undergone. We are not required to agree to your request. If we do agree, we will comply with your request, unless the information is necessary to provide you with emergency treatment.
To request restrictions, you must make your request verbally or in writing to Harrison's Medical Records Department or to the healthcare provider treating you at the hospital. In your request, you must tell us: (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, (for example, disclosures to your spouse).
RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. You must make your request to the employee who is registering you as a patient or to your nurse or other healthcare professional. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
RIGHT TO A PAPER COPY OF THIS NOTICE. A paper copy of this notice will be provided at the time of your first contact with Harrison. You may ask us to give you a copy of this notice at any other time as well. If our first contact with you is by telephone, we will provide you a copy of the notice when you first come in to Harrison for treatment. You may also print a copy of this notice from our website: www.harrisonhospital.org. Or you may pick up a copy at any Harrison Registration Department office or from any Registration staff member, or contact Harrison's privacy officer at 360-792-6603.
How we may use and disclose medical information about you
The following describes and gives examples of ways we use and disclose medical information.
FOR TREATMENT. We use your medical information to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, health care students, or other hospital personnel who are involved in taking care of you at the hospital.
For example, a doctor treating you for a broken leg may need to know if you have diabetes, because this disease may slow the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so that he or she can arrange for appropriate meals. Different hospital departments also may share your medical information in order to coordinate different elements of your care, such as prescriptions, lab work and X-rays. We also may disclose your medical information to those people outside the hospital who may be involved in your medical care after you leave the hospital, such as family members, clergy, nursing homes or others who provide services as part of your care. We will only disclose your medical information with those who have a need to know.
FOR PAYMENT. We may use and disclose your medical information so that the treatment and services you receive at the hospital may be billed to and payment may be collected from you, an insurance company, government payers, or a third party. For example, we may need to give your health plan information about surgery you received at the hospital so your health plan will pay us or reimburse you for the surgery. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the cost of treatment.
FOR HOSPITAL FUNCTIONS AND OPERATIONS. We use and disclose your medical information for hospital administrative functions. These uses and disclosures are necessary to run the hospital and make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical information about many hospital patients to decide what additional services the hospital should offer, what services are not needed, and whether certain new treatments are effective.
We may also disclose information to doctors, nurses, technicians, healthcare students, and other hospital personnel for review and educational purposes. We may also combine the medical information we have with medical information from other hospitals to compare how we are doing and see where we can make improvements in our care and services. We may remove information that identifies you from this medical information so others may use it to study healthcare and healthcare delivery without learning who the specific patients are.
APPOINTMENT REMINDERS. We may use and disclose your medical information to contact you as a reminder that you have an appointment for treatment or medical care at the hospital. Reminders by mail will arrive in a sealed envelope addressed specifically to you. We will not leave phone messages that others may overhear.
TREATMENT ALTERNATIVES. We may use and disclose your medical information to recommend possible treatment options or alternatives that may be of interest to you.
HEALTH-RELATED BENEFITS AND SERVICES. We may use and disclose your medical information to tell you about health-related benefits or services that may be of interest.
FUNDRAISING ACTIVITIES. We may disclose nonmedical contact information such as your name, address and phone number and the dates you received treatment or services at the hospital to the Harrison Hospital Foundation, a nonprofit foundation related to the hospital. The Foundation may contact you in raising money for the hospital. If you do not want the Harrison Hospital Foundation to contact you for fundraising efforts, you must notify Harrison's privacy officer in writing at Harrison Hospital, 2520 Cherry Avenue, Bremerton, WA. 98310.
RESEARCH. We may use and disclose your medical information without identifying your name for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another for the same condition. All research projects, however, are subject to a special Harrison Hospital approval process. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with patients' need for privacy of their medical information. Before we use or disclose medical information for research, the project will have been approved through this process. We may, however, disclose medical information about you to people preparing to conduct a research project, for example, to help them look for patients with specific medical needs, so long as the medical information they review does not leave the hospital. If your identity is necessary to these projects, we will seek your permission.
TO AVERT A SERIOUS THREAT TO HEALTH OR SAFETY. When necessary to prevent a serious threat to your health and safety or to the health and safety of another person or the public, we may use and disclose your medical information. Any disclosure, however, would be solely to assist someone-such as law enforcement-in helping prevent the threat. AS REQUIRED BY LAW. WE WILL DISCLOSE YOUR MEDICAL INFORMATION WHEN REQUIRED TO DO SO BY FEDERAL, STATE OR LOCAL LAW AS IN THE SPECIAL SITUATIONS BELOW.
ORGAN AND TISSUE DONATION. We are required to release your medical information to organizations that oversee organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary, to facilitate organ or tissue donation and transplantation in the event of death.
MILITARY AND VETERANS. If you are or have been a member of the armed forces, we may release your medical information as required by military command authority. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
WORKERS' COMPENSATION. We may release your medical information for workers' compensation or similar programs as it relates to your benefits for work-related injuries or illness.
PUBLIC HEALTH. We may disclose your medical information for public health activities. These activities generally include, but are not limited to the following:
- To prevent or control disease, injury or disability;
- To report births and deaths;
- To report child or adult abuse or neglect;
- To report reactions to medications or problems with healthcare products;
- To notify people of recalls of products they may be using;
- 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.
HEALTH OVERSIGHT ACTIVITIES. We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities may include audits, investigations, inspections, and licensure. Such activities are necessary for the government to monitor the healthcare system, government programs, and compliance with civil rights laws.
LAWSUITS AND DISPUTES. If you are involved in a legal action or dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
LAW ENFORCEMENT. We may release medical information to a law enforcement official including but not limited to:
- In response to a court order, subpoena, warrant, summons or similar process;
- To identify or locate a suspect, fugitive, material witness, or missing person;
- About the victim of a crime if, under certain limited circumstances, we are unable to obtain that person's permission;
- About a death we suspect may be the result of criminal conduct;
- To identify a victim of a gunshot wound;
- About criminal conduct at the hospital;
- In emergency circumstances to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.
CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS. We will release your medical information to a coroner or medical examiner in the case of your death. This may be necessary, for example, to identify you or determine the cause of death. We may also release medical information about patients of the hospital to funeral directors as necessary to carry out their duties.
NATIONAL SECURITY AND INTELLIGENCE ACTIVITIES. We may release your medical information to authorized federal officials for intelligence, counterintelligence, and other national security activities as authorized by law.
PROTECTIVE SERVICES FOR THE PRESIDENT AND OTHERS. We may disclose your medical information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state, or conduct special investigations.
INMATES. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary: (1) for the institution to provide you with healthcare; (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.
Changes of this notice
We reserve the right to change this notice. We reserve the right to make the revised notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the hospital. The notice will contain the effective date on the first page. In addition, each time you register for treatment or healthcare services provided by Harrison Hospital, we will offer you a copy of the current notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with the hospital or with the Health and Human Services Office for Civil Rights. To file a complaint with the hospital, contact Harrison's patient representative in writing: Harrison Hospital, 2520 Cherry Avenue, Bremerton, WA 98310; or by phone at 360-792-6535. Your complaint will be thoroughly investigated, and you will be notified in writing the results of our investigation within 30 days of our receipt of your complaint. For your convenience, we have included at the bottom of this page information on how to file a privacy complaint with the Health and Human Service's Office for Civil Rights.
Other uses of medical information
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose your medical information, you may revoke that permission in writing at any time. If you revoke your permission, we will no longer use or disclose your medical information for the reasons covered by your written authorization. We are unable to withdraw disclosures that were already made by us with your permission.
HOW TO FILE A PRIVACY COMPLAINT OR GET MORE INFORMATION ABOUT YOUR PRIVACY RIGHTS
If you wish to file a privacy complaint with the Health & Human Services Office for Civil Rights (OCR), it must:
- Be in writing, either on paper or electronically;
- Name the person or organization that is the subject of the complaint and describe the acts or omissions you believe violated your right to privacy; and
- Be filed within 180 days of when you knew or should have known that the act or omission occurred (unless you show good cause why the Secretary of Health & Human Services should waive the time limit).
Send your inquiry or complaint to either the OCR Regional Office of the state in which the person or organization is located, or to the OCR Headquarters at the addresses below:
OFFICE FOR CIVIL RIGHTS HEADQUARTERS
Director, Office for Civil Rights
U.S. Dept. of Health and Human Services
200 Independence Ave. SW., Rm. 509F HHH Bldg.
Washington, DC 20201
REGION X SEATTLE (AK, ID, OR, WA)
2201 Sixth Ave., Suite 900
Seattle, WA 98121-1831
206-615-2287/FAX 206-615-2297/ TDD 206-615-2296