Effective Date: April 14, 2003
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.
Each time you visit a hospital, physician, or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, and treatment, a plan for future care or treatment, and billing-related information. This notice applies to all of the records of your care generated by the hospital, whether made by hospital personnel, agents of the hospital, or your doctors. Your personal doctor may have different policies or notices regarding the doctor's use and disclosure of medical information created in the doctor's office or clinic.
If you have any questions about this notice, please contact GMC Hospital Privacy Officer by dialing the main hospital number at 626-573-2222.
All employees, staff, volunteers, other hospital personnel and members of our medical staff are required by law to maintain the privacy of your health information and provide you a description of our privacy practices. We will abide by the terms of this joint notice.
USES AND DISCLOSURES
How we may use and disclose Medical Information about you
The following categories give examples of the way we use and disclose (or release) medical information:
We may use medical information about you to provide you treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical 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 diabetes may slow the healing process. Different departments of the hospital also may share medical information about you in order to coordinate the different things you may need, such as prescriptions, lab work, meals, and x-rays.
We may also provide your physician or a subsequent healthcare provider with copies of various reports that should assist him or her in treating you once you're discharged from the hospital.
We may use and disclose medical information about your treatment and services to bill and collect payment from you, your insurance company or third party payer. For example, we may need to give your insurance company information about your surgery so they will pay us or reimburse you for the treatment. We may also tell your health plan about treatment you are going to receive to determine whether your plan will cover it.
FOR HEALTH CARE OPERATIONS:
Members of the medical staff and/or quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it.
The results will then be used to continually improve the quality of care for all patients we serve. For example, we may combine medical information about many patients to evaluate the need for new services or treatment. We may disclose information to doctors, nurses, and healthcare students for educational purposes. And we may combine medical information we have with that of other hospitals to determine where we can make improvements. We may remove information that identifies you from this set of medical information to protect your privacy.
We may also use and disclose medical information:
¨ To remind you that you have an appointment for medical
¨ To assess your satisfaction with our services;
¨ To inform you about possible treatment alternatives;
¨ To inform you about health-related benefits or
¨ For conducting training programs or reviewing
competence of health care professionals;
¨ To avert a serious threat or safety.
There are some services provided in our organization through contracts with business associates. Examples include a copy service we use when making copies of your health record and transcription services we contract with. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we've asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.
We may include certain limited information about you in the hospital directory while you are a patient at the hospital. The information may include your name, location in the hospital, your general condition (e.g., good, fair, etc.) and your religious affiliation. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name. If you would like to opt out of being in the hospital directory, please request the Opt Out form from the Admitting Representative or Privacy Officer. This information is released so your family, friends and clergy can visit you in the hospital and generally know how you are doing.
INDIVIDUALS INVOLVED IN YOUR CASE OR PAYMENT FOR YOUR CARE:
We may release medical information about you to a friend or family member who is involved in your medical care or who helps pay for your care. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition.
We may disclose information to researchers when an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information has approved their research.
We may communicate with you via newsletters, mailings or other means regarding statement options, health related information, disease-management programs, wellness programs, or other community based initiatives or activities our facility is participating in.
ORGANIZED HEALTH CARE ARRANGEMENT:
Garfield Medical Center and its medical staff members have organized and are presenting you this document as a joint notice. Information will be shared as necessary to carry out treatment payment and health care operations. Physicians and caregivers may have access to protected health information in their offices to assist in reviewing past treatment as it may affect treatment at the time.
AFFILIATED COVER ENTITY:
Protected health information will be made available to hospital personnel as necessary to carry out treatment, payment and health care operations. Caregivers at other facilities may have access to protected health information at their locations to assist in reviewing past treatment information as it may affect treatment at this time.
As Required by Law, we may also disclose health information to the following types of entities, including but not limited to:
¨ Food and Drug Administration
¨ Public Health or Legal Authorities charged with
preventing or controlling disease, injury or
¨ Correctional Institutions (if you are in custody of
the correctional institution or law enforcement
¨ Workers’ Compensation Agents
¨ Organ and Tissue Donation Organizations
¨ Military Command Authorities
¨ Health Oversight Agencies
¨ Funeral Directors, Coroners and Medical Examiners
¨ National Security and Intelligence Agencies
¨ Protective Services for the President and Others
LAW ENFORCEMENT / LEGAL PROCEEDINGS:
We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena or court order.
STATE SPECIFIC REQUIREMENTS:
Many states have requirements for reporting including population-based activities relating to improving health or reducing health care costs. Some states have separate privacy laws that may apply additional legal requirements. If the State privacy laws are more stringent than Federal privacy laws, the State law preempts the Federal law.
YOUR HEALTH INFORMATION RIGHTS:
Although your health record is the physical property of the healthcare practitioner or facility that compiled it, you have the right to:
INSPECT AND COPY:
You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed in some situations. Another licensed health care professional chosen by the hospital will review your request and the denial. The person conducting the review will not be person who denied your request. We will comply with the outcome of the review.
If you feel that medical information we have about you 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 or for the hospital. We may deny your request for an amendment and if this occurs, you will be notified of the reason for the denial.
AN ACCOUNTING OF DISCLOSURES:
You have the right to request an accounting of disclosures. This is a list of certain disclosures we make of your medical information for purposes other than treatment, payment or health care operations. The first list you request within a 12-month period will be free. For additional lists, we may 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.
You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. 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, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had. We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
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 may ask that we contact you at work or by U.S. Mail. The Hospital will grant requests for confidential communications at alternative locations and/or via alternative means only if the request is submitted in writing and the written request includes a mailing address where you will receive bills for services rendered by the facility and related correspondence regarding payment for services. Please realize, we reserve the right to contact you by other means and at other locations if you fail to respond to any communication from us that requires a response. We will notify you in accordance with your original request prior to attempting to contact you by other means or at another location.
A PAPER COPY OF THIS NOTICE:
You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time.
To exercise any of your rights, please obtain the required forms from the Privacy Officer and submit your request in writing.
CHANGES TO THIS NOTICE
We reserve the right to change this notice and the revised notice will be effective for information we already have about you as well as any information we receive in the future. The current notice will be posted in the hospital and include the effective date. In addition, each time you register at or are admitted to the hospital for treatment or health care services as an inpatient or outpatient, 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 by contacting the main number and asking for the Privacy Officer or with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing.
To file a complaint with the Hospital, contact:
Garfield Medical Center
525 North Garfield Avenue Monterey Park, CA 91754
Telephone Number:(626) 307-2108.
Or, if you are dissatisfied with the manner in which our Hospital representative has handled your complaint, you may submit a formal complaint to:
U.S. Department of Health and Human Services (DHHS)
Office of Civil Rights
50 United Nations Plaza, Room 322
San Francisco, CA 94103
You will not be penalized for filing a complaint.
OTHER USES OF THIS 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 medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.