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Notice of Privacy Practices

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THREE RIVERS HEALTH
NOTICE OF PRIVACY PRACTICES

Effective Date: April 14, 2003

THIS NOTICE OF PRIVACY PRACTICES DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

This Notice describes the ways we may use and disclose your “Protected Health Information.” Your Protected Health Information is personal, medical and billing information that we create or collect about you in the course of providing treatment services, and seeking payment for those services. This Notice also describes your rights and certain obligations we have regarding the use and disclosure of your Protected Health Information.
   
This Notice describes Three Rivers Health’s privacy practices and that of:






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    • Any health care professional authorized to enter information into your Hospital chart, including but not limited to active, consulting and courtesy medical staff;






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    • All departments and units of the Hospital;






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    • Any member of a volunteer group we allow to help you while you are in the Hospital;






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    • All employees, staff and other Hospital personnel; and






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    • For the purposes of this Notice, when we mention “Three Rivers Health” or the “Hospital”, we mean any and all but not limited to entities owned and operated by Three Rivers Health. All these entities, sites and locations follow the terms of this notice. In addition, these entities, sites and locations may share medical information with each other for treatment, payment or hospital operations purposes described in this Notice.
       
    We Are Required By Law To:






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    • Ensure that Protected Health Information that identifies you is kept confidential and private;






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    • Provide you with this Notice of our legal duties and privacy practices with respect to Protected Health Information about you; and






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    • Follow the terms of the Notice of Privacy Practices that is currently in effect.
       
    The Use and Disclosure of Protected Health Information:
       
    The following categories describe different ways that we use and disclose your Protected Health Information:
       
    Treatment





    We may use Protected Health Information about you to provide you with medical treatment or services. We may disclose Protected Health Information about you to doctors, nurses, technicians, medical students, or other personnel who are involved in taking care of you at the Three Rivers Health. We also may disclose Protected Health Information about you to people outside Three Rivers Health that may be involved in your medical care after you leave Three Rivers Health.
       
    Payment





    We may use and disclose Protected Health Information about you so that the treatment and services you receive at Three Rivers Health may be billed and payment collected from you, an insurance company or a third party. We may need to give your health plan information about treatment you received so your health plan will pay us or reimburse you for the treatment. We may also tell your health plan about a treatment you are going to receive in order to obtain prior approval or to determine whether your plan will cover the treatment.
       
    Health Care Operations





    We may use and disclose Protected Health Information about you for our health care operations. These uses and disclosures are necessary to run Three Rivers Health and make sure that all of our patients receive quality care. For example, we may use Protected Health Information to review our treatment and services and to evaluate the performance of our staff in caring for you.
       
    Appointment Reminders





    We may use and disclose Protected Health Information to contact you as a reminder that you have an appointment for treatment or medical care.
       
    Treatment Alternatives





    We may use and disclose Protected Health Information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
       
    Health-Related Benefits and Services





    We may use and disclose Protected Health Information to tell you about health-related benefits or services that may be of interest to you.
       
    Fundraising Activities





    Three Rivers Health is a nonprofit charitable organization. As such, we may use your Protected Health Information to contact you in an effort to raise money for Three Rivers Health and its operations. If you do not want us to contact you for fundraising efforts, you must notify Three Rivers Health in writing.
       
    Facility In-Patient Directories





    We may include certain limited information about you in Three Rivers Health directory while you are a patient at the Three Rivers Health. This information may include your name, location in the Three Rivers Health, your general condition and your religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be released to members of the clergy. You have the right to restrict or prohibit these disclosures.
       
    Individuals Involved in Your Care or Payment for Your Care





    We may disclose health information that is directly relevant to your care to individuals you wish to receive such information, including family members, relatives, close personal friends, or other persons you identify. Before we do so, we will ask you, and follow your instructions, as to whether or not to make such disclosures. If you are incapacitated, or involved in an emergency, we may use or make disclosures of your health information that we believe in our professional judgment are in your best interests, but only to the extent that such health information is directly relevant to the recipients’ involvement in your care.
       
    Research





    We may use and disclose Protected Health Information about you for research purposes. In most cases, before we do this, we will provide you with detailed information about the research and ask for your specific written authorization to use and disclose your information. The use and disclosure of Protected Health Information for research projects is subject to a special approval process. In this process, medical experts, health care administrators and other health care professionals who are not involved in the research proposal in question evaluate the proposed research project. This group of professionals may be called an Institutional Review Board or a Privacy Board. In all cases where Protected Health Information may be used for research purposes, researchers will be required to use strict measures to protect the privacy of the information.
       
    As Required By Law





    We will disclose Protected Health Information about you when required to do so by federal, state or local law.
       
    To Avert a Serious Threat to Health or Safety





    We may, consistent with applicable law and standards of ethical conduct, use and disclose Protected Health Information about you when necessary to prevent or lessen a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat and would contain the minimum information necessary.
       
    We May Use and Disclose Your Protected Health Information, Without Obtaining Your Authorization in the Following Special Situations:
       
    Organ and Tissue Donation




    If you are an organ donor, we may release your Protected Health Information to organizations that handle organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
         
    Military and Veterans




    If you are a member of the armed forces, we may release Protected Health Information about you as required by military command authorities. We may also release Protected Health Information about foreign military personnel to the appropriate foreign military authority.
         
    Workers' Compensation




    We may release Protected Health Information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.
         
    Public Health Activities





    We may disclose Protected Health Information about you for public health activities. These activities generally include the following:



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    • to prevent or control disease, injury or disability;



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    • to report births and deaths;



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    • to report child abuse or neglect;



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    • to report reactions to medications or problems with products;



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    • to notify people of recalls of products they may be using;



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    • 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;



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    • to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or if we are legally required to make the disclosure without your consent.

         
    Health Oversight Activities





    We may disclose Protected Health Information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
         
    Lawsuits and Disputes





    If you are involved in a lawsuit or a dispute, we may disclose Protected Health Information about you in response to a court or administrative order. We may also disclose Protected Health Information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, if we are required to do so by State or Federal Law.
         
    Law Enforcement





    We may release Protected Health Information if asked to do so by a law enforcement official:



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    • In response to a court order, subpoena, warrant, summons or similar process;



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    • To identify or locate a suspect, fugitive, material witness, or missing person;



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    • About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement;



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    • About a death we believe may be the result of criminal conduct;



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    • About criminal conduct at the Three Rivers Health; and



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    • 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 may release Protected Health Information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release Protected Health Information about patients to funeral directors as necessary for them to carry out their duties.
         
    National Security and Intelligence Activities





    We may release Protected Health Information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
         
    Protective Services for the President and Others





    We may disclose Protected Health Information about you 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 Protected 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.
         
    Your Individual Rights With Respect to Your Protected Health Information

    The following section of this Notice describes certain rights you have concerning your Protected Health Information. In order to exercise any of the following rights, you must make a written request and send it to the following address:
    Health Information Services
    Three Rivers Health
    701 Ss Health Parkway
    Three Rivers, MI 49093

    If we require any additional information from you, we will promptly send you any forms needed to process your request.
         
    Right to Inspect and Copy Your Protected Health Information





    You have the right to inspect and copy your Protected Health Information. Usually, this includes medical and billing records, but does not include psychotherapy notes, information compiled in reasonable anticipation of or use in a civil, criminal or administrative action or proceedings, or Protected Health Information that is subject to or exempt from the Clinical Laboratories Act of 1988. If you request a copy of the information, we may charge a fee for the costs of copying (including labor), mailing or other supplies associated with your request. We may deny your request to inspect and copy under limited circumstances. If you are denied access to Protected Health Information, you may request that the denial be reviewed.
         
    Right to Amend





    If you feel that Protected Health 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 we maintain the information. You must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:





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    • Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;


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    • Is not part of the Protected Health Information kept by or for the Three Rivers Health;


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    • Is not part of the information which you would be permitted to inspect and copy; or


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    • Is accurate and complete.

         
    Right to an Accounting of Disclosures





    You have the right to request an "accounting of disclosures." This is a list of certain disclosures we made of your Protected Health Information that was not made for treatment, to collect payment or for health care operations or that were made without your authorization.

    Your request must state start and end dates for the accounting period. The start date may not be more than six years from the date of the request or any date before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically). The first report you request within a 12-month period will be free. For additional reports in one 12-month period, we may charge you for the costs of providing the report. After receiving your request, we will notify you if there are any costs. We will provide the report to you no later than 60 days after the receipt of your request. If for some reason we are unable to provide the requested reporting, we may request an additional 30-day extension.
         
    Right to Request Restrictions





    You have the right to request a restriction or limitation on the Protected Health Information we use or disclose about you for treatment, payment or health care operations. 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.

    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 or other caregiver. You may terminate the restriction by notifying us in writing at any time. We may also terminate our agreement to the restriction by notifying you in writing at any time.
         
    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. To request confidential communications, you must make your request in writing to the person responsible for your registration. 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 of Privacy Practices





    You have the right to a paper copy of this Notice of Privacy Practices. You may ask us to give you a copy of this Notice of Privacy Practices at any time. You may obtain a copy of this Notice of Privacy Practices at our website: www.threerivershealth.org.
       
    Changes to This Notice of Privacy Practices
       
    We reserve the right to change this Notice of Privacy Practices. We reserve the right to make the revised or changed Notice of Privacy Practices effective for Protected Health Information we already have about you as well as any information we receive in the future.
       
    Complaints
       
    If you believe your privacy rights have been violated, you may file a complaint with Three Rivers Health or with the Secretary of the Department of Health and Human Services. To file a complaint with our Privacy Official, or to find out how to contact the Secretary of Health and Human Services, please contact:
       
    Privacy Officer
    Three Rivers Health
    701 S. Health Parkway
    Three Rivers, MI 49093

    All complaints must be submitted in writing. You will not be penalized for filing a complaint.
       
    Other Uses of Protected Health Information
       
    Other uses and disclosures of Protected Health Information not covered by this Notice of Privacy Practices or the laws that apply to us will be made only with your written authorization. If you authorize a use or disclosure of Protected Health Information about you, you may revoke that permission, in writing, at any time. If you revoke your authorization, we will no longer use or disclose Protected Health Information about you as described in the revoked authorization. However, we are unable to take back any disclosures we have already made prior to revocation of the authorization, and we are required by law to retain records of the care that we provided to you.

    If you have any questions about this Notice of Privacy Practices or any of our privacy practices please contact the privacy officer by calling 269-278-1145 or in writing at the following address:
       
    Privacy Officer
    Three Rivers Health
    701 S. Health Parkway
    Three Rivers, MI 49093

    Three Rivers Health
    701 S. Health Parkway
    Three Rivers, MI 49093
    Phone: (269) 278-1145
    Fax: (269) 273-9611