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Joint 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.
• Click here for a printer
friendly verson of this notice
• Click here to print Authorization
to Disclose Medical Information
JOINT 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.
Effective Date: March 15, 2006
If you have any questions about
this Notice, please contact our Privacy Officer at 369-4234.
Our Legal Duty to Protect Your
Medical Information
Federal law has determined that your medical information
is confidential and requires reasonable protections.
We must maintain the privacy of your medical information,
provide you with notice of our legal duties and privacy
practices, and abide by the terms of this Notice.
This Notice describes the types of uses and disclosures
that we may make and gives you some examples. In addition,
we may make other uses and disclosures which occur as
a by-product of the uses and disclosures described in
this Notice.
We reserve the right to change our policies, practices,
and this Notice at any time. We reserve the right to
make the revised Notice effective for all medical information
we already have about you as well as any information
we create or receive in the future. We will post a copy
of the current Notice at Angel Medical Center and Angel
Urgent Care and include the effective date. The current
Notice will also be posted on our web site, www.angelmed.com.
Who Will Follow This Notice
The terms of this Notice of Privacy Practices apply
to Angel Medical Center and Angel Urgent Care and professionals
providing care at these sites. Members of our independent
medical staff and Angel Home Health and Hospice will
also abide by the terms of this Notice with respect
to information created or received as part of its participation
in an organized health care arrangement. Medical information
may be shared as necessary for treatment, payment, or
health care operations. This Notice serves as a Notice
of Privacy Practices for our medical staff while they
are providing services within Angel Medical Center or
Angel Urgent Care.
How We May Use and Disclose
Your Medical Information
It is impossible to list every use or
disclosure but the following categories provide examples
of the way we use and disclose your medical information.
Uses and Disclosures Relating to Treatment,
Payment, and Health Care Operations
In order to efficiently coordinate the treatment, payment,
and health care operations aspects of your care, we
may disclose your protected health information in any
format that we determine is secure and expeditious,
e.g. verbally, electronically, via fax, and/or in paper
form.
Treatment: We may use and disclose
your medical information to doctors, nurses, health
care students, or other personnel involved in your care.
Your information may be shared among members of your
treatment team. In addition, we may use or disclose
your medical information for the treatment activities
of another health care provider.
If you are an obstetrical patient, medical information
about you is collected in the baby’s record and
information about the baby is included in your record.
If records are disclosed on the baby, some of your medical
information may be disclosed and if your records are
disclosed they may contain some of the baby’s
information.
Payment: We may use and disclose your
medical information in order to bill and collect payment
for your health care services. We may use and disclose
information to your insurance company or health plan
in order to receive payment for services provided to
you or obtain approval of payment before services are
provided. In the event that payment is not made, we
may also provide limited information to collection agencies,
attorneys, credit reporting agencies and other agencies
as necessary to collect payment for services rendered.
We may use or disclose your medical information for
the payment activities of another health care provider
or health plan.
Health Care Operations: We may use
and disclose your medical information when performing
business activities, which we call “health care
operations.” These operations allow us to improve
the quality of care we provide and evaluate how we can
more efficient and safe. For example: Members of the
medical staff, quality improvement teams, or medical
record review teams may use your information to assess
your care and outcomes in your case. There are some
services provided in our organization through contracts
with business associates. Examples may include transcription
and microfilm vendors. When these services are contracted,
we may disclose your information to our business associate
so they can perform the job we’ve asked them to
do.
We may also use and disclose medical information:
• To remind you that you have an appointment
for medical care and to contact you following a procedure
or hospitalization to check on your recovery for follow-up
purposes
• To assess your satisfaction with our services
• To inform you about possible treatment options
or alternatives
• To tell you about health-related benefits or
services
• To contact you for fund-raising efforts
• Incidental to another use or disclosure of medical
information permitted by law
• As part of a limited data set where certain
identifying information has been removed; for research,
public health, or health care operations purposes. Any
recipient of the limited data set must agree to appropriately
safeguard your information.
Uses and Disclosures with an
Opportunity to Object
In the following situations, we may use and disclose
your medical information if you do not object. If there
is an emergency situation and you cannot be provided
an opportunity to object, disclosure may be made if
it is consistent with any prior expressed wishes and
is determined to be in your best interests.
Patient Directory: We may include
certain limited information about you to create an entry
in our hospital directory while you are a patient. This
information may include your name, location in the facility,
and general condition. This information will be disclosed
to callers or visitors who ask for you by name. This
is so your family and friends can visit you in the hospital
or can call to find out how you are doing. If you do
not want to be included in our facility directory, you
must inform Registration personnel of your objection.
Individuals Involved In Your Care or Payment
for Your Care: Unless you object, we may use
or disclose medical information about you to a friend
or family member who is involved in your medical care
or who helps pay for your care. We may use and disclose
your information to notify a family member or other
person, your location and general condition. In addition,
we may disclose medical information about you to an
agency assisting in a disaster relief effort so your
family can be notified of your condition and location.
Other Uses and Disclosures Not
Requiring Your Consent or Authorization
Required By Law: We will use and disclose
your medical information when required by law.
Public Health Activities: We may use
and disclose your medical information for public health
activities and purposes to a public health authority.
Public health activities may include, but are not limited
to the following:
• to prevent or control disease, injury or disability,
including communicable diseases and conditions
• to report reactions to medications or problems
with products
• to report births and deaths
• to report suspected child abuse and neglect
• to collect and report information for activities
related to the quality, safety, or effectiveness of
a product regulated by the Food and Drug Administration
• to provide reports to an employer regarding
a medical surveillance evaluation of the workplace or
an evaluation related to a work-related illness or injury
Abuse, Neglect or Domestic Violence:
We may use and disclose medical information to report
suspected abuse, neglect, or domestic violence to an
authority authorized by law to receive these reports.
This includes reporting to the Department of Social
Services that a disabled adult may be in need of protective
services.
Health Oversight Activities: We may use and
disclose your medical information to health oversight
agencies for activities authorized by law and may include
audits, investigations, inspections, and licensure.
Legal Proceedings: We may use and disclose
your medical information in the course of a judicial
or administrative proceeding, in response to an order
of the court or administrative tribunal, and in certain
conditions in response to a subpoena or other lawful
process.
Law Enforcement: We may use and disclose
your medical information to law enforcement officials
in certain circumstances.
• To report certain wounds, injuries and illnesses
as required by law
• To comply with a court order or other legal
request for information
• To help identify or locate a criminal, missing
person, crime suspect, or a material witness in a criminal
case
• To help identify the victim of a crime
• To help authorities investigate a death that
may be the result of a crime
• To help authorities investigate a crime that
has occurred at this facility
• To report a crime or the location of a crime,
criminal, suspect or crime victim
Relating to Decedents: We may use
and disclose medical information relating to an individual’s
death to coroners, medical examiners and funeral directors
to enable these individuals to perform their duties.
We may also use and disclose information to facilitate
organ or tissue donation and transplants.
Research: We may disclose information
to researchers when an institutional review board has
reviewed the research proposal, established protocols
to ensure the privacy of your medical information, and
approved the research.
Public Safety: We may use and disclose
your medical information when necessary to prevent or
lessen a serious threat to your health or safety or
the health and safety of others.
Specialized Government Functions:
We may use and disclose your medical information for
military and veteran’s activities, to national
security and intelligence agencies, and to government
protective services personnel. If you are an inmate
of a correctional institution or in the custody of a
law enforcement official, we may use and disclose your
medical information to the correctional institution
or the law enforcement official as necessary for your
health and safety or the health and safety of others.
Workers’ Compensation: We may
use and disclose your medical information for workers’
compensation or other programs which provide benefits
for work-related injuries or illness.
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, except to
the extent that the information has already been used
or disclosed. If you wish to cancel a prior authorization,
please send written notice to the department who has
the original authorization.
Your Rights Regarding Your Medical
Information
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.
Please ask our registration staff for a copy.
See and Obtain a Copy. You have the
right to see and obtain a copy of information used to
make decisions about your care. To look at or obtain
a copy of your information, please send a written request
to the Medical Records Department at Angel Medical Center
or the staff at Angel Urgent Care, depending on the
location of service. A form is available for you to
request your medical information. If you request copies
of information we may charge a fee for the costs of
copying, mailing or other supplies. We will usually
respond to your request within 30 days. We may deny
your request to inspect and obtain a copy in certain
circumstances. If this happens, we will respond to you
in writing, stating why we cannot grant your request
and describe any rights you may have to request a review
of our denial.
Request Restrictions. You have the
right to request that we limit how we use or disclose
your medical information 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 involved in your care or the payment
for your care. We are not required to agree to your
request. To request a restriction, make your request
in writing to the Medical Records Department. In the
request, you must tell us (1) what information you want
to limit or restrict; (2) whether you want to limit
our use, disclosure, or both; and (3) to whom you want
the limit or restriction to apply. A request form is
available in Medical Records.
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,
make your request in writing to the Medical Records
Department. Your request must specify your name, date
of birth, how or where you can be contacted and an alternative
address or other method of contact. A request form is
available in Medical Records. We will do what we can
to comply with your reasonable request.
Request an Amendment. If you believe
that your medical information is incorrect or incomplete,
you may ask us to amend the information. To request
an amendment, make your request in writing to the Medical
Records Department. Your request must state the amendment
desired and provide a reason that supports your request.
A request form is available in Medical Records. We will
usually respond to your request within 60 days. We may
deny your request in certain circumstances, and if this
occurs, you will be notified of the reason for the denial.
Request Accounting of Disclosures.
You have the right to request a listing or accounting
of disclosures we have made of your medical information
for purposes other than those excepted by law. To request
an accounting of disclosures, make your request in writing
to the Medical Records Department; a request form is
available.
You May File A Complaint About
Our Privacy Practices
If you believe your privacy rights have
been violated, you may file a complaint with our
Compliance Officer.
Angel Medical Center
Compliance Officer
P.O. Box 1209
Franklin, NC 28744
828-369-4472
You also have the right to file a complaint
with the Department of Health and Human Services. You
will not be penalized for filing a complaint.
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