SUMMARY OF YOUR PRIVACY RIGHTS
I. Understand Your Medical Record/Information.
Each time you visit a Lake Butler Hospital Hand Surgery Center (LBH) facility for services, a record of your visit is made. A LBH facility includes the Lake Butler Family & Pediatric Clinic, Lake Butler Hospital Rehabilitation Center, and Lake Butler Hospital Weight Loss & Wellness Center. Typically, this record contains your symptoms, examination, test results, diagnosis, treatment, and a plan for future care. This information, often referred to as your medical record, serves as a:
- Plan for your care and treatment.
- Communication source between health care professionals.
- Tool with which we can check results and continually work to improve the care we provide.
- Means by which Medicare, Medicaid, or private insurance payers can verify the services billed.
- Tool for education of health care professionals.
- Source of information for public health authorities charged with improving the health of the people.
- Source of date for medical research, facility planning, and marketing.
- Legal documents that describe the care you receive.
Understanding what is in your medical record and how the information used helps you to:
- Ensure its accuracy.
- Better understand why others may review your health information.
- Make an informed decision when authorizing disclosures.
II. Your Medical Record/Information Rights.
Although your medical record is the physical property of LBH the information belongs to you. You have the right to:
- Inspect and receive a copy of your medical record.
- Request a restriction on certain uses and disclosures of your health information. For example, you may ask that we not disclose your health information and/or treatment to a family member. LBH is not required to agree to your request; but if we do, we will comply with your request unless the information is needed to provide you with emergency services.
- Request a correction/amendment to your medical record if you believe the health information we have about you is incorrect or incomplete, we may amend your record or include your statement of disagreement.
- Request confidential communications about your health information. You may ask that we communicate with you at a location other than your home or by a different means of communication such as telephone or mail.
- Receive a listing of certain disclosures LBH has made of your health information upon request. This information is maintained for 5 years or the life of the record, whichever is longer.
- Revoke your written authorization to use or disclose health information. This does not apply to health information already disclosed or used in circumstances where LBH has taken action in reliance on your authorization or the authorization was obtained as a condition of obtaining insurance coverage and the insurer has a legal right to contest a claim under the policy or the policy itself.
- Obtain a paper copy of LBH Notice of Privacy Practice upon request.
- Obtain a paper copy of LBH Medical, Health and Billing Records, upon request.
III. Lake Butler Hospital Hand Surgery Center (LBH) Responsibilities.
LBH is required by law to:
- Maintain the privacy of your health information.
- Inform you about our privacy practices regarding health information we collect and maintain about you.
- Notify you if we are unable to agree to a requested restriction.
- Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.
- Honor the terms of this Notice or any subsequent revisions of this Notice.
LBH reserves the right to change its privacy practices and to make the new provisions effective for all protected health information (PHI) it maintains. LBH will post any revised Notice of Privacy Practices at public places within its health care facilities and on its web site at http://www.lakebutlerhospital.com and you may request a copy of the Notice.
LBH understands that health information about you is personal and is committed to protecting your health information. LBH will not use or disclose your health information without your permission, except as described in this Notice and as permitted by the Privacy Act and LBH Medical, Health and Billing Records.
IV. How LBH may use and disclose health information about you.
The following categories describe how we may use and disclose health information about you:
We Will Use and Disclose Your Health Information to Provide Your Treatment. For example:
- Your personal information will be recorded in your medical record and used to determine the course of treatment for you. Your health care provider will document in your medical record his or her instructions to members of your healthcare team. The actions taken and the observations made by the members of your healthcare team will be recorded in your medical record so your health care provider will know how you are responding to treatment.
- If LBH refers you to another health care facility under the LBH program, LBH may disclose your health information to that facility to enable them to know the extent of the treatment you have received and other information about your condition.
- If you are transferred to another facility for further care and treatment, LBH may disclose information to that facility to enable them to know the extent of the treatment you have received and other information about your condition.
- Your health care provider(s) may give copies of your health information to others (health care professionals, personal representative, etc.) to assist in your treatment.
We Will Use and Disclose Your Health Information for Payment Purposes. For example:
- If you have private insurance, Medicare, or Medicaid coverage, a bill will be sent to your health plan for payment. The information on or accompanying the bill will include information that identifies you, as well as your diagnosis, procedures, and supplies used in treatment.
- If LBH refers you to another health care provider outside the LBH program, LBH may disclose your health information with that provider for health care payment.
We Will Use and Disclose Your Health Information for Health Care Operations. For example:
- We may use your health information to evaluate your care and treatment outcomes with our quality improvement team. This information will be used to continually improve the quality and effectiveness of the services we provide.
SUMMARY OF YOUR PRIVACY RIGHTS
Business Associates. LBH provides some healthcare services and related functions through the use of contracts with business associates. For example, LBH may have contracts for medical transcription. When these services are contracted, LBH may disclose your health information to business associates so that they can perform their jobs. We require our business associates to protect and safeguard your health information in accordance with all applicable federal laws.
Directory. If you are admitted to a LBH facility, LBH may use or disclose your name, general condition, religious affiliation, and location within our facility, for facility directory purposes, unless you notify us that you object to this information being listed. LBH may provide your religious affiliation only to members of the clergy.
Notification. LBH may use or disclose your health information to notify or assist in the notification of a family member; personal representative or other authorized person(s) responsible for you care, unless you notify us that you object.
Communication with Family. LBH health providers may use or disclose your health information to others responsible for your care unless you object. For example, LBH may provide your family members, other relatives, close personal friends, or any other person you identify, with health information that is relevant to that person’s involvement with your care or payment for such care.
Adults and Emancipated Minors with Personal Representatives or Legal Guardians. LBH shall treat a personal representative or legal guardian of any such individual who has been declared incompetent due to physical or mental incapacity by a court of competent jurisdiction for the purposes of the use and disclosure of PHI as it relates to such personal representation.
Interpreters. In order to provide you proper care and services, LBH may use the services of an interpreter. This may require the use or disclosure of your personal health information to the interpreter.
Research. LBH may use or disclose your health information for research purposes that has been approved by LBH Review Board that has reviewed the research proposal and established protocols to ensure the privacy of your health information. LBH may also disclose your health information for research purposes based on your written authorization.
Organ Procurement Organizations. LBH may use or disclose your health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of facilitating organ, eye, or tissue donation and transplant.
Uses and Disclosures about Decedents. LBH may use or disclose health information about decedents to a coroner or medical examiner for the purpose of identifying a deceased person, determining cause of death, or other duties as authorized by law. LBH also may disclose heath information to funeral directors consistent with applicable law as necessary to carry out their duties. In addition, LBH may disclose protected health information about decedents where required under the Freedom of Information Act or otherwise required by law.
Treatment Alternatives and Other Health-related Benefits and Services. LBH may contact you to provide information about treatment alternatives or other types of health-related benefits and services that may be of interest to you. For example, we may contact you about availability of new treatment or services for diabetes.
Food and Drug Administration. LBH may use or disclose your health information to the Food and Drug Administration (FDA) in connection with a FDA-regulated product or activity. For example, we may disclose to the FDA information concerning adverse events involving food, dietary, supplements, product defects, or problems, and information needed to track FDA-regulated products or to conduct product recall repairs, replacements, or lookbacks (including locating people who have received products that have been recalled or withdrawn), or post marketing surveillance.
Appointment Reminders. LBH may contact you with reminder that you have an appointment for medical care at a LBH facility or to advise you of a missed appointment.
Workers Compensation. LBH may use or disclose your health information for workers compensation purposes as authorized or required by law.
Public Health. LBH may use or disclose your health information to public health or other appropriate government authorities as follows:
(1) LBH may use or disclose your health information to government authorities that are authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury, or disability, or conducting public health surveillances, investigations, or interviews
(2) Those government authorities that are authorized by law to receive reports of child abuse or neglect, and
(3) Those government authorities that are authorized by law to receive reports of other abuse, neglect, or domestic violence as required by law, or as authorized by law if LBH believes it is necessary to prevent serious harm. Where authorized by law, LBH may disclose your health information to an individual who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition. In some situations (for example, if you are employed by LBH or component of the Department of Health and Human Services, or if necessary to prevent or lessen a serious and imminent threat to the health and safety of an individual or the public), LBH may disclose to your employer health information concerning a work-related illness or injury or a workplace-related medical surveillance.
Correctional Institution. If you are an inmate of a correctional institution, LBH may use or disclose to the institution, health information necessary for your health and the health and safety of other individuals such as officers or employees or other inmates.
Law Enforcement. LBH may use or disclose your health information for law enforcement activities as authorized by law or in response to court of competent jurisdiction.
Health Oversight Authorities. LBH may use or disclose your health information to health oversight agencies for activities authorized by law. These oversight activities may include: investigations, audits, inspections, and other actions. These are necessary for the government to monitor the health care system, government benefit programs, and entities subject to government regulatory programs and/or civil rights laws for which health information is necessary to determine compliance. LBH is required by law to disclose protected health information to the Secretary, HHS, to investigate or determine compliance with the HIPAA privacy standards.
Members of the Military. If you are a member of the military services, LBH may use or disclose your health information if necessary to the appropriate military command authorities as authorized by law.
Compelling Circumstances. LBH may use or disclose your health information in certain other situations involving compelling circumstances affecting the health or safety of an individual. For example, in certain circumstances:
(1) LBH may disclose limited protected health information where requested by a law enforcement official for the purpose of identifying or locating a suspect, fugitive, material witness, or missing person;
(2) If you are believed to be a victim of a crime, a law enforcement official requests information about you and we are unable to obtain your agreement because of incapacity or other emergency circumstances, we may disclose the requested information if we determine that such disclosure would be in your best interests;
(3) LBH may use or disclose protected health information as we believe it necessary to prevent or lessen a serious and imminent threat to the health or safety of a person;
(4) LBH may use or disclose protected health information in the course of judiciary and administrative proceedings if required or authorized by law;
(5) LBH may use or disclose protected health information to report a crime committed on LBH facility premises or when LBH is providing emergency medical care;
(6) LBH may use or disclose PHI during a disaster and for disaster relief purposes, and;
(7) LBH may make any other disclosures that are required by law.
Non Violation of this Notice. LBH is not in violation of this Notice of the HIPAA Privacy Rule if any of its employees or its business associates disclose protected health information under the following circumstances:
- Disclosures by Whistle-blowers. If a LBH employee or business associate in good faith believes that LBH has engaged in conduct that is unlawful or otherwise violates clinical and professional standards or that the care or services provided by LBH has the potential of endangering one or more patients or members of the workplace or the public and discloses such information to:
- A Public Health Authority or Health Oversight Authority authorized by law to investigate or otherwise oversee the relevant conduct or conditions, or the suspected violation, or an appropriate health care accreditation organization for the purpose of reporting the allegation of failure to meet professional standards or misconduct by LBH; or
- An attorney on behalf of the workforce member, or business associate or hired by the workforce member or business associate for the purpose of determining their legal options regarding the suspected violation.
- Disclosures by Workforce Member Crime Victims. Under certain circumstances, a LBH workforce member (either an employee or contractor) who is a victim of a crime on or off LBH facility’s premises may disclose information about the suspect to law enforcement official provided that:
- The information disclosed is about the suspect who committed the criminal act.
- The information disclosed is limited to identifying and locating the suspect.
Any other uses and disclosures will be made only with your written authorization, which you may later revoke in writing at any time. (Such revocation would not apply where the health information already has been disclosed or used in circumstances where LBH has taken action in reliance on your authorization or the authorization was obtained as a condition of obtaining insurance coverage and the insurer has a legal right to contest a claim under the policy or the policy itself.)
To exercise your rights under this Notice, to ask for more information, or to report a problem contact: the Chief Executive Officer or the Privacy/Security Officer at (386) 496-2323. If you believe your privacy rights have been violated, you may file a written complaint with the above individual(s) or the Secretary, U.S. Department of Health and Human Services, Washington, D.C. 20201. There will be no retaliation for filing a complaint.