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 INFORMATON. PLEASE REVIEW IT CAREFULLY.
We are committed to protecting the
confidentiality of your medical information, and are required by law to do so.
This notice describes how we may use your medical information within the
Hospital and how we may disclose it to others outside the Hospital. This notice
also describes the rights you have concerning your own medical information.
Please review it carefully and let us know if you have questions.
HOW WILL WE USE AND DISCLOSE YOUR
MEDICAL INFORMATION?
Treatment: We
may use your medical information to provide you with medical services and
supplies. We may also disclose your medical information to others who need that
information to treat you, such as doctors, physician assistants, nurses,
medical and nursing students, technicians, therapists, emergency service and
medical transportation providers, medical equipment providers, and others
involved in your care. For example, we will allow your physician to have access
to your Hospital medical record to assist in your treatment at the Hospital and
for follow-up care. We also may use and disclose your medical information
to contact you to remind you of an upcoming appointment.
Patient Directory:
In order to assist family members and other visitors in locating you while you
are in the Hospital, the Hospital maintains a patient directory. This directory
includes your name, room number, your general condition (such as fair, stable,
or critical), and your religious affiliation (if any). We will disclose this
information to someone who asks for you by name, although we will disclose your
religious affiliation only to clergy members. If you do not want to be included
in the Hospital’s patient directory, please inform our Registration Personnel
during your admission process.
Family Members and Others Involved in Your Care:
We may disclose your medical information to a family member or friend who is
involved in your medical care, or to someone who helps to pay for your
care. If you do not want the Hospital to disclose your medical
information to family members or others who will visit you, please inform our
Registration Personnel during your admission process.
Payment: We
may use and disclose your medical information to get paid for the medical
services and supplies we provide to you. For example, your health plan or
health insurance company may ask to see parts of your medical record before
they will pay us for your treatment.
Hospital Operations:
We may use and disclose your medical information if it is necessary to improve
the quality of care we provide to patients or to run the Hospital. We may use
your medical information to conduct quality improvement activities, to obtain
audit, accounting or legal services, or to conduct business management and
planning.
Fundraising: The
Hospital foundation may contact you in the future to raise money for the
Hospital. If you do not want the Hospital foundation to contact you for
fundraising, please notify the Foundation Department in writing. Send
requests to Foundation Department at NRMC, 2200 Show Low Lake Rd., Show Low, AZ
85901.
Required by Law:
Federal, state, or local laws sometimes require us to disclose patients’
medical information. For instance, we are required to report child abuse or
neglect and must provide certain information to law enforcement officials in
domestic violence cases. We also are required to give information to the
Arizona Workers’ Compensation Program for work-related injuries.
Public Health and Safety:
We also may report certain medical information for public health purposes. For
instance, we are required to report births, deaths, and communicable diseases
to the State of Arizona. We may disclose medical information for public
safety purposes in limited circumstances. We may disclose medical information
to law enforcement officials in response to a search warrant or a grand jury
subpoena.
Health Oversight Activities:
We may disclose medical information to a government agency that oversees the
Hospital or its personnel, such as the Arizona Department of Health Services,
the federal agencies that oversee Medicare, the Board of Medical Examiners or
the Board of Nursing. These agencies need medical information to monitor the
Hospital’s compliance with state and federal laws.
Coroners, Medical Examiners and Funeral Directors:
We may disclose medical information concerning deceased
patients to coroners, medical examiners and funeral directors to assist them in
carrying out their duties.
Organ and Tissue Donation:
We may disclose medical information to organizations that handle organ, eye or
tissue donation or transplantation.
Military, Veterans, National Security and Other Government Purposes:
If you are a member of the armed forces, we may release your medical
information as required by military command authorities or to the Department of
Veterans Affairs. The Hospital may also disclose medical information to federal
officials for intelligence and national security purposes or for presidential
Protective Services.
Judicial Proceedings:
The Hospital may disclose medical information if the Hospital is ordered to do
so by a court or if the Hospital receives a subpoena or a search warrant. You
will receive advance notice about this disclosure in most situations so that
you will have a chance to object to sharing your medical information.
Information with Additional Protection:
Certain types of medical information have additional protection under state or
federal law. For instance, medical information about communicable disease and
HIV/AIDS, drug and alcohol abuse treatment, genetic testing, and evaluation and
treatment for a serious mental illness is treated differently than other types
of medical information. For those types of information, the Hospital is
required to get your permission before disclosing that information to others in
many circumstances.
Other Uses and Disclosures:
If the Hospital wishes to use or disclose your medical information for a
purpose that is not discussed in this Notice, the Hospital will seek your
permission. If you give your permission to the Hospital, you may take back that
permission any time, unless we have already relied on your permission to use or
disclose the information. If you would ever like to revoke your permission,
please notify NRMC Privacy Officers in writing.
WHAT ARE YOUR
RIGHTS?
Right to Request Your Medical Information:
You have the right to look at your own medical information and to get a copy of
that information. (The law requires us to keep the original record.) This
includes your medical record, your billing record, and other records we use to
make decisions about your care. To request your medical information, write to
the NRMC Medical Records Department. If you request a copy of your
information, we will charge you for our costs to copy the information. We will
tell you in advance what this copying will cost. You can look at your record at
no cost.
Right to Request Amendment of Medical Information You Believe Is Erroneous or
Incomplete: If
you examine your medical information and believe that some of the information
is wrong or incomplete, you may ask us to amend your record. To ask us to amend
your medical information, write to the NRMC Medical Records Department .
Right to Get a List of Certain Disclosures of Your Medical Information:
You have the right to request a list of many of the disclosures we make of your
medical information. If you would like to receive such a list, write to [insert
appropriate contact office]. We will provide the first list to you free, but we
may charge you for any additional lists you request during the same year. We
will tell you in advance what this list will cost.
Right to Request Restrictions on How the Hospital Will Use or Disclose Your
Medical Information for Treatment, Payment, or Health Care Operations:
You have the right to ask us not to make uses or disclosures of your
medical information to treat you, to seek payment for care, or to operate the
Hospital. We are not required to agree to your request, but if we do agree, we
will comply with that agreement. If you want to request a restriction,
write to the NRMC Medical Records Department and describe your request in
detail.
Right to Request Confidential Communications:
You have the right to ask us to communicate with you in a way that you feel is
more confidential. For example, you can ask us not to call your home, but to
communicate only by mail. To do this, inform the Registration Personnel or
Nursing staff. You can also ask to speak with your health care providers in
private outside the presence of other patients—just ask them!
Right to a Paper Copy:
If you have received this notice electronically, you have the right to a paper
copy at any time. You may download a paper copy of the notice from our Web
site, at www.nrmc.org or you may obtain a paper copy of the notice at the
Hospital.
CHANGES TO THIS
NOTICE
From time to time, we may change our practices
concerning how we use or disclose patient medical information, or how we will
implement patient rights concerning their information. We reserve the right to
change this Notice and to make the provisions in our new notice effective for
all medical information we maintain. If we change these practices, we will
publish a revised Notice of Privacy Practices. You can get a copy of our
current notice of Privacy Practices at any time by contacting the facility
administrator at 537-4375 or at the Hospital Web site,
www.nrmc.org.
WHICH HEALTH CARE
PROVIDERS ARE COVERED BY THIS NOTICE?
This Notice of Privacy Practices applies to the
Hospital and its personnel, volunteers, students, and trainees. The notice also
applies to other health care providers that come to the Hospital to care for
patients, such as physicians, physician assistants, therapists, other health
care providers not employed by the Hospital, emergency service providers,
medical transportation companies, and medical equipment and suppliers who come
to the Hospital. The Hospital may share your medical information with these
providers for treatment purposes, to get paid for treatment, or to conduct
health care operations. These health care providers will follow this
notice for information they receive about you from the Hospital. These other
health care providers may follow different practices at their own offices or
facilities.
DO YOU HAVE CONCERNS
OR COMPLAINTS
Please tell us about any problems or concerns you have
with your privacy rights or how the Hospital uses or discloses your medical
information. If you have a concern, please contact
contact the facility Corporate Compliance Officer
and/or Privacy Officer(s) at 537-4375. If for some reason the Hospital
cannot resolve your concern, you may also file a complaint with the federal
government. We will not penalize you or retaliate against you in any way for
filing a complaint with the federal government.
DO YOU HAVE
QUESTIONS?
The Hospital is required by law to give you this Notice
and to follow the terms of the Notice that is currently in effect. If you have
any questions about this Notice, or have further questions about how the
Hospital may use and disclose your medical information, please contact the
facility Corporate Compliance Officer and/or Privacy Officer(s) at 537-4375.
Effective date: 1/15/04 |
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