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.
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 health 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 that 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 other 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, to inform you about possible treatment options or alternatives, or to tell you about health-related services available to you.
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 you 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 tell the doctor and/or nurse so that it will be noted in your records.
Family Members and Other 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. We also may disclose your medical information to disaster relief organizations to help locate a family member or friend in a disaster. If you do not want the Hospital to disclose your medical information to family members or other who visits you, please tell the doctor and/or nurse so that it can be noted in your records. This includes your medical record, your billing record, and other records we use to make decisions about your care. To request you medical information, submit a written request to the Health Information Management 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 make a request to amend your medical information, submit a written request to the Privacy Officer.
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, submit a written request to the Health Information Management Department. We will provide the first list to you free, but we will 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 request us not to make uses or disclosures of you 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, submit your request in writing to the Privacy Officer and describe your request in detail.
Right to Request Confidential Communications: You have the right to request us to communicate with you in a way that you feel is more confidential. For example, you can ask us not to call you home, but communicate only by mail. To do this, submit your request in writing to the Privacy Officer. 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: While you may have received this notice electronically, you have the right to a paper copy at any time. You may obtain a paper copy of the notice at Benson 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 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 coming in to Benson Hospital or by writing to Benson Hospital and requesting a copy.
WHICH HEALTH CARE PROVIDERS ARE COVERED BY THIS NOTICE?
This Notice of Privacy Practices applies to Benson Hospital and its personnel, volunteers, students, and trainees. This notice is 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 that are not employed by Benson Hospital, emergency service providers, medical transportation companies, and medical equipment and suppliers that come to the hospital. These health care providers will follow this notice for information they receive about you from Benson 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 Benson Hospital uses or discloses your medical information. If you have a concern, please contact the Privacy Officer.
If for some reason Benson Hospital cannot resolve your concern, you may also file a complaint with the federal government. To file a complaint against the Hospital, contact Ira Pollack, Regional Manager, CMS Region IX, 50 United Nations Plz., Rm. 322 San Francisco, CA 94102. 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 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 Privacy Officer.
Effective date: April 14, 2003