JOINT NOTICE OF PRIVACY PRACTICES
This notice describes how information about you may be used and disclosed by Sheridan Community Hospital and how you can get access to this information. Please review this notice carefully. This notice addresses the changes to HIPAA individual rights made in the Final Rule published January 25, 2013. Please review this notice carefully. If you have any questions please contact Sheridan Community Hospital’s HIPAA Privacy Officer at (989) 291-6302 or through the hotline at (866) 493-4181.
THIS NOTICE APPLIES TO THE PRIVACY PRACTICES OF:
In this Notice, each reference to "we" is meant to include all of the above entities, providers, sites, and locations. Any or all of these entities, providers, sites and locations may share information about you for treatment, payment or health care operation purposes described in this Notice.
USING AND DISCLOSING YOUR HEALTH INFORMATION
Each time you visit a hospital, physician, or other health care provider, a record of your visit and the care provided to you during that visit is made. Typically, this record contains information regarding your health history, symptoms, examinations and tests performed including the results of those tests, any diagnoses or treatment and any plan for future care or follow-up with respect to your condition or treatment. Some of this information may be collected from other health care providers. This information is often referred to as your health or medical record. When we create a record or collect this type of health information about you, we use it for current and future treatment purposes, to obtain payment for treatment provided to you, for administrative and operational purposes, and to evaluate the quality of the care provided to you.
We are required by law to:
By way of example, we may use or disclose certain identifiable health information about you, without your authorization for other reasons such as:
We routinely provide patient health information when otherwise required by law, such as when law enforcement officials are entitled to such information in specific circumstances. In many other instances, we will ask for written authorization before using or disclosing any identifiable health information about you. If we request one and you choose to sign an authorization to disclose your protected health information, you can later revoke that authorization to stop future uses and disclosure of that information without your consent.
We may change our policies or practices regarding the use of your health information from time to time. Before we make a significant change in our policies or practices, we will change our notice and post the new notice in waiting areas and in our exam rooms, and on our website at www.sheridanhospital.com. You have a right to a written copy of and can always request a copy of our current notice, at any time. For more information about our privacy practices and policies, please contact the HIPAA/Compliance Officer at (866) 493-4181.
YOUR HEALTH INFORMATION RIGHTS
If you feel that medical information we have about you in a designated record set is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for SCH. To request an amendment, your request must be made in writing and submitted to Health Information Management Services. In addition, 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. Other reasons for a denial of a request include, but are not limited to, if you ask us to amend information that:
If your request is denied, you may request a review of the denial.
You have the right to request an accounting of disclosures. This is a list of certain disclosures we made of medical information about you. To request this list or accounting of disclosures, you must submit your request in writing to Health Information Management Services. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example: on paper, or electronic). The first list you request within a 12 month period will be free. For additional lists, we may charge you for the cost of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
You may request, in writing, that we not use or disclose your information for treatment, payment or administrative purposes except when specifically authorized by you, when required by law, or in emergency circumstances. We will consider your request, but you should be aware that we are not legally required to accept it and may, if we deem your request too restrictive, or in a non-emergent situation elect not to treat you or we may disregard your restriction in an emergency situation. You have the right to restrict or prohibit some or all of the uses or disclosures of your information from the facility’s directory, including your name, location in the facility, general conditions and religious affiliation.
You have the right to restrict certain disclosures of protected health information to a health plan if you pay for a service in full and out of pocket. If you choose to restrict any information under this circumstance, you must submit your request in writing to Health Information Management Services.
SCH will not disclose genetic information to insurance companies when requested for underwriting purposes.
You have the right, with limited exceptions, to inspect and obtain a copy of your health record. Usually, this includes medical and billing records, but may not include records such as psychotherapy notes. If you request copies of your health records, the request must be in writing and we will charge you an initial $5.00 retrieval fee and $.25 per page for such copies. This charge is directly attributable to the administrative and copying costs associated with meeting your request. If your request for copies of your health record is, in your opinion, an emergency, please let us know as we do not intend to deny you access to your health records or information in an emergency circumstance and will work with you to meet these emergency needs.
You also have the right to request that we communicate with you about medical matters in certain ways or at certain locations. Again, this request should be in writing and should be specific as to how and where you wish to be contacted. We do not need to know the reasons for your request.
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice on the SCH website. Each time you register at, or are admitted to, SCH for treatment or healthcare services, you may request a copy of the current notice in effect.
We are required by law to maintain the privacy of your health information, provide you with this notice of our legal duties and privacy practices, and to abide by the terms of this Notice.
If you are concerned that we have violated your privacy rights or our own policies as summarized in this Notice, or if you disagree with a decision we made about access to your records, you may contact the HIPAA Privacy Officer at (866) 493-4181. You may also send a written complaint to the United States Department of Health & Human Services. You will not suffer any retaliation for filing a complaint.
We are required by law to protect the privacy of your information and to provide you with this Notice about our information practices. We are also required to abide by the terms of this Notice and to notify you if we are unable to agree to a requested restriction you have made relative to the use or disclosure of your information. In addition, we are required to accommodate reasonable requests you make regarding the communication of your health information by alternate means or at alternative locations.
If you have any questions regarding this notice, our use or disclosure of your health information or if you wish to file a complaint regarding our use or disclosure of your health information, please contact:
Bobbi McColley, HIPAA Compliance Officer
Sheridan Community Hospital
301 N. Main Street, P.O. Box 279
Sheridan, Michigan 48884
Phone: (989) 291-6302
Hotline: (866) 493-4181
Effective Date of this Notice: September 23, 2013