USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION
Your Authorization. Except as outlined below, we will not use or disclose your protected health information for any purpose unless you have signed a form authorizing the use or disclosure. You have the right to revoke that authorization in writing unless we have taken any action in reliance on the authorization.
Uses and Disclosures for Treatment. We will make uses and disclosures of your protected health information as necessary for your treatment. For instance, doctors and nurses and other professionals involved in your care will use information in your medical record and information that you provide about your symptoms and reactions to plan a course of treatment for you that may include procedures, medications, tests, etc. We may also release your protected health information to another health care facility or professional who is not affiliated with our organization but who is or will be providing treatment to you. For instance, if, after you leave the hospital, you are going to receive home health care, we may release your protected health information to that home health care agency so that a plan of care can be prepared for you.
Uses and Disclosures for Payment. We will make uses and disclosures of your protected health information as necessary for the payment purposes of those health professionals and facilities that have treated you or provided services to you. For instance, we may forward information regarding your medical procedures and treatment to your insurance company to arrange payment for the services provided to you or we may use your information to prepare a bill to send to you or to the person responsible for your payment; we may send or sell your bill to a collection agency in the event of non-payment, or to agencies who provide information or services on obtaining financial assistance or medical insurance coverage.
Uses and Disclosures for Health Care Operations. We will use and disclose your protected health information as necessary, and as permitted by law, for our health care operations which include clinical improvement, professional peer review, business management, accreditation and licensing, etc. For instance, we may use and disclose your protected health information for purposes of improving the clinical treatment and care of our patients. We may also disclose your protected health information to another health care facility, health care professional, or health plan for such things as quality assurance and case management, but only if that facility, professional, or plan also has or had a patient relationship with you.
Our Facility Directory. We maintain a facility directory for admitted, observation & Emergency Department patients listing your name and room number. Unless you choose to have your information excluded from this directory, the information will be disclosed to anyone who requests it by asking for you by name. This information will also be provided to members of the clergy. You have the right during registration to have your information excluded from this directory and also to restrict what information is provided and/or to whom.
Family and Friends Involved In Your Care. With your approval, we may from time to time disclose your protected health information to designated family, friends, and others who are involved in your care or in payment of your care in order to facilitate that person's involvement in caring for you or paying for your care. If you are unavailable, incapacitated, or facing an emergency medical situation, and we determine that a limited disclosure may be in your best interest, we may share limited protected health information with such individuals without your approval. We may also disclose limited protected health information to a public or private entity that is authorized to assist in disaster relief efforts in order for that entity to locate a family member or other persons that may be involved in some aspect of caring for you.
Business Associates. Certain aspects and components of our services are performed through contracts with outside persons or organizations, such as auditing, accreditation, legal services, etc. At times it may be necessary for us to provide certain protected health information to one or more of these outside persons or organizations who assist us with our health care operations. In all cases, we require these business associates to appropriately safeguard the privacy of your information.
Fund Raising. We may contact you to donate to a fund raising effort for or on our behalf. You have the right to "opt-out" of receiving fund raising materials/communications and may do so by sending your name and address to Marketing & Public Relations, Samaritan Regional Health System, 1025 Center Street, Ashland, OH 44805, together with a statement that you do not wish to receive fund raising materials or communications from us.
Appointments and Services. We may contact you to provide appointment reminders or test results. You have the right to request, and we will accommodate reasonable requests by you, to receive communications regarding your protected health information from us by alternative means or at alternative locations. For instance, if you wish appointment reminders to not be left on voice mail or sent to a particular address, we will accommodate reasonable requests. You may request such confidential communication in writing at the time of registration.
Health Products and Services. We may from time to time use your protected health information to communicate with you about health products and services necessary for your treatment, to advise you of new products and services we offer, and to provide general health and wellness information.
Research. In limited circumstances, we may use and disclose your protected health information for research purposes. For example, a research organization may wish to compare outcomes of all patients that received a particular drug and will need to review a series of medical records. In all cases where your specific authorization has not been obtained, your privacy will be protected by strict confidentiality requirements applied by an Institutional Review Board or privacy board which oversees the research or by representations of the researchers that limit their use and disclosure of patient information.
Other Uses and Disclosures. We are permitted or required by law to make certain other uses and disclosures of your protected health information without your consent or authorization.
• We may release your protected health information for any purpose required by law;
• We may release your protected health information for public health activities, such as required reporting of disease, injury, birth and death, and for required public health investigations;
• We may release your protected health information as required by law if we suspect child abuse or neglect; we may also release your protected health information as required by law if we believe you to be a victim of abuse, neglect, or domestic violence;
• We may release your protected health information to the Food and Drug Administration if necessary to report adverse events, product defects, or to participate in product recalls;
• We may release your protected health information to your employer when we have provided health care to you at the request of your employer; in most cases you will receive notice that information is disclosed to your employer;
• We may release your protected health information if required by law to a government oversight agency conducting audits, investigations, or civil or criminal proceedings;
• We may release your protected health information if required to do so by a court or administrative ordered subpoena or discovery request; in most cases you will have notice of such release;
• We may release your protected health information to law enforcement officials as required by law to report wounds and injuries and crimes;
• We may release your protected health information to coroners and/or funeral directors consistent with law;
• We may release your protected health information if necessary to arrange an organ or tissue donation from you or a transplant for you;
• We may release your protected health information if you are a member of the military as required by armed forces services; we may also release your protected health information if necessary for national security or intelligence activities; and
• We may release your protected health information to workers' compensation agencies if necessary for your workers' compensation benefit determination.
Ohio law requires that we obtain a consent from you in many instances before disclosing the performance or results of an HIV test or diagnosis of AIDS or an AIDS-related condition; before disclosing information about drug or alcohol treatment you have received in a drug or alcohol treatment program; and before disclosing information about mental health services you may have received. For full information on when such consents may be necessary, you can contact the system's Privacy Officer.
RIGHTS THAT YOU HAVE
Although all records concerning your hospitalization and treatment obtained at Samaritan Regional Health System are the property of the system, you have the following rights concerning your protected health information:
Right to Confidential Communications: You have the right to receive confidential communications of your protected health information by alternative means or at alternative locations. For example, you may request that Samaritan Regional Health System only contact you at work or by mail.
Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of your protected health information for treatment, payment, or health care operations to family members, relatives, close personal friends or other individuals involved in your care. Samaritan Regional Health System will consider your request, but is not required to agree to your requested restrictions.
Right to Inspect and Copy: With some exceptions, you have the right to inspect and copy information about your protected health information as long as we maintain the information. In certain limited circumstances, Samaritan Regional Health System may be required to deny your request. Copying requires that you pay a reasonable copying charge.
Right to Amend: With some exceptions you have the right to request an amendment of your protected health information for as long as Samaritan Regional Health System maintains the information.
Right to an Accounting: With some exceptions, you have a right to receive an accounting of certain disclosures of your protected health information that Samaritan Regional Health System has made. A nominal fee will be charged for the record search.
All requests regarding your protected health information must be made in writing on the appropriate Samaritan Regional Health System form and submitted to: Director of Health Information Management, Samaritan Regional Health System, 1025 Center Street, Ashland, OH 44805
If you believe your privacy rights have been violated, you can file a complaint with the Privacy Officer, Samaritan Regional Health System, 1025 Center Street, Ashland, OH 44805, in writing, in person, or by calling the Compliance Hotline at 419-281-7829. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services in Washington D.C. in writing within 180 days of a violation of your rights. There will be no retaliation for filing a complaint.
FOR FURTHER INFORMATION
If you have questions or need further assistance regarding this Notice, you may contact the Privacy Officer, Samaritan Regional Health System, 1025 Center Street, Ashland, OH 44805. Additional paper copies of this Notice of Privacy Practices can be obtained at any time by sending a written request to the Privacy Officer, Samaritan Regional Health System.
You will be asked to sign an acknowledgment that you received this Notice of Privacy Practices.