Notice of Privacy Practices

Effective Date of Notice: April 14, 2003 

St. Vincent Hospital

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. 

For HIPAA compliance purposes this notice shall serve as a joint notice for the following covered entities that are included in an Organized Health Care Arrangement:

A. OUR COMMITMENT TO YOUR PRIVACY:

CHRISTUS St. Vincent is dedicated to maintaining the privacy of your medical information. In conducting our business, we will create records regarding you and the treatment and services we provide to you.

These records are our property. However, we are required by law:

• To maintain the confidentiality of your medical information.
• To provide you with this notice of our legal duties and privacy practices concerning your medical and personal information.
• To follow the terms of our notice of privacy practices in effect at the time.

To summarize, this notice provides you with the following important information:

• How we may use and share your medical information.
• Your privacy rights in your medical information
• Our obligations to protect how we use and share your medical information.

CHANGES TO THIS NOTICE

The terms of this notice apply to all records containing your medical information that are created or retained by us. We reserve the right to change our notice of privacy practices. Any change to this notice will be effective for all of the information that we already have about you, as well as any of your medical information that we may receive, create, or maintain in the future. Our organization will post a copy of our current notice in our offices in a prominent location, and you may request a copy of our most current notice during any visit to our organization.

B. HOW WE MAY USE AND SHARE YOUR MEDICAL INFORMATION

CHRISTUS St. Vincent can use and share your medical information without your written permission as follows:

Treatment. Our organization may use and disclose your medical information to treat you. For example, we may ask you to undergo laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis.

Payment. Our organization may use and disclose your medical information in order to bill and collect payment for the services and items you may receive from us. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding
Your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your medical information to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your medical information to bill you directly for services and items.

Health Care Operations. Our organization may use and disclose your medical information to operate our business. These uses and disclosures are important to ensure that you receive quality care and that our organization is well run. As examples of the ways in which we may use and disclose your information for our operations, our organization may use your medical information to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our organization. Further, we may disclose your information to doctors, nurses, medical students, and other personnel for review and learning purposes.

OTHER USES OF YOUR INFORMATION:

Required by Law. We will use or disclose medical information about you when required by applicable law.

Coroners, Medical Examiners, and Funeral Directors. Our organization may release medical information to a coroner or medical examiner.

Abuse, Neglect, and Domestic Violence. We may disclose your medical information to a government authority if we believe you are a victim of abuse, neglect, or domestic violence. If we make such a disclosure, we will inform you of it, unless we think that informing you places you at risk of serious harm or, if we were to inform your personal representative, is otherwise not in your best interest.

Public Health Activities. Our organization may disclose your medical information for public health activities, including generally:

• to prevent or control disease, injury or disability;
• to maintain vital records, such as births and deaths;
• to report child abuse or neglect;
• to notify a person regarding potential exposure to a communicable disease;
• to notify a person regarding a potential risk for spreading or contracting a disease or condition;
• to report reactions to drugs or problems with products or devices;
• to notify individuals if a product or device they may be using has been recalled;
• to notify appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information; and
• to notify your employer under limited circumstances, related primarily to workplace injury or illness or medical surveillance.

Organ and Tissue Donation. We may use or disclose your medical information to organizations that handle organ and tissue procurement, banking, or transplantation

Health Oversight Activities. Our organization may disclose your medical information to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws, and the health care system in general.

Law Enforcement. We may release medical information if asked to do so by law enforcement officials.

Judicial and Administrative Proceedings. Our organization may use and disclose your medical information in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding.

Research. Under certain circumstances, we may use and disclose medical information about you for research purposes. All research projects, however, are subject to a special approval process.

Specialized Government Functions. Our organization may disclose your medical information if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate military command authorities. In addition, our organization may disclose your medical information to federal officials for intelligence and national security activities authorized by law. We also may disclose your medical
information to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.
Furthermore, our organization may disclose your medical information to correctional institutions or law enforcement officials if you are an inmate or under the custody of law enforcement official.

Workers' Compensation. Our organization may release your medical information for workers' compensation and similar programs.

Avert Serious Threats to Health or Safety. Our organization may use and disclose your medical information when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public.

Facility Directory. We may include certain limited information about you in our facility directory while you are a patient. This information may include your name, location, your general condition and your religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy even if they do not ask for you by name.

If you do not want your information included in our facility directory, please notify the Patient Registration personnel at the time of your registration.

Appointment Reminders. Our organization may use and disclose your medical information to remind you that you have an appointment.

Fundraising. Our organization may use or disclose medical information about you in order to contact you as part of a fundraising activity. In addition, we may disclose your medical information St. Vincent Hospital Foundation related to our organization, which may contact you to raise money for our organization. We would use or disclose your name, address, and phone number and the dates you received health care treatment or service from us.

Should you not wish to be contacted regarding such fundraising activities, please contact SVH Foundation @ 820 -5209.

Marketing. We may use your medical and personal information to make a marketing communication to you that (i) occurs in a fact-to-face encounter with you; (ii) concerns products or services of nominal value; or (iii) concerns our health-related products or services, or those of another party, provided that we tell you that we are the party communicating with you, and that we tell you if we have received, or will receive, directly or indirectly, any money or other remuneration for making the communication to you.

If you do not want to receive marketing communications (other than those that are in a newsletter or other general health communication), please contact the Public Relations Department @ 820 - 3053.

Our organization may use and disclose your medical information to inform you of treatment alternatives and/or health-related benefits and services that may be of interest to you.

C. YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION:

You have the following rights regarding the medical information that we have about you:

Confidential Communications. You have the right to request that your receive information about your health and related issues in a particular manner, or at a certain location. For instance, you may ask that we contact you by mail, rather than by telephone, or at home, rather than work. In order to request a type of confidential communication, you must make a written request to the Health Information Manager, 455 St. Michael's Drive or call @ 820-5320 specifying the requested method of contact, or the location where you wish to be contacted. Our organization will accommodate reasonable requests. You do not need to give a reason for your request.

Amendments. You may ask us to amend your medical information if you believe it is incorrect or incomplete, and you may request an amendment for as long as the information is kept by or for our organization. To request an amendment, your request must be made in writing and submitted to the Health Information Manager, 455 St. Michael's Drive or call @ 820-5320. We may deny your request if you ask us to amend information and we must inform you of the reason.

Accounting of Disclosures. We can use your information for treatment, payment, health care operations and other uses as required by law. You have the right to request a report of disclosures for uses other than those listed. In order to obtain a report of disclosures, you must submit your request in writing to the Health Information Manager, 455 St. Michael's Drive or call @ 820-5320.

Review and Copy: You have the right to review and get a copy of the medical and personal information that may be used to make decisions about you, including patient medical records and billing records, but not psychotherapy notes. You must submit your request in writing to the Health Information Manager, 455 St. Michael's Drive or call @ 820-5320 in order to review and/or obtain a copy of your medical information. Our organization may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Our organization may deny your request to inspect and/or copy in certain limited circumstances; however, you may request a review of our denial.

Requesting Restrictions. You have the right to request limits or restrictions on certain uses or sharing of your medical information. We are not required to agree to your request In order to request a restriction on the use or sharing of your medical information, you must make your request in writing to the Health Information Manager, 455 St. Michael's Drive or call @ 820-5320. Your request must describe in a clear and concise fashion: (1) the information you wish restricted; (2) whether you are requesting to limit the use, sharing or both; and (3) to whom you want the limits to apply.

Right to a Paper Copy of This Notice. You have a right to receive a paper copy of our notice of privacy practices. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact the Health Information Manager, 455 St. Michael's Drive or call @ 820-5320.

Right to File a Complaint. If you believe your privacy rights have been violated, you may file a complaint with our organization or with the Secretary of the Department of Health and Human Services. All complaints must be submitted in writing. To file a complaint with our organization, contact our Privacy Officer @ 820-5321.

Right to Provide an Authorization for Other Uses and Disclosures. Our organization will obtain your written authorization for uses and disclosures that are not identified by this notice or are not permitted by applicable law. Any authorization you provide to us regarding the use and disclosure of your medical information may be revoked at any time in writing. After you revoke your authorization, we will no longer use or disclose your medical information for the reasons described in the authorization. Of course, we are unable to take back any disclosures that we have already made with your permission. Please note that we are required to retain records of your care.

ACKNOWLEDGEMENT STATEMENT:

I hereby acknowledge that I received the Notice of Privacy Practices of St. Vincent Hospital which sets forth the ways in which my personal health information may be used or disclosed by St. Vincent Hospital, and outlines my rights with respect to such information. 

Individual's Signature

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Signature of Authorized Representative of the Individual

______________________________________________________________
Legal Authority of Individual to Act as Personal Representative of Individual

______________________________________________________________
Print Name or attach Patient Identification Label for this registration.

______________________________________________________________
Date Signed

Medical Record Copy