Privacy Policy

NOTICE OF PRIVACY PRACTICES

Effective April 14, 2004

If you have any questions about this policy please contact Our Lady of Peace’s Privacy Officer {Amanda Hansen}.
This notice of Privacy Practices is provided to you as a requirement of the Health Insurance Portability and Accountability Act (HIPAA). It describes how we use or disclose your protected health information, with whom that information may be shared, and the safeguards we have in place to protect it. This notice also describes your rights to access and amend your protected health information. You have the right to approve or refuse the release of specific information outside of our system except when the release is required or authorized by law or regulation.

 

ACKNOWLEDGEMENT OF RECEIPT OF THIS NOTICE
You will be asked to provide a signed acknowledgement of receipt of this notice. Our intent is to make you aware of the possible uses and disclosures of your protected health information and your privacy rights. If you decline to provide a signed acknowledgement, we will continue to provide your treatment, and will use and disclose your protected health information for treatment, payment, and health care operations when necessary.

 

OUR DUTIES TO YOU REGARDING PROTECTED HEALTH INFORMATION
“Protected health information” is individually identifiable health information. This information includes demographics, for example, age, address, e-mail address, and relates to your past, present, or future physical or mental health or condition and related health care services. Our Lady of Peace is required by law to do the following:

• Make sure that your protected health information is kept private.
• Give you this notice of our legal duties and privacy practices related to the use and disclosure of your protected health information.
• Follow the terms of the notice currently in effect.
• Communicate any changes in the notice to you.

 

HIPAA 2

We reserve the right to change this notice. Its effective date is the date at the top of the first page and at the bottom of the last page.

HOW WE MAY USE OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION
Following are examples of permitted uses and disclosures of your protected health information. These examples are not exhaustive.
Required Uses and Disclosures. By law, we must disclose your health information to you unless it has been determined by a competent medical authority that it would be harmful to you. We must also disclose health information to the Secretary of the Department of Health and Human Services (DHHS) for investigations or determinations of our compliance with laws on the protection of your health information.

Treatment
We will use and disclose your protected information to health care providers (doctors, dentists, pharmacies, hospitals and other caregivers) who request it to aid in your treatment.
We may also disclose your personal health information to these health care providers in our effort to provide you with preventive health, early detection, and disease and case management. In emergencies, we will disclose your protected health information to provide the treatment you require.

Payment
Your protected health information will be used, as needed, to obtain payment for your health care services.

Health Care Operations
We may use or disclose, as needed your protected health information to support the daily activities, investigations, oversight or staff performance reviews, training of medical students, licensing, communications, about a product or service, and conducting or arranging for other health care related activities. We will share your protected health information with third party “business associates” who perform various activities (for example, billing, transcription services) for Our Lady of Peace.
The business associates will also be required to protect your health information. We may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that might interest you.

Required by Law
We may use or disclose your protected health information if law or regulation requires the use or disclosure.

Public Health
We may disclose your protected health information to a public health authority who is permitted by law to collect or receive the information. The disclosure may be necessary to do the following:

 

HIPAA 3

• Prevent or control disease, injury, or disability.
• Report births and deaths.
• Report child abuse or neglect.
• Report reactions to medications or problems with products.
• Notify a person who may have been exposed to a disease or be at risk for contracting or spreading a disease or condition.
• Notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect, or domestic violence.

Communicable Diseases
We may disclose your protected health information, if authorized by law, to a person who might have been exposed to a communicable disease or might otherwise be at risk of contracting or spreading the disease or the condition.

Health Oversight
We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. These health oversight agencies that oversee the health care system, government benefit programs, other government regulatory programs, and civil rights law.

Food and Drug Administration
We may disclose your protected health information to a person or company required by the Food and Drug Administration to do the following:

• Report adverse events, product defects, or problems and biologic product deviations.
• Track products.
• Enable product recalls.
• Make repairs or replacements.
• Conduct post-marketing surveillance as required.

Coroners, Funeral Directors, and Organ Donations
We may disclose protected health information to coroners or medical examiners for identification to determine the cause of death or for the performance of other duties authorized by law. We may also disclose protected health information to funeral directors as authorized by law. Protected health information may be used and disclosed for cadaveric organ, eye, or tissue donation.

Research
We may disclose your protected health information to researchers when authorized by law.

Worker’s Compensation
We may disclose your protected health information to comply with worker’s compensation laws and other similar legally established programs.

Military Activity and National Security
We may disclose your health information to armed forces personnel under certain circumstances, and to authorized federal officials for national security and intelligence activities.

 

HIPAA 4

Correctional Institution
If you are an inmate, we may disclose your heath information to your correctional facility to provide safety to you or others.

Parental Access
Some state laws concerning minors permit or require disclosure of protected health information to parents, guardians, and persons acting in a similar legal status. We will act consistently with the law of the state where the treatment is provided and will make disclosures following such laws.

Others involved in your health care
Unless you notify us in writing, we may disclose certain billing information to a family member who calls on your behalf. The kind of information we will disclose is the status of a claim, amount paid, and payment date. We will not, however, disclose medical information, such as diagnosis or the name of the provider.

Our Lady of Peace
Your health coverage that is through us, we may review group claims data or to conduct an audit. All information that could be used to identify specific participants is removed unless such identification is necessary.

 

USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION REQUIRING YOUR PERMISSION
In some circumstances, you have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. Any uses and disclosures described in this notice will require your written authorization. Keep in mind that you may cancel your authorization in writing at any time.

YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
You may exercise the following rights by submitting a written request to the Our Lady of Peace Privacy Officer. Please be aware that Our Lady of Peace might deny your request; however, you may seek a review of the denial.

Right to Inspect and Copy
You have the right to receive, by written request, a copy of your personal health information that is contained in a “designed record set”, with some specified exceptions. For example, if your doctor determines that your records are sensitive, we may not give you access to your records.

Right to Request Confidential Communications
You may request that we communicate with you using alternative means or at an alternative location. We will not ask you the reason for your request. We will accommodate reasonable request, when possible.

Right to Request Restrictions
You have the right to request restrictions on the way we handle your personal health information for treatment, payment, or health care operations. The law, however, does not require us to agree to these restrictions. If we do agree to a restriction, we will send you a written confirmation and will not use or disclose your health information in violation of that restriction. If we don’t agree, we will notify you in writing.

 

HIPAA 5

Right to Request Amendment
If you believe that the information we have about you is incorrect or incomplete, you may request and amendment to your protected health information as long as we maintain this information. While we will accept request for amendment, we are not required to agree to the amendment.

Right to an Accounting of Disclosure
You have the right to request (in writing) information about the times we have disclosed your personal health information for any purpose other than the following exceptions;

• Treatment, payment, or health care operations.
• Disclosure that you or your personal representative have authorized.
• Certain disclosures, such as disclosures for national security purposes.

Complaints
If you believe your privacy rights have been violated you may file a written complaint with Our Lady of Peace’s Privacy Officer {Amanda Hansen}, or the Department of Health and Human Services at:

Medical Privacy Complaint Division
Office of Civil Rights
U.S. Department of Health & Human Services
200 Independence Ave. SW
Room 509F, HHH Building
Washington, DC 20201

No retaliation will occur against you for filing a complaint.