AMERY REGIONAL MEDICAL CENTER NOTICE OF PRIVACY PRACTICES Effective Date: 4/14/03
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.
Amery Regional Medical Center (which includes the Amery site, Clear Lake Clinic, Luck Medical Clinic, Luck PT & Fitness, the Fitness Center, Turtle Lake Medical Clinic and West Campus sites) uses health information about you for treatment, payment, and health care operations. We participate in an organized health care arrangement (OHCA) with Regions Hospital, and those providers that render care there, and with HealthPartners clinics and those providers that render care at those clinics. As an OHCA, it may be necessary to share your personal health information to carry out treatment, payment or for health care operations. Your health information is contained in a medical record that is the physical property of ARMC.
How ARMC May Use or Disclose Your Health Information
For Treatment ARMC may use your health information to provide you with medical treatment or services. For example, information obtained by a health care provider, such as a physician, nurse, or other person providing health services to you, will record information in your record that is related to your treatment. This information is necessary for health care providers to determine what treatment you should receive. Health care providers will also record actions taken by them in the course of your treatment and note how you respond to the actions.
For Payment ARMC may use and disclose your health information to others for purposes of receiving payment for treatment and services that you receive. For example, a bill may be sent to you or a third-party payor, such as an insurance company or health plan. The information on the bill may contain information that identifies you, your diagnosis, and treatment or supplies used in the course of treatment.
For Health Care Operations ARMC may use and disclose health information about you for operational purposes. For example, your health information may be disclosed to members of the medical staff, risk or quality improvement personnel, and others to:
- Evaluate the performance of our staff
- Assess the quality of care and outcomes in your cases and similar cases
- Learn how to improve our facilities and services
- Determine how to continually improve the quality and effectiveness of the health care we provide
Appointments ARMC may use your information to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Fund Raising ARMC may use your information to contact you to raise funds for ARMC. When, and if, ARMC contacts you to raise funds, you may opt out of any future fund raising appeals by calling 715-268-8000.
Required by law ARMC may use and disclose information about you as required by law. For example, ARMC may disclose information for the following purposes:
- For judicial and administrative proceedings pursuant to legal authority
- To report information related to victims of abuse, neglect or domestic violence
- To assist law enforcement officials in their law enforcement duties
Public Health Your health information may be used or disclosed for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury, or disability, or for other health oversight activities.
Decedents Health information may be disclosed to funeral directors or coroners to enable them to carry out their lawful duties.
Organ/Tissue Donation Your health information may be used or disclosed for cadaveric organ, eye or tissue donation purposes.
Health and Safety Your health information may be disclosed to avert a serious threat to the health or safety of you or any other person pursuant to applicable law.
Government Functions Your health information may be disclosed for specialized government functions such as protection of public officials or reporting to various branches of the armed services.
Workers’ Compensation Your health information may be used or disclosed in order to comply with laws and regulations related to Workers’ Compensation.
Facility Directory Your name, location in the facility (example: OB, MedSurg unit, etc.) and condition will be listed on the facility directory for inpatients only. This will be made accessible to clergy, lay ministers, parish nurse and others who ask for you by name. You will be given an opportunity to decline this.
Persons Involved In Your Care Unless you object, we may disclose to a family member, close friend, or to any other person identified by you, your personal information that is directly relevant to that persons involvement with your care.
Other Uses Other uses and disclosures will be made only with your written authorization and you may revoke the authorization except to the extent ARMC has taken action in reliance on such.
Most uses and disclosures of psychotherapy notes, uses, and disclosures of PHI for marketing purposes, and disclosures that constitute a sale of PHI require your written authorization.
Your Health Information Rights
You have the right to:
- Request a restriction on certain uses and disclosures of your information; however, ARMC is not required to agree to a requested restriction.
- Obtain a paper copy of the notice of information practices upon request, if electronically transmitted.
- Inspect and obtain a copy of your health record. You must submit your request in writing to ARMC’s Health Information Management Department. You have the right to an electronic copy of your health record.
- Request that your health record be amended; however, ARMC is not required to agree to this amendment.
- Request communications of your health information by alternative means or at alternative locations.
- Request a restriction on disclosure to health insurance company when the bill has been paid out of pocket in full.
- Receive an accounting of disclosures made of your health information.
Complaints You may complain to ARMC and to the Department of Health and Human Services if you believe your privacy rights have been violated. You will not be retaliated against for filing a complaint.
Obligations of ARMC
ARMC is required by law to:
- Maintain the privacy of protected health information.
- Provide you with this notice of its legal duties and privacy practices with respect to your health information.
- Abide by the terms of this notice.
- Notify you if we are unable to agree to a requested restriction on how your information is used or disclosed.
- Accommodate reasonable requests you may make to communicate health information by alternative means or at alternative locations.
- Notify you following a breach of unsecured PHI.
ARMC reserves the right to change its information practices and to make the new provisions effective for all protected health information it maintains. Revised notices will be posted and made available to you upon request only.
If you have any questions or complaints, please contact:
Amery Regional Medical Center
265 Griffin Street East
Amery, WI 54001