NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Door County Medical Center is committed to protecting the privacy and security of our patients’ confidential health information. We are required by law to maintain the privacy of your health information and to provide you with Notice of our legal duties and privacy practices with respect to your personal health information. If you have any questions about any part of this Notice or if you want more information about the privacy practices at Door County Medical Center, please feel free to contact the Privacy Officer at 920-746-3567. This Notice provides you with the following important information:
Effective Date of This Notice – November 1, 2016
- How we use and disclose your protected health information
- Your privacy rights with regard to your protected health information
- Our obligations to you concerning the use and disclosure of your protected health information
: The terms of this Notice apply to all designated Door County Medical Center records containing your protected health information that are created and maintained by our organization. We reserve the right to revise or amend our Notice of Privacy Practices. Any revisions or amendments to the Notice will be effective for all of your records created or maintained in the past as well as any records we create or maintain in the future. We will post a copy of the most current Notice in a prominent location on site. We will also post the most current Notice to our organizational website. Door County Medical Center will abide by the terms of the Notice currently in effect. At any time, you may request a copy of our most current Notice. You will be asked to acknowledge receipt of the Notice of Privacy Practices during an admission encounter.
Who Will Follow Our Privacy Practices
: Door County Medical Center provides care to our patients, residents, and clients in partnership with physicians and other professionals and affiliated healthcare organizations. Our privacy practices will be followed by:
Health Information Exchange
- Any of our health care professionals who care for you at any one of our locations or sites
- All locations, departments and units that are a part of our organization and staffed by our workforce, regardless of geographical location
- All members of our workforce including employees, medical staff members, students, and volunteers
: We participate in arrangements of healthcare organizations which have agreed to work with each other, to facilitate access to health information that may be relevant to your care. For example, if you are admitted to a hospital on an emergency basis and cannot provide important information about your health condition, these arrangements will allow us to make your health information from other participants available to those who need it to treat you at the hospital. When it is needed, ready access to your health information means better care for you. We may store health information about our patients in a joint electronic medical record with other healthcare providers who participate in the arrangement. You may contact the Privacy Officer for a list of healthcare providers who participate in these shared arrangements.
How Door County Medical Center Will Use and Disclose Your Protected Health Information
: We are committed to ensuring that your health information is used responsibly by our organization. We collect health information about you and store it in paper records and computer/electronic files. We may use and disclose information about you for the following purposes:
Uses of Your Health Information Requiring Your Authorization
- Treatment Purposes: We may use or disclose your health information for treatment purposes. While you are a patient at our organization, we may find it necessary to share your health information with physicians, nurses, lab and radiology technicians, and others involved in your care. We may also share your health information with other healthcare organizations that participate in your care and treatment such as a hospital where you may be transferred.
- Payment Purposes: Your health information may be used or disclosed without your consent for payment purposes. It may be necessary for us to disclose your health information so that we may bill and collect from you, your insurance company or other party responsible for payment for the treatment and services provided.
- Health Care Operations: Your health information may be used for our organizational operations that are necessary to meet our goal of providing the highest quality of care. For example, your health information may be used for performance improvement purposes.
- Information Provided to You: We may use your health information to assist us in communicating with you about appointment reminders, test results, and treatment information. Our communications to you may be by telephone, cell phone, text, e-mail, patient portal, or by mail.
- Facility/Patient Directory: If you are hospitalized, we will list your name, where you are located in the facility, your general medical condition in simple one-worded terms, and your religious affiliation in our directory. The directory information, except for the religious affiliation, will be provided to persons who ask for your information by your name. The directory information with the religious affiliation will be provided to local clergy persons. If you do not want us to list this information in our directory and provide it to clergy and others, you must tell one of our staff members that you object to this practice.
- Notification and Communication with Family and Friends: Your health information may be disclosed to notify a family member, your personal representative or other friend or family member involved in your care. This information may include your location within the organization and your general condition. If you are able and available to agree or object, we will give you the opportunity to object prior to making this notification. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communicating with your family and others.
- Required by Law: As required by law, we may use and disclose your health information to law enforcement officials. In a disaster situation, we may disclose your health information to authorities to assist in locating your family and as needed, for disaster management efforts.
- Correctional Institutions: If you are an inmate of a correctional institution, we may disclose to the institution your health information necessary for your health and the health and safety of others.
- Public Health: As required by law, we may disclose your health information to public health authorities for purposes related to: preventing or controlling disease, injury or disability; reporting child or elder abuse or neglect; reporting to the Food and Drug Administration (FDA) problems with products and reactions to medications; and reporting disease or infection exposure.
- Health Oversight Activities: We may disclose your health information to health agencies during the course of audits, investigations, inspections, licensure and other proceedings authorized by law.
- Judicial and Administrative Proceedings: We may disclose your health information in the course of any administrative or judicial proceedings. If you are involved in a lawsuit or other administrative proceeding, we may release your health information in response to a court or administrative order.
- Deceased Person Information: We may disclose your health information to coroners or medical examiners. For example, this may be necessary to determine cause of death.
- Organ, Eye or Tissue Donation: We may disclose your health information to organizations involved in procuring, banking or transplanting organs and tissues.
- Research: We may disclose your health information to researchers conducting research that has been approved by our Institutional Review Board/Privacy Board.
- Public Safety: We may disclose your health information to governmental agencies in order to prevent or assist when there is a serious threat to the health or safety of others or the general public.
- Specialized Government Functions: We may disclose your health information for specialized government purposes which include: military and veterans activities, national security and intelligence activities, protective service of the President/others, medical suitability determinations for Department of State officials, correctional institutions and law enforcement custody situations, or provision of public benefits.
- Worker’s Compensation: We may disclose your health information in compliance with Worker’s Compensation laws.
- Marketing: We may use your health information to give to you information about other treatments or health-related benefits and services that we provide and that may be of interest to you. If you do not wish Door County Medical Center to use your information for marketing purposes, you may notify the Privacy Officer.
- Fundraising: We may use your health information or share it with our related foundations to contact you regarding our fundraising activities. You also have the right to opt out of receiving fundraising communications. You may do so by contacting the Privacy Officer
Except as described in this Notice of Privacy Practices, we will not use or disclose your health information without written authorization from you. We must obtain your written authorization before we may use or disclose your psychotherapy notes, except for use by the originator of the psychotherapy notes for treatment; use or disclosure by Door County Medical Center for its own mental health training programs; or use or disclosure by Door County Medical Center to defend itself in a legal action or other proceedings brought by the individual. We must obtain your written authorization before we may use or disclose your health information for marketing purposes, except for face-to-face communications made by us to you or a promotional gift of nominal value provided by us to you.
If you revoke your authorization, we will no longer be able to use or disclose health information about you for the reasons covered by your written authorization; however, we will be unable to take back any disclosures we have already made with your authorization.
Your Rights Regarding Your Health Information
: As a patient of Door County Medical Center you have certain rights with regard to the health information that is maintained by our organization. These rights are as follows:
- You have the right to receive a paper copy of this Notice of Privacy Practices. If you would like to have a more detailed explanation of these rights or if you would like to exercise one or more of these rights, you may contact the Privacy Officer at 920-746-3567.
- With a few exceptions, you have the right to access, inspect and receive a copy of your health information. You have the right to request that the copy be provided in an electronic form or format (e.g., PDF saved onto CD). If the form and format are not readily producible, then the organization will work with you to create a reasonable electronic form or format. For example, you may request a copy of your immunization record from your healthcare provider. This right of access does not apply to psychotherapy notes, which are maintained for the personal use of your behavioral health professional. If you request copies of your health information, we may charge a fee for the cost of copying, mailing or other related supplies. If we deny your request to review or obtain a copy of your health information, you may submit a written request for a review of that decision.
- You have the right to request in writing that your health information be amended if you feel it is incorrect or incomplete. The request must be made in writing. Door County Medical Center will review the request and make a determination as to whether or not an amendment will be made. If we did not create the information that you feel is incorrect or incomplete, we may deny your request. Door County Medical Center will communicate to you in writing the final decision on your request, as well as provide information to appeal a denial of your request should it occur.
- You have the right to receive your health information through a reasonable alternative means or at an alternative location in a confidential manner such as sending mail to an address other than your home.
- You have the right to request restrictions on how we use and disclose your health information. We are not required to agree to these requests, except for when you request that we not disclose information to your health plan about services for which you paid out-of-pocket in full. In those cases, we will honor your request, unless the disclosure is necessary for your treatment or is required by law.
- You have the right to receive a list or accounting of those disclosures, which Door County Medical Center has made regarding your health information for purposes other than treatment, payment, healthcare operations, information provided directly to you, information included in facility directory listings, and information disclosed as a result of mandated government functions. Your request must state the time period desired for the accounting, which must be less than a 6-year period starting after April 14, 2003. The first accounting in a 12-month period is free; other requests may be charged according to our cost for producing the information.
Notification of a Breach: Door County Medical Center is required by law to safeguard the privacy and security of patient protected health information and to notify you following a breach of your unsecured protected health information.
If You Would Like to File a Complaint About How Your Health Information is Used and Disclosed: If you are concerned that your privacy rights may have been violated, or you disagree with a decision we made about your access to your health information, you may contact the Privacy Officer at 920-746-3567. You may also send a written complaint to the Secretary of the U.S. Department of Health and Human Services Office for Civil Rights. Door County Medical Center cannot, and will not, require you to waive the right to file a complaint as a condition of receiving treatment or retaliate against you for filing a complaint with the Secretary of Health and Human Services.