NOTICE OF PRIVACY PRACTICES
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.
The terms of this Notice of Privacy Practices apply to H.B. Magruder Memorial Hospital operating as a clinically integrated health care arrangement composed of H.B. Magruder Memorial Hospital, Its Medical Staff, & Allied Health Practitioners. The members of this clinically integrated health care arrangement work and practice at 615 Fulton Street, Port Clinton, OH, and all other locations where H.B. Magruder Memorial Hospital services are provided. All of the entities and persons listed will share personal health information of our patients as necessary to carry out treatment, payment, and health care operations as permitted by law.
We are required by law to maintain the privacy of our patients’ personal health information and to provide patients with notice of our legal duties and privacy practices with respect to your personal health information. We are required to abide by the terms of this Notice so long as it remains in effect. We reserve the right to change the terms of the Notice of Privacy Practices as necessary and to make a new Notice effective for all personal health information maintained by us. You may receive a copy of any revised notices at the Switchboard or a copy may be obtained by mailing a request to Magruder Hospital, 615 Fulton Street, Port Clinton, Ohio 43452.
USES & DISCLOSURES OF YOUR PERSONAL HEALTH INFORMATION
Your Authorization. Except as outlined below, we will not use or disclose your personal health information for any purpose unless you have signed a form authorizing the use and 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 personal 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 personal health information to another 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 you personal 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 personal 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.
Uses and Disclosures for Health Care Operations. We will use and disclose your personal 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 personal health information for purposes of improving the clinical treatment and care of our patients. We may also disclose your personal health information to another 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 has had a patient relationship with you.
Our Facility Directory. We maintain a facility directory listing the name, room number, general condition and, if you wish, your religious affiliation. Unless you choose to have your information excluded from this directory, the information, excluding your religious affiliation, will be disclosed to anyone who requests it by asking for you by name. This information, including your religious affiliation, may be also provided to members of the clergy. You have the right during registration to have your information excluded from this directory.
Family and Friends Involved in Your Care. With your approval, we may from time to time disclose your personal 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 personal health information with such individuals without your approval. We may also disclose limited personal 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 of personal 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.
Appointments and Services. We may contact you to provide appointment reminders or for test results. You have the right to request and we will accommodate reasonable requests by you to receive communications regarding your personal 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 make best efforts to accommodate reasonable requests. You may request such confidential communication in writing and may send your request to Magruder Hospital Privacy Officer, 615 Fulton Street, Port Clinton, Ohio 43452.
Health Products and Services. We may from time to time use your personal 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.
Other Uses and Disclosures. We are permitted or required by law to make certain other uses and disclosures of your personal health information without your consent or authorization.
Ohio law requires that we obtain consent from you in many instances before disclosing:
RIGHTS THAT YOU HAVE
Access to Your Personal Health Information. You have the right to copy and/or inspect much of the personal health information that we retain on your behalf. All requests for access must be made in writing and signed by you or your representative. We will charge you per page according to Ohio State law if you request a copy of the information. This information may be obtained from the Health Information Management Department. We will also charge for postage if you request a mailed copy and will charge $15.00 for preparing a summary of the requested information if you request such summary. You may obtain an access request form from Health Information Management. You have a right to obtain an electronic copy of your health information that exists in an electronic format and you may direct that the copy be transmitted directly to an entity or person designated by you, provided that any such designation is clear, conspicuous, and specific with complete name and mailing address or other identifying information. (Effective February 17, 2010)
Amendments to Your Personal Health Information. You have the right to request in writing that personal health information that we maintain about you be amended or corrected. We are not obligated to make all requested amendments but will give each request careful consideration. All amendment requests, in order to be considered by us, must be in writing, signed by you or your representative, and must state the reasons for the amendment/correction request. If an amendment or correction you request is made by us, we may also notify others who work with us and have copies of the uncorrected record if we believe that such notification is necessary. You may obtain an amendment request form from Health Information Management.
Accounting for Disclosures of Your Personal Health Information. You have the right to receive an accounting of certain disclosures made by us of your personal health information after April 14, 2003. Requests must be made in writing and signed by you or your representative. Accounting request forms are available from Health Information Management. The first accounting in any 12-month period is free; you will be charged a fee of $15 for each subsequent accounting you request within the same 12-month period. When you request an accounting of disclosures of your electronic health record, the accounting will be for three years prior to the date of the request for the accounting and will include, in addition to all types of disclosures listed in general policy, disclosures for treatment, payment and health care operations. [For electronic health records acquired as of January 1, 2009, these requirements will apply to disclosures made by the organization from such a record on and after January 1, 2014. For electronic health records acquired after January 1, 2009, these requirements will apply to disclosures made by the organization from such a record on and after the later of January 1, 2011 or the date that it acquires an electronic health record.]
Restrictions on Use and Disclosure of Your Personal Health Information. You have the right to request restrictions on certain of our uses and disclosures of your personal health information for treatment, payment, or health care operations. A restriction request form can be obtained from Health Information Management. We are not required to agree to your restriction request but will attempt to accommodate reasonable requests when appropriate and we retain the right to terminate an agreed-to restriction if we believe such termination is appropriate. In the event of a termination by us, we will notify you of such termination. You also have the right to terminate, in writing, or orally, any agreed-to restriction to sending such termination notice to the Health Information Management department at H.B. Magruder Memorial Hospital.
Complaints. If you believe your privacy rights have been violated, you can file a complaint in person with the Privacy Officer, by phone at (419) 734-3131 ext. 3560 or by mail at 615 Fulton Street, Port Clinton, Ohio 43452. You may also file a complaint with the Region V Office of Civil Rights of the U.S. Department of Health and Human Services in Washington D.C. in writing at 233 N. Michigan Ave. – Suite 240, Chicago, IL 60601, by calling (312) 886-2356 or TDD (312) 353-5693 or faxing o (312) 886-1807 within 180 days of the violation of your rights. In addition, you file a claim with the Ohio Department of Job and Family Services, Attn: Health Information Privacy Official, PO Box 12825, Columbus, Ohio 43272-5376 or Ohio Medicaid Consumer Hotline, Phone (800) 324-8680 or DD (800) 292-3572. There will be no retaliation for filing a complaint.
Acknowledgment of Receipt of Notice. You will be asked to sign an acknowledgment form that you received this Notice of Privacy Practices.
FOR FURTHER INFORMATION
If you have questions or need further assistance regarding this Notice, you may contact the Privacy Officer at H.B. Magruder Memorial Hospital at (419) 734-3131, ext 3560.
As a patient you retain the right to obtain a paper copy of this Notice of Privacy Practices, even if you have requested such copy by e-mail or other electronic means.
This Notice of Privacy Practices is effective April 14, 2003.
Update to this notice of Privacy Practices is effective February 17, 2010. Revised 12/21/2012