Joint Notice Of Privacy
Date: February 17, 2010
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
Summary of this Notice:
is a summary of the Joint Notice of Privacy Practices (“Notice”) for
PeaceHealth, Oregon Imaging Centers, and their medical staffs, workforce,
volunteers, and students:
- The Community HealthRecord
. We use an electronic medicalrecord.This is a computer
system that allows those listed in the Notice and other providers that are
not related to us to read and add health information about you.
- Use and Disclosures. We generally use and disclose yourinformation:
- For treatment, payment,and health care operations.
- Through a facilitydirectory, to friends and family involved in your care, or for notification
after you have had a chance to object.
- oFor fundraising, to remindyou of appointments, or to give you information about treatment alternatives or
health-related benefits and services.
- As permitted or requiredby law.
- For certain activities,such as:public health; reporting
of abuse, neglect, or domestic violence; health oversight; lawsuits and
disputes; law enforcement activities; coroner, medical examiner, or funeral
director purposes; organ donation; avoidance of a serious threat to health or
safety; workers’ compensation; and national security.
- With your authorization.
- Your Rights. As limited by law, you generallyhave the right to:
- Inspect and obtain copiesyour records.
- oAsk to amend informationin your records (although we do not have to agree).
- Receive an accounting ofcertain disclosures of your health information.
- oAsk for additional privacyprotections (although we do not always have to agree).
- Ask for alternativeconfidential communications.
- Receive a paper copy ofthis Notice.
- oFile a complaint withoutpenalty.
- Our Duties.We must maintain the privacy ofyour health information, and we must give you a copy of and follow the
terms of the Notice.We may
change the Notice.For more
information, please read the Notice or call your Regional Privacy Officer.
is Subject to this Notice:
which includes its employees and workforce members at:
- Sacred Heart Medical Center–RiverBend
- Sacred Heart Medical Center–University District
- Cottage Grove Community Hospital
- South Lane Medical Group
- PeaceHealth Medical Group–Oregon
- oPeace Harbor Hospital
- oPeaceHealth Medical Group–Siuslaw Region
All locations in AK, WA and OR
Lower Columbia Region:
- St. John Medical Center
- PeaceHealth Medical Group–LCR
- St. Joseph Hospital
- PeaceHealthMedical Group–Whatcom Region
- Ketchikan General Hospital
- PeaceHealth Medical Group–SEA
- New Horizons Transitional Care Unit
employee assistance programs, workplace wellness centers, chemical dependency
programs, home health agencies, hospices, and retail pharmacies
Imaging Centers (“OIC”), which includes its employees and workforce members
staff members when providing services at or through PeaceHealth or OIC
and volunteers at PeaceHealth or OIC
Notice covers only the health information collected, created, and maintained
by, through, or at PeaceHealth or OIC.“We,” “us,” and “our” in this Notice refer to the parties listed
above.This Notice does not cover
the care that you may receive from independent providers outside PeaceHealth or
OIC or actions by any health plan including the PeaceHealth health plan for
PeaceHealth employees and their covered family members.
The Community Health
promote quality care, PeaceHealth operates an electronic “community health
record” called the “CHR.”This is
a computer system that keeps information about you, your health, and the care
you receive.We and outside
providers add health information about you and read what other providers put
in.For example, if you had to go
to a PeaceHealth emergency room, then the nurse and the physician treating you
would be able to find out about your health history, medications you are on,
and other information from PeaceHealth and community physicians to treat your
all information about you is kept in the CHR.Some of your health information is kept on paper and in
other media.Not every provider
that treats you looks at and/or adds information in the CHR.We cannot remove information once it is
placed in the CHR.This Notice
does not apply to access to the CHR by non-PeaceHealth and non-OIC
providers.PeaceHealth is not
responsible for actions by independent providers or facilities.PeaceHealth and OIC also are not
responsible for the acts of the other entity.
you have questions, please contact your Regional Privacy Officer.
USE AND DISCLOSURE OF YOUR HEALTH
following categories describe different ways we use and disclose health
information.Not every use or
disclosure in a category will be listed.Generally, except as allowed by law, we restrict access to your
information, including nonpublic financial information, to those workforce
members who need to know that information.We maintain physical, electronic, and procedural safeguards
to protect your information.
Use and Disclosure of Your
Health Information for Treatment, Payment, and Operations:
Treatment: We may use and disclose your health
information to give you care and to coordinate and manage your treatment or
other services.For example, a
doctor treating you for a broken leg may need to know if you have diabetes
because diabetes may slow the healing process.We also may disclose your health information to other health
care providers who are not employed by PeaceHealth or OIC.For example, we may provide your health
information to a doctor who is seeing you in his or her office.
Payment: We may use and disclose your health
information to bill and collect payment from you or your health plan for
services you received. For example, we may give information about your surgery to your health plan so your
health plan will pay us or reimburse you for the treatment.We also may share your information with
other providers who are involved in your care for their payment purposes.For example, we may give your insurance
information to an ambulance company that brought you to the hospital.Some of the health information we
collect includes financial information, including information contained in
forms you complete and submit to obtain services (your social security number,
insurance number, credit information, etc.) and information relating to your
transactions with us or others, such as your payment history and insurance and
Health Care Operations: We may use and disclose your health
information for our operations.For example, our quality improvement teams may use your
health information to assess the care and outcomes in your case and others like
it.We may disclose health information
to health care providers for educational purposes.We may disclose your health information to other providers
or to health plans for their own health care operations as allowed by law.
Appointment Reminders, Treatment
Alternatives, and Health-Related Benefits and Services: We may use and disclose your health
information to:remind you about
appointments with us; tell you about alternative treatment therapies,
providers, or settings of care; and tell you about health-related products,
benefits, or services related to your treatment or care.We may send you newsletters about
general health matters, our services, local health fairs, wellness programs,
and similar events.
Uses and Disclosures That
We May Make Unless You Object:
Directory: Unless you object, the PeaceHealth
inpatient/acute caredirectory may
list certain limited information about you, including your name, location in a
facility, and your general condition (fair, stable, etc.).Directory information may be disclosed
to people who ask for you by name and to members of the clergy, whether or not
they ask for you by name.This is
so family, friends, and clergy may visit you and generally know how you are
doing.If you wish to opt out of
the directory, please notify the Admitting or Patient Registration
Department.If you opt out, then
we will not tell callers or visitors that you are a patient, and we may return
letters and deliveries (such as flowers) addressed to you at PeaceHealth or
Individuals Involved in Your Care
or for Notification: We may disclose to a family member, close personal friend,
or other person you identify certain health information that is needed for that
person’s involvement in your care or payment for your care.Except in limited situations, such as
an emergency, we will ask you or determine if you object.We may use professional judgment and
experience when allowing a person to pick up prescriptions, medical supplies,
x-rays, or other similar health information on your behalf.We also may disclose your health
information, directly or through a disaster relief entity, to find and tell
those close to you of your location or condition.
Uses and Disclosures We
May Make Without Your Authorization:
As Required by Law: We will disclose your health
information when required to do so by federal, state, or local law.
Fundraising: We may use, or disclose to a foundation
related to PeaceHealth or to a business associate, limited health information
about you to raise money for PeaceHealth.They may tell you about PeaceHealth projects as well as sending you fundraising
materials.The fundraising materials
will tell you how to opt-out of receiving future materials.
Business Associates: We may disclose your health information
to “business associates” with which we contract to perform services on our
Public Health Activities: We may disclose your health information
for public health activities, including:to a public health authority authorized by law to collect information to
prevent or control disease, injury, or disability; to report actual or suspected
child abuse or neglect; for certain federal Food and Drug Administration
activities; to a person who may have been exposed to a communicable disease or
may be at risk for contracting or spreading a disease or condition, as
authorized by law; and to an employer about an employee, in certain situations.
Victims of Abuse, Neglect, or
Domestic Violence: As
allowed or required by law, we may disclose health information about an
individual we reasonably believe to be the victim of abuse, neglect, or
domestic violence to a government authority authorized to receive such reports.
Health Oversight: We may disclose your health information
to a health oversight agency for activities authorized by law, such as audits,
investigations, inspections, and licensure.
Lawsuits and Disputes: We may disclose your health information
in response to a court or administrative order, subpoena, discovery request, or
other lawful process, as allowed or required by law.
Law Enforcement Activities: We may disclose your health information
if asked to do so by a law enforcement official:as required by laws that mandate certain types of reporting;
in response to court orders, subpoenas, warrants, summons, grand jury
subpoenas, certain administrative requests, or similar processes; to identify
or locate a suspect, fugitive, material witness, or missing person (but we will
give only limited information); about the victim of a crime in certain
circumstances; about a death webelieve may be the result of criminal conduct; about criminal conduct on
our premises; and, in emergencies, to report a crime, the location of the crime
or victims, or the identity, description, or location of the person who
committed the crime.
Coroners, Medical Examiners, and
Funeral Directors: We may disclose your health information to a medical examiner or coroner
as necessary or required to identify a deceased person or determine the cause
of death.We also may disclose
your health information to funeral directors so they can perform their duties.
Organ and Tissue Donations: We may disclose health information to
authorized organizations as required or needed for organ, eye, or tissue
donation and transplants.
Research: Under certain circumstances, we may use
and disclose your health information for research purposes.Most of the time, we or the provider
conducting the research will ask for your authorization.
To Avert a Serious or Imminent
Threat to Health or Safety: We may use and disclose your health information when we
reasonably believe it is necessary to prevent a serious or imminent threat to
the health and safety of you, the public, or another person.The disclosure would only be to someone
who is likely to help prevent the threat such as law enforcement.
Workers’ Compensation: We may disclose your health information
for workers’ compensation or similar programs.
National Security, Intelligence
Activities, Protective Services, and Military Personnel: We may disclose your health information
to authorized federal officials for intelligence, counterintelligence, special
investigations, and other national security activities authorized by law or to
protect the President or other authorized persons.If you are a member of the armed forces, we may disclose
health information about you as required by your military command authorities.
Inmates: We may disclose health information
about an individual who is an inmate or is in custody to a correctional
institution or law enforcement official.
Organized Health Care
for purposes of complying with federal privacy laws, PeaceHealth and its
medical staff characterize themselves as an “organized health care arrangement”
and have agreed to follow this Notice for services by, at, or through
PeaceHealth.These providers may
share health information with each other for treatment, payment, and the health
care operations of the organized health care arrangement and as described in
this Notice.PeaceHealth is not
responsible for actions by independent medical staff members.
Incidental Disclosures: Certain incidental disclosures of your
health information may occur as a by-product of permitted uses and
disclosures.For example, a
roommate may inadvertently overhear a discussion about your care if you share a
De-identified Information and
Limited Data Sets: We may use and disclose your health information that has been
“de-identified” by removing certain identifiers (such as name and address)
making it unlikely that you could be identified.We also may disclose limited health information, contained
in a “limited data set,” as allowed by law.
Personal Representatives: Minors and incapacitated
adults may have “personal representatives.”These personal representatives may be able to act on the
individual’s behalf and exercise the individual’s privacy rights.
Uses and Disclosures with
Your Authorization: Other uses and disclosures of your
health information not covered by this Notice or permitted by law will be made
only with your written permission or authorization.You may revoke your authorization, in writing, at any time (unless
you are told otherwise at the time you sign the authorization).If you revoke your authorization, then
we will no longer use or disclose your health information for the reasons
covered by your authorization, except to the extent that we already have relied
on your authorization.We are
unable to take back any disclosures we already have made based on your
authorization, and we are required to retain our records of the care that we
provided to you.
Specially Protected Health
Information: Unless otherwise required or permitted by law, we may need your
authorization to disclose your health information regarding treatment for
AIDS/HIV/ARC, mental health, drug addiction, alcoholism, and other substance
abuse treatment, developmental disabilities, and/or genetic information or
HEALTH INFORMATION RIGHTS
your health record is our property, you have the rights described below:
Right to Inspect and Copy: You have the right to inspect and
obtain copies of health information that we may use to make decisions about
your care.We may deny your
request in certain limited circumstances.To inspect or obtain a copy of your health information, you must submit
your request on our designated form to the Health Information Management
(“HIM”)/Medical Records Department or the Regional Privacy Officer.PeaceHealth may charge you a reasonable
fee for the costs of copying, mailing, or other supplies related to your
Right to Amend: If you feel that health information we
have about you is incorrect or incomplete, then you have the right to request
an amendment for as long as we keep this information.We may deny your request in certain situations.To request an amendment, you must
submit your request on our designated form to the HIM/Medical Records
Department or the Regional Privacy Officer.
Right to an Accounting of
have the right to request an accounting of certain disclosures of your health
information made by us.This
accounting will not include disclosures:for treatment, payment, or health care operations; to you under your
right of access to your records; that you authorized; to persons involved in
your care or for facility directory and notification purposes; incidental to an
otherwise permitted use or disclosure; as part of a limited data set; for
national security or intelligence purposes; to correctional institutions or
other custodial law enforcement officials; or that occurred before
April14, 2003.To request
this list or accounting, you must submit your request on our designated form to
the Regional Privacy Officer.
Right to Request Restrictions: You have the right to request a
restriction or limitation on the health information we use about you for
treatment, payment, or health care operations.You also have the right to request a limit on the health
information we disclose about you to someone who is involved in your care or
the payment for your care.To
request a restriction, you must submit your request on our designated form to
the Admitting/Patient Registration Department or the Regional Privacy Officer. You
are entitled to a restriction, upon request, to not disclose information to
your health plan for health care services we provided and for which you paid us
directly in full when the purpose of the disclosure is for the health plan’s
payment or health care operations.We are not required to agree to other types of request.If we do agree, we will comply with
your request unless the information is needed to provide you with emergency
Right to Request Confidential
Communications: You have the right to request that we communicate with you about health
matters in a certain way or at a certain location.To request confidential communications regarding billing,
you must submit our designated form to Patient Financial Services or the
Regional Privacy Officer.To
request confidential communications regarding your health information, you must
submit our designated form to the Admitting/Patient Registration Department or
the Regional Privacy Officer.We
will agree to the request if it is reasonable for us to do so.
Right to a Copy of this Notice: You have the right to receive a written
copy of this Notice (even if you agreed to receive this Notice
electronically).Copies of the
Notice are available from the Admitting/Patient Registration Department or
Regional Privacy Officer.You may
print a copy of this Notice from our website atwww.peacehealth.org.
RESPONSIBILITIES REGARDING YOUR HEALTH INFORMATION
are required by law to:maintain
the privacy and security of your health information; give you this Notice of
our legal duties and privacy practices with respect to the information we
collect and maintain about you; and follow the terms of the Notice that is
currently in effect.
TO THIS NOTICE
reserve the right to change this Notice.The revised Notice will be effective for information we already have
about you as well as any information we receive in the future.Unless required by law, the revised
Notice will be effective on the new effective date of the Notice.The current Notice will be available in
our registration areas or on our websites and will be posted in our
facilities.The Notice will state
an effective date.
you believe that your privacy rights have been violated, you may complain to
the Privacy Officer by calling the PeaceHealth Integrity Line (toll free) at
(877) 261-8031, by emailing to [email protected],
or by faxing to (425) 649-3825.
You also may contact your Regional Privacy Officer at [email protected] or as follows:
St. Joseph Hospital
2901 Squalicum Parkway
Bellingham, WA 98225-1898
123 International Way
Springfield, OR 97477
Peace Harbor Hospital
400 Ninth Street
Florence, OR 97439
|Oregon Imaging Centers:
Physician & Surgeon South
1200 Hilyard St., Suite S-330
Eugene, OR 97401
|Southeast Alaska Region:
|Lower Columbia Region:
St. John Medical Center
1615 Delaware Street
Longview, WA 98632-0302
addition, you may file a complaint with the federal Office for Civil Rights,
Secretary of the Department of Health and Human Services.The Privacy Officer or a Regional
Privacy Officer can give you information about filing a complaint.
You will not be penalized
for filing a complaint.