Notice of Privacy Practice
St. Elizabeth’s Hospital - Belleville, Illinois
THIS NOTICE OF PRIVACY PRACTICES IS PROVIDED TO YOU AS A REQUIREMENT OF THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (“HIPAA”). 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.
If you have any questions, please contact our Privacy Officer at Ext. 1210
WHO WILL FOLLOW THIS NOTICE?
- Any health care professional authorized to enter information into your hospital chart.
- All departments of the hospital (including Home Health, Hospice and all off campus departments).
- All employees, staff, volunteers and other hospital personnel, including staff at HSHS Corporate Offices, with whom we may share information.
- Any business associate or partner with whom we may share health information for the purpose of treatment, payment or health care operations.
OUR PLEDGE REGARDING MEDICAL INFORMATION:
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at the hospital. We need this record to provide you with quality care and to comply with certain legal requirements. This Notice applies to all of the records of your care generated by the hospital, whether made by hospital personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your medical information created in the doctor’s office or clinic.
This Notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information. A more detailed description of our privacy practices is available upon request.
We (St. Elizabeth’s Hospital) are required by law to:- Make sure that medical information that identifies you is kept private;
- Give you this Notice of our legal duties and privacy practices with respect to medical information about you; and
- Follow the terms of the Notice that are currently in effect.
Generally, we may not use or disclose your medical information without your permission, except as otherwise permitted by law. Once your permission has been obtained, we must use or disclose your medical information in accordance with the specific terms of your permission. The following are circumstances under which we are permitted by law to use or disclose your medical information.
HOW WE (St. Elizabeth’s Hospital) MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU:
USE OR DISCLOSURE OF YOUR MEDICAL INFORMATION WITHOUT YOUR AUTHORIZATION
Without your authorization, HIPAA allows us to use or disclose your medical information in order to provide you with services and the treatment you require or request, or to collect payment for those services, and to conduct other related health care operations otherwise permitted or required by law. Also, we are permitted to disclose your medical information within and among its workforce and other entities that have agreed to be bound by these policies in order to accomplish these same purposes. However, even with your authorization, we are still required to limit such uses or disclosures to the minimal amount of medical information that is reasonably required to provide those services or complete those activities.
The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures, this Notice will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways in which we are permitted to use and disclose information without your authorization should fall within one of the categories.
• For Treatment. We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, volunteers, medical students, residents, other personnel or members of our workforce who are involved in taking care of you on our premises. 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. In addition, the doctor may need to tell the dietitian if you have diabetes so that arrangements can be made for appropriate meals. Different departments of the hospital also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work and x-rays. We also may disclose medical information about you to people outside of the hospital who may be involved in your medical care after you leave the hospital, such as providers who you or another responsible party have selected to provide services that are part of your care.
• For Payment. We may use and disclose medical information about you so that the treatment and services you receive from us can be billed to, and payment can be collected from, you, an insurance company or third party payer. For example, we may need to give your health plan information about surgery you received so your health plan will pay us or reimburse you for the surgery. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
• For Health Care Operations. We may use and disclose medical information about you for our operations. These uses and disclosures are necessary to run our hospital, to comply with accreditation and other standards and to make sure that all of our patients receive quality care. For example, we may use your medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical information about our patients to decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, medical students, residents, professional students, trainees or practitioners in health care, non-health care professionals and other hospital personnel or members of our workforce for review, education, teaching and learning purposes. We may also combine the medical information that we have with medical information from other providers to compare how we are doing and to see where we can make improvements in our care and services. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning your identity or the identity of any specific patient.
In addition, under HIPAA, we may use and disclose medical information, without your authorization, as follows:
• To Send You Treatment Reminders and Information About Treatment Alternatives or Health-Related Benefits and Services. We may contact you as a reminder that you have an appointment for treatment or medical care with us or inform you about or recommend possible treatment options, alternatives or health-related benefits or services that may be of interest to you.
• Fundraising Activities. We may contact you in an effort to raise money for the hospital and its operations. We may disclose medical information to a foundation associated with us so that the foundation may contact you in raising money for us. We would only release (i) contact information, such as your name, address and phone number; (ii) demographic information, such as your age, gender, insurance status and employer name; and (iii) the dates you received treatment or services from us. If you do not want us to contact you for fundraising efforts, you must notify our Privacy Officer in writing.
• Provider Directory. We may include certain limited information about you in the hospital directory while you are a patient on our premises. This information may include your name, location in the hospital (e.g., floor, unit or wing), your general condition (e.g., fair, stable, etc.) and your religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name (either in person or by telephone, electronic mail, etc.). This is so your family, friends and clergy can visit you and generally know how you are doing. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they do not ask for you by name. If you would like to restrict or prohibit the use or disclosure of your information for the hospital directory, you must notify our Privacy Officer in writing, or, you may notify the Admitting Department orally at the time of your admission to hospital.
• Individuals Involved in Your Care or Payment for Your Care. We may release medical information about you to a family member, personal representative or friend who is involved in your medical care or who helps pay for your care. We may also tell these persons about your condition and your location in the hospital, or attempt to locate or identify your family, representative or friends. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location. Further, we may make disclosures to a parent, guardian or other person acting in place of a parent if such person has the authority to act on behalf of a minor. Additionally, we may make disclosures to a person appointed by you as your durable power of attorney for health care.
• Research. Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special
approval process. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with patients’ need for privacy of their
medical information. Before we use or disclose medical information for research, the project will have been approved through this research approval process. We may, however, disclose your medical information to people preparing to conduct a research project (for example, to help them look for patients with specific medical needs) so long as the medical information they review is not removed from our premises. We may also disclose the medical information of decedents for a research project, so long as the information is necessary for the research.
- to prevent or control disease, injury or disability;
- to report births and deaths;
- to report child abuse or neglect;
- to collect or report reactions to medications, food supplements or dietary supplements;
- to collect or report product problems or defects;
- to notify persons of recalls, replacements or repairs relating to products they may be using; and
- to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
• Disclosures About Victims of Abuse, Neglect or Domestic Violence. We may disclose medical information to notify the appropriate government authority if we believes a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if the patient agrees or when required or authorized by law.
• Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections and licensure or disciplinary actions. These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.
• As Required by Law. We will disclose medical information about you when required to do so by federal, state or local law.
• To Avert a Serious Threat to Health or Safety. Consistent with Illinois law, we may use and disclose certain medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. In addition, we may use and disclose medical information if we believe that the use or disclosure is necessary for law enforcement to identify or apprehend an individual who has escaped from a correctional institution or from custody.
• Organ and Tissue Donation. We may use or disclose information to an organ procurement or transplant organization or other similar entity.
• Workers’ Compensation. We may release information about you as authorized by (or as
necessary to comply with) workers’ compensation laws. For example, we may release information to a party responsible for payment of workers’ compensation benefits and to an agency responsible for administering and/or adjudicating claims for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
- to report certain types of wounds or injuries;
- in response to a court order or court-ordered subpoena (or court-ordered discovery request) or in response to a subpoena or discovery request if the patient privilege has been waived;
- in response to a court-ordered warrant, subpoena or summons issued by a judicial officer, or a governmental request (including a governmental subpoena or summons) if certain standards are satisfied;
- in response to a law enforcement official’s request for the purpose of identifying or locating a suspect, fugitive, material witness or missing person, but only certain types of information may be disclosed;
- to provide information about the victim of a crime, although we would try to obtain the individual’s consent unless the individual is incapacitated or except under certain limited circumstances;
- about an individual that has died to a law enforcement official for the purpose of alerting law enforcement of the death if the we have a suspicion that such death may have resulted from criminal conduct;
- about criminal conduct that occurred on our premises; and
- in emergency circumstances to report a crime; the location of the crime or victims of the crime; or the identity, description or location of the person who committed the crime.
• Coroners, Medical Examiners and Funeral Directors. We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or to determine the cause of death. We may also release medical information to funeral directors as necessary to carry out their duties.
• For Specific Government Functions. We may release medical information of military personnel (and foreign military personnel) in certain situations, and we may release the medical information of inmates to correctional facilities in certain situations. We may also release medical information for national security reasons, such as the protection of the President of the United States or for national security activities.
ILLINOIS LAW MAY BE MORE STRINGENT THAN HIPAA
Certain provisions of Illinois law may be more stringent than HIPAA or may be, in the future, determined to be more stringent than HIPAA. If such provisions are more stringent than HIPAA, then, according to HIPAA, we must comply with the more stringent provisions of Illinois law.
OTHER USES OF MEDICAL INFORMATION REQUIRE AUTHORIZATION
Other uses and disclosures of medical information not covered by this Notice or the laws that apply to us will be made only with your written authorization. If you give us an authorization to use or disclose medical information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose medical information about you for the reasons covered by your written authorization, unless you authorized disclosure for a research study and your information is needed to protect the integrity of the study.
You understand that we are unable to take back any disclosures which we have already made with your authorization, and that we are required to retain our records of the care which we provide to you. All notices that you are revoking your authorization must be in writing and delivered by U.S. mail, in person, or by other reasonable means to our Privacy Officer.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU:
You have the following rights regarding medical information which we maintain about you:
• Right to Inspect and Copy. You have the right to inspect and have a copy made of the medical information contained in your designated record set. A “designated record set” contains medical and billing records and any other records maintained by us about you. Usually, you have the right to access medical and billing records, subject to certain limitations. For example, you do not have the right to obtain information if its disclosure would have an adverse effect on you or if the information is compiled by us in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding.
To inspect and copy your medical information contained in your designated record set, you must submit your request in writing to the Privacy Officer. If you request a copy of the information, we may charge a reasonable, cost-based fee to cover the costs associated with your request.
We may deny your request in very limited circumstances. If you are denied access to your medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by us will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of any review.
• Right to Amend. If you feel that the medical information in the designated record set which we maintain about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for us.
To request an amendment, you must make the request in writing and submit it to the Privacy Officer. In addition, you must provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that:- was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
- is not part of the medical information kept by or for the hospital;
- is not part of the information which you would be permitted to inspect and copy; or
- we believe is accurate and complete.
• Right to an Accounting of Certain Disclosures. You have the right to request an accounting of certain disclosures which we have made of your medical information within the six (6) years prior to your request. This right applies to disclosures for purposes other than treatment, payment or health care operations as described in this Notice. It excludes disclosures we may have made to you, with your authorization, for a facility directory, to family members or friends involved in your care, or for notification purposes. The right to receive this information is subject to certain exceptions, restrictions and limitations.
To request this list or an accounting of the disclosures of your medical information, you must submit your request in writing to the Privacy Officer. Your request must state a time period which may not be longer than six (6) years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a twelve (12) month period will be free. For additional lists, we may charge you a reasonable, cost-based fee for the cost of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
• Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had.
We are NOT legally required to agree to your request. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment.
To request restrictions, you must make your request in writing to the Privacy Officer. In your request, you must tell the Privacy Officer: (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply; for example, disclosure to your spouse or your former clergy.
• Right to Request Change in Communications. You have the right to request that we
communicate with you about your medical information in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
To request a change in the manner or method of how we communicate with you about your medical information, you must make your request in writing to the Privacy Officer. We will not ask you the reason for your request. We will use reasonable efforts to accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
• Right to a Paper Copy of This Notice. You have the right to receive a paper copy of this Notice. You may ask us to give you a copy of this Notice at any time. To obtain a paper copy of this Notice, please contact the Privacy Officer.
CHANGES TO THIS NOTICE
St. Elizabeth’s Hospital's Privacy Officer and the Privacy Committee will be responsible for developing the Notice of Privacy Practices. The Privacy Officer and the Privacy Committee will also be responsible for promptly revising and distributing the Notice of Privacy Practices as necessary. We reserve the right to make the revised or changed Notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice in the hospital. The Notice will contain the effective date. In addition, each time you register at or are admitted to the hospital for treatment or health care services as an inpatient or outpatient, we will offer you a copy of the current Notice in effect. You will be asked to acknowledge in writing your receipt of this Notice.
EFFECTIVE DATE
This Notice shall go into effect on April 14, 2003, or when you receive a copy of this Notice, whichever date is later. This Notice has been revised as of May 9, 2006.
COMPLAINTS
If you are concerned that your privacy right may have been violated or you disagree with a decision we made about access to your records, you may contact our Privacy Officer at 618/234-2120, Extension 1210. All verbal complaints must be followed by a written description of the cause for the complaint. All written complaints should be addressed to:
HIPAA Privacy Officer
St. Elizabeth’s Hospital
211 South Third Street
Belleville, Illinois 62220
All complaints will be investigated by the Privacy Officer and when necessary, the HIPAA Privacy Committee, and each complaint will receive a response as soon as practical.
- Finally, you may send a written complaint to the U.S. Department of Health and Human Services Office of Civil Rights. Our Privacy Officer can provide you the address.
- Under no circumstance will you be penalized or retaliated against for filing a complaint.
