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NORTH PLATTE NEBRASKA HOSPITAL CORPORATION
d/b/a Great Plains Regional Medical Center
JOINT NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Who Will Follow This Notice
GREAT PLAINS REGIONAL MEDICAL CENTER AND AFFILIATED COVERED ENTITIES. This notice describes the privacy practices of Great Plains Regional Medical Center (referred to in this notice as "GPRMC" or the "Hospital"), its departments and all affiliates, which include:
§ All departments and units of the Hospital;
§ Any member of a volunteer group we allow to help you while you are in the Hospital;
§ All physician clinics operated by the Hospital
§ North Platte Nebraska Physicians Group; and
§ Great Plains Homecare Equipment
The departments and affiliates listed above will share your health information with each other as necessary to carry out treatment, payment and health care operations.
MEDICAL STAFF. This notice also describes the privacy practices of an Organized Health Care Arrangement or OHCA between the Hospital and eligible providers on its Medical Staff. Because the Hospital is a clinically integrated care setting, our patients receive care from Hospital staff and from independent practitioners on the Medical Staff. The Hospital and its Medical Staff must be able to share your health information freely for treatment, payment and health care operations as described in this notice. Because of this, the Hospital and all eligible providers on the Hospital's Medical Staff have entered into the OHCA. Under the OHCA, the Hospital and the eligible providers will:
§ Use this Notice as a Joint Notice of Privacy Practices for all inpatient and outpatient visits and follow all information practices described in this Notice;
§ Obtain a single signed acknowledgment of receipt; and
§ Share medical information from inpatient and outpatient hospital visits with eligible providers so that they can help the Hospital with its health care operations.
The OHCA does not cover the information practices of practitioners in their private offices or at other practice locations.
Understanding Your Health Record/Information
Each time you visit a hospital, physician, or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:
1. Basis for planning your care and treatment
2. Means of communication among the many health professionals who contribute to your care
3. Means by which you or a third-party payer can verify that services billed were actually provided
4. Tool in educating health professionals
5. Source of data for medical research
6. Source of information for public health officials charged with improving the health of the nation
7. Source of data for facility planning
8. Tool with which we can assess and continually work to improve the care we render and the outcomes we achieve
Understanding what is in your record and how your health information is used helps you to:
1. Ensure its accuracy
2. Better understand who, what, when, where, and why others may access your health information
3. Make more informed decisions when authorizing disclosure to others
Your Health Information Rights
1. You have the right to request a restriction on how we use and disclose your health information for treatment, payment, health care operations, or to certain family members or friends identified by you who are involved in your care or the payment for your care. We are not required to agree to your request, and will notify you if we are unable to agree.
2. You have the right to obtain a paper copy of this notice of privacy practices upon request by contacting the Privacy Officer.
3. You may request to inspect and copy much of the health information we maintain about you, with some exceptions. If you request copies, we may charge you a copying fee plus postage. If we agree to prepare a summary of your health information, we will charge a fee to prepare the summary.
4. You may request that we amend certain health information that we keep in your records. We are not required to make all requested amendments, but will give each request careful consideration. If we deny your request, we will provide you with a written explanation of the reasons and your rights.
5. You have the right to receive an accounting of certain disclosures of your health information made by us or our business associates. The first accounting in any 12-month period is free; you may be charged a fee for each subsequent accounting you request within the same 12-month period.
6. You may request that we communicate with you about your health information in a certain way or at a certain location. We must agree to your request if it is reasonable and specifies the alternate means or location.
All requests to exercise these rights must be in writing. We will follow written polices to handle requests and notify you of our decision or actions. Contact the Privacy Officer at 308.696.8615 for more information or to obtain request forms.
Our Responsibilities
Great Plains Regional Medical Center is required to:
1. Maintain the privacy of your health information
2. Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
3. Abide by the terms of this notice
4. Notify you if we are unable to agree to a requested restriction
We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will revise this notice and make a revised copy available to you by posting it in the hospital, or you may refer to the hospital website (www.gprmc.com) for the most current notice. The effective date is listed at the end of the notice.
Uses and Disclosures of Your Health Information Without Your Permission
The following are the types of uses and disclosures we may make of your health information without your permission. Where State or federal law restricts one of the described uses or disclosures, we follow the requirements of such State or federal law. These are general descriptions only, and they do not cover every example of disclosures within a category.
We will use your health information for treatment.
For example: We will use and disclose health information about you with nurses, physicians, technicians and others who are involved in your care at the Hospital. We will also disclose your health information to your physician and other physicians, providers and health care facilities for their use in treating you in the future.
We will use your health information for payment.
For example: We will use your health information to prepare your bill and we will send health information to your insurance company with your bill. We may disclose health information about you to other health care providers, health plans and health care clearing houses for their payment purposes. For example, if you are brought in by ambulance, the information collected will be given to the ambulance provider for billing purposes. If State law requires, we will obtain your permission prior to disclosing to other providers or health insurance companies for payment purposes.
We will use your health information for regular health care operations.
For example: Members of the medical staff, nursing staff, the risk manager or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide. We may also furnish other qualified parties with your health information for their health care operations. The ambulance company, for example, may want information on your condition to help them know whether they have done an effective job of providing care. If State law requires, we will obtain your permission prior to disclosing to other providers or health insurance companies for their operations.
Business associates: There are some services provided in our organization through contracts with organizations or entities (known as business associates). We will disclose your health information to our business associates and allow them to create, use and disclose your information to perform their job. To protect your health information, however, we require the business associate to appropriately safeguard your information.
Hospital directory: We will include your name, location in the facility, general condition, and religious affiliation in a facility directory. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name. We will not include your information in the facility directory if you object or if we are prohibited by State or federal law.
Notification: We may disclose your health information to family, friends and others involved in your care to notify them of your location and general condition. We may also disclose your information to an entity assisting in disaster relief efforts so that your family or other person responsible for your care may be notified of your location and condition.
Communication with family: Health professionals, using their professional judgment, may disclose to a family member, or any other person you identify, health information relevant to that person's involvement in your care or payment related to your care.
Research: We may use or disclose your health information for research, subject to certain safeguards. For example, we may disclose information to researchers when their research has been approved by a special committee that has reviewed the research proposal and established protocols to ensure the privacy of your health information. We may disclose health information about you to people preparing to conduct a research project, but the information will stay on site.
Coroners, medical examiners, and funeral directors: We may disclose health information to coroners, medical examiners and funeral directors consistent with applicable law as necessary to carry out their duties.
Organ procurement organizations: Consistent with applicable law, we may disclose your health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs, eyes, or tissue for the purpose of donation or transplant.
Appointment reminders: We may contact you as a reminder that you have an appointment for treatment or medical care at the hospital.
Treatment alternatives and other health-related benefits and services. We may contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Fundraising: We may contact you as part of a fundraising effort. We may also disclose certain elements of your health information, such as your name, address, phone number and dates you received treatment or services at the Hospital, to a foundation related to the Hospital so that the foundation may contact you to raise money for the Hospital.
Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.
Workers' compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers' compensation or other similar programs established by law.
Public health: We may disclose your health information for public health activities. These activities may include disclosures to public health authorities charged with preventing or controlling disease, injury, or disability; to appropriate authorities authorized to receive reports of child abuse and neglect; or to notify a person who may have been exposed to a disease or may be at risk for getting or spreading a disease or condition.
Military and Veterans: If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
National Security and Intelligence Activities: We may disclose medical information about you to authorized federal officials for intelligence, counterintelligence, and other national securities activities authorized by federal law. We may also disclose medical information about you to authorized federal officials so they may protect the President, other authorized persons or foreign heads of state, or conduct special investigations.
Correctional institutions: Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of the other individuals.
Law enforcement: We may disclose health information to law enforcement officials for law enforcement purposes, such as the following:
· As required by law, including laws that require reporting of certain wounds and physical injuries.
· As required by a court order, warrant, subpoena, summons or administrative request as authorized by and within the limits of the law.
· Limited health information to help identify or locate a suspect, fugitive, material witness or missing person.
· An individual who is believed to be a victim of a crime if we obtain the individual's agreement or, if the individual is unable to agree due to incapacity or emergency circumstances, with certain representations by the law enforcement official.
· To alert authorities of a death that may have resulted from criminal conduct.
· Information that we believe is evidence of criminal conduct occurring on our premises.
· As necessary to alert law enforcement to the commission, nature and location of a crime, and to the identity, description and location of the perpetrator.
Health oversight activities: We may disclose your health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure.
Judicial and Administrative Proceedings: We may disclose your health information in administrative and judicial proceedings. For example, we will disclose your information if we receive a binding order from a court or administrative agency. We may also disclose in response to a subpoena or other discovery request by someone else, but only after reasonable efforts have been made to notify you or to request a court order protecting the information.
Reporting abuse, neglect or domestic violence: We may notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. Unless such disclosure is required by law, we will only make this disclosure if you agree.
To avert a threat to health and safety: We may use or disclose your health information to avert a serious threat to health and safety if in good faith, believe that:
· The use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public; and
· The disclosure is to a person or persons reasonably able to prevent or lessen the threat, including the target of the threat, or is necessary for law enforcement authorities to identify or apprehend an individual.
Required by Law: In addition to the uses and disclosures described above, we will disclose your health information where required to do so by State or federal law.
Other Uses and Disclosures
Other uses and disclosures of your health information not covered by this notice will be made only with your written permission. If you provide your permission for us to use and disclose your information, you may revoke that permission at any time. Such revocation will not affect any action we have taken in reliance on your authorization.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with the Hospital or with the Secretary of the Department of Health and Human Services at:
Privacy Officer
Great Plains Regional Medical Center
601 Leota St.
North Platte, NE 69101
Phone: 308.696.8615
Region VII, Office of Civil Rights
U.S. Department of Health and Human Services
601 East 12th Street, Room 248
Kansas City, MO 64106
Phone: 816.426.7278
FAX: 816.426.3686
TDD: 816.426.7065
For More Information
If you have questions and would like additional information, you may contact the Director of Health Information Management at 308.696.8615.
Effective Date: April 14, 2003
Revised On: September 24, 2008
ACKNOWLEDGMENT OF RECEIPT
I have received a copy of Great Plains Regional Medical Center (and Affiliates)/North Platte Nebraska Physicians Group Joint Notice of Privacy Practices.
Date _______________________________
Signed ______________________________________________________________________________
Patient (If different) ____________________________________________________________________
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