The terms of this Notice of Privacy Practices apply to St. Francis
Health Care Centre and its Medical Staff operating as a clinically
integrated health care arrangement composed of St. Francis Health Care
Centre, the physicians and other licensed professionals seeing and
treating patients at St. Francis Health Care Centre. St. Francis
Health Care Centre, its Medical Staff, and other licensed professionals
will share personal health information of patients as necessary to carry
out treatment, payment, and health care operations as permitted by law.
We are required by law to protect the privacy of your health information. We are
also required to provide you with this notice about our privacy practices.
You can request a copy of this notice from the contact person listed in
Section VII
below at any time and can view a copy of this notice on our web site at
www.sfhcc.org.
St. Francis Health Care Centre collects health information from
you and stores it in a paper chart and on a computer. Except as
outlined below, we will not use or give out information about you
unless you have signed an authorization form.
1. For treatment. We may give information about you to
physicians, nurses, medical students, and other health care
personnel who are involved in your care.
2. To obtain payment for treatment. We may give portions of
your information to our billing department and to your
health plan to get paid for the services we provided to you.
We may give your information to our business associates,
such as billing companies, claims processing companies, law
firms, collection agencies, and others that process our
health care claims. We may also give your information to
another health care provider that has treated you for their
payment purposes.
3. For regular health care operations. We may disclose
information about you to operate this business. For example,
we may use information about you to look at the quality of health
care services that you received or to look at the performance
of the professionals who provided health care services to you.
We may provide information about you to our accountants,
attorneys, consultants, and others in order to make sure we
are complying with the laws that affect us.
We may also give your information to other health care
providers and health plans for their business operations if
they have or had a patient relationship with you.
4. When required by federal, state or local law, judicial or
administrative proceedings, or law enforcement. For
example, we give out your information when a law requires
that we report information to government agencies and law
enforcement personnel about victims of abuse, neglect, or
domestic violence, when dealing with gunshot and other
wounds, or when ordered by the court.
5. For public health activities. For example, we report
information about births, deaths, and various diseases, to
government officials in charge of collecting that
information, and we give coroners, medical examiners, and
funeral directors necessary information relating to a death.
6. For health oversight activities. For example, we will
provide information to assist the government when it
conducts an investigation or inspection of a health care
provider or organization.
7. For purposes of organ donation. We may notify organ
procurement organizations to assist them in organ, eye, or
tissue donation and transplants.
8. For research purposes. We may give information about you in
order to conduct medical research that has been approved by
the entity's medical research committee.
9. To avoid harm. In order to avoid a serious threat to the
health or safety of a person or the public, we may give your
information to law enforcement personnel or persons able to
prevent or lessen such harm.
10. For specific government functions. We may give out
information on military personnel and veterans in certain
situations. We may also give your information for national
security purposes, such as protecting the president of the
United States or conducting intelligence operations.
11. For workers' compensation purposes. We may give out your
information in order to comply with workers' compensation laws.
12. Appointments and service. We may contact you to remind you
of an appointment or give you a test result. You have the
right to request that messages not be left on voice mail or
sent to a particular address. We may also contact you to
give you information about treatment alternatives, or other
health care services and benefits we offer.
13. Fund raising activities. We may contact you to raise funds
for our organization. The money raised through these activities
is used to expand and support the health care services and
educational programs we provide to the community. If you do
not wish to be contacted as part of our fund raising efforts,
please contact the person listed in section VII below.
1. Patient directories. We may include your name, location in
this facility, general condition, and religious affiliation,
in our patient directory for use by clergy and visitors who
ask for you by name. If you do not want us to provide this
information to clergy and others, you must tell us that you
object and fill out the appropriate form.
2. Disclosures to family, friends, or others. We may provide
your information to a family member, friend, or other person
that you indicate is involved in your care or the payment for your
health care, unless you object and fill out the appropriate form.
Disclosures related to psychiatric programs, acquired
immunodeficiency syndrome (AIDS), human immunodeficiency virus
(HIV), and alcohol/drug treatment programs will not be made
without your consent, as required by law.
A. The Right to Request Limits on How We Use and Disclose Your
Health Information. You have the right to ask that we limit how
we use and give out your information. We will carefully consider
your request. If we accept your request, we will put it in
writing and abide by it except in emergency situations. To
request limits, complete the appropriate form.
B. The Right to Choose How We Send Your Information to You. You have
the right to ask that we send information to you to an alternative
address. For example, you may ask us to send information to your
work address rather than your home address. You can also ask that
it be sent by alternative means. For example, you can ask that we
send information by fax instead of regular mail. We will agree to your
request if we can easily provide it in the format you request.
C. The Right to See and Get Copies of Your Health Information. Most
of the time, you have the right to look at or get copies of your
health information that we have. Your request must be on the
appropriate form and signed by you or your legally authorized
representative. In certain situations, we may deny your request.
If we do, we will tell you, in writing, our reasons why and
explain how you can have the denial reviewed.
D. The Right to Get a List of Who We Have Given Your Information To.
You have the right to get a list of instances in which we have
given out your health information after April 14, 2003. To get
this list, you must complete and submit the appropriate form.
E. The Right to Correct or Update Your Health Information. If you
believe that there is a mistake in your information or that a
piece of important information is missing, you have the right to
request that we correct the existing information or add the
missing information. Your request and your reason for the request
must be submitted on the appropriate form.
Each request will be carefully considered. If we approve your
request, we will make the change to your information, tell you
that we have done it, and tell others that need to know the change.
F. The Right to Get This Notice. You have the right to get a copy of this
notice by e-mail. You also have the right to a paper copy of this notice.
If our privacy policy should change at any time in the future, we will
promptly change and post the new notice.
If you think that we may have violated your privacy rights, or you
disagree with a decision we made about your health information, you may
file a complaint with the person listed in Section VII below. You also
may send a written complaint to the Secretary of the Department of
Health and Human Services in Washington, D.C. We will take no action
against you if you file a complaint about our privacy practices.
If you have any questions about this notice or any complaints about our
privacy practices, please contact:
Executive Director
St. Francis Health Care Centre
401 N. Broadway St.
Green Springs, Ohio 44836
419-639-6214
or
keicher@sfhcc.org.
This notice is in effect as of April 14, 2003.