Hamilton Hospital Notice of Privacy Practice

This notice addresses how medical information about you may be used and disclosed and how you can get access to this information. Please read it carefully.

Protected Information
While receiving care from our facility, information regarding your medical history, treatment, and payment for your health care may be originated and/or received by us. Information which can be used to identify you and which relates to your past, present or future medical condition, receipt of health care or payment for health care (“Protected Information”).

Our Responsibilities
Federal law imposes certain obligations and duties upon us as a covered health care provider with respect to your Protected Information. Specifically, we are required to:

• Provide you with notice of our legal duties and our facility’s policies regarding the use and disclosure of your Protected Information;
  
• Maintain the confidentiality of your Protected Information in accordance with state and federal law;
  
• Honor your requested restrictions regarding the use and disclosure of your Protected Information unless under the law we are authorized to release your Protected Information without your authorization;
  
• Allow you to inspect and copy your Protected Information during our regular business hours;
  
• Act on your request to amend Protected Information within sixty (60) days and notify you of any delay which would require us to extend the deadline by the permitted thirty (30) day extension;
  
• Accommodate reasonable requests to communicate Protected Information by alternative means or methods; and
  
• Abide by the terms of this notice.

How Your Protected Information May be Used and Disclosed
Generally, your Protected Information may be used and disclosed by us only with your express written authorization. However, there are some exceptions to this general rule.

• Treatment, Payment or Health Care Operations.

Treatment Purposes
We may use or disclose your Protected information for treatment purposes. During your care at our facility, it may be necessary for various personnel involved in your care to have access to your Protected Information in order to provide you with care. For example, information obtained by a nurse, physician, or other member of your health care team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her plan of care to be carried out by members of your health care team. Members of your health care team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment. In addition, we may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Situations may also arise when it is necessary to disclose your Protected Information to health care providers outside our facility who may also be involved in your care. For example, we would provide a subsequent health care provider with copies of various reports that should assist him or her in treating you once you have been dismissed or transferred from the hospital.

Payment Purposes
Your Protected Information may also be used or disclosed for payment purposes. It is necessary for us to use or disclose Protected Information so that treatment and serviced provided by us may be billed and collected from you, your insurance company, or other third party payer. It may also be necessary to release Protected Information to obtain prior approval from your health insurance. We may also release your Protected Information to another health care provider or individual or entity covered by HIPAA privacy regulations who has a relationship with you for their payment activities.

Health Care Operations
Your Protected Information may also be used for health care operations, which are necessary to ensue our facility provides the highest quality of care. For example, your Protected Information may be used for quality assurance or risk management purposes. We may at times remove information that could identify you from your records so as to prevent others from learning who the specific patients are. In addition, we may release your Protected Information to another individual or entity covered by the HIPAA privacy regulations that has a relationship with you for their fraud and abuse detection or compliance purposes, quality assessment and improvement activities, or review, evaluation or training of health care professionals or students.

Patient Directory
Our facility maintains a patient directory. Unless you object, your name, location in our facility, and religious affiliation will be contained in the directory. The directory is disclosed to members of the clergy and except for religious affiliation, to other persons who specifically ask for the information by your name. You are not obligated, however, in any way to consent to the inclusion of your information in the facility directory. Please notify facility staff if you do not wish to be included in the directory or if you wish for information or disclosure to be limited in some way.

Notification and Communications to Individuals Involved in Your Care
Unless you have informed us otherwise, your Protected Information may be used or disclosed by us to notify or assist in notifying a family member or other persons responsible for your care. In most cases, Protected Information disclosed for notification purposes will be limited to your name, location and general condition. In addition, unless you have informed us otherwise, Protected Information may be released to a family member, relative or close personal friend who is involved in your care to the extent necessary for them to participate in your care. In the event you wish for any of these uses or disclosures to be limited, please contact facility personnel.

Fundraising Activities
We may use your Protected Information for the purpose of contacting you as part of a fund-raising effort. Only demographic information and the dates health care was provided to you will be used or disclosed in connection with fundraising efforts. If you do not wish to be contacted for fundraising activities, you may contact the Privacy Officer at 515-832-9400 to request that your name be removed from our list.

Research Purposes
In some instances, your Protected Information may be used or disclosed for research purposes. All research projects which use Protected Information are subject to a special approval process which will, among other things, evaluate the precautions used to protect patient medical information. In many cases, information that identifies you as the patient will be removed.

Special Circumstances
Situations may arise which warrant us to use or disclose Protected Information without your consent or authorization. The law specifically allows us to use or disclose Protected Information without your consent or authorization in the following special circumstances:

• Public Health Activities
  We are allowed to use or disclose your Protected Information for public health activities and purposes. Examples of public health activities that would warrant the use or disclosure of your Protected Information include:
  
  • Preventing or controlling disease, injury or disability;
  • Reporting births and deaths;
  • Reporting the abuse or neglect of a child or dependent adult;
  • Reporting reactions to medications or problems with products; or\
  • Notifying individuals exposed to disease that may be at risk for contracting or spreading the disease.
    
• Health Oversight Activities
  Your Protected Information may be used or disclosed to a health oversight agency for activities authorized by law. Examples of health oversight activities include audits, investigations, inspections or judicial/administrative proceedings, which you are not the subject of. In most cases, the oversight activity will be for the purpose of overseeing the care rendered by our facility or our facility’s compliance with certain laws and regulations.
  
• Judicial and Administrative Proceedings
  If you are involved in a lawsuit or other administrative proceeding, we may release your Protected Information in response to a court or administrative order requesting the release. In some instances, we may also release Protected Information pursuant to a subpoena or discovery request but only if efforts have been made by the requester to provide you with notice of the request and you have failed to object or the objection was resolved in favor of disclosure, on in the alternative, the requester has obtained a protective order protecting the requested information.
  
• Victims of Abuse or Neglect
  Other than child and dependant adult abuse which is covered under public health activities, we may use or disclose your Protected Information to a protective services or social services agency or other similar government authority, if we reasonably believe you have been the victim of abuse, neglect or domestic violence as long as you agree to such disclosure and we feel it is necessary to prevent serious harm to you or other individuals. If you are incapacitated and unable to agree to such a disclosure, we may release your Protected Information for this purpose but only if failure to release it would materially and adversely effect a law enforcement activity and the information will not be used, in any way, against you.
  
• Law Enforcement
  We may also release your Protected Information to a law enforcement official for the following purposes:
  
  • Pursuant to a court order, warrant, subpoena/summons, or administrative request;
  • Identifying or locating a suspect, fugitive, material witness or missing person;
  • Regarding a crime victim, but only if the victim consents or the victim is unable to consent due to incapacity and the information is needed to determine if a crime has occurred, non-disclosure would significantly hinder the investigation, and disclosure is in the victim’s best interest;
  • Regarding a decedent, to alert law enforcement that the individual’s death was caused by suspected criminal conduct; or
  • By emergency care personnel if the information is necessary to alert law enforcement of a crime, the location of a crime, or characteristics of the perpetrator.
    
• Coroner, Medical Examiners, Funeral Homes
  Protected Information regarding a decedent may be released to a coroner or medical examiner for the purpose of identifying a deceased person, determining cause of death or other duties as authorized by law. Protected Information regarding a decedent may also be disclosed to funeral directors if necessary to carry out their duties.
  
• Specialized Government Functions
  Your Protected Information may be used or disclosed for a variety of government functions subject to some limitations. These government functions include:
  
  • Military and Veterans activities;
  • National security and intelligence activities;
  • Protective service of the President and others;
  • Medical suitability determinations for Department of State officials;
  • Correctional institutions and law enforcement custodial situations; or
  • Provision of public benefits.
    
• Organ Donation
  Your Protected Information may be used or disclosed by us to entities engaged in the procurement, banking or transplantation of organs, eyes or tissues for the purpose of facilitating such donation and transplantation.
  
• Workers’ Compensation
  We are allowed to disclose your Protected Information as authorized and to the extent necessary to comply with laws relating to workers’ compensation or other programs providing benefits for work related injuries or illness without regard to fault.

More Stringent Laws
Some of your Protected Information may be subject to other laws and regulations and afforded greater protection than what is outlined in the Notice. For instance, HIV/AIDS, substance abuse, and mental health information are often given more protection. In the event your Protected Information is afforded greater protection under Federal or State law, we will comply with the applicable law.

Your Rights
Federal law grants you certain rights with respect to your Protected Information. Specifically, you have the right to:

• Receive notice of our policies and procedures used to protect your Protected Information;
  
• Request that certain uses and disclosures of your Protected Information be restricted;
  provided, however, if we may release the information without your consent or authorization, we have the right to refuse your request;
  
• Access to your Protected Information; provided, however, the request must be in writing and may be denied in certain limited situations;
  
• Request that your Protected Information be amended;
  
• Obtain an accounting of certain disclosures by us of your Protected Information for the past six years;
  
• Revoke any prior authorizations or consents for use or disclosure of Protected Information, except to the extent that action has already been taken; and
  
• Request communications of your Protected Information are done by alternative means or at alternative locations.

Important Contact Information
This notice has been provided to you as a summary of how we will use your Protected Information and your rights with respect to your Protected Information. If you have any questions or for more information regarding your Protected Information, please contact the Privacy Officer at 515-832-9400.

If you believe your privacy rights have been violated, you may file a complaint with our office by contacting the Privacy Officer at 515-832-9400. You may also file a complaint with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.

Effective Date
This notice became effective on April 14, 2003 and was updated on June 1st, 2005. Please note, we reserve the right to revise this notice at any time. A current notice of our privacy practices may be obtained from our registration office by calling 832-9400. A current notice of privacy practices will also be located on the Hamilton Hospital website at www.hamiltonhospital.com.

We reserve the right to revise our practices with respect to Protected Information and to amend this notice. Should our information practices change, we will post the revised notice in the facility and on the website(www.hamiltonhospital.com.) and have revised notices available at registration desks.