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JOHNSON MEMORIAL HOSPITAL
1125 W. Jefferson Street, Franklin, IN 46131
NOTICE OF PRIVACY PRACTICES
Effective Date: January 1, 2009
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.
WHO WILL FOLLOW THIS NOTICE.
This notice describes our hospital's practices and that of :
WE MAY USE AND DISCLOSE MEDICAL INFORMATION
ABOUT YOU TO CARRY OUT TREATMENT, PAYMENT OR
HEALTH CARE OPERATIONS.
The following categories describe different ways that we may use and
disclose medical information about you to carry out treatment, payment or
health care operations.
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, medical students or other hospital
personnel who are involved in taking care of you at the hospital. 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 we can
arrange 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 another health care
provider so that the other provider can treat you. For example, we may
disclose medical information about you to your doctor so that he can
provide medical care to you.
Payment. We may use and disclose medical information about you so that
the treatment and services you receive at the hospital may be billed to and
payment may be collected from you, an insurance company or a third party.
For example, we may need to give your health plan or insurance company
information about surgery you received at the hospital so your health plan
or insurance company 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.
We also may disclose medical information about you to another health care
provider, health plan or health care clearinghouse for the payment activities
of that other provider or entity. For example, we may disclose medical
information about you to your doctor so that he may obtain reimbursement
for the services which he has provided to you.
Health Care Operations. We may use and disclose medical information
about you for hospital operations. These uses and disclosures are necessary
to run the hospital and make sure that all of our patients receive quality care.
For example, we may use 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 many hospital patients to
decide what additional services the hospital 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 and
other hospital personnel for review and learning purposes. We may also
combine the medical information we have with medical information from
other hospitals to compare how we are doing and see where we can make
improvements in the care and services we offer. 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 who the specific patients are. We also may disclose medical
information about you to another health care provider, health plan or health
care clearinghouse for the health care operations of that other provider or
entity, if that other provider or entity either has or had a relationship with
you. For example, we may disclose medical information about you to
another hospital where you were treated for the quality assessment and
improvement activities of the other hospital.
Organized Health Care Arrangement. An organized health care
arrangement includes a clinically integrated care setting in which patients
receive health care from more than one health care provider. A hospital is
perhaps the most common example of a clinically integrated care setting,
when a hospital and physicians with medical staff privileges at the hospital
together provide treatment to patients. We may disclose medical
information about you to another entity that participates with the hospital in
providing for your care. For example, we may disclose medical test results
about you to your doctor so that he is able to treat you.
Appointment Reminders. We may use and disclose medical information to
contact you as a reminder that you have an appointment for treatment or
medical care at the hospital.
Treatment Alternatives. We may use and disclose medical information to
tell you about or recommend possible treatment options or alternatives that
may be of interest to you.
Health-Related Benefits and Services. We may use and disclose medical
information to tell you about health-related benefits or services that may be
of interest to you.
Fundraising Activities. We may use medical information about you to
contact you in an effort to raise money for the hospital. If you do not want
the hospital to contact you for fundraising efforts, you must notify the
Johnson County Health Foundation at 1125 W. Jefferson Street, Franklin, IN
46131 in writing.
WE MAY USE AND DISCLOSE MEDICAL INFORMATION
ABOUT YOU FOR A HOSPITAL DIRECTORY AND TO GIVE
INFORMATION TO INDIVIDUALS INVOLVED IN YOUR CARE
OR PAYMENT FOR YOUR CARE.
The following categories describe different ways that we may use and
disclose medical information about you for a hospital directory and to give
information to individuals involved in your care or payment for your care.
However, generally speaking, we must orally inform you of this and give
you the opportunity to orally agree to or prohibit or restrict use and
disclosure of medical information about you for these purposes. In certain
situations, such as emergencies, your incapacity or disaster relief purposes,
we do not have to inform you or give you an opportunity to agree or object
to our use and disclosure of medical information about you for these
purposes.
Hospital Directory. We may include certain limited information about you
in the hospital directory while you are a patient at the hospital. This
information may include your name, location in the hospital, your general
condition (e.g., fair, stable, etc.) and your religious affiliation. The directory
information, except for your religious affiliation, may be released to people
who ask for you by name. Your religious affiliation may be given to a
member of the clergy, such as a priest or rabbi, even if they don't ask for you
by name. This is so your family, friends and clergy can visit you in the
hospital and generally know how you are doing.
Individuals Involved in Your Care or Payment for Your Care. We may
release medical information about you to a person who has been determined
to be involved in your medical care. We may also give information to
someone who helps pay for your care. We may also tell your family or
friends your condition and that you are in the hospital. 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.
WE MAY USE AND DISCLOSE MEDICAL INFORMATION
ABOUT YOU WITHOUT YOUR WRITTEN AUTHORIZATION OR
THE OPPORTUNITY FOR YOU TO ORALLYAGREE OR OBJECT
IN CERTAIN SITUATIONS.
The following categories describe different ways that we may use and
disclose medical information about you in certain situations without your
written authorization or the opportunity for you to orally agree or object to
the use and disclosure.
As Required By Law. We will disclose medical information about you
when required to do so by federal, state or local law.
Public Health Activities. We may disclose medical information about you
for public health activities. These activities include but are not limited to
the following: reports to public health authorities for the purpose of
preventing or controlling disease, injury or disability, including reporting
such items and reporting births and deaths, and reports to the Food and Drug
Administration.
Victims of Abuse, Neglect or Domestic Violence. We may disclose to a
government authority medical information about a person whom we believe
to be a victim of abuse, neglect or domestic violence.
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. These activities are necessary for the government to monitor the
health care system, government programs, and compliance with civil rights
laws.
Judicial and Administrative Proceedings. If you are involved in a lawsuit
or a dispute, we may disclose medical information about you in response to
a court or administrative order. We may also disclose medical information
about you in response to a subpoena, discovery request, or other lawful
process by someone else involved in the dispute, but only if efforts have
been made by the person seeking the information to tell you about the
request or to obtain an order protecting the information requested.
Law Enforcement Purposes. We may release medical information about
you to a law enforcement official under certain circumstances. These
include, but are not limited to: a response to a court order, subpoena,
warrant, summons or similar process; to identify or locate a suspect,
fugitive, material witness, or missing person; to give information about the
victim of a crime if, under certain limited circumstances, we are unable to
obtain the person's agreement; about a death we believe may be the result of
criminal conduct; about criminal conduct at the hospital; and in emergency
circumstances 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 release
medical information to a coroner or medical examiner. This may be
necessary, for example, to identify a deceased person or determine the cause
of death. We may also release medical information about patients of the
hospital to funeral directors as necessary to carry out their duties.
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, but we may, however, disclose
medical information about you 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 does not leave the
hospital. We will almost always ask for your specific permission if the
researcher will have access to your name, address or other information that
reveals who you are, or will be involved in your care at the hospital.
To Avert a Serious Threat to Health or Safety. We may use and disclose
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. Any disclosure, however, would only be to someone able to help
prevent the threat.
Specialized Government Functions. Military and veterans activities: If
you are or have been a member of the armed forces, we may release medical
information about you as required by military command authorities or for
veterans purposes. We may also release medical information about foreign
military personnel to the appropriate foreign military authority. National
security and intelligence activities: We may release medical information
about you to authorized federal officials for intelligence,
counterintelligence, and other national security activities authorized by law.
Protective services for the President and others: We may disclose medical
information about you to authorized federal officials so they may provide
protection to the President, other authorized persons or foreign heads of
state or conduct special investigations. Law enforcement custodial
situations: If you are an inmate of a correctional institution or under the
custody of a law enforcement official, we may release medical information
about you to the correctional institution or law enforcement official.
Workers' Compensation. We may release medical information about you
for workers' compensation or similar programs that provide benefits for
work-related injuries or illness.
YOU HAVE RIGHTS REGARDING YOUR MEDICAL
INFORMATION. You have the following rights regarding your medical
information:
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 required to agree to your request. If we do agree, we will comply
with your request unless the information is needed to provide you
emergency treatment.
To request restrictions regarding your medical information from the hospital
or the Immediate Care and Occupational Health Center, or Todd-Aikens
Rehab Care Center, you must make your request in writing to the Medical
Information Department of Johnson Memorial Hospital. To request
restrictions regarding your medical information from Johnson Memorial
Home Care Services, you must make your request in writing to Johnson
Memorial Home Care Services. In your request, you must tell us (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, disclosures to your spouse. We have the right to terminate
restrictions that we have agreed to.
Right to Request Confidential Communications. You have the right to
request that we communicate with you about medical matters 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 confidential communications from the hospital or from the
Immediate Care and Occupational Health Center, or Todd-Aikens Rehab
Care Center, you must make your request in writing to the Medical
Information Department of Johnson Memorial Hospital. To request
confidential communications from Johnson Memorial Home Care Services,
you must make your request in writing to Johnson Memorial Home Care
Services. We will not ask you the reason for your request. We will
accommodate all reasonable requests. Your request must specify how or
where you wish to be contacted.
Right to Inspect and Copy. You have the right to inspect and copy your
medical information. Usually, this includes medical and billing records, but
it does not include psychotherapy notes.
To inspect and copy medical information from the hospital or the Immediate
Care and Occupational Health Center, or Todd-Aikens Rehab Care Center,
that may be used to make decisions about you, you must submit your request
in writing to the Medical Information Department of Johnson Memorial
Hospital. To inspect and copy medical information from Johnson Memorial
Home Care Services that may be used to make decisions about you, you
must submit your request in writing to Johnson Memorial Home Care
Services. If you request a copy of the information, we may charge a fee for
the costs of copying, mailing or other supplies associated with your request.
We may deny your request to inspect and copy in certain circumstances. If
you are denied access to medical information, in most situations you may
request that the denial be reviewed. If we deny your request and if you have
the right of review, another licensed health care professional chosen by the
hospital or other entity which denied your request 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 the review.
Right to Amend. If you feel that medical information we have 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 the hospital or other entity.
To request an amendment from the hospital or the Immediate Care and
Occupational Health Center, or Todd-Aikens Rehab Care Center, your
request must be made in writing and submitted to the Medical Information
Department of Johnson Memorial Hospital. To request an amendment from
Johnson Memorial Home Care Services, your request must be made in
writing and submitted to Johnson Memorial Home Care Services. 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:
