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NOTICE OF HEALTH
INFORMATION PRIVACY
PRACTICES
Effective: April 14, 2003
THIS NOTICE DESCRIBES HOW
HEALTH INFORMATION ABOUT YOU MAY BE USED OR DISCLOSED BY
Downeast Health Services AND HOW YOU CAN ACCESS THIS INFORMATION
PLEASE REVIEW THIS NOTICE CAREFULLY
We understand that health information about
you is very personal. A Federal Law called HIPAA, the Health Insurance
Portability and Accountability Act, was created to support your privacy
and rights surrounding your health information. DEHS takes your rights
very seriously and has created this form to explain our policies.
HOW WE MAY USE AND DISCLOSE
(SHARE) HEALTH INFORMATION ABOUT YOU
Health information is recorded every time
you seek treatment from a health care provider or visit a health center.
Typically, health information contains your symptoms, examination and test
results, diagnoses, treatment, and plans for future care.
The following three categories are the most common ways that DEHS uses or
shares your health information.
For Treatment:
DEHS general policy is that we may use
and disclose health information about you to nurse practitioners,
physician assistants, doctors, nurses, health care associates, nursing
and medical students, volunteers or other personnel who work within the
DEHS health services and administrative office network without your
written authorization (consent).
We may also disclose health information about you without your written
authorization if you are hospitalized under our supervision, sent by us
to a lab to perform tests, to a pharmacy to have prescriptions filled,
to the hospital for x-rays or for other treatment purposes.
However, if we need to refer you to a specialist for treatment or if
another healthcare provider calls us for information about you, we will
not release any information unless we have your authorization to do so.
For Payment:
We may use and disclose health
information about you without your written authorization so that the
services you received from us may be billed for and payment collected.
For example, we may need to give your health insurance plan information
about your office visit so they will pay us or reimburse you.
For Healthcare Operations:
We may use and disclose health
information about you without your written authorization to make sure
that all of our patients receive quality care. For example, we may use
health information to review our services, to evaluate the performance
of our staff, or to review your records if you file a complaint.
OTHER WAYS WE MAY USE AND DISCLOSE
HEALTH INFORMATION ABOUT YOU:
- In addition to the situations listed
above, here are more examples of times when DEHS will not release your
health information without your written authorization to do so:
- For a Worker’s Compensation claim;
- Before sending out an appointment
reminder to you;
- Before you enter into a research
study;
- If your records are requested for a
common legal proceeding (e.g. a local lawyer or local police unit
requests your records).
- There may be times when someone outside
of the DEHS network requests your records, and because of a timing
conflict, an inability to locate you or an over-riding state or federal
law, we are unable to gain your consent, but still need to release
health information about you. A few examples of those times are:
- Serious legal situations. This is a
large category, but a few examples are:
- If we receive a court order or
subpoena to produce your health information;
- If your health information could
help to identify or locate a suspect, fugitive, material witness, or
missing person;
- If you are the victim of a crime and
we are unable to obtain your consent.
- If you are an inmate at a correctional
facility and your records are necessary to protect the health or
safety of other people in the institution.
- Lastly, there may also be times other
than those listed in the first section of this Notice (under treatment,
payment and operations) when DEHS may release your health information
without your written authorization. Some examples of those
times are:
- Public Health Information
(these are all required by state or federal law):
- To report birth, deaths and
abortions;
- To report abuse or neglect of
minors;
- To report reactions to medications
or problems with products, such as when a product is recalled
(called back in to the manufacturer);
- To report certain diseases to the
health department, such as confirmed cases of chlamydia, gonorrhea,
syphilis or hepatitis.
- Health Oversight Activities: We
may disclose health information to a health oversight agency for them
to make sure we are following the law. These activities might include
audits and inspections, investigations, accreditation or licensure.
- In an Emergency Situation: If
an emergency were to happen to you while you were in our care that
required us, for example, to call an ambulance we might need to
release health information about you without your consent in order for
the emergency personnel to care for you. Similarly, we may disclose
health information about you if we feel it could prevent someone else
from being hurt by you.
- As Required By Law: We may
disclose health information about you in situations not already
mentioned when required to do so by federal, state, or local law.
YOUR RIGHTS REGARDING HEALTH
INFORMATION ABOUT YOU
You have the following rights to your
health information:
- Right to Inspect and Copy your
health care and billing records.
- Right to Amend your records if
you feel that health information we have about you is incorrect or
incomplete. Any amendment will become a permanent part of your medical
record.
- Right to request a list of how we
shared your health information except for treatment, payment and
health care operations, as previously described on the first page of
this notice.
The above three requests must be made in
writing on a form provided by us. In some cases, we may deny your
requests.
- Right to Request Restrictions on
uses or sharing of your health care information. For example, you could
ask that your healthcare information not be viewed by a staff person you
know personally. In some cases we may need to deny your request.
- Right to Request Confidential
Communications: You have the right to ask that we contact you in a
certain manner or at a certain location. For example, you can ask that
we only contact you at work or by mail to a post office box. We will try
to agree with all reasonable requests.
- Right to a Paper Copy of This Notice:
You have the right to obtain a paper copy of this Notice at any time
upon request.
MINORS AND PERSONS WITH GUARDIANS
Minors have all the rights outlined in this
Notice with respect to health information relating to reproductive
healthcare, except for emergency situations or when the law requires
reporting of abuse and neglect. If you are a minor or a person with a
guardian obtaining healthcare that is not related to reproductive health,
your parent or legal guardian may have the right to access your medical
record and make certain decisions regarding the uses and disclosures of
your health information.
CHANGES TO THIS NOTICE
We reserve the right to revise or change
this Notice. A dated copy of the revised Notice will be posted.
OTHER USES OF HEALTH INFORMATION
Other uses and sharing of health
information not covered by this Notice or the laws that apply to us will
be made only with your written permission. If you give us permission you
may change your mind, in writing, at any time, and we will no longer use
or share that health information in the future. Information already used
or shared cannot be taken back. We are required to keep the records of the
care that we have given to you.
COMPLAINTS
If you believe your privacy rights have
been violated, you may file a complaint with us. Please contact:
The Privacy Officer at Downeast Health
Services
52 Christian Ridge Rd.
Ellsworth, ME 04605
Phone: 207-667-5304
or
The Secretary of the Department of Health and Human Services.
All complaints must be
submitted in writing. You will not be penalized for filing a complaint. |
