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THIS
NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY
BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO
THIS INFORMATION. PLEASE REVIEW, CAREFULLY. |
WHO
WILL FOLLOW THIS NOTICE
This
notice describes the health information practices of Physicians
Medical Center Carraway (PMCC), its subsidiaries, sites,
locations and the members of their medical staffs. All
will follow the terms of this notice. In addition, these
entities, sites and locations may share medical information
about you. We create a record of the care and services
you receive at PMCC. We need this record to provide you
with quality care and to comply with certain legal requirements.
This notice applies to all of the records of your care
generated by PMCC, whether made by hospital/clinic personnel
or your personal doctor; however, PMCC accepts no legal
responsibility for activities attributable to your personal
doctor or the members of the medical staff. This notice
will tell you about the ways in which we use and disclose
medical information about you. We also describe your rights
and certain obligations we have regarding the use and
disclosure of medical information. We are required by
law to: |
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Make sure that medical information that identifies you
is kept private;
> Give you this notice of our legal
duties and privacy practices with respect to medical information
about you;
> Follow the terms of the notice that
is currently in effect. |
HOW
WE MAY USE AND DISCLOSE MEDICAL INFORMATION
The following categories describe different ways that
we use and disclose medical information. Not every use
or disclosure in a category will be listed. However, all
of the ways we are permitted to use and disclose information
will fall within one of the categories. |
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For Treatment and Treatment Alternatives. 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 residents or students, or other PMCC personnel
or people outside our facility who are involved in taking
care of you. 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 PMCC 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 people outside
PMCC who may be involved in your medical care after you
leave, such as your local physician, family members, clergy
or others we use to provide services that are a part of
your care. We may use and disclose your medical information
to tell you about or recommend possible treatment options
or alternatives that may be of interest to you.
> For Payment. We may use and disclose
medical information about you so that treatment and services
you received through PMCC 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
information about surgery you received at PMCC so your
health plan 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.
> For Routine Health Care Operations.
We may use and disclose medical information about you
for PMCC routine operations. These uses and disclosures
are necessary to run PMCC 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
other PMCC patients to decide what additional services
PMCC should offer, what services are not needed, and whether
certain new treatments are effective. We may also disclose
information to doctors, nurses, technicians, medical residents
and students, and PMCC personnel for review and learning
purposes. We may combine medical information we have with
medical information from other entities 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.
> Individuals Involved in Your Care or Payment
for Your Care. We may release medical information
about you to a friend or family member who is involved
in your medical care. We may also give information to
someone who helps pay for your care. We may also tell
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.
> Appointment Reminders and Health-Related
Benefits and Services. We may use and disclose
medical information to contact your as a reminder that
you have an appointment for treatment or medical care
at PMCC. We may use and disclose medical information to
tell you about health-related benefits or services that
may be of interest to you.
> Research and Statistical Analyses.
Under certain circumstances, we may use and disclose medical
information about you to researchers when their clinical
research has been approved by an Institutional Review
Board or when PMCC participates in analyses. While most
clinical research studies require specific patient consent,
there are some instances where patient authorization is
not required. For example, a research project may involve
comparing the health and recovery of all patients who
receive one medication to those who received another,
for the same condition. This would be done through a retrospective
record review with no patient contact. The Institutional
Review Board reviews the research proposal to make certain
that the proposal has established protocols to protect
the privacy of your health information.
> Fundraising Activities. We may use
medical information about you to contact you in an effort
to raise money for PMCC. We may disclose medical information
to a foundation related to PMCC so that the foundation
may contact you in raising money for PMCC. We only would
release contact information, such as your name, address
and phone number and the dates you received treatment
or services at PMCC. If you do not want PMCC to contact
you for fundraising efforts, you must notify the PMCC
Privacy Officer, 1600 Carraway Boulevard, Birmingham,
AL 35234, in writing.
> Certain Marketing Activities. PMCC
may use medical information about you to forward promotional
gifts of nominal value, to communicate with you about
services offered by PMCC, to communicate with you about
case management and care coordination and to communicate
with you about treatment alternatives.
> Physicians Medical Center Carraway Directory.
We may include certain limited information about you in
the PMCC directories while you are a patient at PMCC.
This information may include your name, location in PMCC,
your general condition (e.g., fair, stable, etc.) and
your religious affiliation. The directory information,
except for your religious affiliation, may also be released
to people who ask for you by name. This information and
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 and generally know how you are doing.
> Business Associates. There are some
services provided in PMCC through contracts with business
associates. Examples include a copy service we use when
making copies of your health record, consultants, accountants,
lawyers, medical transcriptions and third-party billing
companies. When these services are contracted, we may
disclose your health information to our business associate
so that they can perform the job we’ve asked them
to do. To protect your health information, however, we
require the business associate to appropriately safeguard
your information.
> 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 to public health or legal authorities
charged with preventing or controlling disease, injury,
or disability. For example, we are required to report
the existence of a communicable disease, such as tuberculosis,
to the Alabama Department of Public Health to protect
the health and well being of the general public. We may
disclose medical information about you to individuals
exposed to a communicable disease or otherwise at risk
for spreading the disease. We may disclose medical information
to an employer if the employer requires the healthcare
services to determine whether you suffered a work-related
injury.
> Food and Drug Administration (FDA).
We may disclose to the FDA and to manufacturers 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.
> Victims of Abuse, Neglect or Domestic Violence.
We are required to report child, elder and domestic abuse
or neglect to the State of Alabama.
> 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.
> Lawsuits and Disputes. If you are
involved in a lawsuit or a dispute, we may 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 to
tell you about the request or to obtain an order protecting
the information requested. We may disclose medical information
for judicial or administrative proceedings, as required
by law.
> Law Enforcement. We may release
medical information for law enforcement purposes as required
by law, in response to a valid subpoena, for identification
and location of fugitives, witnesses or missing persons,
for suspected victims of crime, for deaths that may have
resulted from criminal conduct and for suspected crimes
on the premises.
> 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.
> Organ and Tissue Donation. If you
are an organ donor, we may use or release medical information
to organizations that handle organ procurement or other
entities engaged in procurement, banking or transportation
of organ, eye or tissue to facilitate organ or tissue
donation and transplantation.
> 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.
> 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
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.
> Worker’s Compensation. We
may release medical information about you for worker’s
compensation or similar programs. These programs provide
benefits for work-related injuries or illness.
> Inmates or Individuals in Custody.
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.
> Other uses and disclosures. Any
other uses and disclosures will be made only with your
written authorization. |
YOUR
RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
Although all records concerning your hospitalization obtained
at PMCC are the property of PMCC, you have the following
rights regarding medical information we obtain about you. |
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Right to Inspect and Copy. You have the right
to inspect and copy medical information that may be used
to make decisions about your care. Usually this includes
medical and billing records, but does not include psychotherapy
notes. To inspect and copy medical information that may
be used to make decisions about you, you must submit your
request in writing to the PMCC Privacy Officer. 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 very limited circumstances. If you
are denied access to medical information, you may request
that the denial be reviewed. Another physician chosen
by PMCC 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. To request
an amendment, your request must be made in writing and
submitted to the PMCC Privacy Officer. 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: |
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Was not created by us, unless the person or entity that
created the information is no longer available to make
the amendment;
> Is not a part of the medical information
kept by or for the hospital;
> Is not a part of the information
which you would be permitted to inspect or copy; or
> Is accurate and complete. |
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Right to an Accounting of Disclosures. You have
the right to request an ‘accounting of disclosures’.
This is a list of certain disclosures we made or medical
information about you. To request this list or accounting
of disclosures, you must submit your request in writing
to the PMCC Privacy Officer. Your request must state a
time period that may not be longer than six years and
may not include dates before April 14, 2003. Your request
should indicate in what form you want the list (for example,
on paper, electronically). The first list you request
within a 12 month period will be free. For additional
list, we may charge you for the costs of providing the
list. We will notify you of the cost involved and you
may choose to withdraw or modify your request at that
time before any costs are incurred.
> 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 a 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, you must make your request in writing to
the PMCC Privacy Officer. 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.
> 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,
you must make your request in writing to the PMCC Privacy
Officer. 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 Revoke Authorization. You
have the right to revoke, in writing, your authorization
to use or disclose your medical information except to
the extent that action has already been taken in reliance
on your authorization.
> Right to a Paper Copy of This Notice.
You have the right to a paper copy of this notice. You
may ask us to give you a copy of this notice at any time.
Even if you have agreed to receive this notice electronically,
you are still entitled to a paper copy of this notice. |
To obtain a paper copy of this notice contact the PMCC
Privacy Officer.
CHANGES
TO THIS NOTICE
We reserve the right to change this notice. We reserve
the right to make the revised or changed notice effective
for medical information we already have about you as
well as any information we receive in the future. We
will post a copy of the current notice in PMCC facilities.
The notice will contain on the first page, in the top
left hand corner, the effective date. In addition, each
time you visit PMCC to receive services, we will offer
you a copy of the current notice in effect.
FOR
MORE INFORMATION OR TO REPORT A PROBLEM
Please contact:
PMCC Privacy Officer
1600 Carraway Boulevard
Birmingham, Alabama 35234
If
you believe your privacy rights have been violated,
you may file a complaint with PMCC or with the Secretary
of the Department of Health and Human Services.
To file a complaint with PMCC, contact the PMCC Privacy
Officer at 205.502.4472.
All complaints must be submitted in writing.
You will not be penalized for filing a complaint.
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