NOTICE OF PRIVACY PRACTICES OF HAMILTON MEMORIAL HOSPITAL DISTRICT
611 So. Marshall Avenue
McLeansboro, IL 62859
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.
Effective: April 14, 2003
Updated: June 27, 2017
If you have any questions or requests, please contact:
Compliance/Privacy Officer, Jenee Burchell
Compliance Hotline: 618.643.2361 ext. 2003
Hamilton Memorial Hospital District • P.O. Box 429 • 611 S. Marshall • McLeansboro, IL 62859
TABLE OF CONTENTS
- We may use and disclose PHI about you in the following circumstances.
- We may use and disclose PHI about you to provide health care treatment to you.
- We may use and disclose PHI about you to obtain payment for services.
- We may use and disclose your PHI for health care operations.
- We may use and disclose PHI under other circumstances without your authorization.
- You can object to certain uses and disclosures.
- We may contact you to provide appointment reminders.
- We may contact you with information about treatment, services, products or health care providers.
- We may contact you for fundraising activities.
- We may not disclose your genetic information.
- You have several rights regarding PHI about you.
- You have the right to request restrictions on uses and disclosures of PHI about you.
- You have the right to request different ways to communicate with you.
- You have the right to see and copy PHI about you.
- You have the right to request amendment of PHI about you.
- You have the right to a listing of disclosures we have made.
- You have a right to a copy of this Notice.
- You have a right to be notified in the event of a breach of your PHI.
- You may file a complaint about our privacy practices.
- Effective date of this Notice.
Effective: April 14, 2003 Updated: April 25, 2022
HIPAA NOTICE OF PRIVACY PRACTICES
As required by the Privacy Regulations Promulgated Pursuant to the
Health Insurance Portability and Accountability Act of 1996 (HIPAA)
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.
This Notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment, or health care operations (TPO), and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. “Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services. We are required by law to notify you in the event of a breach of your unsecured protected health information.
Uses and Disclosures of Protected Health Information: Your protected health information may be used and disclosed by our organization, our office staff and others outside of our office that are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the organization, and any other use required by law.
Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party.
- For example, we would disclose your protected health information, as necessary, to a home health agency that provides care to you.
- For example, your protected health information may be provided to a physician to whom you have been referred to ensure that the physician has the necessary information to diagnose or treat you.
Payment: Your protected health information will be used, as needed, to obtain payment for your health care services.
- For example, obtaining approval for equipment or supplies coverage may require that your relevant protected health information be disclosed to the health plan to obtain approval for coverage.
Healthcare Operations: We may use or disclose, as needed, your protected health information in order to support the business activities of our organization. These activities include, but are not limited to, quality assessment activities, employee review activities, accreditation activities, and conducting or arranging for other business activities.
- For example, we may disclose your protected health information to accrediting agencies as part of an accreditation survey.
- We may also call you by name while you are at our facility.
- We may contact you for fundraising activities. You may opt out of this in writing addressed to the Compliance/Privacy Officer whose contact information is listed at the end of this Notice.
We may use or disclose your protected health information in the following situations without your authorization: as Required By Law, Public Health issues as required by law, Communicable Diseases, Health Oversight, Abuse or Neglect, Food and Drug Administration requirements, Legal Proceedings, Law Enforcement, Criminal Activity, Inmates, Military Activity, National Security, and Workers’ Compensation. Required Uses and Disclosures: Under the law, we must make disclosures to you and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the requirements of Section 164.500.
Other Permitted and Required Uses and Disclosures Will Be Made Only with Your Consent, Authorization, or Opportunity to Object, Unless Required by Law.
You may revoke this authorization at any time in writing, except to the extent that your physician or this organization has taken an action in reliance on the use or disclosure indicated in the authorization.
Your Rights: The following is a statement of your rights with respect to your protected health information.
You have the right to inspect and copy your protected health information. Under federal law, however, you may not inspect or copy the following records; psychotherapy notes; information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information.
You have the right to request a restriction of your protected health information. You have the right to request restrictions on uses and disclosures of your protected health information for treatment, payment, or health care operations. We are not required to agree to most restriction requests, but will attempt to accommodate reasonable requests when appropriate. You do, however, have the right to restrict disclosure of your protected health information to a health plan if the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law, and the protected health information pertains solely to a health care item or service for which you, or someone other than the health plan on your behalf, has paid HMHD in full. If we agree to any discretionary restrictions, we reserve the right to remove such restrictions as we deem appropriate. We will notify you if we remove a restriction imposed in accordance with this paragraph. You also have the right to withdraw, in writing or orally, any discretionary restriction by communicating your desire to do so to the individual responsible for medical records.
You have the right to request to receive confidential communications from us by alternative means or at an alternative location. You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice alternatively, e.g., electronically.
You have the right to request that our organization amend your protected health information. You have the right to request in writing that protected health information that we maintain about you be amended or corrected. We are not obligated to make requested amendments, but we will give each request careful consideration. All amendment requests must be in writing, signed by you or a legal representative, and must state the reasons for the amendment/correction request. If an amendment or correction request is made, we may notify others who work with us if we believe that such notification is necessary.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information up to and including the prior six (6) years.
We reserve the right to change the terms of this notice and will inform you by public postings and orally at admitting of any changes. You will be given the opportunity to receive a physical copy of the new terms. You then have the right to object or withdraw as provided in this notice.
Complaints: You may complain to us or to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may file a complaint with us by notifying our Privacy Officer of your complaint. We will not retaliate against you for filing a complaint.
We are required by law to maintain the privacy of, and provide individuals with, this notice of our legal duties and privacy practices with respect to protected health information. If you have any questions concerning or objections to this form, please ask to speak with our Compliance Officer in person or by any of the methods listed below.
- Compliance Officer:
- (618) 643 – 2361 ext. 2003
- HMHD Compliance Officer
611 S. Marshall Ave.
PO Box 429
McLeansboro, IL 62859
- Compliance Hotline
- (618) 643 – 2361 Option 5