DCH Health System Organized Healthcare Arrangement
Joint Notice of Privacy Practices
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.The Radiology Clinic LLC
As part of your health care team, DCH Healthcare Authority, facilities DCH Regional Medical Center, Northport Medical Center, DCH Home Health, Phelps Outpatient Center, Fayette Medical Center Fayette Long-term Care Facility, and Pickens County Medical Center originate and maintain numerous medical, billing, and other related records containing private information about you. You provide the facility with your personal information and medical information. Personal information includes your name, address, phone number, Social Security number, and driver’s license number. Medical information includes your medical history, insurance coverage, or information from other doctors, nurses or medical providers. This document describes how this information may be used and disclosed by the facility, as well as your rights and the facilities’ duties with respect to such information. You should also know that the facility shares some of your information with its medical staff and some physician groups in order to provide treatment, payment and health care operations. These doctors work at the facility, but are not usually employed by the facility. This notice also describes their practices, with appropriate modification specific to that facility, as well. They are:
DCH Regional Medical Center Medical Staff
Northport Medical Center Medical Staff
Fayette Medical Center Medical Staff
Pickens County Medical Center
Pickens County Medical Center Medical Staff
Capstone College of Community Health Sciences
YOUR HEALTH INFORMATION RIGHTSYou have the right to ask for restrictions on the ways in which we use and disclose your medical information beyond those required by law. We will consider your request, but we are not required to accept it.
Although all records relating to the treatment you receive at the facility are property of the facility, you have the following rights with respect to your health information:
You have the right to obtain a copy of this notice in paper form upon request. You may also obtain a copy of this notice at our Web site. Click here to print off a copy of this noticeNote: You will need Adobe Acrobat Reader software.
Except under certain circumstances, you have the right to inspect and obtain a copy of your medical record and billing records. You do not have the right to have free copies of these records; we will charge you a fee for copying, summarizing and mailing.
If you believe that information in your records is incorrect or incomplete, you have the right to ask the facility to correct the existing information or correct the missing information. Under certain circumstances, we may be unable to meet your request.
You have the right to ask for a list of instances when the facility used or disclosed your medical information for reasons other than your treatment, payment for services furnished to you, our health care operations, or disclosures you give us authorization to make. If you ask for this information more than once every 12 months, we may charge you a fee.
You have the right to request that you receive communications containing your protected health information by alternative means or at alternative locations to protect your confidentiality. For example, you may ask to be contacted only at home or through the mail at a post office box.
To exercise any of your rights, please contact the facility in writing at DCH Health System, 809 University Blvd East, Tuscaloosa, AL 35401 Attention Chris Jones.
The facility is required by law to maintain the privacy of your health information and to provide you with a notice as to the facility’s legal duties and privacy practices with respect to your health information. The facility is also required to abide by the terms of this notice, which may be revised from time to time. The facility reserves the right to change the terms of this notice and to make any revisions to the notice effective for all your health information that the facility maintains. Should the facility change the terms of this notice, it will post a copy of the revised notice at locations within the facility accessible to the public. Additionally, you can request a copy of the revised notice at any time.
COMPLAINTS/COMMENTS/FOR MORE INFORMATION
If you have any complaints concerning your privacy at a DCH facility, you may contact the Secretary of the Department of Health and Human Services, at 200 Independence Ave., S.W., Room 509F, HHH Building, Washington, D.C. (email: firstname.lastname@example.org) You may also contact the facility Privacy Officer Chris Jones PH# (205) 759-7949, 809 University Blvd. East, Tuscaloosa, AL 35401. The law protects you from retaliation for filing a complaint.
USE AND DISCLOSURE OF YOUR HEALTH INFORMATION
The facility is permitted to use or disclose your health information in the following ways:
The facility will use your health information in the provision and coordination of your health care. We may disclose all or any portion of your health information to your attending physician, consulting physician or physicians, nurses, technicians, and other health care providers who have a legitimate need for such information in your care and continued treatment. The facility may share information about you with other providers in order to coordinate specific services, such as prescriptions, lab work and X-rays. The facility also may disclose your health information outside the facility to whomever may be involved in your medical care after you leave the facility, such as family members, clergy, and others used to provide services that are part of your care.
Family and Friends
The facility may release health information about you to a friend or a 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 your family or friends your condition and that you are in the facility.
The facility may release health information about you for the purposes of determining coverage, billing, claims management, medical data processing, and reimbursement. Your health information may be released to an insurance company, third-party payor or other entity or their authorized representatives involved in the payment of your medical bill. The information may include copies or excerpts of your medical record which are necessary for payment of your account. For example, a bill sent to a third-party payor may include information that identifies you, your diagnosis, and the services and supplies provided to you.
Routine Health Care Operations
The facility may use and disclose your health information during routine health care operations, including but not limited to, quality assurance, utilization review, medical review, internal auditing, accreditation, certification, licensing or credentialing activities of the facility.
Unless you notify us that you object, we will use your name, location in the facility, general condition, and religious affiliation for directory purposes. This information may be provided to members of the clergy and, with the exception for religious affiliation, to other people who ask for you by name.
The facility may disclose certain health information about you to an organization assisting with disaster relief. For example, we may disclose the name of tornado victims to the Red Cross in the event of a weather disaster in our community.
The facility may disclose certain health information about you to our business associates. A business associate is an individual or entity under contract with the facility to perform or assist the facility in a function or activity which necessitates a disclosure of health information. Examples of business associates include, but are not limited to, consultants, accountants, lawyers, medical transcriptionists and third-party billing companies. The facility requires the business associate to protect the confidentiality of your health information.
The facility may use or disclose your health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.
The facility may disclose your health information to a health oversight agency for activities authorized by law, including, but not limited to, licensure, certification, audits, investigations and inspections. These activities are necessary for the government and other health oversight agencies to monitor the health care system, government programs and compliance with civil rights.
The facility may disclose your health information for law enforcement purposes as required by law or in some response to a valid response or court order.
Serious Threat to Health or Safety
Consistent with applicable federal and state laws, we may use and disclose health information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
As required by law, the facility may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.
Abuse, Neglect, Violence
As required by law, the facility will disclose your health information to the appropriate authorities in instances of suspected abuse or neglect.
The facility may release health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.
Required By Law
The facility will disclose medical information about you when required to do so by law.
Coroner, Medical Examiner, Funeral Directors
The facility may release your health information to a coroner or medical examiner. This may be necessary, for example, to determine the cause of death. The facility may also release your health information to funeral directors as necessary to carry out their duties.
Organ Procurement Organizations
Consistent with applicable law, we may disclose health information to an organ procurement organization or entity engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.
Specialized Government Functions
The Practice may use and disclose PHI when authorized by law with regard to certain military and veteran activity.
We may disclose your health information to researchers when the research has been approved by an institutional review board that has reviewed the research purpose and established protocols to ensure the privacy of your health information. Before disclosing any of your health information, we will verify that the researchers have obtained your consent to participate in the study.
We may contact you to discuss opportunities for which you may chose to support the facilities’ mission or services.
Appointments, Reminders and Treatment Alternatives
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.
Food and Drug Administration
We may disclose to the FDA health information relative to adverse events with respect to food supplements, products, and product defects or post-marketing surveillance to enable product recalls, repairs, or replacement.
Any other use or disclosure of your health information will be made only with your written authorization. Your may revoke your authorization in writing to contact person in this notice.
The effective date of this notice is April 14, 2003.