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Effective:
April 14, 2003
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.
If you have any questions, please contact our Privacy Office at
the address or phone number at the bottom of this notice.
St.
Rita's Medical Center provides healthcare to our patients, residents,
and clients in partnership with physicians and other professionals
and organizations. The information about privacy practices in this
notice will be followed by:
- Any
healthcare professional who treats you at any of our
locations
- All
departments and units of our organization, including:
Physical Medicine and Rehabilitation, Physical Medicine
and Rehabilitation - Wapakoneta YMCA, Disease Management
Clinic, Renal Dialysis, Community Diabetes Center, Delphos
Ambulatory Care Center, Putnam County Ambulatory Care
Center, Pediatric Rehabilitation, Specialty Clinic, Orthopedic
Clinic, Adolescent/Child Partial Hospitalization, Adult
Outpatient Partial Hospitalization, St. Rita's Regional
Cancer Center, Women's Wellness Center, Healthy Lifestyles
Center, Community Services, Med-Care Clinic, Dental Clinic,
Neighborhood Nurse, Home Health, Hospice, Home Infusion,
Home Medical Equipment, Occupational Health Services,
SRHC Foundation, Medical Staff, McAuley Management Services
- All
employed associates, staff or volunteers of our organization,
including staff at Catholic Healthcare Partners, our
parent organization with whom we may share information
- Any
business associate or partner of St. Rita's Medical Center
with whom we share health information
We
understand that medical information about you is personal. We are
committed to protecting medical information about you. We create
a record of the care and services you receive to provide quality
care and to comply with legal requirements. This notice applies
to all of the records of your care that we maintain, whether created
by facility staff or your personal doctor. Your personal doctor
may have different policies or notices regarding the doctor’s use
and disclosure of your medical information created in the doctor’s
office. We are required by law to:
- Keep
medical information about you 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 changes
to this notice
We
may change our policies at any time. Changes will apply to medical
information we already hold, as well as new information after the
change occurs. Before we make a significant change in our policies,
we will change our notice and post the new notice in waiting areas,
exam rooms, and on our Web site at http://www.stritas.org. You
can receive a copy of the current notice at any time. The effective
date is listed just below the title. You will be offered a copy
of the current notice each time you register at our facility for
treatment. You will also be asked to acknowledge in writing your
receipt of this notice.
- We
may use and disclose medical information about you for
treatment (such as sending medical information about
you to a specialist as part of a referral); to obtain
payment for treatment (such as sending billing information
to your insurance company or Medicare); and to support
our healthcare operations (such as comparing patient
data to improve treatment methods.)
- We
may use or disclose medical information about you without
your prior authorization for several other reasons. Subject
to certain requirements, we may give out medical information
about you without prior authorization for public health
purposes, birth, death, abuse, neglect or domestic violence
reporting, health oversight audits or inspections, qualified
research studies, funeral arrangements and organ donation,
workers’ compensation purposes, to prevent or lessen
a serious and imminent threat to the health or safety
of a person or the public, and other emergencies. We
also disclose medical information when required by law,
such as in response to a request from law enforcement
certain independent review organizations, or the coroner's
office in specific circumstances, or in response to valid
judicial or administrative orders.
- We
also may contact you for appointment reminders, or to
tell you about or recommend possible treatment options,
alternatives, health-related benefits or services that
may be of interest to you, or to support fundraising
efforts.
- If
admitted as a patient, unless you tell us otherwise,
we will list in the patient directory your name, location
in the hospital, your general condition (good, fair,
etc.) and your religious affiliation, and will release
all but your religious affiliation to anyone who asks
about you by name. Your religious affiliation may be
disclosed only to a clergy member, and even if they do
not ask for you by name.
- We
may disclose medical information about you to a friend
or family member who is involved in your medical care,
or to disaster relief authorities so that your family
can be notified of your location and condition.
- In
any other situation not covered by this notice, we will
ask for your written authorization before using or disclosing
medical information about you. If you choose to authorize
use or disclosure, you can later revoke that authorization
by notifying us in writing of your decision.
- In
most cases, you have the right to look at or get a copy
of medical information that we use to make decisions
about your care, when you submit a written request. If
you request copies, we may charge a fee for the cost
of copying, mailing or other related supplies. We must,
however, provide a free copy of your medical information
to the Bureau of Workers' Compensation, the Industrial
Commission, the Department of Jobs and Family Services,
or to you or your representative if the purpose of the
request is to support a claim under the Social Security
Act and if your request is accompanied by documentation
to support such a claim. If we deny your request to review
or obtain a copy, you may submit a written request for
a review of that decision.
- If
you believe that information in your record is incorrect
or if important information is missing, you have the
right to request that we correct our records, by submitting
a request in writing that provides your reason for requesting
the amendment. We could deny your request to amend a
record if the information was not created by us; if it
is not part of the medical information maintained by
us; of if we determine that record is accurate. You may
appeal, in writing, a decision by us not to amend a record.
- You
have the right to a list of those instances where we
have disclosed medical information about you, other than
for treatment, payment, healthcare operations or where
you specifically authorized a disclosure, when you submit
a written request. The request must state the time period
desired for the accounting, which must be less than a
6-year period and starting after April 14, 2003. You
may receive the list in paper or electronic form. The
first disclosure list request in a 12-month period is
free; other requests will be charged according to our
cost of producing the list. We will inform you of the
cost before you incur any costs.
- If
this notice was sent to you electronically, you have
the right to a paper copy of this notice.
- You
have the right to request that medical information about
you be communicated to you in a confidential manner,
such as sending mail to an address other than your home,
by notifying us in writing of the specific way or location
for us to use to communicate with you.
- You
may request, in writing, that we not use or disclose
medical information about you for treatment, payment
or healthcare operations or to persons involved in your
care except when specifically authorized by you, when
required by law, or in an emergency. We will consider
your request but we are not legally required to accept
it. We will inform you of our decision on your request.
- All
written requests or appeals should be submitted to our
Privacy Office listed at the bottom of this notice.
If you are concerned that your privacy rights may have been
violated, or you disagree with a decision we made about access
to your records, you may contact our Privacy Office (listed
below). You may also contact our Corporate Responsibility
Officer at (419) 226-9216 or the Catholic Healthcare Partners
ReportLine, a 24-hour hotline, at (888) 302-9224.
Finally, you may send a written complaint to the U.S. Department
of Health and Human Services Office of Civil Rights. Patient
Relations can provide you the address.
Under no circumstances will you be penalized or retaliated
against for filing a complaint. |
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For More Information
(419)
226-9745
Fax
(419) 226-9750 |
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