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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 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 health care 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
health care 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.
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 health care 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, health care 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 1-888-302-9224.
- 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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