Joint Notice of Privacy Practices

This notice describes our hospital's practices and that of:

• Any health care professional authorized to enter information into your medical record.
• All departments and units of the hospital, including our outpatient clinics.
• Any member of a volunteer group we allow to help you while you are in the hospital.
• All employees, staff and other hospital personnel.
• Members of the medical staff and other health care providers who deliver services jointly with the hospital.
• Monroe County Medical Center Adult Day Care Service personnel.
• Monroe County Medical Center Ambulance Service personnel.

All these entities, sites and locations follow the terms of this notice. In addition, these entities, sites and locations may share medical information with each other for treatment, payment or health care operations purposes described in this notice.

This hospital may provide services to you in an integrated way with our medical staff. However, Monroe County Medical Center accepts no legal responsibility for activities solely attributable to these other providers.

We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive from our organization. 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 our organization, whether made by hospital personnel 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 or clinic.

This notice will tell you about the ways in which we may 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:

• Maintain the privacy of your health information.
• Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you.
• Abide by the terms in this notice.

Members of our medical staff, appropriate hospital employees and other participants in our patient care system may share your medical information as necessary for your treatment, payment for services provided and health care operations, without your express permission. Other uses and disclosures require your specific authorization. The following categories describe different ways that we may use and disclose medical information. For each category of uses and disclosures we will explain what we mean and try to give some examples. 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.

• For Treatment – 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 students, or other personnel who are involved in your care. 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 the hospital also 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 the hospital who may be involved in your medical care after you leave the hospital, such as family members, clergy or others we use to provide services that are part of your care.
• For Payment – We may use and disclose medical information about you so that the treatment and services you receive by our organization 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 an x-ray you have received or will receive at the hospital so your health plan will pay us or reimburse you for the x-ray. 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 Health Care Operations – We may use and disclose medical information about you for health care operations. These uses and disclosures are necessary to run the hospital and make sure that all 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 many hospital patients to decide what additional services the hospital should offer, what services are needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, medical students, and other hospital personnel for review and learning purposes. We may also combine the medical information we have with medical information from other hospitals 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.
• Fundraising Activities – We may use medical information about you to contact you in an effort to raise money for the hospital and its operations. We may disclose medical information to a foundation related to the hospital so that the foundation may contact you in raising money for our organization. We would only release contact information, such as your name, address and phone number and the dates you received treatment or services within our organization. If you do not want our organization to contact you for fundraising efforts, you may opt out of receiving such communications by notifying the Privacy Officer in writing.
• Hospital Directory – We may include certain limited information about you in the hospital directory while you are a patient at the hospital. This information may include your name, location in the hospital, your general condition (e.g., fair, stable, etc.), your gender, and your religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name. 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 in the hospital and generally know how you are doing. You have the right to object to the disclosure of some or all of this information. If you do object, we will honor your objection. However, if we cannot practicably offer you the opportunity to object because you entered our facility in a situation requiring emergency treatment, we may exercise professional judgment to decide whether such disclosures would be in your best interest.
• 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 the information to someone who helps pay for your care. We may also tell your family or friends your condition and that you are in our care. 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.
• As Required by Law – We will disclose medical information about you when required to do so by federal, state or local law.
• To Avert 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 lessen the threat.
• To Business Associates – We may disclose medical information to an organization that performs services necessary for us to provide health care services to you, such as accountants or companies providing data processing services, if they need medical information in order to provide these services to us. These "Business Associates" have agreed in writing to protect the privacy of any medical information they receive.

• Organ and tissue Donation – We may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary, to facilitate organ or tissue donation and transportation.
• Milatary and Veterans – If you are 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 military personnel to the appropriate foreign military authority.
• Worker's Compensation – We may release medical information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.
• Public Health Risks – We may disclose medical information about you for public health activities. These activities generally include the following:
  • to prevent or control disease, injury or disability
  • to report births or deaths
  • to report child abuse or neglect
  • to report reactions to medications or problems with products
  • to notify people of recalls of products they may be using
  • to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition
  • to notify your employer if, for example, we provide health care to you at the request of your employer for medical surveillance for purposes or to evaluate whether you have a work-related illness or injury and your employer needs the findings to comply with state or federal law
  • to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law
• 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 actions. 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 dispute, we may disclose medical information about you in response to a court or administrative order. We may also 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.
• Law Enforcement – We may release medical information if asked to do so by a law enforcement official:
  • In response to a court order, subpoena, warrant, summons or similar process
  • To identify or locate a suspect, fugitive, material witness, or missing person
  • About the victim of a crime if, under certain limited circumstance, we are unable to obtain the person's agreement
  • About a death we believe may be the result of criminal conduct
  • About criminal conduct at the hospital
  • In emergency circumstances to report a crime; the location of the crime or victims; or the identity description or location of the person who committed the crime.
• Coroners, Medical Exarminers, 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 release medical information about patients of the hospital to funeral directors as necessary to carry out their duties.
• 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.
• Inmates – 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. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; (3) for the safety and security of the correctional institution.

You have the following rights regarding medical information we maintain about you

• 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 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, or for creating a summary of your information at your request.
  • We may deny your request to inspect or copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by the hospital 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 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 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 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 to amend information that:
  • Was not created by us, unless the person or entity that created the information is no longer available to make the amendment
  • Is not part of the medical information kept by or for the hospital
  • Is not part of the information which you would be permitted to inspect and copy
  • Is accurate and complete
• Right to an Accounting of Disclosures – You have the right to request an "accounting of disclosures". This is a list of the disclosures we made of medical information about you. To request this list or accounting of disclosures, you must submit your request in writing to the Privacy Officer. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. The first list within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the lists. 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 friend. For example, you could ask that we not use or disclose information about an x-ray you had.
  • We are not required to agree to your request, except if the requested restriction is to your health plan when you have paid in full for the healthcare service or item. If we do agree to your request, 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 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; (3) to whom you want the limits to apply, for example, disclosure 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 contact you only at work or by mail.
  • To request confidential communications, you must make your request in writing to the 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 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.
  • You may obtain a copy of this notice at our website, www.mcmccares.com
  • To obtain a paper copy of this notice, contact the Privacy Officer.

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 the hospital. The notice will contain on the first page, in the top right-hand corner, the effective date. In addition, each time you register at or are admitted for treatment or health care services as an inpatient or outpatient, we will offer you a copy of the current notice in effect.

If you believe your privacy rights have been violated, you may file a complaint with the hospital or with the Secretary of the Department of Health and Human Services. To file a complaint with the hospital, contact the Privacy Officer at 270-487-9231, ext. 1140. All complaints must be submitted in writing.

You will not be retaliated against for filing a complaint.

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. Your medical information will not be used or disclosed without your written permission for psychotherapy notes, for marketing purposes or for the sale of your medical information. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

Monroe County Medical Center and medical staff members of the hospital are participants in an organized health care arrangement. These entities will share protected health information with each other, as necessary to carry out treatment, payment and health care operations relating to the organized health care arrangement. The hospital and members of the medical staff agree to abide by the terms of this privacy notice as part of their participation, with respect to created or received protected health information. This joint notice by separate covered entities covers the hospital and active medical staff members, including but not limited to, the consulting, courtesy and telemedicine physicians practicing at Monroe County Medical Center and other health care providers who deliver services jointly with the hospital.