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.

Effective date: August 1, 2016

This notice is applicable to the following:

• All Departments and Units of the Medical Center, including NMRMC Home Health, Horizon Hospice, Home Care Products, New Horizons Counseling, NMRMC Women's Health Center, NMRMC Orthopedic Clinic
• NMRMC Erie Family Care Clinic, RHC
• NMRMC Family Medicine, RHC
• Rehabilitation and Fitness Associates (Physical Therapy), Chanute Radiology, P.A., Clinical Colleagues, Inc.
• NMRMC Medical Staff members who are treating patients admitted to the Medical Center as inpatients or outpatients. This Notice does not apply to privacy practices of physicians in their private offices or at other practice locations, or to clinic visits which occur at the Medical Center, but where the patient is not admitted to the Medical Center as an outpatient (e.g. cardiologist, podiatrist, etc.)

We are committed to protecting the confidentiality of our records containing information about you. This notice applies to records of your care created or received by NMRMC. Other healthcare providers from whom you obtain treatment may have different policies or notices regarding the use and disclosure of healthcare information. We are required by law to maintain the privacy of your health information; to provide individuals with notice of its legal duties and privacy practices with respect to protected health information; to notify affected individuals following a breach of unsecured protected health information; give you this notice of our legal duties and privacy practices; and make a good faith effort to obtain your acknowledgement of receipt of this notice; and follow the terms of the notice that is currently in effect.

Your rights regarding your health information

Right to inspect and copy. You have the right to inspect and copy some of the health information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. When your medical information is contained in an electronic health record, as that term is defined in federal laws and rules, you have a right to obtain a copy of such information in an electronic format, and you may request that we transmit such a copy directly to an entity or person designated by you, provided that any such choice is clear, conspicuous and specific. If you request a copy of the information, we may charge a fee for the cost of copying, mailing or other supplies associated with your request.

To inspect and copy your health information, you must complete a specific form providing information we need to process your request. To obtain this form or to obtain more information concerning this process, please contact the person identified on the last page of this Notice. You will be asked to complete a written authorization form. We may require that you pay such fee prior to receiving the requested copies.

We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health information, you may request that the denial be re-viewed. Another licensed health care professional chosen by NMRMC 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 the outcome of the review.

Right to request amendment. If you believe that our records contain 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 for as long as the information is kept by or for NMRMC

To request an amendment, you must complete a specific form providing information we need to process your request, including the reason that supports your request. To obtain this form or to obtain more information concerning this process, please contact the person identified on the last page of this Notice.

We may deny your request for an amendment if you fail to complete the required form in its entirely. In addition, we may deny your request if you ask us 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 health information kept by or for NMRMC;
• Is not part of the information that you would be permitted to inspect and copy; or
• Is accurate and complete.

If your request is denied, you will be informed of the reason for the denial and will have an opportunity to submit a statement of disagreement to be maintained with your records.

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 health information about you, with certain exceptions specifically defined by law. This accounting will exclude certain disclosures as provided in applicable laws and rules such as disclosures made directly to you, disclosures you authorize, disclosures to friends and family members involved in your care, disclosures for notification purposes and certain other types of disclosures made to correctional institutions or law enforcement agencies.

To request this list or accounting of disclosures, you must complete a specific form providing information we need to process your request. To obtain this form or to obtain more information concerning this process, please contact the person identified on the first page of this Notice.

Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate the form you want the list (for example, on paper, electronically). The first list you request within a 12 month period will be free. For additional lists, we may charge you for the costs of providing the list. 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 health 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 health 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 a surgery you had.

 

We are not required to honor your request for restrictions, except if (a) the disclosure is for purposes of carrying out payment or healthcare operations and is not otherwise required by law, and (2) the protected health information that pertains solely to a healthcare item or services for which you or any person (other than a health plan on your behalf) has paid the hospital in full.

To request restrictions, you must complete a specific form providing information we need to process your request. To obtain this form or to obtain more information concerning this process, please contact Gretchen Keller, RHIA at 620-432-5352.

Right to request alternative methods of 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 only contact you at work or by mail.

To request an alternative method of communications, you must complete a specific form providing information we need to process your request. To obtain this form or to obtain more information concerning this process, please contact the person identified on the first page of this Notice. 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.nmrmc.com. To obtain a paper copy of this notice, contact the person identified on the first page of this Notice.

Right to a notice of breach. You have the right to receive a written notification of a breach if your unsecured medical information has been accessed, used acquired or disclosed to an unauthorized person as a result of such breach, and if the breach compromises the security or privacy of your medical information. Unless specified in writing by you to receive notification by electronic mail, we will provide such written notification by first-class mail or, if necessary, by such other substituted forms of communication allowable under the law.

Rights relating to electronic health information exchange. The hospital participates in electronic health information exchange, or HIE. New technology allows a provider or a health plan to make a single request through a health information organization, or HIO, to obtain electronic records for a specific patient from other HIE participants for purposes of treatment, payment, or healthcare operations.

You have two options with respect to HIE. First, you can permit authorized individuals to access your electronic health information through an HIO. If you choose this option, you do not have to do anything. Second, you can restrict access to all of your electronic health information (except access by properly authorized individuals as needed to report specific information as required by law.) If you wish to restrict access, you must complete and submit a specific form available at http://www.khie.org. You cannot restrict access to certain information only; your choice is to permit or restrict access to all of your information.

If you have questions regarding HIE or HIOs, please visit http://www.khie.org for additional information. Your decision to restrict access through an HIO does not impact other disclosures of your health information. Providers and health plans may share your information directly through other means (e.g. facsimile or secure e-mail) without your specific written authorization.

If you receive healthcare services in a state other than Kansas, different rules may apply regarding restrictions on access to your electronic health information. Please communicate directly with your out-of-state healthcare provider about what action, if any, you need to take to restrict access.

How we may use and disclose health information about you without your specific authorization

We may share your medical information in any format we determine is appropriate to efficiently coordinate the treatment, payment, and health care operation aspects of your care. For example, we may share your information orally, via fax, on paper, or through electronic exchange.

The following categories describe different ways that we are permitted to use and disclose health information without a specific authorization from you. If you desire to restrict our use of your health information for any of these purposes, you need to submit a request for restrictions in the manner described above.

For treatment. We may use information about you to provide you with medical treatment or services. We may disclose health information about you to doctors, nurses, technicians, medical students, or other personnel who are involved in taking care of you at NMRMC. 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. Different departments of NMRMC also may share health information about you in order to coordinate the different things you need, such as prescriptions, lab work, and x-rays.

We also may disclose health information about you to people outside NMRMC who may be involved in your medical care after you leave NMRMC, such as family members, friends, or others we use to provide services that are part of your care. You have a right to request restrictions on such communications.

We may disclose health information about you to other health care providers who request such information for purposes of providing medical treatment to you.

For payment. We may use and disclose health information about you so that the treatment and services you receive at NMRMC may be billed to and payment may be collected from you, an insurance company, or other third party. For example, we may need to give your health plan information about surgery you received so your health plan will pay us or reimburse you for the surgery. 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.

We also may provide information about you to other health care providers to assist them in obtaining payment for treatment and service provided to you by that provider. We may also provide information to a health plan for purposes of arranging payment for treatment and services provided to you.

For health care operations. We may use and disclose health information about you for our internal operations. These uses and disclosures are necessary to run NMRMC and make sure that all of our patients receive quality care. For example, we may use health information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine health information about many patients to decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, medical students, and other personnel for review and learning purposes. We may also combine the health information we have with health information from other health care providers 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 health information so others may use it to study health care and health care delivery without learning who the specific patients are.

We may disclose health information about you to another health care provider or health plan with which you also have had a relationship for purposes of that provider’s or plans internal operations.

Appointment reminders. We may use and disclose health information to contact you as a reminder that you have an appointment for treatment or medical care at NMRMC. Unless you direct us to do otherwise, we may leave messages on your telephone answering machine identifying NMRMC and asking for you to return our call. Unless we are specifically instructed by you otherwise in a particular circumstance, we will not disclose any health information to any person other than you who answers your phone except to leave a mes-sage for you to return the call.

Surveys. We may use and disclose health information to contact you to assess your satisfaction with our services.

Treatment alternatives. We may use and disclose health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.

Health-related benefits and services. We may use and disclose health information to tell you about health-related benefits or services that may be of interest to you, or to provide you with promotional gifts of nominal value.

Fundraising activities. We may use health information about you to contact you in an effort to raise money for NMRMC and its operations. We may disclose health information to a foundation related to NMRMC so that the foundation may contact you in raising money for NMRMC. We only would release contact information, such as your name, address and phone number and the dates you received treatment or services at NMRMC. You have a right to opt out of receiving such fundraising communications. To opt out of fundraising, please contact the NMRMC Communications Office at 620-432-5311.

Business associates. There are some services provided in our organization through contracts or arrangements with business associates. For example, we may contract with a copy service to make copies of your health record. When these services are contracted, we may disclose your health information to our business associate so they can perform the job we’ve asked them to do. To protect your health information, however, we require our business associates to appropriately safeguard your information.

Hospital directory. We may include certain limited information about you in the directory while you are a patient at NMRMC. This information may include your name, location in the hospital, your general condition (e.g., fair, stable, etc.) 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 minister, 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 gener-ally know how you are doing.

Individuals involved in your care or payment for your care. We may release health information about you to a friend or 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 in NMRMC. In addition, we may disclose health information about you to an organization assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.

Research. Under certain circumstances, we may use and disclose health information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of health information, trying to balance the research needs with patients' need for privacy of their health information. Before we use or disclose health information for research, the project will have been approved through this research approval process, but we may, however, disclose health information about you to people preparing to conduct a research project, for example, to help them look for patients with specific medical needs, so long as the health information they review does not leave NMRMC. We will almost always ask for your specific permission if the researcher will have access to your name, address, or other information that reveals who you are, or will be involved in your care at NMRMC.

As required by law. We will disclose health information about you when required to do so by federal, state, or local law.

To avert a serious threat to health or safety. We may use and disclose health 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 prevent the threat.

Organ and tissue donation. If you are an organ donor, we may use or disclose health information to organizations that handle organ procurement or organ, eye or tissue trans-plantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

Military and veterans. If you are a member of the armed forces, we may release health information about you as required by military command authorities. We may also re-lease health information about foreign military personnel to the appropriate foreign military authority.

Employers. We may release health information about you to your employer if we provide health care services to you at the request of your employer, and the health care services are provided either to conduct an evaluation relating to medical surveillance of the workplace or to evaluate whether you have a work-related illness or injury. In such circumstances, we will give you written notice of such release of information to your employer. Any other disclosures to your employer will be made only if you execute a specific authorization for the release of that information to your employer.

Workers' compensation. We may release health 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 health information about you for public health activities. These activities generally include the following:

• to prevent or control disease, injury or disability;
• to report births and 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 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 health information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. 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 a dispute, we may disclose health information about you in response to a court or administrative order. We may also disclose health 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 health 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 circumstances, 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 NMRMC; and
• In emergency circumstances to report a crime; the location of the crime or vic-tims; or the identity, description or location of the person who committed the crime.

Coroners, medical examiners and funeral directors. We may release health 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 also release health information about patients of NMRMC to funeral directors as necessary for them to carry out their duties.

National security and intelligence activities. We may release health 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 health information about you to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state, or to conduct special investigations. .

Inmates/persons in custody. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health 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; or (3) for the safety and security of the correctional institution.

Other uses of health information

Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written authorization. For example, authorizations are required for use and disclosure of psychotherapy notes, certain types of marketing arrangements, and certain instances involving the sale of your information. If you provide us authorization to use or disclose health information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose health information about you for the reasons covered by your written authorization. Of course, 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.

Changes to this notice

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health 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 at our facility and on our website. The notice will contain on the first page the effective date. In addition, each time you register at or are admitted to the hospital for treatment or health care services as an outpatient or inpatient, we will make available a copy of the current notice in effect.

Acknowledgement

You will be asked to provide a written acknowledgement of your receipt of this Notice. This acknowledgment may be on paper or through an electronic signature pad. We are required by law to make a good faith effort to provide you with our Notice and obtain such acknowledgement from you. However, your receipt of care and treatment from NMRMC is not conditioned upon you.

Questions or complaints

If you believe your rights with respect to health information about you have been violated by NMRMC, you may file a complaint with NMRMC or with the Secretary of the Department of Health and Human Services. To file a complaint with NMRMC, contact Gretchen Keller RHIA, Director, Health Information Management, Neosho Memorial Regional Medical Center, PO Box 426, Chanute, KS 66720 or at 620-432-5352. The address and phone num-ber for the Department of Health and Human Services will be available from Gretchen Kel-ler, RHIA. All complaints must be submitted in writing.

You will not be penalized for filing a complaint.