|
|
| |
| Privacy Statement |
| |
Effective Date: 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 about this notice, please contact
Privacy Officer @ this HELPLINE (888) 30-2HELP
WHO WILL FOLLOW THIS NOTICE
This notice describes our hospital’s practices and that of:
Any health care professional authorized to enter information
into your hospital chart.
All departments and units of the hospital.
Any member of a volunteer group we allow to help you while
you are in the hospital.
All employees, staff and other hospital personnel.
OUR PLEDGE REGARDING MEDICAL INFORMATION
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 at the hospital. 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 the hospital, whether made by hospital
personnel or your physician. Your physician 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:
make sure that medical information that identifies you is
kept private (with certain exceptions);
give you this notice of our legal duties and privacy practices
with respect to medical information about you;
and follow the terms of the notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following categories describe different ways that we use
and disclose medical information. For each category of uses
or 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 hospital personnel
who are involved in taking care of you at the hospital. 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 skilled nursing facilities
or home health agencies
For Payment. We may use and disclose medical information
about you so that the treatment and services you receive at
the hospital 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 surgery
you received at the hospital 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.
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 of 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 not 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.
Appointment Reminders. We may use and disclose medical
information to contact you as a reminder that you have an
appointment for treatment or medical care at the hospital.
Treatment Alternatives. We may use and disclose medical
information to tell you about or recommend possible treatment
options or alternatives that may be of interest to you.
Health-Related Products and Services. We may use and
disclose medical information to tell you about our health-related
products or services that may be of interest to you.
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.) and your religious affiliation.
Unless there is a specific written request from you to the
contrary, this 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 information is released so your
family, friends and clergy can visit you in the hospital and
generally know how you are doing.
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 information to someone who helps pay for your care.
Unless there is a specific written request from you to the
contrary, we may also tell your family or friends your condition
and that you are in the hospital. 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 a 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 prevent the
threat.
SPECIAL SITUATIONS
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 transplantation.
Military and Veterans. If you are a 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.
Workers’ 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 and deaths;
to report the abuse or neglect of children, elders and dependent
adults;
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 medical 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 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 (which may include written notice
to you) 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 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 the hospital; and 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 Examiners 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 also 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; or (3) for the safety and security of
the correctional institution.
YOUR RIGHTS REGARDING MEDICAL INFORMATION
ABOUT YOU
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 may not include some mental health information.
To inspect and copy medical information that may be used to
make decisions about you, you must submit your request in
writing to 531 W. College Street, Los Angeles, CA 90012 Attn:
Medical Records. 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. We may deny your request
to inspect and 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
the 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 for 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 Medical Records. 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 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 medical information kept by
or for the hospital; Is not part of the information which
you would be permitted to inspect and copy; or Is accurate
and complete. Even if we deny your request for amendment,
you have the right to submit a written addendum, not to exceed
250 words, with respect to any item or statement in your record
you believe is incomplete or incorrect. If you clearly indicate
in writing that you want the addendum to be made part of your
medical record we will attach it to your records and include
it whenever we make a disclosure of the item or statement
you believe to be incomplete or incorrect.
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 other than our own uses for treatment, payment and health
care operations, (as those functions are described above)
and with other expectations pursuant to the law. To request
this list or accounting of disclosures, you must submit your
request in writing to Medical Records. 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 in what 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 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 a surgery you
had.
We are not required to agree to your request.
If we do agree, 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 Medical Records. 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; and (3) to whom you want
the limits to apply, for example, disclosures 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 only contact you at work or by mail. To
request confidential communications, you must make your request
in writing to Medical Records. 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: http://www.pamc.net. To obtain a paper
copy of this notice: Admitting Department
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
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
to the hospital for treatment or health care services as an
inpatient or outpatient, we will offer you a copy of the current
notice in effect.
COMPLAINTS
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 Privacy Officer, at this
HELPLINE (888) 30-2HELP. All complaints must be submitted
in writing. You will not be penalized for filing a complaint.
OTHER USES OF MEDICAL INFORMATION.
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. 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, this will stop any further use or disclosure
of your medical information for the purposes covered by your
written authorization, except if we have already acted in
reliance on your permission. 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. |
| |
| |
| |
| |
| |
|
|
