Privacy Practices

Jefferson Hospital

Summary of 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.

Our Legal Duty:

We have a duty to protect the confidentiality of medical information about you. We are required to provide you with a Notice of Privacy Practices explaining ways we may use and disclose your health information. The Notice also describes your legal rights and our obligations regarding the use and disclosure of your health information.

Parties Following the Notice:

The Notice will be followed by the Hospital and its affiliates, together with their health care professionals, staff and volunteers; members of the Hospital Medical Staff and those participating in managed care networks with the Hospital; and other legal entities that provide services to the Hospital.

How we may use and disclose health information about you:

We may use or disclose identifiable health information about you for many reasons, including:

Treatment
Payment
Health care operations
Health oversight activities
Public health purposes
Auditing
National security and protective services
Research
Workers’ compensation
Lawsuits and disputes
Law enforcement purposes
Breach notification purposes

To decedents
Activities of managed care networks in which we participate
Activities of other affiliates
Appointment reminders
Fundraising activities
Organ donation
To avert a serious threat to health or safety
Disclosures about victims of abuse, neglect or domestic violence
To coroners, medical examiners & funeral directors
To military command authorities
As required by law
Specialized government functions

How do we typically use or share your health information?

Bill for Your Services

We can use and disclose your health information to bill and get payment from health plans or other entities. Example: We give information about you to your health insurance plan so it will pay for your services.

Treat You

We can use your health information and share it with other professionals who are treating you. Example: A doctor
treating you for an injury asks another doctor about your overall health condition.

Health Care Operations

We can use and disclose your health information to run our facility, improve your care, and contact you when
necessary. Example: We use health information about you to manage your treatment and services.

In general, other uses and disclosures of your health information will require your written authorization. We may use or disclose certain limited information about you, unless you object or request a limitation of the disclosure, for:

Hospital directories

Individuals involved in your care or payment

Other Uses and Disclosures of Health Information:

Jefferson Hospital will not disclose your health information for the following purposes without your specific,
written authorization.

For our marketing purposes.
Most uses and disclosures of your psychotherapy notes.

Uses and Disclosures That Require Us to Give You an Opportunity to Object:

Individuals involved in your care or payment for your care—Unless you object, we may disclose to a member of
your family, a relative, a close friend or any other person you identify, your Protected Health Information that
directly relates to the person’s involvement in your health care. If you are unable to agree or object to such a
disclosure, we may disclose such information as necessary if we determine that it is in your best interest based
on our professional judgment.
Disaster relief—We may disclose your Protected Health Information to disaster relief organizations that seek
your Protected Health Information to coordinate your care, or notify family and friends of your location or
condition in a disaster. We will provide you with an opportunity to agree or object to such a disclosure
whenever we practically can do so.

Your Rights Regarding Health Information About You:

The right to request an amendment of your health information.
The right to an accounting of certain disclosures of your health information.
The right to request confidential communications and alternative means of communication with you.
The right to request restrictions on certain uses of your health information.
- We are not required to agree to your request.
The right to inspect and copy certain medical information that we maintain about you.
- This includes the right to obtain an electronic copy if
  readily producible by us in the form and format requested. Please contact medical records if you
  wish to inspect or copy your medical information.

The right to receive notice of a breach concerning your health information.
The right to request a paper copy of this Notice.
Right to request payer exception.
- If otherwise allowed by law, we will agree to a requested restriction to your health insurance plan for purposes of carrying out payment or health care operations if you have agreed to pay in full for the health care item or service. Please note that we contract certain services that might relate to your bill for this health care item or service. Therefore, it will be your responsibility to contact each contract service associated to this health care item or service to request payer exception. You will also be responsible for paying them in full.

Breach of Health Information:

You will be informed if there is a breach of your health information.

Changes to the Notice:

We reserve the right to change the Notice. We will post any revised Notice in the Hospital registration area. The Notice will be available through the admissions/registration process. Jefferson Hospital will promptly revise and distribute its notice whenever there is a material change to the uses and disclosures, the individual’s rights, the covered entity’s legal duties, or other privacy practices.

Complaints:

If you believe your rights have been violated, you may file a written complaint with the Hospital Administrator, Privacy Officer or with the Secretary of the U.S. Department of Health and Human Services. Complaints may be filed verbally or in writing. Jefferson Hospital will not retaliate against the individual filing a complaint.

Contact:

For further information about the Notice you may contact the medical records department during normal business hours at (478) 625-7000.