This notice describes how medical information about you can be used and disclosed, and how you can get access to this information. Please review it carefully!
Person Memorial Hospital
Notice of Privacy Practice
Effective April 14, 2003
This Notice will tell you how we may use and disclose protected health information about you. The term "protected health information" means any health information about you that identifies you or for which there is a reasonable basis to believe the information can be used to identify you. In this notice, we call all of that protected health information "medical information".
This Notice will also tell you about your rights and our duties with respect to medical information about you. In addition, it will tell you how to complain if you believe we have violated any of your privacy rights.
Each time you become a resident in an extended care unit, or visit a hospital, physician, or other health care provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, a plan for your future care or treatment, and billing-related information. This Notice applies to all of the records of your care that may be generated by Person Memorial Hospital and related care providers, whether made by hospital personnel, agents of the hospital, your personal doctor, or others.
If you have any questions about this Notice, please dial the main hospital number and ask to speak to our Privacy Officer.
I. Who Will Follow This Notice?
This Notice describes the practices of Person Memorial Hospital, including:
- Any health care professional authorized to enter information into your hospital chart;
- All departments, units, and clinics of the hospital, including the Extended Care Unit;
- Any member of a volunteer group that we allow to help you while you are in the hospital; and
- All employees, staff, and other hospital or clinic personnel
This Notice also describes the privacy practices of the following physician groups, who have agreed to follow the terms of this Notice:
(Important Note: Although the physician groups listed below have agreed to follow the terms of this Notice, they remain physically, financially, and legally separate from Person Memorial Hospital. In other words, their agreement to follow the terms of this Notice do not make them employees or agents of Person Memorial Hospital. 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.)
- Person Memorial Hospital medical staff physicians (such as your personal physician)
- ED Physicians [Person Emergency Physicians] (physicians and their staff who provide emergency services to you);
- Radiology [Duke Radiology] (physicians and their staff who provide radiology services to you);
- Private Diagnostic Clinics, P.L.L.C. (Duke University Medical Center affiliates);
- Anesthesiology [Duke Anesthesiology] (physicians and their staff who provide anesthesiology services to you)
II. Our Responsibilities
We are required by federal law to protect the privacy of your medical information, and to provide you with our Notice of Privacy Practices. We are also required to let you know how you can obtain copies of any changes to the Notice, and to abide by the terms of the Notice that is currently in effect.
We reserve the right to make changes to this Notice, and to make the new Notice effective for all medical information that we maintain. If we do change the Notice, we will post the new Notice in our waiting areas, and will provide you with a copy of the revised Notice upon your request. You can always obtain a copy of our current Notice by contacting our Privacy Officer.
III. How We May Use and Disclose Medical Information About You
We will share medical information about you with each other as necessary to provide you with health care, to obtain payment for that health care, and to operate our business effectively. We may also use and disclose medical information about you for a number of different purposes, which are described below.
The following categories describe different ways that we may use and disclose your medical information. For each of the categories of uses or disclosures we will explain what we mean and try to give an example. Not every use or disclosure in a category will be listed; however, all of the ways we are permitted to use and disclose your health information will fall within one of the categories.
A. Treatment, Payment, and Health care Operations
(i) For Treatment
We may use medical information about you to provide health care treatment to you. In other words, we may use and disclose your medical information in order to provide, coordinate, or manage your health care and related services by us and other health care providers. 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 become involved in your care.
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. If we refer you to another health care facility, we will also contact that facility and provide medical information about you to them so they have information they need to provide services to you.
(ii) For Payment
We may use and disclose medical information about you so that we can be paid for the services we provide to you. This means that we may use medical information about you to arrange for payment, such as preparing bills and managing accounts. We may also disclose medical information about you to others such as insurers and collection agencies for payment purposes.
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 need to provide your insurance company or a government program (such as Medicare or Medicaid), with information about your medical condition and the health care you need so that we can determine whether your plan will cover the treatment.
(iii) For Health Care Operations
We may use and disclose medical information about you for a variety of business activities that we call "health care operations". We make these uses and disclosures so that we can improve the quality of care we provide, and to reduce health care costs.
Example: We may use and disclose your medical information to review the treatment and services that we provide to you, and to evaluate the skills, qualifications, and performance of health care providers taking care of you. We may use or disclose your health information in providing training programs for students, health care provider or non-health care professionals to help them practice or improve their skills. We may also share medical information about you with accountants, lawyers, and others who assist us in complying with this Notice and applicable laws.
B. Uses and Disclosures That You May Object To
Unless you object, we may use or disclose medical information about you in the following
- Hospital Directory - We may share your name, room number, and your general condition (such as fair, stable, etc.) with clergy and with people who ask for you by name. We may also share your religious affiliation with clergy. This is so you can receive cards, flowers, etc., and so that your family, friends, and clergy can visit you in the hospital and generally know how you are doing. In addition, we may post your name outside of your room.
- Persons involved in your care or payment for your care - We may disclose medical information about you to a relative, close personal friend or any other person you identify if that person is involved in your care or payment for your care, and the information is relevant to your care or payment for your care. If the patient is a minor, we may disclose medical information about the minor to a parent, guardian or other person responsible for the minor, except in limited circumstances. For more information on the privacy of minors' information, see Section IV of this Notice.
You may ask us at any time not to disclose medical information about you to persons involved in your care with the exception of persons involved in your treatment. We will agree to your request and not disclose the information except in certain limited circumstances (such as emergencies) or if the patient is a minor. If the patient is a minor, we may or may not be able to agree to the request.
- Disaster Relief - We may release medical information about you to a public or private such as the American Red Cross for disaster relief purposes. Even if you object, we may still share medical information about you if necessary for the emergency circumstances.
- Fundraising Activities - We may use information about you (such as your name, address, and phone number) and the dates you received services here in order to contact you in the future to raise money for our organization. The money raised through these activities is used to expand and support the health care services and educational programs we provide to the community.
If you would like to object to our use or disclosure of your medical information for any of the above purposes, please indicate so on the "Objection to Certain Uses or Disclosures of Medical Information" form that is attached to this Notice or available from the hospital.
C. Other Uses and Disclosures
In addition to the uses and disclosures discussed above, we may use or disclose your medical information for the following purposes:
- Appointment Reminders - We may use and disclose medical information to contact you as a reminder that you have an appointment at the hospital. We may contact you by telephone or by mail at either your home or your office. At either location, we may leave messages for you on the answering machine or voice mail. If you want to request that we communicate with you in a certain way or at a certain location, see "Your Rights Regarding Medical Information About You" on page 11 of this Notice.
- Health-Related Benefits and Services - We may use and disclose medical information to tell you about treatment, services, products, and/or other healthcare providers. For example, if you are diagnosed with diabetes, we may tell you about nutritional and other counseling services that may be of interest to you. We may also use and/or disclose medical information about you to give you gifts of a small value.
- Research - Under certain circumstances, we may use or disclose medical information about you for research purposes. Before we disclose such information, the research will have been approved through a process that balances the needs of the research project against your needs for privacy of your medical information.
- As Required by Law - There are many federal, state, and local laws that require us to use and disclose medical information about you. For instance, North Carolina law requires us to report gunshot wounds and other injuries to the police, and to report known or suspected child abuse or neglect to the Department of Social Services. We will comply with those state laws and all other applicable laws, including the following:
- We will report known or suspected child abuse or neglect, child dependency, and child deaths believed to be due to maltreatment to the county Department of Social Services.
- If we have a reasonable cause to believe that a disabled adult is in need of protective services, we will make a report to the Director of Social Services.
- We will report known or suspected cases or outbreaks of reportable communicable diseases to the local Health Department.
- We will report the following types of wounds/injuries to law enforcement authorities: wounds and injuries caused by firearms; illnesses caused by poisoning; wounds and injuries caused by knives or sharp instruments (if it appears to the treating physician that a criminal act was involved); and any other wound, injury, or illness involving grave bodily harm if it appears to the treating physician that criminal violence was involved.
- We will report symptoms, diseases, conditions, trends, or other health-related information that the State Health Director determines is needed to conduct a public health investigation of a possible bioterrorism incident.
- We will report all diagnoses of cancer to the central cancer registry.
- When appropriate, we will release medical information about you to organizations that handle organ procurement or organ, eye or tissue transplantation, or to an organ donation bank.
North Carolina law also requires us to disclose medical information or records to certain people upon their demand. Patient permission is not necessary for these disclosures. The following is a partial list of those who may demand records or information:
- Local health directors or the State Health Director may demand medical records pertaining to the diagnosis, treatment, or prevention of communicable diseases.
- In certain circumstances, a guardian ad litem (GAL) may demand confidential information.
- In certain circumstances, the N.C. Child Facility Task Force and other groups that are involved in the review of child deaths may demand confidential records or information.
- Threat to health or safety - We may use or disclose medical information about you if we believe it is necessary to prevent or lessen a serious threat to health or safety. For example, we may disclose medical information about you to law enforcement officers if a threat is made to commit a crime on the hospital's premises or against hospital personnel.
- Public health activities: - We may use or disclose medical information about you for the purposes of preventing or controlling disease, injury, or disability. For example, we will notify you if you have been exposed to a disease or are at risk for contracting or spreading a disease or condition. We will track and report adverse events that are related to drugs or devices regulated by the Food and Drug Administration (FDA), and may use medical information about you to tell you that a medical product has been recalled. We will also report vital events such as births or deaths to the State.
- Abuse, neglect or domestic violence: - In certain circumstances, we may disclose medical information about you to a government authority. For example, if you are an adult and we reasonably believe that you may be a victim of abuse, neglect or domestic violence, we may disclose information about you to the Department of Social Services (with certain limitations).
- Health oversight activities - We may disclose medical information about you to a health oversight agency (which is basically an agency responsible for overseeing the health care system, or certain government programs). For example, a government agency may request information from us while investigating whether we are in compliance with the various laws and regulations that we must comply with.
- Court proceedings - In certain circumstances, we may disclose medical information about you to a court, or an officer of the court (such as an attorney). For example, we would disclose medical information about you to a court if a judge ordered us to do so.
- Law enforcement - We may disclose medical information about you to a law enforcement official for specific law enforcement purposes. For example, we may disclose limited medical information about you to a police officer if the officer needs the information to help find or identify a missing person.
- Coroners and others - We will release medical information if state or federal law requires the information for collection of vital statistics or inquiry into cause of death. For example, we may disclose medical information to a coroner or medical examiner to identify a deceased person, or to determine a cause of death. We will also release medical information about patients of the hospital to funeral directors as necessary to carry out their duties.
- Workers' compensation - We may disclose medical information about you in order to comply with workers' compensation laws.
- Certain government functions - We may use or disclose medical information about you for certain government functions. For example, we may disclose medical information about you if it relates to military and veterans' activities, national security and intelligence activities, protective services for the President, and medical suitability or determination of the Department of State. If you are an inmate, we may also use or disclose medical information about you to a correctional institution.
IV. Uses and Disclosures Requiring Your Authorization
Categories of uses and disclosures of your medical information that are not listed above will be made only with your written authorization (or "permission"). In some instances, you may want us to disclose medical information on your behalf, and we will ask you to sign an authorization form. In other instances, we may wish to use or disclose medical information about you and we may contact you to ask you to sign an authorization form. If you sign a written authorization allowing us to disclose medical information about you, you may later revoke (or cancel) your authorization in writing (except in very limited circumstances related to obtaining insurance coverage). If you would like to revoke your authorization, you must fill out an Authorization Revocation Form. If you revoke your authorization, we will follow your instructions except to the extent that we have already relied upon your authorization and taken some action. Authorization Revocation Forms are available from the Medical Records Department.
When North Carolina Law Provides You with Greater Protection
In certain circumstances, North Carolina law provides you with stronger privacy protections of your medical information than federal law requires.
Privacy of Minors' Information
If the patient is an unemancipated minor under North Carolina law, we will not disclose information that is related to the prevention, diagnosis or treatment of venereal disease, pregnancy (except in the case of sterilization or abortion), drugs or alcohol abuse, or emotional disturbance to the person who is legally responsible for the minor, without the minor's consent. However, we may provide notification of the information to the patient's legal guardian in two circumstances: (1) if, in the opinion of the attending physician, the notification is essential to the life or health of the minor; or (2) if the minor's parent, legal guardian, or other legal custodian contacts Person Memorial Hospital concerning the minor's treatment.
Privacy of information about AIDS, HIV infection or a reportable communicable
disease or condition
We will not disclose information regarding your AIDS, HIV, or communicable disease status without your written permission. However, such information may disclosed in certain circumstances, including: (1) if your identity could not be determined from the information disclosed; (2) if the disclosure is required or permitted for public health surveillance, investigation, or intervention; or (3) if a subpoena or court order requires us to disclose the information.
Privacy of patients in the Extended Care Unit
We will not disclose your medical information without your written permission unless disclosure is required by law or a third party payment contract, if the communication is to family members (provided you do not object), or in other limited circumstances such as may be needed when transferring you to another health care facility. When you give us written authorization, you are agreeing that we may disclose your medical information for purposes of payment, treatment or healthcare operations. If we disclose information for any other purpose, you must sign a different permission form.
Privacy of confidential information provided to a social worker
We will not disclose your medical information without your written permission unless disclosure is required by law, or if not revealing the information would result in clear and imminent danger to you or others. When you give us written authorization, you are agreeing that we may disclose your medical information for purposes of payment, treatment or healthcare operations. If we disclose information for any other purpose, you must sign a different permission form.
Privacy of a patient receiving mental health, developmentally disabled, or substance
We will not disclose your medical information without your written consent or authorization that specifies the name of the persons to whom we may disclose the information and the specific time period during which the permission is valid. If the patient has been adjudicated as incompetent or is a minor, we will not disclose the patient's health information to a person acting as an external client advocate unless both the patient and the legally responsible person have executed a consent or authorization. We may disclose your medical information without your consent or authorization in certain limited circumstances, including: (1) disclosures to other health care providers who are treating you under emergency circumstances (provided we attempt to obtain your consent after the emergency); (2) to health oversight agencies or internal client advocates to monitor services that we are providing to you; (3) to law enforcement agencies (in limited circumstances); (4) to an attorney or personal representative (in certain circumstances) (5) pursuant to a court order; (6) to the court, certain attorneys, and/or other interested parties in connection with certain legal proceedings (such as involuntary commitment, guardianship, and others); (7) where required by law; (8) to a correctional institute to facilitate your treatment; (9) to avert an imminent and serious threat to the health or safety of yourself or another individual; (10) to certain business associates who perform services for us; and (11) in certain cases, limited information (such as the act of admission, discharge, transfer, decisions to leave against medical advise, etc.). We will not disclose detailed information about your diagnosis, prognosis, treatment, etc., to these individuals unless you have given your consent or authorization, or if your health care professional determines that disclosing the information is therapeutically beneficial to you.
V. Your Rights Regarding Medical Information About You
You Have the Right to Request Restrictions on Uses and Disclosures of Medical Information About You
You have the right to ask that we limit how we use or disclose your medical information. We will consider your request, but are not legally bound to agree to the restriction. If we do agree to any restrictions on our use/disclosure of your medical information, we will put the agreement in writing and abide by it except in emergency situations. We cannot agree to limit uses or disclosures that are required by law. You may request a restriction by contacting the Medical Records Department.
You Have the Right to Request Confidential Communications
You have the right to ask 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. We must agree to your request as long as it is reasonable for us to do so. You may request confidential communications by contacting the Medical Records Department.
You Have the Right to See and Copy Medical Information About You
Unless your access is restricted for clear and documented treatment reasons, you have the right to see and copy your medical information. Usually, this includes medical and billing records, but does not include psychotherapy notes. If you request a copy of the information, we will charge a fee for the costs of copying, mailing or other supplies associated with your request. You have the right to choose what portions of your information you want copied, and to have prior information on the cost of copying. We will respond to your request within 30 days. We may deny your request to inspect and copy in limited circumstances. If we deny your access, we will give you written reasons for the denial and explain your rights to have the denial reviewed. You may request to inspect and copy your medical information by contacting the Medical Records Department.
You Have the Right to Request an Amendment of Medical Information About You
If you believe that there is a mistake or missing information in our record of your medical information, you may request, in writing, that we correct or add to the record. You have the right to request an amendment for as long as the information is kept by or for the hospital. We will respond within 60 days of receiving your written request. We may deny your request if it is not in writing or does not include a reason to support the request. In addition, we may deny your request to amend medical information if we determine that the information:
(i) Was not created by us (unless the person or entity that created the information is no longer available to make the amendment);
(ii) Is not part of the medical information kept by or for the hospital;
(iii) Is not part of the information which you would be permitted to inspect and copy; or
(iv) Is accurate and complete.
If we deny your request, we will give you our reasons for the denial in writing. We will also explain your rights to give us a written statement disagreeing with the denial, and to have the request, denial, and your statement of disagreement included in any future use or disclosure of your medical information. If we accept your request to amend the information, we will make reasonable efforts to inform others of the amendment, including persons you name who have received medical information about you and who need the amendment. To request an amendment, your request must be made in writing and submitted to Director of Medical Records.
You Have the Right to a Listing of Disclosures We Have Made
You have the right to request an "accounting of disclosures." This is a list of certain disclosures we have made of medical information about you, including the date of the disclosure, the name (and address, if available) of the person or organization receiving the information, a brief description of the information disclosed, and the purpose of the disclosure. We are not required to include an accounting of the following disclosures: (1) disclosures made for your treatment; (2) for billing and collection of payment for your treatment; (3) for our health care operations; (4) requested by you, that you authorized, or which are made to individuals involved in your care; (5) for our facility directory; (6) for national security or intelligence purposes; (7) to correctional institutions or law enforcement officials; or disclosures made before April 14, 2003.
You can request an accounting of disclosures for as far back as six years. We will respond to your written request for such a list within 60 days of receiving it. There will be no charge for up to one such list each year, but we will charge you for more frequent requests. We will notify you of any cost involved and you may choose to withdraw or modify your request at the time before any costs are incurred.
To request this list or accounting of disclosures, you must submit your request in writing to the Director of Medical Records.
You Have the Right to a Copy of This Notice
You have the right to receive a paper copy of this Notice and/or an electronic copy by e-mail upon request. We will provide a copy of this Notice no later than the date you first receive service from us (except for emergency services, and then we will provide the Notice to you as soon as possible).
To obtain a copy of our most current Notice, contact the Privacy Officer at : 336-598-7220.
VI. How You May File a Complaint
If you think we may have violated your privacy rights, or you disagree with a decision we have made about access to your medical information, you have the right to file a complaint. You will not be penalized for filing a complaint against us. To file a compliant with us, contact the person listed below:
Person Memorial Hospital
615 Ridge Rd.
Roxboro, NC 27573
E-mail: Privacy Officer
You may also send a written complaint to the United States Secretary of the Department of Health and Human Services by sending your complaint to:
Office for Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue SW
Washington, DC 20201