Regional Care Services Corporation
Joint Notice of Privacy Practices for Medical Information
Effective Date: January 27, 2010
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.
WHO MUST FOLLOW THIS NOTICE?
The following organizations and/or people or groups are covered by this joint notice of privacy practices because they use health information about you for treatment, to obtain payment for treatment, for administrative purposes and to evaluate the quality of care you receive:
• Casa Grande Regional Medical Center (CGRMC)
• Desert Reflections Imaging Center
• CGRMC Urgent Care
• Regional Care Physicians Group
• Any health care provider who comes to CGRMC to care for you. This includes physicians, nurses, physician’s assistants, technicians and other allied health professionals
• Ambulance and emergency personnel
• Our employees, contractors, students and volunteers
OUR PLEDGE TO YOU
We understand that medical information about you is private and personal. We are committed to protecting medical information about you and safeguarding the integrity and confidentiality of that information. This notice applies to records of the care you received at any of our facilities whether created by your physician or other hospital staff. Your doctor and other health care providers may have different practices or notices about their use and sharing of medical information in their own offices or clinics. We will gladly explain this notice to you or your family members.
We are required by law to:
• Keep medical information about you private.
• Give you this notice describing our legal duties and privacy practices for medical information about you.
• Follow the terms of this notice that are currently in effect.
HOW WE MAY USE AND SHARE YOUR MEDICAL INFORMATION
This section of our notice describes how we may share medical information about you. In any cases not covered by this notice, we will get separate written permission from you before we use or share your medical information. You can cancel this permission at a later date by notifying us in writing.
Treatment: We will use and share your medical information for purposes of treatment. For example, we may send medical information about you to your physician or a specialist as part of a referral.
Payment: We will use your medical information to obtain payment for your treatment. For example, sending billing information to your insurance provider or to Medicare.
Heath Care Operations: We will use your medical information for healthcare operations. For example, using information to improve the quality of care provided to our patients, patient satisfaction surveys and medical benchmarking studies.
Appointment reminders: We may contact you with appointment reminders.
Treatment options and health related benefits and services: We may contact you about possible treatment options or other health related services that might be of interest to you.
Fund raising activities: We may use a limited amount of information to contact you about fund raising activities or share such information with our fundraising foundation.
Research: We may share your medical information for research purposes. Under certain circumstances we may share medical information about you without your written permission; however, these research projects must go through a special process that protects the confidentiality of your medical information. We may also share information about tumors with state tumor registries for research reasons.
Facility Directory: We may use or disclose the following information about you in order to maintain a directory of individuals in the facility: your name; your location (room number); your condition, described in general terms that do not communicate specific medical information; and your religious affiliation, if you have provided that information. We will give this information (except your religious affiliation) to anyone who asks about you by name. Your religious affiliation will only be given to the appropriate member of the clergy. You may ask to be excluded from the directory, in which case we will not give out any of the above mentioned information.
Lawsuits and Disputes: If you are involved in a lawsuit or dispute, your medical information will be disclosed in response to a court or administration order, subpoena, discovery request, or other lawful process by someone else involved in the dispute, when we are legally required to respond.
As Required by Law: We are required by law to report certain information. We may need to notify the appropriate government authority if we believe that you have been the victim of abuse, neglect, assault or domestic violence. We will only make this disclosure if you agree or when required by law. We may also give information to your employer for Worker’s Compensation purposes regarding work related illness or injury.
Law Enforcement: We may share medical information about you with police or other law enforcement personnel without your permission:
• In response to a court order, subpoena, warrant, summons or similar process
• If the police bring you to the hospital and ask us to test your blood for alcohol or substance abuse
• If the police present a valid release, search warrant or court order
• If you are in police custody or are an inmate of a correctional institution and the information may be necessary to provide you with health care, to protect your health and safety, the health and safety of others or to safeguard the security of the institution
Public Safety: We may share medical information about you to prevent a serious threat to the health and safety of a particular person or the general public. Your medical information will be released if requested by law 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 including:
• To identify or locate a suspect, fugitive, material witness or missing person
• National security and intelligence activities
• Protective services for the President and others
• To alert a serious threat to health or safety
Public Health: Subject to certain requirements, we may report certain information for public health reasons. For example, we are required by law to report births, deaths and certain diseases to the state. We may also report problems with certain medicines or medical products to the FDA or the manufacturer. We may contact you about recalls of products you are using.
Military and Veterans: If you are a member of the armed forces, your medical information may be released as required by military command authorities.
Health Oversight Agencies: We may share information for inspections, audits or other health oversight activities.
Coroners, Medical Examiners and Funeral Directors: We may share information about deceased patients with coroners, medical examiners or funeral directors.
Organ and Tissue Donation: If you are an organ or tissue donor, we may share medical information with organizations that oversee organ, eye or tissue donation/transplantation.
Disaster Organizations: We may share medical information about you with disaster organizations so that your family can be notified of your condition and location in case of a disaster or other emergency.
Family Members and Others Involved in Your Care: Unless directed otherwise by you, we may share medical information about you with family members or friends who you have designated as assisting you with your care.
YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION
Requesting Information about You: In most cases you have the right to look at or receive a copy of your medical information. You will be given an Authorization for Release of Confidential Medical Information form to fill out to make the request. There is no charge for reviewing your medical records. However, we may charge a fee to cover the costs of copying, mailing or other related supplies. If we cannot honor your request for copies or to review your records, you may request, in writing, a review of our decision.
Amending or Correcting Information about You: If you believe that information about you is incorrect or missing, you may request an amendment or correction to your medical record. You will be given a form or you may send the request in letter format clearly outlining the error or omission and the desired correction. We may deny the request to amend your record if the information was not created or maintained by us, or if we determine the record is accurate, complete and correct. You may ask us, in writing, to review the denial.
Obtaining an Accounting of Disclosures: You have the right to request, in writing, a listing of every time we have shared medical information about you, other than for treatment, payment or health care operations, or where you have given us written authorization to share your information. Your request must state the time period for the listing, and must be less than six years starting after April 14, 2003. 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 and will give you an estimate of the cost when you request the additional list.
Restricting How We Use or Share Your Information: You have the right to request that your information be communicated to you in a confidential manner. For example, you may request that we contact you at an office telephone number or that we send mail to an address other than your home. You must tell us in writing the exact way or place to communicate with you.
You may also request that we not use or disclose information for treatment, payment or healthcare operations and limit sharing to only those involved in your care. We will consider your request, but may not be able to agree to it. We are not legally bound to agree to your request. We will tell you of our decision about your request.
All written requests for review of denials should be directed to our Privacy Officer listed at the end of this notice.
CHANGES TO THIS NOTICE
We may change our privacy practices at any time. If we make significant changes, we will change our notice. We will post the new notice throughout the facility and on our website. You have a right to a paper copy of this notice and can request a copy by contacting the Privacy Officer. You will be offered this notice at the time of registration.
CONCERNS OR COMPLAINTS
If you are concerned that we have violated your privacy or you disagree with a decision we made about access to your records, you may contact the Privacy Officer at 520-381-6420. You may also file a written complaint with the U.S. Department of Health and Human Services, Office of Civil Rights. Our Privacy Officer can provide you with that address. We have an anti- retaliation policy. No action will be taken against you for filing a complaint.
If you have any questions or complaints, please contact:
Kellie Zeno, RHIT
Privacy Officer and Director of Health Information Management
Casa Grande Regional Medical Center
1800 E. Florence Blvd.
Casa Grande, AZ 85122
Casa Grande Regional Medical Center has created this statement to demonstrate our commitment to on-line privacy. It discloses our information-gathering and dissemination practices for this website.
You may visit our website without submitting any information about yourself. If you send us e-mail or subscribe to one of our on-line publications, you will be asked to submit information about yourself. We will use this information for replying to your message or forwarding the requested material. We do not share this information with any other partners, affiliates or members of CGRMC. Our website may log the IP addresses of visitors, but only to administer the site and diagnose problems with our server. IP addresses are not used to identify individuals.
This site contains links to other sites. We are not responsible for their privacy practices or content. You will be asked to "accept" or "decline" a statement dealing with this.
Please note that CGRMC will not respond to any question concerning a specific medical or health condition. If you submit such a request you will receive a standard response that you should consult with your own health care professional. Of course, we will not intentionally share the contents of this type of an e-mail with any third party. However, due to the nature of electronic communications, we cannot and do not provide any assurances that the contents of your e-mail will not become known or accessible to third parties. WE URGE YOU NOT TO PROVIDE ANY CONFIDENTIAL INFORMATION ABOUT YOU OR YOUR HEALTH TO US VIA ELECTRONIC COMMUNICATION. If you do so, it is at your own risk.
If you have any questions about this privacy statement or the practices of this site, you can contact us at CGRMC Webmaster.