Copper Queen Community Hospital
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: April 14, 2003
If you have any questions or would like additional information
about this Notice or our Privacy practices, please contact the
Privacy Officer at
(520) 432-5383 x207
WHO WILL FOLLOW THIS NOTICE
This notice describes the privacy practices of Copper Queen Community
Hospital including those 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.
- All employees of Copper Valley Home Health.
- All employees of Copper Queen Surgery Clinic.
- All of the above-identified entities, sites and locations
will follow the terms of this Notice. In addition, these entities,
sites and locations may share medical information with each
other for treatment, payment or hospital operations as described
in this Notice.
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 as needed to provide you with quality care and
to comply with legal requirements. This Notice applies to all
of the records of your care generated by the hospital, whether
made by hospital personnel or your personal doctor. 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.
This Notice of Privacy Practices will tell you about the ways
in which we may use and disclose medical information about you.
It also describes your rights and certain obligations we have
regarding the use and disclosure of your medical information.
We are required by law to:
- make sure that medical information that identifies you
is kept private;
- 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 may disclose medical
information about you to people and entities outside the hospital
who may be involved in your ongoing medical care, such as family
members, clergy or others we use to provide services that are
part of your care.
- 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 tell your health plan
about a treatment you are going to receive to obtain prior approval
or to determine whether your health plan will cover the treatment.
We also may disclose information about you to entities outside
the hospital who may need this information to bill for services
they provided to you.
- For Health Care Operations. We may use and disclose
medical information about you for hospital 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. We may 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 disclose information to doctors, nurses, technicians,
medical students, and other hospital personnel for review and
learning purposes. We may disclose medical information about
you to entities outside of the hospital for certain healthcare
operations as long as both entities have a treatment relationship
with you. We may also combine the medical information we have
with medical information from other hospitals to compare how
we are doing and to 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
patient specifics. We also use patient names in order to seek
information to improve our services. This is accomplished by
the distribution of a patient survey.
- Business Associates. We may disclosure medical information
to other persons or organizations, known as business associates,
who provide services on our behalf under contract. To protect
your medical information, we require our business associates
to appropriately safeguard the information we disclose to them.
- 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 Benefits and Services. We may use and
disclose medical information to tell you about health-related
benefits or services that may be of interest to you.
- Fundraising Activities. We may use medical information
about you to contact you in an effort to raise money for hospital
operations. We may disclose medical information to a foundation
related to the hospital so that the foundation may contact you
in raising money for the hospital. We will only release contact
information, such as your name, address and phone number and
the dates you received treatment or services at the hospital.
If you do not want to be contacted for fundraising efforts,
you must notify [the Copper Queen Community Hospital Development
Fund Committee in writing.
- Hospital Directory. We may include certain limited
information about you in the hospital directory while you are
a patient. 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 be released to people
who ask for you by name. Limited information about you, including
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 is 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, including information
about your condition or that you are in the hospital, to a friend,
family member, or any other person identified by you as being
involved in your medical care or who is involved in the payment
for your care. We will only release information if you agree
to the disclosure, are given the opportunity to object to such
a disclosure and do not, or if in our professional judgment
it would be common practice that it is in your best interest
to allow a person to act on your behalf such as in the case
of picking up a filled prescription or medical supplies for
you. 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.
- Research. Under certain circumstances, we may use and
disclose medical 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 medical information, trying to balance the research needs
with patients' need for privacy of their medical information.
Before we use or disclose medical information for research,
the project will have to be approved through our research approval
process. We may disclose medical information about you to people
preparing to conduct a research project, for example, to help
them look for patients with specific medical needs, as long
as the medical information they review does not leave the hospital.
We will almost always ask for your specific permission if the
researcher will have access to your name, address or other identifying
information, or will be involved in your care at the hospital.
- 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
would only be to someone able to help prevent the threat.
- Organ and Tissue Donation. If you are an organ donor,
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 that
provide benefits for work-related injuries or illness.
- Public Health Activities. 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 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 suspect
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. Oversight activities that are necessary for the government
to monitor the health care system, government programs, and
compliance with civil rights laws include audits, investigations,
and inspections.
- 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 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;
- In response to inquiries 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,
as 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 to 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.
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,
we will no longer use or disclose medical information about you
for the reasons covered by your written authorization. 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.
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 does not include psychotherapy notes.
You must submit your request to inspect and copy medical information
that may be used to make decisions about your care in writing
to Copper Queen Community Hospital Medical Records Department.
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. A 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 in writing and
submitted to Copper Queen Community Hospital Medical Records
Department. In addition, you must provide a reason that supports
your request for amendment.
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:
- Not created by us, unless the person or entity that created
the information is no longer available to make the amendment;
- Not part of the medical information kept by or for the hospital;
- Not part of the information which you would be permitted
to inspect and copy; or
- That is accurate and complete.
- Right to an Accounting of Disclosures. You have the
right to request an accounting of disclosures, which is a list
of medical information disclosures made about you.
To request an accounting of disclosures, you must submit your
request in writing to Copper Queen Community Hospital Medical
Records Department. Your request must state a time period which
may not be longer than six years and may not include dates before
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. 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 submit your request in writing
to Copper Queen Community Hospital Medical Records Department.
In your request, you must tell us:
- what information you want to limit;
- whether you want to limit our use, disclosure or both;
and
- 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 submit your
request in writing to Copper Queen Community Hospital Medical
Records Department. 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.cqch.org. To
obtain a paper copy of this notice, contact the Privacy
Officer.
CHANGES TO THIS NOTICE
We reserve the right to or may be required by law to change our
privacy practices which may result in changes to this Notice.
We further reserve the right to make the revised or changed privacy
practices 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 and
on our website. The Notice will
contain on the first page, in the top right-hand corner, the version
number and effective date. In addition, each time you register
at or are admitted to the hospital for treatment or health care
services, 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's Privacy Officer or with the
Secretary of the Department of Health and Human Services.
To file a complaint with the hospital, contact the hospital's
Privacy Officer.
All complaints must be submitted in writing. You will not be
penalized or otherwise retaliated against for filing a complaint.
CONTACTS
Copper Queen Community Hospital's Privacy Officer
101 Cole Avenue
Bisbee, Arizona 85603
(520) 432-5383 x207
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