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.

Understanding Your Medical Record Information

Each time you visit Bell Memorial Hospital, Bell Medical Center or one of our clinics, a record of your visit is made.  This record typically contains your symptoms, examination, test results, diagnoses, treatment and a  plan for future care or treatment.  This information, referred to as your medical record, serves as a:

• basis for planning your care and treatment

• means of communication among health professionals who contribute to your care

• legal document describing the care you received

• means by which you or a third-party payor can verify that services billed were provided

• tool in educating health professionals

• source of data for medical research

• source of information for public health officials charged with improving the health of the nation

•  source of data for facility planning and marketing

• tool with which we can assess and continually work to improve the care we render and the outcomes we achieve

Understanding what’s in your record and how your health information is used help you to:

• ensure its accuracy

• understand who, what, when, where, and why others may access your health information

• make decisions about authorizing disclosure to others

Your Health Information Rights

Although your physical medical record belongs to Bell Memorial Hospital and/or Bell Medical Center,  the information contained in the record belongs to you.  You have the right to:

• request a restriction on certain uses and disclosures of your information

• obtain a paper copy of this notice upon request

• inspect and obtain a copy your medical record

• amend your health record

• obtain an accounting of disclosures of your information

• request communications of your information  by alternative means or locations

• revoke your authorization to use or disclose information except to the extent that action has already been taken

Our Responsibilities

• maintain the privacy of your health information

• provide you with a notice of our legal duties and privacy practices concerning information we collect and maintain about you

• abide by the terms of this notice

• notify you if we are unable to agree to a requested restriction

• accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain.  Should our information practices change, we will post a revised notice.

We will not use or disclose your health information without your authorization, except as described in this notice.

Examples of Disclosures for Treatment, Payment and Health Care Operations

We will use your health information for treatment:  Information gathered by a nurse, physician, or other healthcare team member will be recorded and used to determine the course of treatment best for you.  Team members will then record the actions they took and their observations.  We will provide your physician or subsequent healthcare provider with copies of the various reports that assist him or her in treating you.

We will use your health information for payment:  A bill will be sent to your insurance carrier and/or you.  The information on and accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.

We will use your health information for regular health operations:  Members of  Management, the Medical Staff, Quality Improvement Team, or the Quality Improvement Manager may use your information to continually improve the quality and effectiveness of the healthcare services we provide.

Facility Directory:  Unless specifically requested otherwise, we will include limited information about you in our facility directory.  This information may include you name, location in the facility and general condition.  The directory information may be released to people who ask for you by name.  This is so your family and friends can visit you and/or so that flowers or gifts may be sent to you.

Business Associates:  There are some services at Bell Memorial that are provided through contracts with business associates.  Examples include a Radiologist reading, certain lab tests and dictation services.  When contracted, we may disclose your health information to our associates so that they can do the job we’ve asked them to do and bill you or your insurance carrier.  We require the business associate to safeguard your information.

Religious Referral:  If requested,  we will provide your name, location in the hospital and religious affiliation to members of the clergy.

Notification:  We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location and general condition.

Research:  We may disclose information to researchers once a review board has established protocols to insure the privacy of your health information.

Funeral Directors:  We disclose health information to funeral directors consistent with applicable law to carry out their duties.

Organ Procurement:  Consistent with applicable law, we disclose health information to organ procurement organizations or their entities engaged in the procurement, banking, or transplanting of organs for the purpose of tissue donation and transplant.

Marketing:  We may contact you to provide appointment reminders or information about new treatments or other health related benefits and services that may be of interest to you.

Fund Raising:  We may notify you of hospital fund raising efforts.

Food and Drug Administration (FDA):  We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs or replacements.

Workers Compensation:  We disclose health information to the extent authorized  by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

Public Health:  As required by law, we disclose your health information to public health or legal authorities  charged with preventing or controlling disease, injury, or disability.

Correctional institution:  Should you be an inmate of a correctional institution, we disclose to the institution or agents thereof health information necessary for your health and the health and safety of others.

Law enforcement:  We disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.

Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a Bell Memorial work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards.

For More Information or to Report a Problem

If you have any questions or would like additional information, you may contact the Corporate Compliance Specialist at (906) 485-2108.

If you believe your privacy rights have been violated, you can file a complaint with the Corporate Compliance Specialist or with the Secretary of  Health and Human Services.  There will be no retaliation for filing a complaint.

This Notice Describes Privacy Practices for:

All Bell Memorial Hospital Departments

All Bell Medical Center Clinics/Physician Offices

Superior Woman's Care