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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.
If you have any questions,
please contact our Privacy Officer at
the address or phone number at the bottom
of this notice.
WHO WILL FOLLOW THIS NOTICE?
Covered Entities of Bon Secours Hampton
Roads Health System that provide health
care to patients, residents, and clients
in partnership with physicians and other
professionals and organizations. The
information privacy practices in this
notice will be followed by:
- Any health care professional who
treats you at any of our locations.
- All departments and units of our
organization.
- All employed associates, staff
or volunteers of our organization,
including staff at our corporate office,
with whom we may share information.
- Any business associate or partner
of Bon Secours Hampton Roads with
whom we share health information.
OUR PLEDGE TO YOU
We understand that medical information
about you is personal. We are committed
to protecting medical information about
you. We create a record of the care
and services you receive to provide
quality care and to comply with legal
requirements. This notice applies to
all of the records of your care that
we maintain, whether created by our
staff 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.
We are required by law to:
- keep medical information about you
private.
- give you this notice of our legal
duties and privacy practices with
respect to medical information about
you.
- follow the terms of the notice that
is currently in effect.
CHANGES TO THIS NOTICE
We may change our policies at any time.
Changes will apply to medical information
we already hold, as well as new information
after the change occurs. Before we make
a significant change in our policies,
we will change our notice and post the
new notice in waiting areas, exam rooms,
and on our Web site at Bonsecourshamptonroads.com.
You can receive a copy of the current
notice at any time. The effective date
is listed just below the title. You
will be offered a copy of the current
notice each time you register for treatment.
You will also be asked to acknowledge
in writing your receipt of this notice.
HOW WE MAY USE AND DISCLOSE MEDICAL
INFORMATION ABOUT YOU?
- We
may use and disclose medical information
about you for treatment (such
as sending medical information about
you to a specialist as part of a referral);
to obtain payment for treatment
(such as sending billing information
to your insurance company or Medicare);
and to support our health care
operations (such as comparing
patient data to improve treatment
methods.)
- Where
applicable we may use or disclose
medical information about you without
your prior authorization for several
other reasons. Subject to certain
requirements, we may give out medical
information about you without prior
authorization for public health
purposes, abuse or neglect reporting,
health oversight audits or inspections,
research studies, funeral arrangements
and organ donation, workers’
compensation purposes, and emergencies.
We also disclose medical information
when required by law, such
as in response to a request from law
enforcement in specific circumstances,
or in response to valid judicial or
administrative orders.
-
We also may contact you for appointment
reminders, or to tell you about
or recommend possible treatment
options, alternatives, health-related
benefits or services that may
be of interest to you, or to support
fundraising efforts. If you do not
want to be contacted for these fundraising
efforts, please write to: V.P.
Fund Development, DePaul Medical Center,
150 Kingsley Lane, Norfolk, Virginia
23505.
-
If admitted as a patient, unless you
tell us otherwise, we may list in
the patient directory your name,
location in the hospital, your general
condition (good, fair, etc.) and your
religious affiliation, and will release
all but your religious affiliation
to anyone who asks about you by name.
Your religious affiliation may be
disclosed only to a clergy member,
and even if they do not ask for you
by name.
- We
may disclose medical information about
you to a friend or family member
who is involved in your medical care,
or to disaster relief authorities
so that your family can be notified
of your location and condition.
OTHER
USES OF MEDICAL INFORMATION
- In any other situation not covered
by this notice, we will ask for your
written authorization before using
or disclosing medical information
about you. If you choose to authorize
use or disclosure, you can later revoke
that authorization by notifying us
in writing of your decision.
YOUR RIGHTS REGARDING MEDICAL INFORMATION
ABOUT YOU
-
In most cases, you have the right
to look at or get a copy of medical
information that we use to make
decisions about your care, when you
submit a written request. If you request
copies, we may charge a fee for the
cost of copying, mailing or other
related supplies. If we deny your
request to review or obtain a copy,
you may submit a written request for
a review of that decision.
- If
you believe that information in your
record is incorrect or if important
information is missing, you have
the right to request that we correct
the records, by submitting a request
in writing that provides your reason
for requesting the amendment. We could
deny your request to amend a record
if the information was not created
by us; if it is not part of the medical
information maintained by us; or if
we determine that the record is accurate.
You may appeal, in writing, a decision
by us not to amend a record.
- You
have the right to a list of those
instances where we have disclosed
medical information about you,
other than for treatment, payment,
health care operations or where you
specifically authorized a disclosure,
when you submit a written request.
The request must state the time period
desired for the accounting, which
must be less than a 6-year period
and starting after April 14, 2003.
You may receive the list in paper
or electronic form. The first disclosure
list request in a 12-month period
is free; other requests will be charged
according to our cost of producing
the list. We will inform you of the
cost before you incur any costs.
-
If this notice was sent to you electronically,
you have the right to a paper copy
of this notice.
- You
have the right to request that medical
information about you be communicated
to you in a confidential manner,
such as sending mail to an address
other than your home, by notifying
us in writing of the specific way
or location for us to use to communicate
with you.
- You
may request, in writing, that we not
use or disclose medical information
about you for treatment, payment
or healthcare operations or to persons
involved in your care except when
specifically authorized by you, when
required by law, or in an emergency.
We will consider your request but
we are not legally required to accept
it. We will inform you of our
decision on your request.
All written requests or appeals should
be submitted to our Privacy Officer
listed at the bottom of this notice.
COMPLAINTS
- If
you are concerned that your privacy
rights may have been violated, or
you disagree with a decision we made
about access to your records, you
may contact our Privacy Officer (listed
below). You may also contact our Values
Line 1-888-880-1286.
- Finally,
you may send a written complaint to
the U.S. Department of Health and
Human Services Office of Civil Rights.
Our Privacy Officer can provide you
the address.
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