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NOTICE OF PRIVACY
PRACTICES OF KNOXVILLE HOSPITAL & CLINICS
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.
Each time you visit our facility,
Knoxville Area Community Hospital, a record of your visit is made. Typically,
this record contains your symptoms, examination and test results, diagnoses,
treatment and a plan for future care or treatment. This information, often
referred to as your health or medical record, serves as a:
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Basis for planning
your care and treatment |
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Means of
communication among the many health professionals who contribute to your
care |
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Legal document by
which you or a third-party payer can verify that services billed were actually
provided. |
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A tool in
educating health professionals |
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A source of data
for facility planning and marketing |
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A tool with which
we can assess and continually work to improve the care we render and the
outcomes we achieve |
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Understanding
what is in your record and how your health information is used helps you
to:
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Ensure its
accuracy |
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Better understand
who, what, when, where and why others may access your health
information |
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Make more informed
decisions when authorizing disclosure to others |
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WHO WILL
FOLLOW THIS NOTICE
Knoxville Area
Community Hospital: This notice describes the privacy practices of Knoxville
Area Community Hospital (the "Hospital") and all of its programs, departments
and facilities.
MEDICAL STAFF: This notice also describes the privacy
practices of an "organized health care arrangement" or "OHCA" between the
hospital and eligible providers on its Medical Staff. Because the Hospital is a
clinically integrated care setting, our patients receive care from Hospital
staff and from independent practitioners on the Medical Staff. The Hospital and
its Medical Staff must be able to share your medical information freely for
treatment, payment and health care operations as described in this notice.
Because of this, the Hospital and all eligible providers on the Hospital's
Medical Staff have entered into the OHCA under which the hospital and the
eligible providers will:
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Use this Notice as
a joint notice of privacy practices for all inpatient and outpatient visits and
follow all information practices described in this notice; |
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Obtain a single
signed acknowledgment of receipt; and |
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Share medical
information from inpatient and outpatient hospital visits with eligible
providers so that they can help the Hospital with its health care
operations. |
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The OHCA
does not cover the information practices of practitioners in their
private offices or at other practice locations.
USES AND DISCLOSURES OF INFORMATION WITHOUT YOUR AUTHORIZATION
The following are the types
of uses and disclosures we may make of your medical information without your
permission. Medical information includes medical, insurance and medical payment
information, such as your diagnoses, medications or medical payment history,
which identifies you. Where State or federal law restricts one of the described
uses or disclosures, we follow the requirements of such State or federal law.
These are general descriptions only. They do not cover every example of
disclosure within a category.
Treatment: We will use and disclose
your medical information for treatment. For example, we will share medical
information about you with our nurses, your physicians and others who are
involved in your care at the Hospital. We will also disclose your medical
information to your physician and other practitioners, providers and healthcare
facilities for their use in treating you in the future. For example, if you are
transferred to a nursing facility, we will send medical information about you
to the nursing facility.
Payment: We will use and disclose your
medical information for payment purposes. For example, we will use your medical
information to prepare your bill and we will send medical information to your
insurance company with your bill. We may also disclose medical information
about you to other medical care providers, medical plans and healthcare
clearinghouses for their payment purposes. For example, if you are brought in
by ambulance, the information collected will be given to the ambulance provider
for its billing purposes. If State law requires, we will obtain your permission
prior to disclosing to other providers or health insurance companies for
payment purposes.
Healthcare Operations: We may use or disclose your
medical information for our healthcare operations. For example, medical staff
members may review your medical information to evaluate the treatment and
services provided, and the performance of our staff in caring for you. In some
cases, we will furnish other qualified parties with your medical information
for their healthcare operations. The ambulance company, for example, may also
want information on your condition to help them know whether they have done an
effective job of providing care. If State law requires, we will obtain your
permission prior to disclosing to other providers or health insurance companies
for their operations.
Business Associates: We will disclose your
medical information to our business associates and allow them to create, use
and disclose your medical information to perform their job. For example, we may
disclose your medical information to an outside billing company who assists us
in billing insurance companies. To protect the information, we require our
business associates to appropriately safeguard your information.
Appointment Reminders: We may contact you as a reminder that you
have an appointment for treatment or medical services.
Treatment
Alternatives: We may contact you to provide information about treatment
alternatives or other health-related benefits and services that may be of
interest to you.
Fundraising: We may contact you as part of a
fundraising effort. We may also disclose certain elements of your medical
information, such as your name, address, phone number and dates you received
treatment or services, to a business association or a foundation related to the
Hospital so that they may contact you to raise money for the
Hospital
Hospital Directory: We may include your name, location in
the facility, general condition and religious affiliation in a facility
directory. This information may be provided to members of the clergy and,
except for religious affiliation to other people who ask for you by name. We
will not include your information in the facility directory if you object or if
we are prohibited by State or federal law.
Family and Friends: We
may disclose your location or general condition to a family member or your
personal representative. If any of these individuals or others you identify are
involved in your care, we may also disclose such information as is directly
relevant to their involvement. We will only release this information if you
agree, are given the opportunity to object and do not, or if in our
professional judgment, it would be in your best interest to allow the person to
receive the information or act on your behalf. For example, we may allow a
family member to pick up your prescriptions, medical supplies or x-rays. We may
also disclose your information to an entity assisting in disaster relief
efforts so that your family or individual responsible for your care may be
notified of your location and condition.
Required by Law: We will use
and disclose your information as required by federal, State or local law.
Public Health Activities: We may disclose medical information
about you for public health activities. These activities may include
disclosures:
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To a public health
authority authorized by law to collect or receive such information for the
purpose of preventing or controlling disease, injury or disability. |
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To appropriate
authorities authorized to receive reports of child abuse and
neglect. |
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To FDA-regulated
entities for purposes of monitoring or reporting the quality, safety or
effectiveness of FDA-regulated products; or |
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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. |
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Abuse,
Neglect or Domestic Violence: We may notify the appropriate government
authority if we believe a patient has been the victim of abuse, neglect or
domestic violence. Unless such disclosure is required by law, we will only make
this disclosure if you agree.
Health Oversight Activities: We may
disclose medical information to health oversight agency for activities
authorized by law. These oversight activities include, for example, audits,
investigations, inspections and licensure. These activities are necessary for
the government to monitor the healthcare system, government programs and
compliance with civil rights laws.
Judicial and Administrative
Proceedings: 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 reasonable efforts have been made to notify you of the
request or to obtain an order from the court protecting the information
requested
Law Enforcement: We may release certain medical information
if asked to do so by a law enforcement official:
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As required by
law, including reporting wounds and physical injuries; |
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In response to a
court order, subpoena, warrant, summons or similar process; |
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To identify or
locate a suspect, fugitive, material witness or missing person; |
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About the victim
of a crime if we obtain the individual's agreement or, under certain limited
circumstances, if we are unable to obtain the individual's
agreement; |
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To alert
authorities of a death we believe may be the result of criminal
conduct; |
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Information we
believe is evidence of criminal conduct occurring on our premises;
and |
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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. |
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Deceased
Individuals: We may release medical information to a coroner, medical
examiner or funeral director as necessary for them to carry out their
duties.
Organ, Eye or Tissue Donation: We may release medical
information to organ, eye or tissue procurement, transplantation or banking
organizations or entities as necessary to facilitate organ, eye or tissue
donation and transplantation.
Research: Under certain circumstances,
we may use or disclose your medical information for research, subject to
certain safeguards. For example, we may disclose information to researchers
when their research has been approved by a special committee that has reviewed
the research proposal and established protocols to ensure the privacy of your
medical information. We may disclose medical information about you to people
preparing to conduct a research project, but the information will stay on site.
Threats to Health or Safety: Under certain circumstances, we may use
or disclose your medical information to avert a serious threat to health and
safety if we, in good faith, believe the use or disclosure is necessary to
prevent or lessen the threat and is to a person reasonably able to prevent or
lessen the threat (including the target) or is necessary for law enforcement
authorities to identify or apprehend an individual involved in a crime.
Specialized Governmental Functions: We may use and disclose your
medical information for national security and intelligence activities
authorized by law or for protective services of the President. If you are a
military member, we may disclose to military authorities under certain
circumstances. If you are an inmate of a correctional institution or under the
custody of a law enforcement official, we may disclose to the institution, its
agents or the law enforcement official your medical information necessary for
your health and the health and safety of other individuals.
Worker's
Compensation: We may release medical information about you as authorized by
law for workers' compensation or similar programs that provide benefits for
work-related injuries or illness.
Incidental Uses and Disclosures:
There are certain incidental uses or disclosures of your information that occur
while we are providing service to you or conducting our business. For example,
after surgery the nurse or doctor may need to use your name to identify family
members that may be waiting for you in a waiting area. Other individuals
waiting in the same area may hear your name called. We will make reasonable
effort to limit these incidental uses and disclosures.
Other Uses and
Disclosures: Other uses and disclosures of your medical information not
covered above will be made only with your written permission. If you authorize
us to use and disclose your information, you may revoke that authorization at
any time. Such revocation will not affect any action we have taken in reliance
on your authorization. |
INDIVIDUAL
RIGHTS
Request for Voluntary
Restrictions: You have the right to request a restriction on how we use and
disclose your medical information for treatment, payment and healthcare
operations, or to certain family members or friends identified by you who are
involved in your care or the payment for your care. We are not required to
agree to your request, and will notify you if we are unable to agree.
Access to Medical Information: We may request to inspect and copy
much of the medical information we maintain about you, with some exceptions. If
you request copies, we may charge you a copying fee plus postage. If we agree
to prepare a summary of your medical information, we will charge a fee to
prepare the summary.
Amendment: You may request that we amend
certain medical information that we keep in your records. We are not required
to make all requested amendments, but will give each request careful
consideration. If we deny your request, we will provide you with a written
explanation of the reasons and your rights.
Accounting: You have the
right to receive an accounting of certain disclosures of your medical
information made by us or our business associates. The first accounting in any
12-month period is free; you may be charged a fee for each subsequent
accounting you request within the same 12-month period.
Confidential
Communication: You may request that we communicate with you about your
medical information in a certain way or at a certain location. We must agree to
your request if it is reasonable and specifies the alternate means or location.
How to Exercise These Rights: All requests to exercise these rights
must be in writing. We will follow written polices to handle requests and
notify you of your decision or actions and your rights. Contact Beth Stanwood,
Director HIM 641-842-1478 or Pat Whitlatch, Compliance Officer 641-842-1440 for
more information or to obtain request forms. |
ABOUT THIS
NOTICE
We are required to follow the
terms of the Notice currently in effect. We reserve the right to change our
practices and the terms of this Notice and to make the new practices and notice
provisions effective for all medical information that we maintain. Before we
make such changes effective, we will make available the revised Notice by
positing it at admissions, in ER and at the clinic where copies will also be
available. The revised Notice will also be posted on our website at
www.kach.org. You are entitled to receive this
Notice in written form. Please contact Beth Stanwood or Pat Whitlatch at the
address listed below to obtain a written copy.
COMPLAINTS
If you have
concerns about any of our privacy practices or believe that your privacy rights
have been violated, you may file a complaint with the Hospital using the
contact information at the end of this Notice. You may also submit a written
complaint to the U.S. Department of Health and Human Services. There will be no
retaliation for filing a complaint.
CONTACT INFORMATION
Beth Stanwood, Director HIM 641-842-1478 or Pat Whitlatch, Compliance
Officer 641-842-1440, Knoxville Area Community Hospital, 1002 S Lincoln,
Knoxville, IA 50138.
EFFECTIVE DATE
OF NOTICE: April 14, 2003 |
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