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.
Your health information and your family's health information are personal. Robinson Memorial Hospital protects the privacy of your personal health information. This notice of Privacy Practices describes the privacy practices of all Robinson Memorial Hospital workforce members (including physicians employed by the hospital, nurses, technicians and volunteers). This notice also describes your rights to privacy of your personal health information. Please be aware that your personal doctor may not be employed by the hospital and may have slightly different policies or notices regarding the doctor's use and disclosure of personal health information.
Our Responsibilities for Your Privacy
We have a responsibility to maintain the privacy of your personal health information and, as required by law, to provide you with notice of our legal duties and privacy practices with respect to your personal health information. We are required to abide by the terms of this notice so long as it remains in effect. We reserve the right to change the terms of this notice as necessary and to make the new notice effective for all personal health information maintained by us. You may obtain a copy of any revised notices at registration locations, or by mailing a request to the Privacy Officer.
Permitted Uses and Disclosures of Your Personal Health Information
This section of the notice lists the circumstances where we are allowed to use and disclose your personal health information. Otherwise, we will not use or disclose your personal health information for any purpose unless you have signed a form authorizing that use or disclosure. You have the right to revoke that authorization in writing, unless the use or disclosure has already been made.
We will make use and disclosure of your personal health information as necessary for your treatment. For instance, doctors and nurses and other professionals involved in your care will use information in your medical record and information that you provide about your symptoms and reactions to plan a course of treatment for you that may include procedures, medications, tests, etc. We may also release your personal health information to another health care facility or professional who is not affiliated with our organization but who is or will be providing treatment to you. For instance, if, after you leave the hospital, you are going to receive home healthcare, we may release your personal health information to that home health care agency so that a plan of care can be prepared for you.
We will make use and disclosure of your personal health information as necessary for the purposes of payment to those health professionals and facilities that have treated you or provided services to you. For instance, we may forward information regarding your medical procedures and treatment to your insurance company to arrange payment for the services provided to you, or we may use your information to prepare a bill to send to your or to the person responsible for your payment.
Health Care Operations
We will use and disclose your personal health information as necessary, and as permitted by law, for our health care operations, which includes clinical improvement, business management, professional peer review, accreditation and licensing, etc. For instance, we may use and disclose your personal health information for purposes of evaluating the clinical treatment and care of our patients. We may also disclose your personal health information to another health care facility, health care professional, or health plan for such things as quality improvement and case management, but only if that facility, professional, or plan also has or had a patient relationship with you.
Hospital Facility Directory
If you are admitted to the hospital, we maintain a facility directory that may include your name, your location in the hospital, your condition described in general terms (e.g., good, fair, critical, etc.) and, if you wish, your religious affiliation. Unless you choose to have your information excluded from this directory, the information, excluding your religious affiliation, will be disclosed to anyone who requests it by asking for you by name. This information, including your religious information, may also be provided to members of the clergy. You have the right during registration to have your information excluded from this directory and also to restrict what information is provided.
Family and Friends Involved in Your Care
With your approval, we may from time to time disclose your personal health information to family, friends and others who are involved in your care or in payment of your care. For example, we may assume that you agree to let us share your health information with a family member if they accompany you into the exam room during your treatment or white treatment is being discussed. If you are unavailable, incapacitated, or facing an emergency medical situation, and we determine that a limited disclosure may be in your best interest, we may share limited personal health information with such individuals without your approval. We may also disclose limited personal health information to a public or private entity that is authorized to assist in disaster relief efforts in order for that entity to locate a family member or other persons who may be involved in some aspect of caring for you.
Some services are performed through contracts with outside persons or organizations, such as auditing, accreditation, legal services, etc. At times it may be necessary for us to provide certain details of your personal health information to one or more of these outside persons or organizations who assist us with our healthcare operations. In all cases, we require these business associates to appropriately safeguard the privacy of your information.
While we do not intend to, we may use demographic information (e.g., name, address, age, etc.) and dates of healthcare provided to you for the purposes of raising funds for Robinson Memorial Hospital. Any fundraising material sent would describe how you may opt out of receiving any further fundraising communications.
Appointments and Services
We may contact you to provide appointment reminders or test results. You have the right to request - and we will accommodate reasonable requests by you - to receive communications regarding your personal health information from us by alternative means or at alternative locations. For instance, if you wish appointment reminders not to be left on voice mail or sent to a particular address, we will accommodate reasonable requests. You must request such alternative communication in writing to the Privacy Officer.
Health Products and Services
We may from time to time use your personal health information to communicate with you about health products and services necessary for your treatment, to advise you of new products and services we offer, and to provide general health and wellness information.
In limited circumstances, we may use and disclose your personal health information for research purposes. For example, a research organization may wish to compare outcomes of all patients that received a particular drug and will need to review a series of medical records. In all cases where your specific authorization has not been obtained, your privacy will be protected by strict confidentiality requirements applied by an Institutional Review Board or privacy board which oversees the research, or, through direct agreements with researchers, that limits their use and disclosure of patient information.
Required by Law
We are permitted or required by law to release your personal health information without your authorization:
• for public health activities, such as required reporting of disease, injury, birth and death, and for required public health investigations;
• if we suspect child abuse or neglect;
• if we believe you to be a victim of abuse, neglect, or domestic violence;
• to the Food and Drug Administration to report adverse events, product defects, or to participate in product recalls;
• to your employer when we have provided healthcare to you at the request of your employer to determine workplace-related illness or injury. (In most cases you will receive notice that information is disclosed to your employer);
• to a government oversight agency conducting audits, investigations, or civil or criminal proceedings;
• if required to so do by subpoena or discovery request (in some cases you will have notice of such release);
• to law enforcement officials to report wounds and injuries and crimes;
• to coroners and/or funeral directors;
• if necessary to arrange an organ or tissue donation from you or a transplant for you;
in limited instances if we suspect a serious threat to health or safety;
• if you are a member of the military, we may also release your personal health information for national security or intelligence activities; and
• to workers' compensation agencies for your workers' compensation benefit determination.
State and federal laws require that, except for limited disclosures, we obtain a consent from you before disclosing: the performance or results of an HIV test or diagnoses of AIDS or an AIDS-related condition; information about drug or alcohol treatment program; and before disclosing information about mental health services you may have received. For full information on when such consents may be necessary, you can contact the Privacy Officer.
Your Rights to Privacy
Access to Your Health Information
You have the right to copy and/or inspect much of the personal health information that we retain on your behalf. All requests for access must be made in writing and signed by you or your authorized representative. We will charge you a fee per page if you request a copy of the information. We will also charge for postage if you request a mailed copy. You may obtain an access request form from:
Health Information Management
Robinson Memorial Hospital
P.O. Box 1204
6847 N. Chestnut Street
Ravenna, Ohio 44266-1204
Amendments to Your Personal Health Information
You have the right to request in writing that the personal health information that we maintain about you be amended or corrected. We are not obligated to make all requested amendments but will give each request careful consideration. In order to be considered, all amendment requests must be made in writing, signed by you or your representative, and must state the reasons for the amendment/correction request. If an amendment or correction you request is made by us, we may also notify others who work with us and have copies of the uncorrected record if we believe that such notification is necessary. You may obtain an amendment request form from the Director, Health Information Management.
Accounting for Disclosures of Your Personal Health Information
You have the right to receive an accounting of certain disclosures made by us of your personal health information after April 14, 2003. The first accounting in any 12-month period is free; you will be charged a fee for each subsequent accounting you request within the same 12-month period. Requests must be made in writing and signed by you or your representative. Accounting request forms are available from the Director, Health Information Management.
Restrictions on Use and Disclosure of Your Personal Health Information
You have the right to request restrictions on some of the uses and disclosures of your personal health information for treatment, payment, or health care operations. A restriction request form can be obtained from the Director, Health Information Management. We are not required to agree to your restriction request but will attempt to accommodate reasonable requests when appropriate, and we retain the right to terminate an agreed-to-restriction if we believe such termination is appropriate. In the event of a termination by us, we will notify you of such termination. You also have the right to terminate, in writing or orally, any agreed-to-restriction by sending or communicating such termination notice to the Director, Health Information Management.
Obtain a Copy of this Notice
As a patient, you have the right to obtain a paper copy of this notice, even if you have requested such copy by e-mail or other electronic means.
If you believe your privacy rights have been violated, you can file a complaint in writing to the Privacy Officer. You may also file a complaint with:
The Region V
Officer of Civil Rights
U.S. Department of Health and Human Services
233 N. Michigan Avenue, Suite 240
Chicago, Illinois 60601
You must file a complaint in writing within 180 days of a violation of your rights. There will be no retaliation for filing a complaint.
If you have questions or need further assistance regarding this notice, you may contact the Privacy Officer by mail or telephone as follows:
Robinson Memorial Hospital
P.O. Box 1204
6847 N. Chestnut Street
Ravenna, Ohio 44266-1204
Acknowledgement of Receipt of Notice
We are required to ask you to sign an acknowledgement form that this notice has been made available to you on the date of the first delivery of service. The purpose of this notice is to make you aware of the possible uses and disclosures of your personal health information and your privacy rights. The delivery of your health care services will not be conditioned upon your signed acknowledgement. If you decline to provide a signed acknowledgement, we will continue to provide your treatment and will use and disclose your protected health information for treatment, payment and health care operations as necessary.