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MERCY HOSPITAL CADILLAC
NOTICE OF PRIVACY PRACTICES
Effective Date: 4/14/03
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.
We at Mercy Hospital Cadillac are a member
of Trinity Health. Trinity Health is required by law to maintain
the privacy of individually identifiable patient health information
(this information is "Protected Health Information"
and is referred to herein as "PHI"). We are also required
to provide patients with a Notice of Privacy Practices regarding
PHI. We will only use or disclose your PHI as permitted or required
by applicable state law. Federal and state laws further restrict
the uses and disclosures of your mental health, substance abuse,
and infectious disease information. This notice applies to your
individually identifiable health information in our possession
including the medical records generated by us.
Mercy Hospital Cadillac understands that your
health information is highly personal, and we are committed to
safeguarding your privacy. Please read this Notice of Privacy
Practices thoroughly. It describes how we will use and disclose
your PHI.
This Notice applies to the delivery of health
care by Mercy Hospital Cadillac and their medical staff in the
main hospital, outpatient departments and clinics. This Notice
also applies to the utilization review and quality assessment
activities of Munson Healthcare and Mercy Hospital Cadillac as
a strategic partner of Munson Healthcare.
I. Permitted Use or Disclosure
A. Treatment: Mercy Hospital Cadillac
will use and disclose your PHI in the provision and coordination
of health care to carry out treatment functions.
Mercy Hospital Cadillac will disclose all
or any portion of your patient medical record information to your
attending physician, consulting physician(s), nurses, pharmacists,
technicians, medical students, dieticians, spiritual/ethical care
providers, and other health care providers who have a legitimate
need for such information in your care and continued treatment.
Different departments will share medical information
about you in order to coordinate specific services, such as lab
work, x-rays and prescriptions.
Mercy Hospital Cadillac also will disclose
your medical information to people or entities outside Mercy Hospital
Cadillac who will be involved in your medical care after you leave
Mercy Hospital Cadillac, such as other care providers and family
who will provide services that are part of your care.
Mercy Hospital Cadillac will share certain
information such as your name, address, employment, insurance
carrier, emergency contact information and appointment scheduling
information in an effort to coordinate your treatment with us
and with other health care providers.
Mercy Hospital Cadillac will use and disclose
your PHI to inform you of, or recommend possible treatment options
or alternatives that will be of interest to you.
Mercy Hospital Cadillac will use and disclose
PHI to contact you as a reminder that you have an appointment
for treatment or medical care at Mercy Hospital Cadillac.
If you are an inmate of a correctional institution
or under the custody of a law enforcement officer, Mercy Hospital
Cadillac will disclose your PHI to the correctional institution
or law enforcement official.
B. Payment: Mercy Hospital Cadillac
will disclose PHI about you for the purposes of determining coverage,
eligibility, funding, billing, claims management, medical data
processing, stop loss/reinsurance and reimbursement.
The medical information will be disclosed
to an insurance company, third party payer, third party administrator,
health plan or other health care provider (or their duly authorized
representatives) involved in the payment of your medical bill
and will include copies or excerpts of your medical records which
are necessary for payment of your account. It will also include
sharing the necessary information to obtain pre-approval for payment
for treatment from your health plan.
The medical information may also be released
to independent health care providers who were involved in your
treatment (for example, Emergency Room physicians and Radiologists
who are not employed by Mercy Hospital Cadillac) or emergency
delivery (via ambulance service) to Mercy Hospital Cadillac so
that they may seek payment for caring for you.
Mercy Hospital Cadillac will disclose PHI
to collection agencies and other subcontractors engaged in obtaining
payment for care.
C. Health Care Operations: Mercy Hospital
Cadillac will use and disclose your PHI during routine health
care operations including quality review, utilization review,
medical review, internal auditing, accreditation, certification,
licensing or credentialing activities of Mercy Hospital Cadillac,
and for educational purposes.
For instance, Mercy Hospital Cadillac will need to share your
demographic information, diagnosis, treatment plan and health
status for population based activities relating to improving health
or reducing health care costs, protocol development, case management
and care coordination, and contacting health care providers and
patients with information about treatment alternatives, in order
for us to operate our business in an efficient, safe and legal
manner.
Mercy Hospital Cadillac may also use and disclose
your PHI to support the sale, transfer, or other corporate restructuring
of Mercy Hospital Cadillac's assets.
D. Other Uses and Disclosures: As part
of treatment, payment and health care operations, we may also
use your PHI for the following purposes:
Fundraising Activities: Mercy Hospital
Cadillac will use and may also disclose some of your PHI for certain
fund raising activities. For example, Mercy Hospital Cadillac
will use your demographic information (e.g., name, address and
other contact information, age, gender, and insurance status)
and the dates Mercy Hospital Cadillac provided service to you.
Any communication sent to you will let you know how you may opt
out of receiving similar communications in the future. Mercy Hospital
Cadillac may disclose limited PHI to a company contracted to conduct
fundraising for Mercy Hospital Cadillac. This company will use
your PHI only for the purposes of fundraising for Mercy Hospital
Cadillac. (If you wish to opt-out, you may do so by contacting
the Privacy Official.)
Medical Research: Mercy Hospital Cadillac
may disclose your PHI without your Authorization to medical researchers
who request it for approved medical research projects; however,
with very limited exceptions such disclosures must be cleared
through a special approval process before any PHI is disclosed
to the researchers. Researchers will be required to safeguard
the PHI they receive.
Information and Health Promotion Activities:
Mercy Hospital Cadillac will use and disclose some of your PHI
for certain health promotion activities. For example, your name
and address will be used to send you newsletters or general communications.
We may send you cards for relevant events such as the birth of
your child. Mercy Hospital Cadillac will also send you information
based on your own health concerns. Mercy Hospital Cadillac may
send you this information if we have determined that a product
or service may help you. The communication will explain how the
product or service relates to your well being and can improve
your health.
E. More Stringent State and Federal Laws:
The State law of Michigan is more stringent than HIPAA in several
areas. State law is more stringent when the individual is entitled
to greater access to records than under HIPAA and when under state
law the records are more protected from disclosure than under
HIPAA. Certain federal laws also are more stringent than HIPAA.
Mercy Hospital Cadillac will continue to abide by these more stringent
state and federal laws. The federal laws include applicable internet
privacy laws, such as the Children's Online Privacy Protection
Act and the federal laws and regulations governing the confidentiality
of health information regarding substance abuse treatment.
In Michigan patients have more rights of access
to behavioral health information under Michigan law than under
HIPAA and the state law defines a minimum necessary standard for
release of mental health information. Disclosure is permitted
with consent and for treatment without consent but only in an
emergency. Minors in Michigan have more rights to confidentiality
and protection of certain information (reproductive health, behavioral
health and substance abuse) than under HIPAA. State law requires
facilities to adopt policies regarding release of information
outside the facility. If the facility policy requires consent
for release, then consent will be required. State law genetic
and HIV testing and disclosure consents remain in place.
II. Permitted Use or Disclosure with an
Opportunity for You to Agree or Object
A. Family/Friends: Mercy Hospital Cadillac
will disclose PHI about you to a friend or family member who is
involved in your medical care. Mercy Hospital Cadillac will also
give information to someone who helps you pay for your care. In
addition, Mercy Hospital Cadillac will disclose PHI about you
to an agency assisting in a disaster relief effort so that your
family can be notified about your condition, status and location.
You have a right to request that your PHI not be shared with some
or all of your family or friends.
B. Facility Directory: Mercy Hospital
Cadillac will list certain limited information about you in its
Facility Directory if you are a hospital patient at Mercy Hospital
Cadillac. This information will include your name, location in
Mercy Hospital Cadillac, and your general condition (e.g., fair,
stable, critical, etc.). This directory information will also
be disclosed to people who ask for you by name, including your
family members, friends, or other visitors. You have the right
to request that your name not be included in Facility Directory.
If you request to opt out of the Facility Directory, we cannot
inform visitors of your presence, location, or general condition.
C. Spiritual Care: A hospital spiritual
care provider may consult you as part of the healthcare team,
or you may request a visit from a spiritual care provider by speaking
to your nurse.
With your permission, Directory information
including your name, location in Mercy Hospital Cadillac, general
condition, and religious affiliation will be given to a member
of the community clergy from your denomination, such as a minister,
priest or rabbi, even if they don't ask for you by name. You have
a right to request that your name not be given to any community
member of the clergy.
D. Promotional Communications: Mercy
Hospital Cadillac does not share or sell your PHI to companies
that market health care products or services directly to consumers
for use by those companies to contact you, such as drug companies.
Mercy Hospital Cadillac does maintain a database of individuals
for promotional communications, disease management, health promotion,
and fundraising purposes. This database includes individuals to
whom Mercy Hospital Cadillac may have sent health improvement
materials and news about Mercy Hospital Cadillac previously and
also individuals who have donated to Mercy Hospital Cadillac or
who have expressed an interest in donating to Mercy Hospital Cadillac
or other health-related activities. You may be included in this
database. Mercy Hospital Cadillac sends information to the individuals
in this database about the programs and services of Mercy Hospital
Cadillac. If you wish to be deleted from this database, you may
notify the Privacy Official of Mercy Hospital Cadillac.
E. Media Conditions Reports: Mercy
Hospital Cadillac may release information for an update to the
media if the media requests information about you using your full
name and after we have given you an opportunity to agree or object.
The following information may then be disclosed: your condition
described in general terms that do not communicate specific medical
information, such as "good", "fair", "serious",
or "critical".
III. Use or Disclosure Requiring Your Authorization
A. Marketing: Mercy Hospital Cadillac
is not permitted to provide your PHI to any other person or company
for marketing to you of any products or services other than Mercy
Hospital Cadillac's products or services unless you have signed
an authorization.
B. Research: Mercy Hospital Cadillac
will use or disclose your PHI as part of research that includes
providing you with treatment. For example, if you are part of
a research study that includes treatment, Mercy Hospital Cadillac
may require that you sign an authorization to allow the researchers
to use or disclose your PHI for this research.
C. Other Uses: Any uses or disclosures
that are not for treatment, payment or operations and that are
not permitted or required for public policy purposes or by law
will be made only with your written authorization. Written authorizations
will let you know why we are using your PHI. You have the right
to revoke an authorization at any time, except to the extent that
Mercy Hospital Cadillac has taken action in reliance on the authorization.
IV. Use or Disclosure Permitted by Public
Policy or Law without your Authorization
A. Law Enforcement Purposes: Mercy
Hospital Cadillac will disclose your PHI for law enforcement purposes
as required by law, such as responding to a court order or subpoena,
identifying a criminal suspect or a missing person, or providing
information about a crime victim or possible criminal conduct
as part of a criminal investigation.
Required by Law: Mercy Hospital Cadillac
will disclose PHI about you when required by federal, state or
local law to make reports or other disclosures. Mercy Hospital
Cadillac also will make disclosures for judicial and administrative
proceedings such as lawsuits or other disputes in response to
a court order or subpoena. Mercy Hospital Cadillac will disclose
your medical information to government agencies concerning victims
of abuse, neglect or domestic violence. Mercy Hospital Cadillac
will report drug diversion and information related to fraudulent
prescription activity to law enforcement and regulatory agencies.
Specialized government functions will warrant the use and disclosure
of PHI. These government functions will include military and veteran's
activities, national security and intelligence activities, and
protective services for the President and others. Mercy Hospital
Cadillac will make certain disclosures that are required in order
to comply with workers' compensation or similar programs.
B. Coroners, Medical Examiners, Funeral
Directors: Mercy Hospital Cadillac will disclose your PHI
to a coroner or medical examiner. For example, this will be necessary
to identify a deceased person or to determine a cause of death.
Mercy Hospital Cadillac will also disclose your medical information
to funeral directors as necessary to carry out their duties.
C. Organ Procurement: Mercy Hospital
Cadillac will disclose PHI to an organ procurement organization
or entity for organ, eye or tissue donation purposes when donation
has been authorized or to verify that appropriate organ procurement
procedures were followed.
D. Health or Safety: Following the
requirements of the Michigan Department of Commerce, Mercy Hospital
Cadillac will use and disclose PHI to avert a serious threat to
health and safety of a person or the public. Mercy Hospital Cadillac
will use and disclose PHI to Public Health Agencies for immunizations,
communicable diseases, etc. Mercy Hospital Cadillac will use and
disclose PHI for activities related to the quality, safety or
effectiveness of FDA-regulated products or activities, including
collecting and reporting adverse events, tracking and facilitating
product recalls, etc. and post marketing surveillance. Any patient
receiving a medical device subject to FDA tracking requirements
may refuse to disclose, or refuse permission to disclose, their
name, address, telephone number and social security number, or
other identifying information for the purpose of tracking.
V. Your Health Information Rights
Although we at Mercy Hospital Cadillac must
maintain all records concerning your hospitalization and treatment
by Mercy Hospital Cadillac, you have the following rights concerning
your PHI:
A. Right to Inspect and Copy: You have
the right to access your PHI and to inspect and have a copy made
of your PHI as long as we maintain it except for: psychotherapy
notes, information that may be used in anticipation of, or that
will be used in a civil, criminal or administrative action or
proceeding, and where prohibited or protected by law.
Mercy Hospital Cadillac will deny your request
for access to your PHI without giving you an opportunity to review
that decision if:
- You don't have the right to inspect the
information; or it is otherwise prohibited or protected by law;
- You are an inmate at a correctional institution
and obtaining a copy of the information would risk the health,
safety, security, custody or rehabilitation of you or other
inmates;
- The disclosure of the information would
threaten the safety of any officer, employee or other person
at the correctional institution or who is responsible for transporting
you;
- You are involved in a clinical research
project and Mercy Hospital Cadillac created or obtained the
PHI during that research. Your access to the information will
be temporarily suspended for as long as the research is in progress;
- Mercy Hospital Cadillac obtained the information
that you seek access to from someone other than the health care
provider under a promise of confidentiality and your access
request is likely to reveal the source of the information; or
- Under other limited circumstances. In these
instances, however, Mercy Hospital Cadillac will allow the review
of its decision by a health care professional that Mercy Hospital
Cadillac has chosen. This person will not have been involved
in the original decision to deny your request.
You agree to pay a reasonable copying charge.
You must make your requests to access and copy your PHI in writing
to Mercy Hospital Cadillac's Health Information Services Department.
Mercy Hospital Cadillac will respond to your request within 30
days of its receipt. If Mercy Hospital Cadillac cannot, Mercy
Hospital Cadillac will notify you in writing to explain the delay
and the date by which we will act on your request. In any event,
Mercy Hospital Cadillac will act on your request within 60 days
of its receipt.
B. Right to Amend: You have the right
to amend your PHI for as long as Mercy Hospital Cadillac maintains
it. However, Mercy Hospital Cadillac will deny your request for
amendment if:
- Mercy Hospital Cadillac did not create
the information;
- The information is not part of the designated
record set;
- The information would not be available
for your inspection (due to its condition or nature); or
- The information is accurate and complete.
If Mercy Hospital Cadillac denies your request
for changes in your PHI, Mercy Hospital Cadillac will notify you
in writing with the reason for the denial. Mercy Hospital Cadillac
will also inform you of your right to submit a written statement
disagreeing with the denial. You may ask that Mercy Hospital Cadillac
include your request for amendment and the denial any time that
Mercy Hospital Cadillac discloses the information that you wanted
changed. Mercy Hospital Cadillac may prepare a rebuttal to your
statement of disagreement and will provide you with a copy of
that rebuttal.
You must make your request for amendment of
your PHI in writing to Mercy Hospital Cadillac's Health Information
Services Department, including your reason to support the requested
amendment. Mercy Hospital Cadillac will respond to your request
within 60 days of its receipt. If Mercy Hospital Cadillac cannot,
Mercy Hospital Cadillac will notify you in writing to explain
the delay and the date by which Mercy Hospital Cadillac will act
on your request. In any event, Mercy Hospital Cadillac will act
on your request within 90 days of its receipt.
C. Right to an Accounting: You have
a right to receive an accounting of the disclosures of your PHI
that Mercy Hospital Cadillac made, except for the following disclosures:
- To carry out treatment, payment or health
care operations;
- To you;
- To persons involved in your care;
- For national security or intelligence purposes;
- To correctional institutions or law enforcement
officials in custodial situations; or
- That occurred prior to April 14, 2003.
For each disclosure, you will receive: the
date of the disclosure, the name of the receiving organization
and address if known, a brief description of the PHI disclosed
and a brief statement of the purpose of the disclosure or a copy
of the written request for the information, if there was one.
You must make your request for an accounting
of disclosures of your PHI in writing to Mercy Hospital Cadillac's
Health Information Services Department. You must include the time
period of the accounting, which may not be longer than 6 years.
Mercy Hospital Cadillac will respond to your request within 60
days from its receipt. If Mercy Hospital Cadillac cannot, Mercy
Hospital Cadillac will notify you in writing to explain the delay
and the date by which Mercy Hospital Cadillac will act on your
request. In any event, Mercy Hospital Cadillac will act on your
request within 90 days of its receipt.
In any given 12-month period, Mercy Hospital Cadillac will provide
you with an accounting of the disclosures of your PHI at no charge.
Any additional requests for an accounting within that time period
will be subject to a reasonable fee for preparing the accounting.
D. Right to Request Restrictions: You
have the right to request restrictions on certain uses and disclosures
of your PHI:
- To carry out treatment, payment or health
care operations functions;
- Restricting specific information to only
specified family members, relatives, close personal friends
or other individuals involved in your care; or
- Limited information in the facility directory.
For example, you may ask that your name not
be used in the waiting room or that information about your expected
discharge date not be shared with your family. Mercy Hospital
Cadillac will consider your request but is not required to agree
to the requested restrictions.
E. Right to Confidential Communications:
You have the right to receive confidential communications of your
PHI by alternative means or at alternative locations. For example,
you may request that Mercy Hospital Cadillac only contact you
at work or by mail. We will make every attempt to honor your request,
but we reserve the right to deny unreasonable requests.
F. Right to Opt Out of the Facility Directory:
You have the right to ask that your name not be included in the
Facility Directory. If you request to opt out of the Directory,
Mercy Hospital Cadillac cannot inform visitors and callers of
your presence, location, or general condition.
G. Right to Receive a Copy of this Notice:
You have the right to receive a paper copy of this Notice of Privacy
Practices, upon request.
VI. Complaints
If you believe your privacy rights have been
violated, you may file a complaint with Mercy Hospital Cadillac
or with the Secretary of the Department of Health and Human Services.
To file a complaint with Mercy Hospital Cadillac, please contact
Mercy Hospital Cadillac's Customer Relations Manager at:
400 Hobart Street
Cadillac, MI 49601
(231) 876-7473
All complaints must be submitted in writing
directly to Mercy Hospital Cadillac's Customer Relations Manager.
Mercy Hospital Cadillac assures you that there will be no retaliation
for filing a complaint.
VII. Sharing and joint use of your Health
Information
In the course of providing care to you and
in furtherance of Mercy Hospital Cadillac's mission to improve
the health of the community, Mercy Hospital Cadillac will share
your PHI with other organizations as described below who have
agreed to abide by the terms described below:
A. Medical Staff: The medical staff
and Mercy Hospital Cadillac participate together in an organized
health care arrangement to deliver health care to you. Mercy Hospital
Cadillac and its medical staff have agreed to abide by the terms
of this Notice with respect to PHI created or received as part
of delivery of health care services to you in Mercy Hospital Cadillac.
Physicians and allied health care providers are members of Mercy
Hospital Cadillac's medical staff and will have access to and
use your PHI for treatment, payment and health care operations
purposes related to your care within Mercy Hospital Cadillac.
Mercy Hospital Cadillac will disclose your PHI to the medical
staff for payment, treatment and health care operations.
B. Business Associates: Mercy Hospital
Cadillac will use and disclose your PHI to business associates
contracted to perform business functions on its behalf including
Munson Healthcare, who performs certain business functions for
Mercy Hospital Cadillac.
Whenever an arrangement between Mercy Hospital Cadillac and another
company involves the use or disclosure of your PHI, that business
associate will be required to keep your information confidential.
C. Membership in Munson Healthcare:
Mercy Hospital Cadillac, members of Munson Healthcare and Munson
Healthcare participate together in an organized health care arrangement
for utilization review and quality assessment activities. We have
agreed to abide by the terms of this Notice with respect to PHI
created or received as part of utilization review and quality
assessment activities of Munson Healthcare and its members. Members
of Munson Healthcare will abide by the terms of their own Notice
of Privacy Practices in using your PHI for treatment, payment
or healthcare operations. As a strategic partner of Munson Healthcare,
Mercy Hospital Cadillac and other hospitals, nursing homes, and
health care providers in Munson Healthcare share your PHI for
utilization review and quality assessment activities of Munson
Healthcare and its members. Members of Munson Healthcare also
use your PHI for your treatment, payment to Mercy Hospital Cadillac
and/or for the health care operations permitted by HIPAA with
respect to our mutual patients.
VIII. Additional Information
For further information regarding the subjects
covered in this Notice of Privacy Practices, please contact Mercy
Hospital Cadillac's Privacy Official at (231) 876-7200.
IX. Changes to this Notice
Mercy Hospital Cadillac will abide by the terms
of the Notice currently in effect. Mercy Hospital Cadillac reserves
the right to change the terms of its Notice and to make the new
Notice provisions effective for all PHI that it maintains. Mercy
Hospital Cadillac will provide you with the revised Notice at
your first visit following the revision of the Notice.
If you have any unresolved concerns about patient care and safety at Mercy Hospital Cadillac, please contact our Patient
Relations Office at (231) 876-7473.
We welcome your comments and suggestions about this Web site.
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