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Notice of Privacy Practices
Effective April 2003
This Joint Notice of Privacy Practices describes how
medical information about you may be used and disclosed, and how you can
get access to this information. Please review it carefully.
At Saint John’s, patient privacy is a priority. We are happy to
comply with the government’s requirement 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 and to abide by its terms currently in
effect. We are required to post this Notice in a prominent place within
our facility. We will use or disclose your PHI only as permitted or
required by applicable state law. This Notice applies to your PHI in our
possession, including the medical records generated by us.
Saint John’s 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 Saint John’s and its medical staff in the main hospital,
outpatient departments and clinics, and to utilization review and
quality assessment activities.
We are Permitted to Use or Disclosure PHI for:
Treatment: Saint John’s will use and disclose your PHI in the
provision and coordination of heath care to carry out treatment
functions.
• Saint John’s will disclose all or any portion of your PHI to your
attending physician, consulting physician(s), nurses, technicians,
medical students and other health care providers who have a legitimate
need for such information in your care and continued treatment.
• Saint John’s is a Catholic sponsored health care provider. Spiritual
care providers are members of our care staff and will be a part of Saint
John’s team of care providers who use your medical information to
provide health care services to you when you are in our facilities.
• Saint John’s also will disclose your medical information to people or
entities outside our organization who will be involved in your medical
care after you leave our facilities, such as family members, clergy and
others who will provide services that are part of your care. We might
disclose your PHI to other providers for your treatment, regardless of
whether it pertains to the treatment you received at Saint John’s.
• We will use and disclose your PHI to inform you of, or recommend,
possible treatment options or alternatives that will be of interest to
you.
• Saint John’s will use and disclose PHI to contact you as a reminder
that you have an appointment for treatment or medical care at our
facilities.
For example, we might use your medical information to make a physician
treating you for a leg fracture aware that you have diabetes.
Payment: Saint John’s 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.
• We will disclose PHI to collection agencies and other subcontractors
engaged in obtaining payment for care.
• We may also disclose your PHI to other providers or entities covered
by privacy laws for the billing and payment purposes of those entities.
For example, we might disclose your PHI to a physician group involved
with your treatment at Saint John’s in order to carry out their billing
and payment activities.
Health Care Operations: Saint John’s will use and disclose
your PHI during routine health care operations, including quality
assurance, utilization review, medical review, internal auditing,
accreditation, certification, licensing or credentialing activities of
our organization, and for educational purposes.
For instance, Saint John’s 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. We might also disclose your PHI to
other entities covered by privacy laws for some of their health care
operations, but only if they also have a relationship with you.
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: Saint John’s may use and may also
disclose some of your PHI to a related foundation for certain fund
raising activities. For example, we may use your demographic information
(e.g., name, address and other contact information, age, gender, and
insurance status) and the dates we 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. We may disclose limited
PHI to a company contracted to conduct fundraising for us. This company
will use your PHI only for the purposes of fundraising for Saint John’s.
If you wish to opt-out, you may do so by contacting the Privacy Official
at (765) 646-8303.
Medical Research: Saint John’s may disclose your PHI without
your Authorization to medical researchers who request it for approved
medical research projects; however, 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. If you are receiving treatment from us and we are conducting a
research study that is involved with your treatment, we may ask you to
sign an authorization that permits us to use or disclose your PHI as
part of the research. In this case, we can require you to sign the
authorization in order to continue receiving treatment.
Information and Health Promotion Activities: Saint John’s 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 will also send you information
based on your own health concerns. Saint John’s 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.
Permitted Use or Disclosure with Opportunity to Agree or Object:
Family/Friends: Saint John’s will disclose PHI about you to a friend or
family member who is involved in your medical care. We will also give
information to someone who is involved with or who helps you pay for
your care. In addition, we 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.
Saint John’s Directory: We will include certain limited
information about you in our hospital Directory while you are a patient.
This information will include your name, location in Saint John’s (e.g.,
inpatient, ER, surgery, etc.), your general condition (e.g., fair,
stable, critical, etc.) and your religious affiliation. This is so your
family and friends can visit you and know how you are doing. The
directory information, except for your religious affiliation, will also
be disclosed to people who ask for you by name. This disclosure would
include disclosures to members of the media if they ask about your
location or condition by name. You have the right to request that your
name not be included in the Saint John’s Directory. If you request to
opt out of the Directory, we cannot inform visitors of your presence,
location, or general condition. Also, patients not listed in the
directory cannot receive mail or flowers.
Spiritual Care: Directory information including your name,
your general condition, your room number and your religious preference
is provided to Saint John’s Center for Spiritual Care. As members of
Saint John’s care team; chaplains / spiritual care ministers visit each
patient within 24 hours of admission. It is the policy of the Center for
Spiritual Care to notify your church / faith group of your admission,
unless you state otherwise.
It is the policy of Saint John’s to provide census information (your
name, room number, general condition and religious preference) to
churches that call the hospital requesting a list of patients from their
church hospitalized at Saint John’s, unless you have declared yourself
to be a Not For Publication patient.
Promotional Communications: Saint John’s does not share or
sell your PHI to companies that market health care products or services
to consumers for use by those companies to contact you, such as drug
companies. We maintain a database of individuals for promotional
communications, disease management, health promotion, and fundraising
purposes. This database includes individuals to whom we may have sent
health improvement materials and news about Saint John’s previously and
also individuals who have donated to Saint John’s or who have expressed
an interest in donating to our organization or other health-related
activities. You may be included in this database. Saint John’s sends
information to the individuals in this database about our programs and
services. If you wish to be deleted from this database, you may notify
Saint John’s Privacy Official at (765)646-8303.
Use or Disclosure Permitted by Public Policy or Law without your
Authorization:
Law Enforcement Purposes: Saint John’s 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 criminal
conduct. Except for disclosures under court order or subpoena, the
information disclosed to law enforcement officials will be limited to
your contact information or physical characteristics.
Required by Law: Saint John’s will disclose PHI about you when
required by federal, state or local law to make reports or other
disclosures. We also will make disclosures for judicial and
administrative proceedings such as lawsuits or other disputes in
response to a court order or subpoena. Saint John’s will disclose your
medical information to government agencies concerning victims of abuse,
neglect or domestic violence. We will report drug diversion and
information related to fraudulent prescription activity to 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. We will make certain
disclosures that are required in order to comply with workers’
compensation or similar programs.
Coroners, Medical Examiners, Funeral Directors: Saint John’s
may 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. Saint John’s will also disclose your medical information
to funeral directors as necessary to carry out their duties.
Organ Procurement: Saint John’s may disclose PHI to an organ
procurement organization or entity for organ, eye or tissue donation
purposes.
Health or Safety: Saint John’s may use and disclose PHI to
avert a serious threat to health and safety of a person or the public.
We may use and disclose PHI to Public Health Agencies for immunizations,
communicable diseases, preventing or controlling disease, injury or
disability; reporting births and deaths; and notifying a person who may
have been exposed to a disease or may be at risk for contracting or
spreading a disease or condition. If we believe that a person is a
victim of child or adult abuse or neglect, we are required by law to
report certain information to public authorities. Saint John’s 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.
Health Oversight Activities: We may disclose your PHI to a
health oversight agency for activities authorized by law. These
oversight activities might include audits, investigations, inspections,
and licensure. These activities are necessary for the government to
monitor the health care system, government benefit programs, and
compliance with civil rights laws.
Inmates: If you are an inmate of a correctional institution or
under the custody of a law enforcement officer, Saint John’s will
disclose your PHI to the correctional institution or law enforcement
official. Except for disclosures to another provider for your treatment,
the information disclosed will be limited to your contact information or
physical characteristics.
Disclosures of Records Containing Drug or Alcohol Abuse
Information: Because of federal law, we will not release your
medical information if it contains information about drug or alcohol
abuse without your written permission, except in very limited
situations.
Disclosures of Medical Information of Minors: Under Indiana
law, we cannot disclose the medical information of minors to
non-custodial parents if a court order or decree is in place that
prohibits the non-custodial parent from receiving such information.
However, we must have documentation of the court order prior to denying
the non-custodial parent such access.
Disclosures of Mental Health Records: If your records contain
information regarding your mental health, we are restricted in the ways
that we can use and disclose them. We can disclose such records without
written permission only in the following situations:
• If the disclosure is made to you (unless it is determined by a
physician that the release would be detrimental to your health);
• Disclosures to our employees in certain circumstances;
• For payment purposes;
• For data collection, research, and monitoring managed care providers
if the disclosure is made to the division of mental health;
• For law enforcement purposes or to avert a serious threat to the
health and safety of you or others;
• To a coroner or medical examiner;
• To satisfy reporting requirements;
• To satisfy release of information requirements that are required by
law;
• To another provider in an emergency;
• For legitimate business purposes;
• Under a court order;
• To the Secret Service if necessary to protect a person under Secret
Service protection; and
• To the Statewide waiver ombudsman.
Incidental Uses and Disclosures: We may occasionally
inadvertently use or disclose your medical information when such use or
disclosure is incident to another use or disclosure that is permitted or
required by law. For example, while we have safeguards in place to
protect against others overhearing our conversations that take place
between doctors, nurses or other Saint John’s personnel, there may be
times that such conversations are in fact overheard. Please be assured,
however, that we have appropriate safeguards in place to avoid such
situations, and others, as much as possible.
Disclosures to You: Upon a request by you, we may use or
disclose your medical information in accordance with your request.
Limited Data Sets: We may use or disclose certain parts of
your medical information, called a “limited data set,” for purposes of
research, public health reasons or for our health care operations. We
would disclose a limited data set only to third parties who have
provided us with satisfactory assurances that they will use or disclose
your medical information only for limited purposes.
Disclosures to the Secretary of Health and Human Services: We
might be required by law to disclose your medical information to the
Secretary of the Department of Health and Human Services, or his/her
designee, in the case of a compliance review to determine whether we are
complying with privacy laws.
De-Identified Information: We may use your medical
information, or disclose it to a third party whom we have hired, to
create information that does not identify you in any way. Once we have
de-identified your information, it can be used or disclosed in any way
according to law.
Disclosures by Members of Our Workforce: Members of our
workforce, including employees, volunteers, trainees or independent
contractors, may disclose your medical information to a health oversight
agency, public health authority, health care accreditation organization
or attorney hired by the workforce member, to report the workforce
member’s belief that we have engaged in unlawful conduct or that our
care or services could endanger a patient, workers or the public. In
addition, if a workforce member is a crime victim, the member may
disclose your medical information to a law enforcement official.
Other Uses and Disclosures of PHI: Other uses and disclosures
of PHI not covered by this Notice or the laws that apply to us will be
made only with your written authorization. If you provide us
authorization to use or disclose your health information, you may revoke
that authorization, in writing, at any time. If you revoke your
authorization, we will no longer use or disclose health information
about you for the reasons covered by your written authorization. You
understand that we are unable to take back any disclosures we have
already made under the authorization, and that we are required to retain
our records of the care that we provided to you.
Your Health Information Rights:
Although we at Saint John’s must maintain all records concerning your
hospitalization and treatment, you have the following rights concerning
your PHI:
Right to Inspect and Copy: You have the right to access your
PHI and to inspect and copy your PHI as long as we maintain it except
for: psychotherapy notes, information that will be used in a civil,
criminal or administrative action or proceeding, and where prohibited or
protected by law.
You agree to pay a reasonable copying charge in accordance with state
law. You must make your requests to access and copy your PHI in writing
to Saint John’s. We will respond to your request within 30 days of its
receipt. If we cannot, we will notify you in writing to explain the
delay and the date by which we will act on your request. In any event,
Saint John’s will act on your request within 60 days of its receipt.
Right to Amend: You have the right to amend your PHI for as
long as Saint John’s maintains it. However, we will deny your request
for amendment if:
• Saint John’s 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
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;
• Limited information in the facility directory.
Saint John’s will consider your request, but is not required to agree to
the requested restrictions.
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 Saint John’s
only contact you at work or by mail.
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.
Complaints:
If you believe your privacy rights have been violated, you may file a
complaint with Saint John’s or with the Secretary of the Department of
Health and Human Services. To file a complaint with Saint John’s, please
contact our Privacy Officer, at (765) 646-8303. All complaints
must be submitted in writing directly to Saint John’s Privacy Official.
Saint John’s assures you that there will be no retaliation for filing a
complaint.
Sharing and Joint Use of Your Health Information:
In the course of providing care to you and in furtherance of Saint
John’s mission to improve the health of the community, we will share
your PHI with other organizations as described below who have agreed to
abide by the terms described below:
Medical Staff: The medical staff and Saint John’s participate
together in an organized health care arrangement to deliver health care
to you. Both Saint John’s 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 Saint John’s. Physicians
and allied health care providers are members of Saint John’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 our
organization. We will disclose your PHI to the medical staff for
payment, treatment and health care operations.
Business Associates: Saint John’s will use and disclose your
PHI to business associates contracted to perform business functions on
its behalf. Whenever an arrangement between Saint John’s and another
company involves the use or disclosure of your PHI, that business
associate will be required to keep your information confidential.
Affiliations: Saint John’s is affiliated with the other
entities that provide care or treatment. Examples include mobile
lithotripsy service providers and mobile PET scan service providers.
We will share your PHI with these organizations for purposes of your
treatment, payment and health care operations by these organizations.
This Notice applies to the above individuals and entities, as well as to
any Saint John’s health care professional authorized to enter
information into or consult your medical record; all departments and
units of Saint John’s; any member of a volunteer group we allow to help
you; all employees, staff and other Saint John’s personnel, and any
resident, student or trainee that we have allowed to train at the
hospital.
Additional Information:
For further information regarding the issues covered by this Notice of
Privacy Practice, please contact our Privacy Officer at (765)
646-8303.
Changes to this Notice:
Saint John’s will abide by the terms of the Notice currently in effect.
We reserve the right to change the terms of our Notice and to make the
new Notice provisions effective for all PHI that we maintain. We will
provide you with the revised Notice at your first visit following the
revision of the Notice.
RLT 4/10/2003 |
