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 about this Notice, please contact the Health Information Management Department at:

Helen Newberry Joy Hospital & Healthcare Center
Attention: Privacy Officer
502 W. Harrie Street
Newberry, MI 49868
906-293-9211

WHO WILL FOLLOW THIS NOTICE

Helen Newberry Joy Hospital & Healthcare Center is part of an organized health care arrangement with other Upper Peninsula hospitals and their medical staffs. The current participating hospitals and each hospital's current medical staff are listed in the UPHCN Physician Directory. The policy will be followed by employees, staff and other personnel of hospitals participating in the organized health care arrangement with our hospital. All of these hospitals and their entities, sites and locations they operate, follow the terms of this notice. This notice applies to all of the records of your care generated by the hospital and other hospitals whether made by hospital personnel 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 or clinic.

OUR PLEDGE REGARDING MEDICAL INFORMATION

We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at HNJH. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by HNJH.

This notice will tell you about the ways in which we may use and disclose medical information about you. It describes your rights and certain obligations we have regarding the use and disclosure of medical information.

We are required by law to:

• make sure that medical information that identifies you is kept private;
• make available to you this Notice of our legal duties and privacy practices with respect to medical information about you; and
• follow the terms of this Notice that is currently in effect. This Notice may change, in the manner described below under "CHANGES TO THIS NOTICE"

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU

The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures, we provide examples, but not every use or disclosure in a category is listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.

• FOR TREATMENT. We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you at the hospital. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments of the hospital also may share medical information about you among themselves, in order to coordinate the different things you need, such as prescriptions, lab work and x-rays. We also may disclose medical information about you to people outside the medical group who may be involved in your medical care, such as family members, clergy or others we use to provide services that are part of your care.
• FOR PAYMENT. We may use and disclose medical information about you so that the treatment and services you receive at the hospital may be billed to and payment may be collected from you, an insurance company or health plan or other third party. For example, we may need to give your health plan information about surgery you received at the hospital so your health plan will pay us or reimburse you for the surgery. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. We may have our bills and payment arrangements outsourced to one or more third party service providers who issue, process, and collect bills on our behalf.
• FOR HEALTH CARE OPERATIONS. We may use and disclose medical information about you for HNJH operations. These uses and disclosures are necessary to run HNJH and make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical information about many HNJH patients to decide what additional services HNJH should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, medical students, and other HNJH personnel for review and learning purposes. We may also combine the medical information from other health care providers to compare how we are doing and see where we can make improvements in the care and service we offer. We may remove information that identifies you from this set of medical information, so others may use it to study health care and health care delivery without learning who the specific patients are.
• APPOINTMENT REMINDERS. We may use and disclose medical information to contact you as a reminder the you have an appointment for treatment of medical care at HNJH.
• TREATMENT ALTERNATIVES. We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
• HEALTH-RELATED BENEFITS AND SERVICES. We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
• INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE. Your medical records are protected - they may only be released under your written authorization, or that of your Durable Power of Attorney or Legal Guardian. Information may also be released to your insurance companies for the purpose of payment. In addition, we may disclose pertinent medical information about you to an entity assisting in a disaster relief effort.
• RESEARCH. Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with patients' need for privacy of their medical information. Before we use or disclose medical information for research being conducted, the project will have been approved through this research approval process. However, we may disclose medical information about you to people preparing to conduct a research project, for example, to help them look for patients with specific medical needs, so long as the medical information they review does not leave HNJH. We will almost always ask for your specific permission (on an authorization form) if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at HNJH.
• AS REQUIRED BY LAW. We will disclose medical information about you when required to do so by federal, state or local law.
• TO AVERT A SERIOUS THREAT TO HEALTH OR SAFETY. We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
• SPECIAL SITUATIONS. We may also use and disclose medical information about you in the situations described under "SPECIAL SITUATIONS" below.

OTHER USES OF MEDICAL INFORMATION

Other uses and disclosures of medical information not covered by this Notice or the laws that apply to us will be made only with your written authorization. A form for those authorizations, both those that you request and those that we request, is available from the Health Information Management Department at the location noted on the first page of this Notice. If you give us an authorization, you may later revoke that permission in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. In that case, however, we will still be required to retain our records of the care that we provided to you.

SPECIAL SITUATIONS

ORGAN AND TISSUE DONATION. If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

MILITARY AND VETERANS. If you are a member of the armed forces, we may release medical information about you as required by military command authorities or, some cases if needed to determine benefits, to the Department of Veterans Affairs. We may also release medical information about foreign military personnel to the appropriate foreign military authority.

WORKERS' COMPENSATION. We may release medical information about you for workers' compensation, short or long term disability, life insurance or similar programs. These programs provide benefits for work-related injuries or illness.

PUBLIC HEALTH RISKS. We may disclose medical information about you for public health activities. These activities generally include the following:

• To prevent or control disease, injury or disability;
• To report births and deaths;
• To report child abuse or neglect;
• To report reactions to medications or problems with products;
• To notify people of recalls of products they may be using;
• 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;
• To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will make this disclosure if you agree or when required or authorized by law.

HEALTH OVERSIGHT ACTIVITIES.  We may disclose medical information to a 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 health care system, government programs, and compliance with civil rights laws.

LAWSUITS AND DISPUTES.  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 efforts have been made to tell you about the request or to obtain an order protecting the information requested.

LAW ENFORCEMENT.  We may release medical information, if asked to do so by a law enforcement official:

• In response to a court order, subpoena, warrant, summons or similar process;
• To identify or locate a suspect, fugitive, material witness, or missing person;
• About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement;
• About a death we believe may be the result of criminal conduct;
• About criminal conduct at HNJH; and
• 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.

CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS. 
We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients of the hospital to funeral directors as necessary to carry out their duties.

NATIONAL SECURITY, INTELLIGENCE AND FEDERAL PROTECTIVE SERVICE ACTIVITIES.  We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law, and to authorized federal officials when required to provide protection to the President of the United States, other authorized persons or foreign heads of state or conduct special investigations.

INMATES.  If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official when necessary for the institution to provide you with health care; to protect your health and safety or the health and safety of others; or for the safety and security of the correctional institution.

FUND RAISING.  It is the policy of Helen Newberry Joy Hospital & Healthcare Center to not generally use or disclose information about you for any fundraising purposes. Exceptions to this rule must be approved, in writing, by both the Director of Community Relations and the Privacy Officer and be consistent with the special fundraising provisions of 45 C.F.R. Section 164.514(f); 65 Fed Reg. 82546.

The hospital may use or disclose information about you without authorization for fund raising on its own behalf, provided that it is limited to a) demographic information about you; b) and dates service was provided to you. You may opt out of any further fundraising communications. Fundraising that is not on behalf of HNJH would require your written authorization.

HNJH may also disclose information about you (as stated above) to other business associates or foundations. For example: HNJH may disclose, for fundraising on its own behalf, limited information about you to a nonprofit foundation established for the specific purpose of raising funds for the hospital or to a foundation that has as its mission, the support of the members of a particular hospital chain that includes HNJH.

MARKETING. The Hospital is generally required to obtain authorization for uses and disclosures of information about you for marketing purposes.

"Marketing" means:

a. To make a communication about a product or service that encourages you to purchase or use the product or service, unless the communication is made:

• To describe a health-related product or service if HNJH is participating in a health care provider network or health plan network;
• For treatment of the individual; or
• For case management or care coordination for the individual, or to direct or recommend alternative treatments, therapies, health care providers, or settings of care to the individual.

b. An arrangement between HNJH and any other entity whereby HNJH discloses information about you in exchange for direct or indirect remuneration. The other entity (or its affiliate) may contact you regarding their service that encourages you to purchase or use that product or service.

HNJH does not need your authorization for marketing under the following conditions:

a. The Hospital may use or disclose information about you in a marketing communication with you in a face-to-face encounter.
b. The Hospital may provide promotional gifts or nominal value (e.g., distributing sample products or pens/calendars with its own or another company's name or product name on them).

This approach accommodates the needs of the hospital to be able to discuss their own health-related products and services, or those of third parties, as part of their everyday business and as part of promoting the health of their patients and enrollees.

An authorization is required if remuneration is involved if, for example, HNJH sells its patient list or receives payment from a third party for your information which the third party will use in promoting its own products or services.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU

You have the following rights regarding medical information we maintain about you:

• RIGHT TO INSPECT AND COPY. You have the right to inspect and obtain a copy of medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes.

  You must submit any request to inspect or obtain a copy of your medical information to the Health Information Management Department at the location noted on the first page of this Notice, in writing. If you request a copy of your information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.

  We may deny requests in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by HNJH will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of that review.

• RIGHT TO AMEND. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for HNJH. If you wish to request an amendment, your request must be made in writing. In addition, you must provide a reason that supports your request.

  We may deny your request if you ask us to amend information that
  - Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
  -Is not part of the medical information kept by or for HNJH;
  -Is not part of the information which you would be permitted to inspect and copy; or
  -Is accurate and complete

• RIGHT TO AN ACCOUNTING OF DISCLOSURES. You have the right to request an "accounting of disclosures." This is a list of the disclosures we have made of medical information about you, with some exceptions. The exceptions are governed by federal health privacy law, and may include (1) many routine disclosures for treatment, payment and operations, and (2) disclosures to you.

  You must submit any request for an accounting of disclosures to the Health Information Management Department at the location noted on the first page of this notice, in writing. Your written request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003, when current federal health privacy laws become effective for HNJH. The first report you request within a 12-month period will be free. For additional reports, we may charge you for the costs of providing the list. We will notify you of the cost involved, and you may choose to withdraw or modify your request at that time before any costs are incurred.

• RIGHT TO REQUEST RESTRICTIONS. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations, you also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had. Please note that we are not required to agree to your request. However, if we do agree, we will comply with your request unless that information is needed to provide you emergency treatment.

  You must submit a written request for restrictions to the Health Information Management Departments at the location noted on the first page of this Notice. Your written request must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.

• RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail. To request confidential communications, you must make your request in writing. You will not be asked the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

• RIGHT TO A PAPER COPY OF THIS NOTICE. You have the right to a paper copy of this notice. You may ask us to give you a paper copy of this notice at any time.

  To obtain a copy of this notice, please ask at the Admitting Office or call 906-293-9200.

CHANGES TO THIS NOTICE

We reserve the right to change this Notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the hospital. The notice will contain on the first page, in the top right-hand corner, the effective date. Upon initial receipt of this notice, each time you register at or are admitted to the hospital for treatment or health care services as an inpatient or outpatient, a copy of the current notice in effect, is available to you.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with HNJH. To file a complaint with the hospital, contact the Director of Quality & Risk Management at (906) 293-9254 and/or the Patient Advocate at (906) 293-9223. All complaints must be submitted in writing. YOU WILL NOT BE PENALIZED FOR FILING A COMPLAINT.  You may also file a complaint with the Secretary of the Department of Health and Human Services.

Printable Version

HIPAA Incident Form

Privacy Practice Acknowledgment