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Notice of Privacy Practices
Effective 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.
If you have any questions, please contact our Privacy Officer, whose name
and number is at the bottom of this notice.
Who will follow this notice?
The City of Hamilton Health Department (CHHD) provides health care to our
patients, residents, and clients in partnership with physicians and other
professionals and organizations. The information privacy practices in this
notice will be followed by:
Any health care professional who treats you at any of our locations.
All employed associates, staff or volunteers of our organization.
Any business associate or partner of CHHD with whom we share health
information.
Our pledge to you.
We understand that medical information about you is personal. We are
committed to protecting medical information about you. We create a record of
the care and services you receive to provide quality care and to comply with
legal requirements. This notice applies to all of the records of your care
that we maintain, whether created by facility staff or your personal doctor.
We are required by law to:
Keep medical information about you private.
Give you this notice of our legal duties and privacy practices with respect
to medical information about you.
Follow the terms of the notice that is currently in effect.
Changes to this Notice.
We may change our Privacy policies at any time. Changes will apply to
medical information we already hold, as well as new information after the
change occurs. Before we make a significant change in our Privacy policies,
we will change our notice and post the new notice in a prominent place in
each of our facilities. You can receive a copy of the current notice or
policy at any time. The effective date is listed just below the title. You
will be offered a copy of the current notice when you first register at our
facility for treatment. You will also be asked to acknowledge in writing
your receipt of this notice.
How we may use and disclose medical information about you.
We may use and disclose medical information about you for treatment (such as
sending medical information about you to a specialist as part of a
referral); to obtain payment for treatment (such as sending billing
information to your insurance company or Medicare); and to support our
health care operations (such as reviewing patient data to improve treatment
methods.) We may also contact you by phone to provide you with test results,
return your answer questions or obtain additional information.
We may use or disclose medical information about you without your prior
authorization for several other reasons. Subject to certain requirements, we
may give out medical information about you without prior authorization for
public health purposes, such as providing schools with immunization records.
We may also give out medical information for abuse or neglect reporting,
health oversight audits or inspections, research studies, funeral
arrangements and organ donation, workers’ compensation purposes, and
emergencies. We also disclose medical information when required by law, such
as in response to a request from law enforcement in specific circumstances,
or in response to valid judicial or administrative orders.
We also may contact you for appointment reminders, immunization reminders or
to tell you about or recommend possible treatment options, alternatives,
health-related benefits or services that may be of interest to you.
We may disclose medical information about you to a friend or family member
who is involved in your medical care, or to disaster relief authorities so
that your family can be notified of your location and condition.
Other uses of medical information.
In any other situation not covered by this notice, we will ask for your
written authorization before using or disclosing medical information about
you. If you chose to authorize use or disclosure, you can later revoke that
authorization by notifying us in writing of your decision.
Your rights regarding medical information about you.
In most cases, you have the right to look at or get a copy of medical
information that we use to make decisions about your care, when you submit a
written request. If you request copies, we may charge a fee for the cost of
copying, mailing or other related supplies. If we deny your request to
review or obtain a copy, you may submit a written request for a review of
that decision.
If you believe that information in your record is incorrect or if important
information is missing, you have the right to request that we correct the
records, by submitting a request in writing that provides your reason for
requesting the amendment. We could deny your request to amend a record if
the information was not created by us; if it is not part of the medical
information maintained by us; or if we determine that record is accurate.
You may appeal, in writing, a decision by us not to amend a record.
You have the right to a list of those instances where we have disclosed
medical information about you, other than for treatment, payment, health
care operations or where you specifically authorized a disclosure, when you
submit a written request. The request must state the time period desired for
the accounting, which must be less than a 6-year period and starting after
April 14, 2003. The first disclosure list request in a 12-month period is
free; other requests will be charged according to our cost of producing the
list. We will inform you of the cost before you incur any costs.
If this notice was sent to you electronically, you have the right to a paper
copy of this notice.
You have the right to request that medical information about you be
communicated to you in a confidential manner, such as sending mail to an
address other than your home, by notifying us in writing of the specific way
or location for us to use to communicate with you.
You may request, in writing, that we not use or disclose medical information
about you for treatment, payment or healthcare operations or to persons
involved in your care except when specifically authorized by you, when
required by law, or in an emergency. We will consider your request but we
are not legally required to accept it. We will inform you of our decision on
your request. All written requests or appeals should be submitted to our
Privacy contact listed at the bottom of this notice.
Complaints.
If you are concerned that your privacy rights may have been violated, or you
disagree with a decision we made about access to your records, you may
contact our Privacy Officer (listed below).
Finally, you may send a written complaint to the U.S. Department of Health
and Human Services Office of Civil Rights. You may call 1-(866)-627-7748 to
obtain their address.
Under no circumstance will you be penalized or retaliated against for filing
a complaint.
Privacy Officer:
Susan Irvine
City of Hamilton Health Department
345 High St., Hamilton, OH 45011
Telephone: (513) 785-7087
Fax: (513) 785-7065
Email: irvines@ci.hamilton.oh.us
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