This Notice describes the privacy practices of Altus Lumberton, LP, a hospital emergency room. We are obligated by law to maintain the privacy of your identifiable health information (known as Protected Health Information or “PHI”), whether in paper or electronic records, and to protect the integrity, confidentiality, and availability of your PHI. Altus Lumberton, LP may use and disclose your PHI to the extent necessary to provide you with quality health care, and for purposes of payment and health care operations. All members of our workforce including employees, independently contracted doctors and other persons who work with Altus Lumberton, LP are required to follow the privacy practices described in this Notice.
II. Uses and Disclosures Which Do Not Require Your Written Authorization
In certain situations, we must obtain your written authorization before we use or disclose your PHI. Listed below are a number of uses and disclosures for which we do not need your prior written authorization.
o Uses and Disclosures for Treatment. We may use and disclose your PHI to provide diagnosis and treatment of an injury or illness. In addition, we may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. We may also disclose PHI to other providers involved in your treatment.
o Payment. We may use and disclose your PHI to obtain payment for our services from your health insurer, HMO, or other company that arranges or pays the cost of some or all of your health care to verify that such company will pay for health care furnished to you by Altus Lumberton, LP Management. We also may disclose your PHI to other providers to help them receive payment for the services they furnished to you.
o Health Care Operations. We may use and disclose your PHI for our health care operations, which include internal administration and various activities that improve the quality and cost effectiveness of the care that we deliver to you. For example, we may use PHI to evaluate the quality and competence of our nurses and other health care workers. We may disclose PHI to our Patient Relations Manager in order to resolve any complaints you may have and ensure that you have a comfortable visit with us. We may also disclose your PHI to other providers who have treated you in order to assist them with quality assessment and improvement activities.
o Disclosure to Relatives, Close Friends and Other Caregivers. We may use or disclose your PHI to a family member, other relative, close personal friend or any other person identified by you when you, prior to the disclosure, are present or otherwise available, if we (1) obtain your agreement; (2) provide you with the opportunity to object to the disclosure and you do not object; or (3) reasonably infer that you do not object to the disclosure. If you are not present or are unable to agree or object due to an emergency situation or incapacity, we may exercise our professional judgment to determine whether a disclosure is in your best interests. If we disclose information to a family member, other relative or a close personal friend, we would disclose only the information that we believe is directly relevant to that person’s involvement with your health care or payment related to your health care. We may also disclose your PHI in order to notify (or assist in notifying) a relative, friend or caregiver of your location, general condition or death.
o Public Health Activities. We may disclose your PHI for certain public health purposes including, but not limited to disease prevention, injury or disability, reporting births and deaths, reporting reactions to medications or product problems, notification of recalls, infectious disease control, notifying government authorities of suspected abuse, neglect or domestic violence (if you agree or as required or authorized by law).
o Health Oversight Activities. We may disclose your PHI to a health oversight agency in connection with an audit, inspection, investigation or licensing.
o Judicial and Administrative Proceedings. We may disclose your PHI in the course of a judicial or administrative proceeding in response to a legal order or other lawful process.
o Law Enforcement Officials. We may disclose your PHI to the police or other law enforcement officials as required or permitted by law or in compliance with a court order or a grand jury or administrative subpoena.
o In the Event of Death. We may disclose your PHI to coroners, medical examiners and funeral directors.
o Organ, Eye and Tissue Donation. If you are a donor or a proposed organ, eye or tissue recipient, we may release information to organizations that handle organ, eye or tissue procurement, storage or transplants in order to facilitate donation, banking or transplants.
o Research. We may use or disclose your PHI without your authorization for the purpose of preparing a research project. In most cases, we must obtain your authorization to use or disclose your PHI to conduct a research project. In some cases, we may use or disclose your PHI to conduct a research project without your authorization, but only if an Institutional Review Board approves a waiver of authorization for disclosure or the use of a limited data set, which includes only a limited amount of identifying information.
o Health or Safety. We may use or disclose your PHI to prevent or lessen a serious and imminent threat to a person’s or the public’s health or safety.
o Specialized Government Functions. We may use and disclose your PHI to units of the government with special functions, such as the U.S. military, Secret Service, or the U.S. Department of State under certain circumstances.
o Workers’ Compensation. We may disclose your PHI as authorized by and to the extent necessary to comply with state law relating to workers’ compensation or other similar programs.
o Ordered Examinations. We may disclose your PHI when required to report findings from an examination ordered by a court or detention facility.
o Business Associates. We may use and disclose your PHI to carry out treatment, payment, and health care operations functions through our business associates, for example, to install a new computer system.
o Required By Law. We may use and disclose your PHI when required to do so by any other law not already referred to in the preceding categories.
IV. Uses and Disclosures Requiring Your Written Authorization
Except as described above, we will not use or disclose your medical information unless you authorize (permit) Altus Lumberton, LP, in writing to disclose your information. You may revoke your permission, which will be effective only after the date of your written revocation.
V. Your Rights Regarding Your Protected Health Information
You have the following rights regarding your medical information, provided that you make a written request to invoke the right on the form provided by Altus Lumberton, LP Management:
o Complaints. If you are concerned that we have violated your privacy rights or disagree with a decision that we made about access to your PHI, you may contact our Patient Relations Office at 409-755-2273. You may also file written complaints with the Director, Office for Civil Rights of the U.S. Department of Health and Human Services. Upon request, we will provide you with the correct address for the Director. We will not retaliate against you if you file a complaint with us or the Director.
o Right to Request Restrictions. You may request restrictions on our use and disclosure of your PHI (1) for treatment, payment and health care operations, (2) to individuals (such as a family member, other relative, close personal friend or any other person identified by you) involved with your care or with payment related to your care, or (3) to notify such individuals regarding your location and general condition. While we will consider all requests for additional restrictions carefully, we are not required to agree to a requested restriction except in certain limited circumstances. For instance, we are required to agree to your request to restrict our use and disclosure of your PHI to a health plan under certain circumstances. If you wish to request additional restrictions, please obtain a request form from our HIM/Medical Records Department and submit the completed form to the HIM/Medical Records Department. We will send you a written response. Except in certain limited circumstances, we may terminate our agreement to a restriction if we inform you that we are terminating the restriction and such termination is effective for PHI received or created after we have informed you.
o Right to Confidential Communications. You may request, and in certain situations we may be able to accommodate, any reasonable written request to contact you at a location other than the address we have on file or by alternative means of communication. Your request should be made in writing and must include exactly how we should contact you.
o Right to Revoke Your Authorization. You may revoke your Authorization, your Marketing Authorization or any other written authorization by you, except to the extent that we have taken action in reliance upon it, by delivering a written revocation statement to the Privacy Office identified below. A form of written revocation is available upon request from the HIM/Medical Records Department.
o Right to Inspect and Copy Your Health Information. You may request access to your PHI maintained by us in order to inspect and request copies of the records, and we are required to provide you with access in a timely manner to your PHI in the form and format requested. Under limited circumstances, we may deny you access to a portion of your records. If we deny you access to a portion of your records, we will tell you why and you will have an opportunity to have a third person review your request. If you would like access to your records, please obtain a record request form from the HIM/Medical Records Department and submit the completed form to the HIM/Medical Records Department. If you request copies, we will charge you a reasonable fee. We will also charge you for our postage costs, if you request that we mail the copies to you. If you are a parent or legal guardian of a minor, certain portions of the minor’s medical record may not be accessible to you, for example, records relating to abortion, contraception and/or family planning services, and other health care issues which are protected by law.
o Right to Request Amendments to Your Records. You have the right to request that we correct, change or delete certain PHI maintained in our records that may be used to make decisions about you and your health care, if you believe that the information is incorrect or incomplete. If you would like us to amend your records, please obtain an amendment request form from the HIM/Medical Records Department and submit the completed form to the HIM/Medical Records Department. If we cannot or do not believe it is appropriate to amend your PHI, we will notify you of this decision in writing. You will then have the option of asking us to make your request for a change/correction of your PHI a part of your record or ask to have a third party review our decision. We cannot amend information that we did not create without receiving information or instructions to do so from the creator of the records.
o Right to Receive an Accounting of Disclosures. You have the right to obtain a list of when and with whom we have shared your PHI. Our response will not include uses or disclosures related to treatment, payment or health care operations or uses or disclosures for which you signed a written authorization. You may obtain an accounting of the remaining disclosures made by us during any period of time prior to the date of your request provided such period does not exceed six years. If you request an accounting more than once during a twelve (12) month period, we will charge you a reasonable, fee for each additional statement.
o Right to Receive Paper Copy of this Notice. Upon request, you may obtain a paper copy of this Notice, even if you previously agreed to receive the notice electronically.
VI. Duration of This Notice
Right to Change Terms of this Notice. We may change the terms of this Notice at any time. If we change this Notice, we may make the new Notice terms effective for all Protected Health Information that we maintain, including any information created or received prior to issuing the new Notice. If we change this Notice, we will post the new Notice in designated areas at Altus Lumberton, LP and on our Internet site atwww.AltusHMS.com. You also may obtain any new Notice by contacting the Privacy Office.
VII. Privacy Office
You may contact our Privacy Officer by calling 409-755-2273 or writing to:
137 North LHS Drive Lumberton, TX 77567
To obtain copies of authorization, amendment or other forms, please contact the HIM/Medical Records Department where you received your care.