Notice of Privacy Practices
THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Your Health Information Rights.
Although your health record is the physical property of ACH the health information contained in the record belongs to you. You have the following rights:
To Inspect and Copy. You have the right to inspect and obtain a copy of your health information. This right is not absolute and, by law, there are a few situations in which Ascension Crittenton Hospital (ACH) can refuse to permit access or copying. To inspect and copy your health information you must submit your request in writing to our Health Information Management Department (HIM). The mailing address is:
Ascension Crittenton Hospital
Health Information Management Department
1101 W. University Drive
Rochester, MI 48307- 1863
ACH will charge a fee for the costs of copying, mailing or other services associated with your request. You may contact our HIM Department by phone at (248)-652-5221.
To Amend. To request an amendment to your health information, your request must be made in writing and submitted to our Health Information Management Department.
ACH will act upon your request for amendment no later than 60 days after receipt of your written request but may extend this time frame an additional 30 days under certain circumstances. If your request is denied you will be given a written denial and be provided the opportunity to submit a written statement disagreeing with the denial.
To an Accounting of Disclosures. You have the right to request an accounting of uses and disclosures of your health information. An accounting does not include disclosures associated with treatment, payment, and healthcare operations, disclosures made pursuant to an authorization, disclosures required by law, incidental disclosures, or some other disclosures. This request must be in writing to our Health Information Management Department and pertain to a specific time frame of less than six (6) months. ACH will act upon your request for an accounting no later than 60 days after receipt of your written request but may extend this time frame an additional 30 days under certain circumstances. You may have one accounting per year free of charge but will be charged a reasonable fee for any additional accountings.
To Request Restrictions on Uses and Disclosures. You have the right to request a restriction on the health information ACH uses or discloses about you for treatment, payment, and health care operations. You also have the right to request a limit on the medical information ACH discloses about you to someone who is involved in your care or the payment for such care. ACH is not required to agree to your request. If ACH does agree with your request, ACH will comply with the request unless the information is needed to provide you emergency treatment. Such requests must be made in writing to our Health Information Management Department.
To Request Confidential Communications. You have the right to request communications of your health information by alternative means or at alternative locations. For example, you can ask that ACH contact you only at work or by mail. ACH will accommodate reasonable requests that are submitted in written form and specify how and where ACH should communicate with you.
To Revoke Your Authorization. You have the right to revoke your authorization to ACH to use or disclose health information about you. Your revocation will be honored to the extent that action has not already been taken and as otherwise provided by law. Revocations must be submitted in writing to the Health Information Management Department.
To a Paper Copy of This Notice. The most current Notice of Privacy Practices will be posted in visible areas of ACH. ACH will provide you with our Notice of Privacy Practices upon request.
To File a Complaint. If you believe that your privacy rights have been violated, you can file a complaint, in writing, with our Privacy Officer in the Department of Legal Affairs at the following address:
Ascension Crittenton Hospital
Department of Legal Affairs
1101 W. University
Rochester, MI 48307
Attn: Privacy Officer
Questions or comments regarding our Privacy Practices may be communicated using our Privacy hotline (248)-652-5854. You may also file a complaint with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.
How ACH May Use and Disclose Medical Information About You.
The following categories describe different ways that we use and disclose medical information about you. For each category of uses or disclosures we will explain what we mean and try to give examples. Not every use or disclosure in a category will be listed.
(i) Treatment, Payment and Health care Operations (these do not require your authorization).
Treatment: ACH may use health information about you to provide you with medical treatment or services. ACH may disclose health information about you to hospital personnel who will care for you, your personal physician, or any physician or other health care provider rendering health care services to you.
For example: Information obtained by an emergency room physician, an anesthesiologist, a nurse, your personal physician or any other member of your health care team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your healthcare team. Members of your healthcare team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment. ACH will also provide your physician or a subsequent healthcare provider with copies of various reports that should assist him or her in treating you once you are discharged from this hospital.
Payment: ACH may use and disclose health information about you so that the medical care and services you receive may be billed to and payment may be collected from you, an insurance company or a third party. For example: A bill may be sent to your third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used. In the event that payment is not made, ACH may also provide limited information to collection agencies, attorneys, credit reporting agencies and other organizations as is necessary to collect for services rendered.
ACH may also use and disclose medical information to assist you in obtaining certain medical benefits to which you may be entitled.
Health care operations: ACH may use and disclose medical information about you for purposes of health care operations. These uses and disclosures are necessary to run the hospital and help make sure that all of our patients receive quality care. For example: Members of the medical staff, the risk or quality improvement departments, or members of the quality improvement team may use health information to assess the care and outcomes in your case and others like it.
Unless you notify us that you object, ACH will use your name, location in the facility, general condition, and religious affiliation for the Hospital directory. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name. This is so your friends and clergy can visit you in the hospital and generally know how you are doing.
Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care.
ACH may use and disclose medical information to contact you at your home, office or other location that you have designated to provide a reminder that you have an appointment for treatment or medical care at the hospital.
ACH may use and disclose medical information to tell you about or recommend possible treatment alternatives or other health-related benefits and services that may be of interest to you.
ACH may use, or disclose to a business associate or to an institutionally related foundation, protected health information for the purpose of raising funds for its own benefit. The information disclosed will be limited to name and address. Any fundraising material that you receive will include a description of how you may opt out of receiving any further fundraising communications. Should you decide to opt out of receiving future fundraising communications, ACH will take reasonable efforts to ensure that you do not receive such communications.
(ii) Other uses and disclosures without permission.
As required by Law: ACH will disclose health information about you when required by federal, state or local law. This includes disclosures required to the Department of Public Health which is charged with preventing or controlling disease, injury or disability. It also includes disclosure for law enforcement purposes as required by law or in response to a valid subpoena.
Worker’s Compensation: ACH may release health information about you to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation.
Organ and tissue donation: If you are a possible organ donor, ACH may release medical information about you to organizations that handle organ procurement or organ, eye or tissue transplantations for the organ donation bank.
Health oversight activities: ACH may disclose health information to a health oversight agency for activities authorized by law. These oversight activities include audits, investigations, inspections, and licensure. These activities are necessary for the government and licensing bodies to monitor the health care system.
To avert a serious threat to health or safety: ACH may use and disclose health information about patients when necessary to prevent a serious threat to a patient’s 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.
Military and Veterans: If patients are a member of the armed forces, ACH may release health information about patients as required by military command authorities. ACH may also release health information about foreign military personnel to the appropriate foreign military authority.
Lawsuits and disputes: If patients are involved in a lawsuit or a dispute, ACH may disclose medical information about patients in response to a court or administrative order. ACH may also disclose health information about patients 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 patients about the request or to obtain an order protecting the information requested.
Law Enforcement: ACH may release health 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 ACH believes may be the result of criminal conduct;
- About criminal conduct at the hospital; 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.
National security and intelligence activities: ACH may release health information about patients to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Protective services for the President and others: ACH may disclose health information about patients to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
Inmates: If patients are an inmate of a correctional institution or under the custody of a law enforcement official, ACH may release health information about patients to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide patients with health care; (2) to protect a patient’s health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
Public Health risks: ACH may disclose health information about patients 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 only make this disclosure if patients agree or when required or authorized by law.
Research: ACH may use or disclose protected health information for research, regardless of the source of funding of the research, provided that ACH has documentation that an appropriate Institutional Review Board or privacy board has approved the research and established that the individual authorization required for use or disclosure has been approved. Use or disclosure of protected health information is limited to that information necessary to prepare a research protocol or for similar purposes of the research project. No protected health information will be removed from ACH by the researcher in the course of the review.
Uses and disclosures about decedents:
Coroners and medical examiners: ACH may disclose protected health information to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death, or other duties as authorized by law.
Funeral directors: ACH may disclose protected health information to funeral directors, consistent with applicable law, as necessary to carry out their duties with respect to the decedent. If necessary for funeral directors to carry out their duties, ACH may disclose the protected health information prior to, and in reasonable anticipation of, the individual’s death.
Organ, eye or tissue donation procurement organizations: ACH may use or disclose protected health information to organ procurements or other entities engaged in the procurement, banking or transplantation of cadaveric organs, eyes, or tissue for the purpose of facilitating organ, eye or tissue donation and transplantation.
(iii) Other Uses and Disclosures requiring authorization:
ACH will not make any other uses or disclosures of your health information unless you sign a written authorization form. You do not have to sign an authorization form. If you do sign the authorization, you may revoke it at any time unless ACH have already acted in reliance upon it. Revocation must be in writing and sent to the Health Information Management Department.
The effective date of the Notice of Privacy Practices is April 14, 2003. ACH reserves the right to change our privacy practices and to make new provisions for all health information ACH maintains in accordance with applicable law. At any time revisions are made in the ACH’s Notice of Privacy, the revised Notice will be posted within ACH, on the ACH website and will be available to anyone who requests a copy.
Revised and Effective June 1, 2012