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.
This Notice of Privacy Practices (“Notice”) for Brattleboro Memorial Hospital, its physician prac-tices and its Community Health Team (collectively referred to as “BMH”) describes how your protected health information (“PHI)” may be used and disclosed to provide treatment to you; to seek payment for the medical services you receive; and to support the legitimate health care operations of our facility.
PHI includes your demographic information such as name, address, telephone number, and family; past, present, or future information about your physical or mental health or condition; and information about the medical services provided to you, including payment information, if any of that information may be used to identify you.
2. Organized Health Care Arrangement (OHCA) of BMH
BMH and its medical staff members present this document to you as a joint notice.
Included in the OHCA along with BMH are:
- Any health care professional providing services to you in BMH’s clinically integrated care setting, regardless of whether specific services are provided by BMH employees or by independent members of the BMH Medical Staff.
- All departments of BMH.
- Any member of the volunteer group we allow to help you while you are being cared for at any BMH location.
- All employees, staff, and other BMH personnel
The entities and individuals participating in the OHCA will share PHI with each other, as nec-essary to carry out treatment, payment, or health care operations within BMH.
3. Safeguarding PHI Within our Facility
We are required by law to maintain the privacy of your PHI, to provide you with notice of our legal duties and privacy practices and to notify you following a breach of unsecured PHI. We are required to abide by the terms of this Notice currently in effect.
A. Electronic Health Records
BMH uses an electronic record to store and retrieve much of your PHI. One of the advantages of BMH’s electronic health record is the ability to share and exchange PHI among BMH personnel and other community health care providers.
4. Uses and Disclosures of PHI with your Consent or Authorization
This document serves as notification of how BMH will utilize our PHI to support treatment, payment and health care operations. Your PHI may be used and disclosed by your physician and BMH staff. Before we provide medical care, except in an emergency or other special cir-cumstances, we will ask you to read and sign a written consent (“Your Consent”), authorizing us to use and disclose your health information for the following purposes:
- Treatment. Treatment means the provision, coordination, or management of your health care and related services by BMH and health care providers involved in your care. For example, your PHI may be provided to a physician to whom you have been re-ferred to ensure that the physician has the necessary information to diagnose or treat you.
Different departments in the hospital may share medical information about you in order to coordinate prescriptions, lab work, meals, and x-rays.
- Payment. Your PHI will be used, as needed, to obtain payment for your health care services. This may include certain activities to obtain reimbursement for the medical services provided to you, including billing, claims management, and collection activities. This may include your insurance carrier’s efforts in determining eligibility, claims processing, assessing medical necessity, and utilization review. Payment may also in-clude activities carried out on our behalf by one or more of our collection agencies or agents in order to secure payment on delinquent bills.
- Health Care Operations. We may use and disclose your medical information for health care system operations. These activities may include but are not limited to, quality assessment and improvement activities; fraud & abuse compliance; business planning & development; and business management & general administrative activities. These can also include our telephoning you to remind you of appointments, or using a translation service if we need to communicate with you in person, or on the telephone, in a language other than English. When we involve third parties in our business activities, we will have them sign a Business Associate Agreement obligating them to safeguard your PHI according to the same legal standards we follow.
- Patient Directory. We maintain a patient directory when you are an inpatient that in-cludes your name, a general statement about your condition, your religious affiliation, and your location in the hospital. Such information is disclosed to members of the clergy or (except for religious affiliation) to other persons who ask for you by name. You may choose to have limited or no information about you listed in this directory by con-tacting the Switchboard Supervisor at (802) 257-0341.
5. Uses and Disclosures of PHI Based Upon Your Written Authorization
Other uses and disclosures not described in this Notice will be made only with your written au-thorization, unless otherwise permitted or required by law as described below in section 6. .
You may revoke authorizations at any time, provided each revocation is in writing. You may not revoke an authorization to the extent that (1) we have relied on that authorization; or (2) if the authorization was obtained as a condition of obtaining insurance coverage, law provides the in-surer the right to contest the claim under the policy.
6. Uses and Disclosures of PHI that are Permitted or Required by Law
In some circumstances, we may be legally bound to use or disclose your PHI without your con-sent or authorization. State and federal privacy law permit or require such use or disclosure regardless of your consent or authorization in certain situations, including, but not limited to:
- Emergencies. If you are incapacitated and require emergency medical treatment, we will use and disclose your PHI to ensure you receive the necessary medical services. We will attempt to obtain your consent as soon as practical following your treatment.
- Others Involved in Your Healthcare: Upon your verbal authorization, we may disclose to a family member, close friend or other person you designate only that PHI that directly relates to that individual’s involvement in your healthcare and treatment. We may also need to use PHI to notify a family member, personal representative or someone else responsible for your care of your location and general condition.
- Communication barriers. If we try but cannot obtain your consent to use or disclose your PHI because of substantial communication barriers and your physician, using his or her professional judgment, infers that you consent to the use or disclosure, or the physician determines that a limited disclosure is in your best interests, BMH may permit the use or disclosure.
- Required by Law: We may disclose your PHI to the extent that its use or disclosure is required by law. This disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law.
- Public Health/Regulatory Activities: We may disclose your PHI to an authorized public health authority to prevent or control disease, injury, or disability or to comply with state child or adult abuse or neglect law. We are obligated to report suspicion of abuse and neglect to the appropriate regulatory agency.
- Food and Drug Administration: We may disclose your PHI to a person or company as required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations as well as to track product usage, enable prod-uct recalls, make repairs or replacements or to conduct post-marketing surveillance.
- Health oversight activities. We may disclose your PHI to a health oversight agency for audits, investigations, inspections, and other activities necessary for the appropriate oversight of the health care system and government benefit programs such as Medicare and Medicaid.
- Judicial and administrative proceedings. We may only disclose your PHI in the course of any judicial or administrative proceeding in response to a court order expressly directing disclosure, or in accordance with specific statutory obligation compelling BMH to do so, or with the permission of the patient.
- Law enforcement activities. In accordance with Vermont state law, we may not dis-close your PHI to a law enforcement officer for law enforcement purposes without court order, statutory obligation or patient authorization.
- Coroners, medical examiners, funeral directors and organ donation organizations: We may disclose your PHI to a coroner or medical examiner for the purpose of identifying a deceased person, determining a cause of death, or other lawful duties. We also may disclose your PHI to enable a funeral director to carry out his or her lawful duties. PHI may also be disclosed to organ banks for cadaveric organ, eye, bone, tissue and other donation purposes.
- Research. We may disclose your PHI for certain medical or scientific research where the researchers have a protocol to ensure the privacy of your PHI.
- Serious threats to health or safety. We may disclose your PHI to prevent or lessen a serious and imminent threat to the health or safety of a person or the public.
- Military activity & national security. We may disclose the PHI of members of the armed forces for activities deemed necessary by appropriate military command authori-ties to assure proper execution of the military mission. We also may disclose your PHI to certain federal officials for lawful intelligence and other national security activities.
- Worker’s Compensation: We may disclose your PHI as authorized to comply with worker’s compensation law.
- Inmates of a Correctional Facility: We may use or disclose PHI if you are an inmate of a correctional facility and our facility created or received your PHI in the course of providing care to you while in custody.
- US Department of Health and Human Services: We must disclose your PHI to you upon request and to the Secretary of the United States Department of Health & Hu-man Services to investigate or determine BMH’s compliance with the privacy laws.
- Disaster Relief Activities: We may disclose your PHI to local, state or federal agencies engaged in disaster relief and to private disaster relief assistance organizations (such as the Red Cross if authorized to assist in disaster relief efforts).
Marketing & Fundraising
- Fundraising Use: BMH may contact you for the express purpose of internal fundraising activities. The information disclosed to our fundraising staff shall be limited to contact information and dates of services rendered.
- Patients Right to “Opt Out”: You may “opt out” of having such information used for development purposes. To do so, we ask patients to contact our Development Office.
- Marketing Use: BMH may use or disclose your PHI to identify health related services and products that may be beneficial to your health and we may contact you about these services and products.
7. Your Rights Regarding PHI
- Right to request restriction of uses and disclosures. You have the right to request that we not use or disclose any part of your PHI unless it is a use or disclosure required by law. Please advise us of the specific PHI you wish restricted and the individual(s) who should not receive the restricted PHI. We are not required to agree to your restriction request, except as set forth in the paragraph below. If we do agree to a restriction request, we will not use or disclose the restricted PHI unless it is necessary for emergency treatment. In that case, we will ask that the recipient not further use or dis-close the restricted PHI. You may specify the restricted parties in writing to the Director of Medical Information.
- We must agree to a request to restrict disclosure of PHI to a health plan, if the disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law and the PHI pertains solely to an item or service for which BMH has otherwise been in full.
- Right of access to PHI. You have the right to inspect and obtain a copy of your PHI upon your written request. Your right of access may be limited if providing certain PHI, in the judgment of your physician or some other licensed health care professional, may endanger the health or safety of yourself or others or the PHI makes reference to another person and access is likely to cause substantial harm to you or the other person. To request access to your medical record call the Medical Information Department during business hours. We will respond to your request as soon as possible, but no later than 30 days from the date of your request. If access is denied you will receive a denial letter within 30 days. We may extend the time for responding to such requests by no more than 30 days if we provide you written statement of the reason for the delay and the date by which we will act on the request. There is an appeals process. We have the right to charge a reasonable fee for providing copies of your PHI.
- Right to confidential communications. You have the right to accommodation of rea-sonable requests to receive communication of PHI by alternative means or at alternative locations. For example, you may wish your bill to be sent to an address other than your home. Please make your request in writing to the Director of Patient Financial Services. We will not require an explanation of your reasons for the request, and will attempt to comply with reasonable requests, but you will be required to assume any costs associ-ated with forwarding your PHI by alternate means.
- Right to amend PHI. You have the right to request that we amend your PHI. Your re-quest must be made in writing to the Compliance Officer. We will respond to your re-quest as soon as possible, but no later than 60 days from the date of your request. If we deny your request for amendment, you have the right to submit a written statement disagreeing with the denial; the hospital also has the right to submit a rebuttal state-ment. A record of any disagreement about amendment will become part of your medical record and may be included in subsequent disclosures of your PHI.
- Right to accounting of disclosures. Subject to certain limitations, you have the right to a written accounting of disclosures by us of your PHI for not more than 6 years prior to the date of your request. Your right to an accounting applies to disclosures other than those for treatment, payment, or health care operations; to yourself; for a facility directory; to your family or close friends involved in your care; or for notification pur-poses. Please make your request in writing to the Director of Medical Information. We will respond to your request as soon as possible, but no later than 60 days from the date of your request. We will provide you with one accounting every 12 months free of charge. We will charge a reasonable fee based upon our costs for any subsequent accounting requests.
- Right to a copy of our Notice of Privacy Practices. We will ask you to sign a written acknowledgement of receipt of this Notice. We may change the terms of this Notice, at any time. The revised Notice will be in effect for all PHI that we maintain at that time. We will post any revised Notice on our website, www.bmhvt.org. Upon your request, we will provide you with the revised Notice or you may obtain a copy by accessing our web-site at www.bmhvt.org, or by calling any BMH office and requesting that a revised copy be sent to you in the mail, or asking for one at your next appointment.
8. Complaint Procedure
- Within our Facility: If you want further information about your privacy rights, are concerned that we have violated your privacy rights, or disagree with a decision that we have made about your health information, you may contact the BMH Director of Risk Management at (802) 257-8244. We will not retaliate against you for filing a complaint.
- Outside our Facility: If you believe that BMH is not complying with its legal obligations to protect the privacy of your PHI, you may file a complaint with the Secretary of the U.S. Department of Health & Human Services, Office of Civil Rights. You must make your complaint to the Secretary in writing within 180 days of the act or omission forming the basis of your complaint.
This notice will go into effect on August 2, 2004. Orig. 03/2003, Rev. 11/2007, 3/2013