Privacy Notice

Notice of Health Information Privacy Practices
Effective March 2003
 
This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
 
How we may use and disclose your health information. We use health information about you for treatment, to get paid for treatment, for administrative purposes, and to evaluate the quality of care that you receive. For example, your health information may be shared with other providers to whom you are referred. Information may be shared by paper, mail, electronic mail, fax, or other methods. We may use or disclose your health information without your authorization for several reasons. But beyond those situations, we will ask for your written authorization before using or disclosing your health information. If you sign an authorization to disclose information you can later revoke it to stop any future uses and disclosures.
 
Your rights. In most cases, you have the right to look at or get a copy of your health information that we use to make decisions about you. If you request copies, we may charge you a cost-based fee. If you believe your health information is incorrect or information is missing, you have the right to request that we correct the existing information or add the missing information. You also have the right to request a list of certain types of disclosures of your information that we have made.
 
Our legal duty. We are required by law to protect the privacy of your health information, provide this notice about our privacy practices, follow the privacy practices that are described in this notice, and seek your acknowledgment of receipt of this notice. We may change our privacy policies any time. Before we make a significant change in our policies, we will change our notice and post the new notice in the waiting area. You can also request a copy of our notice at any time. For more information about our privacy policies, contact the person listed below.
 
Privacy complaints. If you are concerned that we have violated your privacy rights, our privacy policies, or if you disagree with a decision we made about access to your health information, you may contact the person listed below. You also may send a written complaint to the U.S. Department of Health and Human Services. The person listed below can provide you with the appropriate address upon request.
 
If you have any questions or complaints, please contact:

Peggy Dorgan
Health Information Manager/Privacy Officer
West Shore Medical Center
1465 E. Parkdale Avenue
Manistee, MI 49660

8 a.m. to 4:30 p.m. — Monday through Friday
Call (231) 398-1568 or the Compliance Hotline at (231) 398-1510
 

Notice of Privacy Practices

This notice describes how health information about you may be used and disclosed and how you can get access to this information.
 
If you have any questions about this notice, please contact: The Health Information Management Department.

This notice describes the privacy practices of West Shore Medical Center and the radiologist(s), anesthesiologist(s), CRNAs and pathologist(s) who may provide services to West Shore Medical Center patients but who are not members of West Shore Medical Center's workforce. All of these entities may share health information about you with each other as necessary to carry out treatment, payment, or health care operations and all have agreed to abide by the terms of this notice. Your personal physician may have a separate notice that describes how he or she will use or disclose your health information. This notice applies to all of West Shore Medical Center's service delivery sites, including the hospital, the Northwest Michigan Health Center, the West Shore Health Connection, Onekama Area Health Center, West Shore Outpatient Services—Wellston, West Shore Outreach Lab, and West Shore Outpatient Services—Bear Lake.
 
Our Pledge Regarding Health Information:
We understand that health information* about you is personal. We are committed to protecting health information about you. We create a record of the care and services you receive at West Shore Medical Center, any divisions, departments, or affiliated services. We need this record to provide you with care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by the Medical Center, whether made by the Medical Center's personnel or your personal doctor. This notice describes our Medical Center's privacy practices and the requirements placed on the members of our workforce. Your personal doctor may have different policies or notices regarding the doctor's use and disclosure of your health information created in the doctor's office or clinic. This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of health information.
 
We are required by law to:

• Make sure that health information that identifies you is kept private;
• Give you this notice of our legal duties and privacy practices with respect to health information about you;
• Follow the terms of the notice that is currently in effect.

How we may use and disclose health information about you.
The following categories describe different ways that we use and disclose health information. For each category of uses or disclosures, we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be 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 health information about you to provide you with medical treatment or services. We may disclose health information about you to doctors, nurses, technicians, students, or other Medical Center personnel who are involved in taking care of you at the Medical Center. 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 Medical Center also may share health information about you in order to coordinate the different things you need, such as prescriptions, lab work, and x-rays. We also may disclose health information about you to people outside the Medical Center who may be involved in your medical care after you leave the Medical Center, 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 health information about you so that the treatment and services you receive at the Medical Center may be billed to and payment may be collected from you, an insurance company, or a third party. For example, we may need to give your health plan information about surgery you received at the Medical Center 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.
• For Health Care Operations. We may use and disclose health information about you for Medical Center operations. These uses and disclosures are necessary to run the Medical Center and make sure that all of our patients receive quality care. For example, we may use health information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine health information about many Medical Center patients to decide what additional services the Medical Center should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, students, and other Medical Center personnel for review and learning purposes. We may also combine the health information we have with health information from other health care providers to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of health 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 health information to contact you as a reminder that you have an appointment for treatment or medical care at the Medical Center.
• Treatment Alternatives. We may use and disclose health information to tell you about possible treatment options or alternatives that may be of interest to you.
• Health-Related Benefits and Services. We may use and disclose health information to tell you about health-related benefits or services that may be of interest to you.
• Fundraising Activities. We may use health information about you to contact you in an effort to raise money for the Medical Center and its operations. We may disclose health information to a foundation related to the Medical Center so that the foundation may contact you in raising money for the Medical Center. We only would release contact information, such as your name, address, phone number, and the dates you received treatment or services at the Medical Center. You may choose to not be included in this release of information by notifying us in writing.
• Medical Center Directory. We may include certain limited information about you in the Medical Center directory while you are a patient at the Medical Center. This information may include your name, location in the Medical Center, your general condition (e.g., fair, stable, etc.), and your religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they don't ask for you by name. This is so your family, friends, and clergy can visit you in the Medical Center and generally know how you are doing. You may choose not to be included on our directory at the time of registration.
• Individuals Involved in Your Care or Payment for Your Care. We may release health information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family or friends your condition and that you are in the Medical Center. In addition, we may disclose health information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.
• Research. Under certain circumstances, we may use and disclose health 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 health information, trying to balance the research needs with patients' need for privacy of their health information. Before we use or disclose health information for research, the project will have been approved through this research approval process, but we may, however, disclose health 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 health information they review does not leave the Medical Center. Under the control and oversight of West Shore Medical Center's Institutional Review Committee, a researcher may have access to your name, address, or other information that reveals who you are, or who will be involved in your care at the Medical Center.
• To Avert a Serious Threat to Health or Safety. We may use and disclose health 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
 
Disclosures as required by law or regulation or to assist in law enforcement or national security.

We may disclose health information, including individually identifiable health information about you, as required by state or federal laws and regulations relating to any or all of the following, as such may apply to you:

1. Community/public health activities and reports such as disease control, abuse or neglect, and health and vital statistics.
2. Administrative oversight for such things as audits, investigations, licensure, or determining cause of death.
3. Court order or other legal processes related to law enforcement activities including custody of inmates, legal actions, or national security activities.
4. Military and veteran reporting on members of the armed forces of United States or foreign military as required by military command authorities.
5. Organ and tissue donation and transplant reports as required by regulatory organizations as necessary to facilitate organ or tissue donation and transplant.
6. Workers' compensation or other rehabilitative activities reporting as required by law or insurers in order to provide benefits for work-related or victim injuries or illnesses.
7. Law Enforcement. We may release health information if asked to do so by a law enforcement official:
   • 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 the Medical Center; 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.
8. Coroners, Medical Examiners and Funeral Directors. We may release health 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 health information about patients of the Medical Center to funeral directors as necessary to carry out their duties.
9. National Security and Intelligence Activities. We may release health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
10. Protective Services for the President and Others. We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons, or foreign heads of state or conduct special investigations.
11. 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. This release would be necessary
    • For the institution to provide you with health care;
    • For the safety and security of the correctional institution.

Your Rights Regarding Health Information About You

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

• Right to Inspect and Copy. You have the right to inspect and copy health information that may be used to make decisions about your care. Usually this includes medical and billing records, but does not include psychotherapy notes.
  
  To inspect and copy health information that may be used to make decisions about you, you must submit your request in writing to the Health Information Management Department. If you request a copy of the information, we may charge a reasonable fee for the costs of copying, mailing, or other supplies associated with your request, as allowed by law or regulation. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health information, you may request that the denial be reviewed. A licensed health care professional chosen by the Medical Center 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 the 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 add a statement. To request an amendment, your request must be made in writing and submitted to the Health Information Management Department. In addition, you must provide a reason that supports your request. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, 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 health information kept by or for the Medical Center;
  • 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 made of health information about you. To request this list or accounting of disclosures, you must submit your request in writing to the Health Information Management Department. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). The first list you request within a 12-month period will be free. For additional lists, 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 health 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 health 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.
  
  We are not required by federal regulation to agree to your request. Due to the great cost of additional resources necessary to comply with such requests, West Shore Medical Center may be unable to grant requests for restrictions on the health information we use or disclose about you for treatment, payment, or health care operations. We will, however, consider requests for a limit on the health information we disclose about you to someone who is involved in your care, like a family member or friend. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. To request restrictions, you must make your request in writing to the Health Information Management Department.
  
  In your request, you must tell us:
  • What information you want to limit;
  • Whether you want to limit our use, disclosure or both; and
  • 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 to the Health Information Management Department. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted. For example, you may ask us not to contact you at work.
• Right to Paper Copy of this Notice. You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain a copy of this notice at our website, www.westshoremedcenter.org. You will be given a copy of this notice and asked to sign an acknowledgement that you received it.

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 health 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 Medical Center. The notice will contain on the first page, in the top right-hand corner, the effective date. In addition, each time you register at or are admitted to the Medical Center for treatment or health care services as an inpatient or outpatient, we will offer you a copy of the current notice in effect.
 
Complaints
If you believe your privacy rights have been violated, you may file a complaint with the West Shore Medical Center Privacy Office at (231) 398-1568 or with the Secretary of the Department of Health and Human Services. To file a complaint with the Medical Center, you must submit your complaint in writing to:

Peggy Dorgan
Health Information Manager/Privacy Officer
West Shore Medical Center
1465 E. Parkdale Avenue
Manistee, MI 49660

8 a.m. to 4:30 p.m. — Monday through Friday
Call (231) 398-1568 or the Compliance Hotline at (231) 398-1510

If you wish to discuss your complaint, you may call the Privacy Office Line at (231) 398-1568 Monday through Friday, between 8 a.m. and 4:30 p.m. To report a concern/complaint, you may call the Compliance Hotline at (231) 398-1510.
 
You will not be penalized for filing a complaint.

Other Uses of Health Information
Other uses and disclosures of health information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose health information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
 
*Definition of Health Information
Health (patient) Information, which is defined at 45 C.F.R. 160.103, is "any information, whether oral or recorded in any form or medium, that:

1. Is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse; and
2. Relates to the past, present, or future physical or mental health or condition of an individual; or the past, present, or future payment for the provision of health care in an individual." In addition, HIPAA Regulations define "individually identifiable health information" as "information that is a subset of health information, including demographic information collected from an individual." IIHI includes the definition at 45 C.F.R. 160.13 and, in addition information: "(i) that identifies the individual; or (ii) with respect to which there is a reasonable basis to believe the information can be used to identify the individual."