Edward John Noble Hospital/Kinney Nursing Home

NOTICE OF PRIVACY PRACTICES

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.

We are legally required to protect the privacy of your health information.  We call this information “Protected Health Information” or PHI.  This includes health information that can individually identify you and your past, present, or future health conditions, care provided, or payment for healthcare services.  We are required to provide you with this notice about our Privacy Practices.  We are obligated to abide by the terms of this notice.  We reserve the right to revise this notice at any time.  If it is necessary to make changes in this notice or our Privacy Practices, we will promptly post a new notice in Patient Receiving Areas.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU

We may use and/or disclose your PHI for various reasons.  For some of these reasons we need your consent or a specific written authorization.

1. Uses and Disclosures relating to treatment, payment, and healthcare operations require  your prior written consent.  The opportunity to consent may be obtained retro-actively in emergency situations.

A. Treatment - Your PHI may be used and/or disclosed to healthcare personnel who are involved in providing you with healthcare services.  For example, results of your diagnostic tests may be available in your medical record for health professionals who may be providing treatment or consulting to provide your care.

B. Payment - Your PHI may be used and/or disclosed in order to collect payment from your insurance provider.  For example, your insurance provider may require portions of your PHI in order to process a billing claim.

C. Healthcare Operations - Your PHI may be used and/or disclosed to monitor and evaluate the quality of care we provide.  For example, portions of your PHI may be used in quality assurance/management programs evaluating the quality of services provided or the performance of our healthcare personnel.

2. Some uses and disclosures do not require consent - Your PHI may be used and/or disclosed in certain situations without your consent.  For example, portions of your PHI  may be disclosed to law enforcement agencies to carry out law enforcement activities.  Additionally, portions of your PHI may be disclosed in accordance with State and  Federal law for public health or oversight purposes.

3. Some other uses and disclosures require your written authorization - Your PHI may be used and/or disclosed for purposes other than those listed above only with your specific written authorization. You may later revoke that authorization in writing to stop and future uses and disclosures.  However, your decision to revoke this authorization will not effect any uses and disclosures that have already transpired.

Special Situations & Additional Uses of Information -

Portions of your PHI may be used and/or disclosed in a patient directory for use by clergy and visitors who ask for you by name, unless you object.  We may provide your PHI to a family member, friend, or other person who you indicate is involved in your care or payment for your healthcare, unless you object.  We may use your PHI to send you appointment reminders.  We may use your Name/Address only, to support any fund raising activities.  If you do not wish to be contacted for fund raising efforts, please contact the Privacy Officer listed below.

You have the following Rights regarding your PHI:

1. Right to request restrictions - You have the right to request in writing that we limit use and disclosure of your PHI.  We will consider your request and respond in writing but we are not required to accept your request.

2. Right to receive confidential communication - You have the right to request that we send information to you at an alternate address or by alternate means and we must agree to your request within our capabilities.  For example, sending information to your work address instead of your home address, or via email instead of regular postal services.

3. Right to inspect and copy - In most cases you have the right to look at and/or obtain copies of your PHI.  You  must exercise this right via a written request.  We will respond to your written request within thirty (30) days. 

4. Right to amend - You have the right to submit in writing a request to correct/amend your PHI if you believe    there is a mistake or there is pertinent information missing.  We will respond to your written request within sixty (60) days.

5. Right to receive an accounting of disclosures - You have the right to request in writing a list of instances in  which we have disclosed your PHI.  This list will not include uses and/or disclosures that you have consent to or authorized.  This list will not include uses and disclosures made to the facility directory, for national security purposes, to correctional institutions or a custodial law enforcement official, or before April 13, 2003.  We will respond to your written request within sixty (60) days.

6. Right to receive electronic and/or paper copy of this notice - This notice is available on our web site (www.ejnoble.org). You may receive a paper copy of this notice by contacting the Privacy Officer listed below.

Complaints/Contact

If you would like to submit a comment about our Privacy Practices or obtain further information about this notice, please contact our Privacy Officer:

Ms. Mary Jane Gotham, RN
Director of Quality Improvement
E.J. Noble Hospital
77 West Barney Street
Gouverneur, NY 13642
Telephone: (315) 287-1000

If you believe your Privacy Rights have been violated or you have a related complaint please submit a written letter of complaint to the above named individual.

Revised: 4/05

(Initial Effective Date: April 14, 2003)