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.
This Notice of Privacy Practices describes the privacy practices of Wyandot Memorial Hospital, Physician Services of Wyandot Memorial Hospital and the Specialty Healthcare Center located within Wyandot Memorial Hospital. It is provided to you in accordance with the Health Insurance Portability and Accountability Act of 1996.
This notice describes how your health information, information that constitutes protected health information as defined in the rules of the Act, may be used and disclosed for purposes of providing you treatment, obtaining payment for your care and conducting health care operations. This notice will also explain your legal rights and our duties regarding your health information. We are required by law to maintain the privacy of our patients' personal health information and to provide patients with notice of our legal duties and privacy practices with respect to your personal health information and to notify you in the unlikely event of a breach or unauthorized disclosure of your personal health information. We are required to abide by the terms of this Notice so long as it remains in effect. We reserve the right to change the terms of this Notice of Privacy Practices as necessary and to make the new Notice effective for all personal health information maintained by us. You may receive a copy of any revised notices by picking one up at the hospital or by mailing a request to: Chief Executive Officer, Wyandot Memorial Hospital, 885 North Sandusky Avenue, Upper Sandusky, OH 43351.
Uses and Disclosures of your Personal Health Information
Your Authorization and Consent. Except as outlined below, we will not use or disclose your personal health information for any purpose unless you have signed a form authorizing the use or disclosure. You have the right to revoke that authorization in writing unless we have taken any action in reliance on the authorization.
Uses and Disclosures for Treatment. We will make uses and disclosures of your personal health information as necessary for your treatment. For instance, doctors and nurses and other professionals involved in your care will use information in your medical record and information that you provide about your symptoms and reactions to plan a course of treatment for you that may include procedures, medications, tests, etc. We may also release your personal health information to another health care facility or professional who is not affiliated with our organization but who is or will be providing treatment to you. For instance, if, after you leave the hospital, you are going to receive home health care, we may release your personal health information to that home health care agency so that a plan of care can be prepared for you. In emergencies, we will use and disclose your personal health information to provide the treatment you require.
Uses and Disclosures for Payment. We will make uses and disclosures of your personal health information as necessary for the payment purposes of those health professionals and facilities that have treated you or provided services to you. For instance, we may forward information regarding your medical procedures and treatment to your insurance company to arrange payment for the services provided to you or we may use your information to prepare a bill to send to you or to the person responsible for your payment.
Uses and Disclosures for Health Care Operations. We will use and disclose your personal health information as necessary, and as permitted by law, for our health care operations which include clinical improvement, professional peer review, business management, accreditation and licensing, etc. These uses are necessary for us to function and to maintain quality health care for all patients.
Our Facility Directory. We maintain a facility directory listing the name, room number, general condition and, if you wish, your religious affiliation. Unless you choose to have your information excluded from this directory, the information, excluding your religious affiliation, will be disclosed to anyone who requests it by asking for you by name. This information, including your religious affiliation, may also be provided to members of the clergy. This information is available so your family, friends and clergy can visit you and generally know how you are doing. You have the right during registration to have your information excluded from this directory and also to restrict what information is provided and/or to whom.
Family and Friends Involved In Your Care. With your approval, we may from time to time disclose your personal health information to designated family, friends, and others who are involved in your care or in payment of your care in order to facilitate that person’s involvement in caring for you or paying for your care. If you are unavailable, incapacitated, or facing an emergency medical situation and we determine that a limited disclosure may be in your best interest, we may share limited personal health information with such individuals without your approval. We may also disclose limited personal health information to a public or private entity that is authorized to assist in disaster relief efforts in order for that entity to locate a family member or other persons that may be involved in some aspect of caring for you.
Business Associates. Certain aspects and components of our services are performed through contracts with outside persons or organizations, such as auditing, accreditation, legal services, technical support, etc. At times it may be necessary for us to provide personal health information to one or more of these outside persons or organizations who assist us with our health care operations. In all cases, we require these business associates to appropriately safeguard the privacy of your information.
Fundraising. We may contact you to donate to a fundraising effort for or on our behalf. You have the right to "opt-out" of receiving fundraising materials/communications and may do so by sending your name and address to: Chief Executive Officer, Wyandot Memorial Hospital, 885 North Sandusky Avenue, Upper Sandusky, OH 43351 together with a statement that you do not wish to receive fundraising materials or communications from us.
Appointments and Services. We may contact you to provide appointment reminders or test results. We may call you by name in the waiting room when it is your turn to receive services. We may send you information about services offered by the hospital that might interest or benefit you. You have the right to request and we will accommodate reasonable requests by you to receive communications regarding your personal health information from us by alternative means or at alternative locations. For instance, if you wish appointment reminders to not be left on voice mail or sent to a particular address, we will accommodate reasonable requests. Such requests should be directed to the Physician office or to the hospital administrator, as appropriate.
Other Uses and Disclosures. We are permitted or required by law to make certain other uses and disclosures of your personal health information without your consent or authorization. For example, we may release your personal health information:
- for any purpose required by law;
- for public health activities, such as required reporting of disease, injury, and birth and death, and for required public health investigations;
- as required by law if we suspect child abuse or neglect; we may also release your personal health information as required by law if we believe you to be a victim of abuse, neglect, or domestic violence;
- we many release immunization records to a student’s school but only if parents or guardians (or the student if not a minor) agree either orally or in writing;
- to the Food and Drug Administration if necessary to report adverse events, product defects, or to participate in product recalls;
- to your employer when we have provided health care to you at the request of your employer to determine workplace-related illness or injury; in most cases you will receive notice that information is disclosed to your employer;
- if required by law to a government oversight agency conducting audits, investigations, or civil or criminal proceedings;
- if required to do so by subpoena or discovery request; in some cases you will have notice of such release;
- to law enforcement officials as required by law to report wounds and injuries and crimes;
- to coroners and/or funeral directors consistent with law;
- if necessary to arrange an organ or tissue donation from you or a transplant for you;
- for certain research purposes when such research is approved by an institutional review board with established rules to ensure privacy;
- in limited instances if we suspect a serious threat to health or safety;
- if you are a member of the military as required by armed forces services; we may also release your personal health information if necessary for national security or intelligence activities;
- to workers' compensation agencies if necessary for your workers' compensation benefit determination;
- if you are an inmate of a correctional facility, information may be disclosed for the purpose of the institution being able to provide you with health care; for your health and safety or the health and safety of others, or for the safety and security of the correctional institution.
Ohio law requires that we obtain a consent from you in many instances before disclosing the performance or results of an HIV test or diagnoses of AIDS or an AIDS-related condition; before disclosing information about drug or alcohol treatment you have received in a drug or alcohol treatment program; and before disclosing information about mental health services you may have received.
RIGHTS THAT YOU HAVE
Access to Your Personal Health Information. You have the right to copy and/or inspect much of the personal health information that we retain on your behalf. All requests for access must be made in writing, signed by you or your representative, and submitted to the Medical Records Department of the hospital or to the appropriate medical office. If you request a copy of records, you may be charged a fee. This fee is established by Ohio law.At such time as the hospital information system develops the capability, you will have the right to obtain an electronic copy of your health information that exists in an electronic format and you may direct that the copy be transmitted directly to an entity or person designated by you, provided that any such designation is clear, conspicuous, and specific with complete name and mailing address or other identifying information. You may be charged a fee for our labor and supplies in preparing your copy of the electronic health information.
Amendments to Your Personal Health Information. You have the right to request in writing that personal health information that we maintain about you be amended or corrected. We are not obligated to make all requested amendments but will give each request careful consideration. All amendment requests, in order to be considered by us, must be in writing, signed by you or your representative, and must state the reasons for the amendment/correction request. If an amendment or correction you request is made by us, we may also notify others who work with us and have copies of the uncorrected record if we believe that such notification is necessary.
Accounting for Disclosures of Your Personal Health Information. You have the right to receive an accounting of certain disclosures made by us of your personal health information for six years prior to the date of your request. Requests must be made in writing and signed by you or your representative. The first accounting in any 12-month period is free; you may be charged a fee for each subsequent accounting you request within the same 12-month period.
Restrictions on Use and Disclosure of Your Personal Health Information. You have the right to request restrictions on certain of our uses and disclosures of your personal health information for treatment, payment, or health care operations. We are not required to agree to your restriction request but will attempt to accommodate reasonable requests when appropriate and we retain the right to terminate an agreed-to restriction if we believe such termination is appropriate. In the event of a termination by us, we will notify you of such termination. You also have the right to terminate, in writing or orally, any agreed-to restriction. We will honor any request to restrict disclosures to your health plan if the information to be disclosed pertains solely to a health care item or service for which you have made other acceptable arrangements for payment.
Breach Notification: In the unlikely event that there is a breach, or unauthorized release of your personal health information, you will receive notice and information on steps you may take to protect yourself from harm.
Complaints. We are committed to protecting your privacy rights and encourage you to express any concerns you may have regarding the privacy of your health information. If you believe your privacy rights have been violated, you may file a complaint by contacting the office of the Chief Executive Officer, Wyandot Memorial Hospital, 885 North Sandusky Avenue, Upper Sandusky, OH 43351. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services in Washington D.C. in writing within 180 days of a violation of your rights. There will be no retaliation for filing a complaint.
Acknowledgment of Receipt of Notice. You will be asked to acknowledge receipt of this Notice. Our intent is to make you aware of the possible uses, disclosures and protections of your health information.
FOR FURTHER INFORMATION
If you have questions or need further assistance regarding this Notice, you may contact the office of the Chief Executive Officer, who is the Privacy Officer of Wyandot Memorial Hospital, at 885 North Sandusky Avenue, Upper Sandusky, OH 43351.
As a patient you retain the right to obtain a paper copy of this Notice of Privacy Practices, even if you have requested such copy by e-mail or other electronic means.
This Notice of Privacy Practices is effective September, 2013.