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When this notice refers to “we” or “us” it is referring to Nason Hospital, including Nason OB/GYN, Nason Pediatrics, Nason Home Health & Hospice, as well as members of the Nason Hospital Medical Staff and health care providers associated with the organization. This notice applies to protected health information created or obtained in connection with medical care provided to you at Nason or one of its offices. It does not apply to care provided to you in your physician’s private office where you should expect to receive that provider’s Privacy Notice.

Your Medical Record: A medical record is created for each Nason patient. This record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information serves as a: basis for planning your care and treatment means of communication among the many health professionals who contribute to your care legal document describing the care you received means by which you or a third party payer can verify that services billed were actually provided a tool in educating health professionals a source of data for medical research a source of information for public health officials charged with improving the health of the nation a source of data for facility planning and marketing a tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.

Understanding what is in your record and how health information is used helps you to:
ensure its accuracy
better understand who, what, when, where, and why others may access it
make more informed decisions when authorizing disclosures

Your Health Information Rights
Although your health record is the physical property of Nason Hospital, the information belongs to you. You have the right to:
request a restriction of certain uses and disclosures
obtain a paper copy of the notice of information practices upon request
inspect and copy your health record
request an amendment to your health record
obtain an accounting of disclosures of your record
request communications of your health information by alternative means or at alternative locations
revoke your authorization to use or disclose health information except to the extent that action has already been taken

Our Responsibilities

We are required to:
maintain the privacy of your health information provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
abide by the terms of this notice
notify you if we are unable to agree to a requested restriction
accommodate reasonable requests you may have to communicate health information by alternative means or locations

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our practices change, we will provide you with a revised notice prior to providing care in the future.

We will not use or disclose your health information without your authorization, except as described in this notice or required by state or federal law.

For More Information or to Report a Problem
If have questions and would like additional information, you may contact one of our Privacy Officers as follows:
Nason Hospital: 224-6212
Nason OB/GYN: 224-5455
Nason Pediatrics: 224-2555

If you were unable to resolve your concerns with the Privacy Officer, you may file a complaint with our Compliance Officer: 224-6201; or with the Office of Civil Rights, Dept. of Health & Human Services.
There will be no retaliation for filing a complaint.
DHHS Regional Office Toll Free#: 800-368-1019.

Examples of Disclosures for Treatment, Payment, and Health Operations

We will use your health information for treatment.
For example: Information obtained by a nurse, physician, or other member of your healthcare team will be recorded in your record and used to determine the course of diagnostic workup and treatment.
Results of diagnostic tests and your response to treatment will be documented.

We will also provide your physician and other healthcare providers involved in your diagnosis and treatment copies of various reports that should assist in your treatment. This would occur when ever there is a change in your level of care or referral to another provider.

We will use your health information for payment. A bill may be sent to you or a third-party payer that includes information that identifies you, as well as your diagnosis, procedures, and supplies used. The same type of information may be shared with members of the medical staff who cared for you at Nason so they can perform their own billing.

We will use your health information for regular health operations. Members of the medical staff, the patient safety or quality improvement team members may use information in your health record to assess the care and outcomes in your case and others like it. We may ask your opinion via written or telephone satisfaction surveys. This information will then be used in an effort to continually improve the quality and effectiveness of the
healthcare and service we provide.

Business associates:
There are some services provided in our organization through contacts with business associates.
Examples include: physician services
in the emergency department, cardiology, radiology, certain lab tests, pathology and physical rehabilitation. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we've asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

Unless you notify us that you object, when you are a Hospital patient, we will use your name, room number, general condition and religious affiliation for directory purposes. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask
for you by name.

We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition.

Communication with family:
We may, using our best judgment, 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.

We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.

Funeral directors:
We may disclose health information to funeral directors consistent with applicable law to carry out their duties.

Organ procurement organizations:
Consistent with state law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Fund raising: We may contact you in the future as part of a fund-raising effort.

Food and Drug Administration (FDA):
We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs or replacement.

Workers compensation:
We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation.

Employers: If you were tested or examined at the request of your employer or potential employer, we will share the results with that company. Care will be taken to limit the information to that which is necessary for the employer to make a decision regarding hire, continued employment or modified duty.

Public health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

Correctional institution: Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.

Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena. Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority, or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers, or the public.

This notice is available in larger print. Please ask a staff member if you need a larger print or if you would like someone to explain the contents of this notice to you. Form 1823 01/01/04

This notice describes how information about you may be used and disclosed and how you can get access to this information. Please review carefully.