"You
matter to us
because you are you.
You
matter
to the last moment
of your life,
and we will do
all we can,
not only to
help you die peacefully,
but also to
live until you die."
Cicely Saunders, M.D.
Founder of Hospice
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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.
If
you have any questions about this notice, please contact
Health Information Services at 881.7220
To obtain a printed copy of this
notice - click here
Holy
Rosary Medical Center and affiliate Catholic Health Initiatives’ facilities
are required by law to maintain the privacy of your health information;
give you notice of our legal duties and privacy practices with
respect to your health information; and follow the terms of this
notice. This notice applies to all of your health records generated
by Holy Rosary Center Medical, whether made by our personnel
or your personal physician.
This
notice will tell you about the ways in which we may use and disclose
your health information in Holy Rosary Medical Center and with
other entities. We also describe your rights and certain obligations
we have regarding the use and disclosure of your health information.
WHO WILL FOLLOW THIS NOTICE?
Holy Rosary Medical Center, Dominican Health Services, Sports and Orthopedic
Rehab, Treasure Valley Internal Medicine, Holy Rosary Home Care, Pathway Hospice
and Holy Rosary Maternity Clinic.
HOW
WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
FOR
TREATMENT:
We will use your health information to provide you with health care treatment
and to coordinate or manage services with other health care providers, including
third parties. We may disclose all or any portion of your health information
to your attending physician, consulting physician(s), nurses, technicians,
medical students, or other facility or health care personnel who have a legitimate
need for such information in order to take care of you. Different departments
of the facility will share your health information in order to coordinate
the health care services you need, such as prescriptions, lab work and X-rays.
We may disclose your health information to family members or friends, guardians
or personal representatives who are involved with your medical care. We may
also use and disclose your health information to contact you for appointment
reminders, and to provide you with information about possible treatment options
or alternatives, and other health- related benefits and services. We also
may disclose your health information to people outside the facility who may
be involved in your health care after you leave the facility, such as other
physicians involved in your care, specialty hospitals, skilled nursing care
facilities and other health care-related services.
FOR PAYMENT
We will use and disclose your health information for activities that are
necessary to receive payment for our services, such as determining insurance
coverage, billing, payment and collection, claims management, and medical
data processing. For example, we may tell your health plan about a treatment
you are planning in order to receive approval or to determine whether your
plan will cover the proposed treatment. We may disclose your health information
to other health care providers so they can receive payment for health care
services that they provided to you, such as ambulance services. We may also
give information to other third parties or individuals who are responsible
for payment for your health care.
FOR HEALTH CARE
OPERATIONS
We may disclose your health information for routine facility operations,
such as business planning and development, quality review of services provided,
internal auditing, accreditation, certification, licensing or credentialing
activities, medical research and education for staff and students, and to
other healthcare entities that have a relationship with you and need the
information for operational purposes.
FACILITY DIRECTORY
We may include your name, location in the facility, your general condition
(for example, fair or stable, or even the death of a person) and your religious
affiliation in the facility directory. The directory information, except
for your religious affiliation, may be released to people who ask for you
by name. Your name and 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. The facility directory is available so your family, friends and
clergy can visit you and generally know how you are doing. You must notify
Admitting/Registration Staff at (541)881.7070 or (541)881.7000 orally or
in writing if you do not want us to release information about you in the
facility directory. If you do not want information released in the facility
directory, we cannot tell members of the public, flower or other service
persons and organizations, and even your friends and family that you are
here and your general condition.
FUNDRAISING ACTIVITIES
We may use your health information, or disclose your health information to
a foundation related to us for Holy Rosary Medical Center’s fundraising
efforts. We would only release information such as your name, address and
phone number and the dates that you received treatment or services from us.
If you do not want us to contact you for fundraising efforts you must notify
our Marketing Department, HRMC 351 SW 9th St. Ontario, OR 97914 in writing,
stating that you do not want to receive the information.
RESEARCH.
We may use and disclose your health information to researchers when the Institutional
Review Board and/or Privacy Board approve the research study and the use
of your health information.
ORGAN AND TISSUE
DONATION
If you are an organ donor, we may release your health information to organizations
that handle organ procurement and transplantation or to an organ donation
bank, as necessary to facilitate organ or tissue donation and transplantation.
USES
AND DISCLOSURES THAT ARE REQUIRED OR PERMITTED BY LAW
- Subject
to requirements of federal, state and local laws, we are
either required or permitted to report your health information
for various purposes. Some of these reporting requirements
include:
PUBLIC
HEALTH ACTIVITIES
We may disclose your health information to public health officials for activities
such as the prevention or control of communicable disease, injury or disability;
to report births and deaths; to report suspected child abuse or neglect;
to report reactions to medications or problems with medical products.
DISASTER
RELIEF EFFORTS
We may disclose your health information to an entity assisting in a disaster
relief effort so that your family can be notified about your condition and
location.
HEALTH
OVERSIGHT ACTIVITIES
We may disclose your health information to a health oversight agency for
activities authorized by law. These oversight activities may include audits,
investigations, inspections, and licensure. These activities are necessary
for the government to monitor the health care system, government programs
and compliance with civil rights laws.
JUDICIAL
OR ADMINISTRATIVE PROCEEDING
We may disclose your health information in response to a court or administrative
order, a valid subpoena, discovery request, civil or criminal proceedings,
or other lawful process.
LAW
ENFORCEMENT
We may release your health information if asked to do so by a law enforcement
official:
- In
response to a court order, subpoena, warrant, summons
or similar legal process;
- Regarding
a victim or death of a victim of a crime in limited circumstances;
- 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, including
crimes that may occur at our facility.
CORONERS, MEDICAL EXAMINERS & FUNERAL
DIRECTORS
We may release health information to a coroner or a medical examiner. This
may be necessary, for example, to identify a person who died or determine
the cause of death. We may also release health information to help a funeral
director to carry out his/her duties.
WORKERS'
COMPENSATION
We may release your health information for workers' compensation benefits
or to similar programs that provide benefits for work-related injuries or
illness.
TO AVERT A SERIOUS THREAT TO
HEALTH OR SAFETY
We may disclose your health information when necessary to prevent a serious
threat to your health and safety or the health and safety of another person
or the public.
NATIONAL
SECURITY
We may disclose your health information to federal official(s) for national
security activities and for the protection of the President and other Heads
of State.
MILITARY
AND VETERANS
If you are a member of the armed forces, we may release your health information
as required by military command authorities. We may also release health information
about foreign military personnel to the appropriate foreign military authority.
INMATES
If you are an inmate of a correctional institution or in the custody of a
law enforcement official, we may release your health information to the institution
or law enforcement official. This release would be necessary (1) for the
institution to provide you with health care; or (2) to protect your health
and safety or the health and safety of others; or (3) for the safety and
security of the correctional institution.
OTHER
USES OF YOUR HEALTH INFORMATION
Other uses and disclosures of your health information not covered by this
notice or the laws that apply to us will be made only with your written authorization.
If you provide us with authorization to use or disclose your health information,
you may revoke that authorization in writing at any time. When we receive
your written revocation we will no longer use or disclose your health information
for the purpose of that authorization. However, we are unable to retrieve
any disclosures already made based upon your prior authorization.
YOUR
RIGHTS REGARDING YOUR HEALTH INFORMATION.
 You
have the following rights regarding your health information:
RIGHT TO INSPECT AND COPY
You have the right to inspect your health information and copy medical, billing
or other records that may be used to make decisions about your care.
Submit your request in writing to Health Information Services, 351 SW 9th
St, Ontario, OR 97914, (541) 881.7220. We charge a fee for document requests
to cover the costs of copying, mailing or other supplies.
In limited circumstances we may deny your request to inspect and copy your
health information. If you are denied access to your health information,
you may request that the denial be reviewed. A licensed health care professional
chosen by Holy Rosary Medical Center will review your request and the denial.
The person who conducts the review will not be the same person who denied
your request. We will comply with the outcome of the review.
RIGHT TO AMEND
You have the right to request an amendment to your health information that
you believe is incorrect or incomplete.
Submit your request in writing, using a Request for Amendment to PHI form,
and including your reason for the amendment, to the Privacy Officer or Risk
Manager at HRMC, 351 SW 9th St, Ontario, OR 97914. Phone # (541) 881.7220
We may deny your request for an amendment if it is not in writing or does
not include a reason to support the request. We may also deny your request
if you ask us to amend information that:
- Was
not created by Holy Rosary Medical Center; unless the person
or entity that created the information is no longer available
to make the amendment;
- Is
not part of the medical information kept by or for Holy Rosary
Medical Center;
- Is
not part of the information that you would be permitted to
inspect and copy; or;
- Is
accurate and complete.
To
obtain a paper copy of this request, contact:
Privacy Officer or Risk Manager at HRMC
351 SW 9th St,
Ontario, OR 97914.
Phone (541) 881.7220
RIGHT
TO AN ACCOUNTING OF DISCLOSURES
We are required to maintain a list of disclosures of your health information.
However, we are not required to maintain a list of disclosure that we made
by acting upon your written authorizations. You have the right to request
an accounting of disclosures that were not subject to your written authorization.
Submit your request in writing to Health Information Services, 351 SW 9th
St. Ontario, OR 97914. Phone Number (541) 881.7220. Your request must state
a time period, not longer than six years, and may not include dates before
April 14, 2003. 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 before any costs are incurred.
RIGHT TO REQUEST RESTRICTIONS
You have the right to request a restriction or limitation on how much of
your health information we use or disclose for treatment, payment or health
care operations. You also have the right to request a restriction on the
disclosure of your health information to someone who is involved in your
care or payment for your care, such as a family member or friend.
We are not required to agree to your request. However, if we do agree, we
will comply with your request unless the information is needed to provide
you with emergency treatment.
Submit
your request in writing to Health Information Services at HRMC,
351 SW 9th St, Ontario, OR 97914. Phone # (541) 881.7220 or
request and submit a Request for Restrictions to Protected
Health Information form. You must include: (1) what information
you want to limit; (2) whether you want to limit our use, disclosure
or both; and (3) to whom you want the limits to apply.
RIGHT TO REQUEST CONFIDENTIAL
COMMUNICATIONS
You have the right to request that we communicate with you about health care
matters in a certain way or at a certain location. For example, you can ask
that we only contact you at an alternative location from your home address,
such as work, or only contact you by mail instead of by phone.
You must make your request in writing to Patient Access Staff or Financial
Account Representatives at 351 SW 9th St. Ontario, OR 97914 or to request
and submit a “Confidential Communications Opt Out” form. Your
request must specify how or where you wish to be contacted. We do not require
a reason for the request. We will accommodate all reasonable requests.
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 facility and on the Web site at
www.holyrosary-ontario.org. The notice will contain on the first page, in
the top right-hand corner, the effective date.
Upon your initial registration or admittance to the facility for treatment
or health care services as an inpatient or outpatient, we will offer you
a copy of the current notice in effect. Whenever the notice is revised, it
will be available to you upon request.
COMPLAINTS
You may file a complaint with us or with the Secretary of the Department
of Health and Human Services if you believe that we have not complied with
our privacy practices. You may file a complaint with us orally or in writing
by contacting the Risk Manager at (541) 881.7022
You
will not be penalized for filing a complaint.
RIGHT
TO A 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.
If you have agreed to receive this notice electronically, you are still entitled
to a paper copy of this notice
You may print a copy of this notice by clicking the link at the bottom of
the page (Printer Firendly Version). Note: you
will need Acrobat Reader to view and then print this document.
 To
obtain a paper copy of this notice, contact: Patient
Access
Holy Rosary Medical Center
351 SW 9th St
Ontario, OR 97914.
Phone: (541) 881.7000
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