Patient Privacy Notice
California CHW Facilities
Joint Notice of
Privacy Practices for Medical Information
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.
WHO MUST FOLLOW THIS NOTICE?
CHW provides you (the patient) with health
care by working with doctors and many other health care providers
(referred to as we, our or us). This is a joint notice of our
information privacy practices. The following people or groups
will follow this notice:
- any health care provider who comes to CHW
to care for you. These professionals include doctors,
nurses, technicians, physician assistants and others.
- all departments and units of our
organization, including skilled nursing, home health, clinics,
outpatient services, mobile units, hospice, and emergency
department.
- our employees, contractors, students and
volunteers, including regional support offices and
affiliates.
OUR PLEDGE TO YOU
We understand that medical information about
you is private and personal. We are committed to protecting
it. Hospitals, doctors and other staff make a record each
time you visit. This notice applies to the records of
your care at CHW, whether created by hospital staff or your
doctor. Your doctor and other health care providers may
have different practices or notices about their use and sharing of
medical information in their own offices or clinics. We
will gladly explain this notice to you or your family member.
We are required by law to:
-
keep medical information about you private.
-
give you this notice describing our legal duties and privacy
practices for medical information about you.
-
follow the terms of the notice that is currently in effect.
HOW WE MAY USE AND SHARE YOUR MEDICAL INFORMATION
This section of our notice tells how we may
use medical information about you. In all cases not covered by this
notice, we will get a separate written permission from you before
we use or share your medical information. You can later
cancel your permission by notifying us in writing.
We will protect medical information as much
as we can under the law. Sometimes state law gives more
protection to medical information than federal law. Sometimes
federal law gives more protection than state law.
In each case, we will apply the laws that protect medical
information the most.
Catholic Healthcare West is a large health
system. We may use or share medical information about you
with hospital personnel at any Catholic Healthcare West hospital or
facility for treatment, payment and health care operations. Please
contact the Facility Privacy Office (at the address below) for a
list of all Catholic Healthcare West facilities.
EXAMPLES:
Treatment:
We will use and
share medical information about you for purposes of
treatment. An example is sending medical information about
you to your doctor or to a specialist as part of a referral.
Payment:
We will use and share medical information about you so we can be
paid for treating you. An example is giving information about
you to your health plan or to Medicare.
Health care
operations:
We will use and share medical information
about you for our health care operations. Examples are using
information about you to improve the quality of care we give you,
for disease management programs, patient satisfaction surveys,
compiling medical information, de-identifying medical information
and benchmarking.
Appointment
reminders:
We may contact you with appointment
reminders.
Treatment options
and health-related benefits and services:
We may
contact you about possible treatment options, health-related
benefits or services that you might want.
Fund-raising
activities:
We may use limited information to
contact you for fundraising. We may also share such
information with our fundraising foundation.
Research:
We may share
your medical information for research projects, such as studying
the effectiveness of a treatment you received. We will
usually get your written permission to use or share medical
information for research. Under certain
circumstances we may share medical information about you without
your written permission however these research projects must go
through a special process that protects the confidentiality of your
medical information.
Facility
Directory:
Unless you tell us otherwise, we may list your
name, location in the hospital, your general condition (good, fair,
etc.) and your religious affiliation in our directory. We
will give this information (except your religious affiliation) to
anyone who asks about you by name. Your religious affiliation
will be given only to appropriate clergy members.
Public
Health:
We will report certain medical information for
public health purposes. For example, we are required by law
to report births, deaths and certain diseases to the state.
We may also report problems with medicines or medical products to
the manufacturer and to the FDA. We may tell you about
recalls of products you are using.
Required by
Law:
We are sometimes required by law to report certain
information. For example, we must report abuse or
neglect. We also must give information to your employer
about work-related illness, injury or workplace-related
medical surveillance. Another example is that we will share
information about tumors with state tumor registries for their
research purposes.
Public
Safety:
We may, and sometimes have to share medical
information about you in order to prevent or lessen a serious
threat to the health or safety of a particular person or the
general public.
Health Oversight
Activities:
We may share medical information about you for
health oversight activities, audits or inspections.
Coroners, Medical
Examiners and Funeral Directors:
We may share medical
information about deceased patients with coroners, medical
examiners and funeral directors.
Organ and Tissue
Donation:
We may share medical information with
organizations that handle organ, eye or tissue donation or
transplantation.
Military,
Veterans, National Security and Other Government Purposes:
We may use or share medical information about you for national
security purposes. We may share medical information about you with
the military for military command purposes when you are a member of
the armed forces.
Judicial
Proceedings:
We may use or share medical information about
you in response to court orders or subpoenas only when we have
followed procedures required by law.
Law Enforcement
California:
We may share medical information about
you with police (or other law enforcement personnel) without your
written permission:
-
If the police bring you to the hospital and ask us to test
your blood for alcohol or substance abuse
-
If the police present a valid search warrant
-
If the police present a valid court order
-
To report abuse, neglect, or assaults as required or
permitted by law
-
To report certain threats to third parties
-
If you are in police custody or are an inmate of a
correctional institution and the information is necessary to
provide you with health care, to protect your health and
safety, the health and safety of others or for the safety and
security of the correctional institution.
Family Members and
Others Involved in Your Care:
Unless you tell us
otherwise, we may share medical information about you with friends,
family members, or others you have named who help with your
care. We may use or share medical information about you with
disaster organizations so that your family can be notified of your
location and condition in case of disaster or other emergency.
YOUR RIGHTS REGARDING MEDICAL INFORMATION
Requesting
Information about You:
In most cases, when you ask in
writing, you can look at or get a copy of medical information about
you. We will give you a form to fill out to make the
request. You can look at medical information about you for
free. If you request copies of the information we may charge a fee
for the cost of copying, mailing or other related supplies.
If we say no to your request to look at the information or get a
copy of it, you may ask us in writing for a review of that
decision.
Correcting
Information about You:
If you believe that information
about you is wrong or missing, you can ask us in writing to correct
the records. We will give you a form to fill out to
make the request. We may say no to your request to correct a
record if the information was not created or kept by us or if we
determine the record is complete and correct. If we say no to
your request, you can ask us in writing to review that denial.
Obtaining a List
of Certain Disclosures of Information:
You can ask in
writing for a listing of every time we have shared medical
information about you, other than for treatment, payment, health
care operations or where you have given us written permission for
the sharing. Your request must state the time period for the
listing, which must be less than 6 years starting after April 14,
2003. The first request in a 12-month period is free.
We will charge you for any additional requests for our cost of
producing the list. We will give you an estimate of the cost
when you request the additional list.
Restricting How We
Use or Share Information about You:
You can ask that
medical information be given to you in a confidential manner.
You must tell us in writing of the exact way or place for us to
communicate with you.
You also can ask in writing that we limit our
use or sharing of medical information about you. For example,
you can ask that we use or share medical information about you only
with persons involved in your care. We will consider
your request but we may not be able to agree to it. We are
not legally required to agree to your request. We will tell
you of our decision on your request.
All written requests or requests for review
of denials should be given to our Facility Privacy Office listed at
the end of this notice.
CHANGES TO THIS NOTICE
We may change our privacy practices from time
to time. Changes will apply to current medical information,
as well as new information after the change occurs. If we
make an important change, we will change our notice. We will
also post the new notice in our facilities and on our Web site at:
www.chwHEALTH.org/privacy
. You can ask in
writing for a copy of this notice at any time by contacting the
Facility Privacy Office. If our notice has changed, we will
give you a copy of the notice the next time you register for
treatment.
DO YOU HAVE CONCERNS OR COMPLAINTS?
If you think your privacy rights may have
been violated, you may contact our Facility Privacy Office (listed
below). You may also contact our Chief Privacy and Data
Security Administrator at (415) 438-5565. Finally, you may
send a written complaint to the U.S. Department of Health and Human
Services, Office of Civil Rights. Our Facility Privacy Office
can provide you the address. We will not take any action
against you for filing a complaint.
Catholic Healthcare
West
Privacy Office
185 Berry Street
Lobby 5, Suite 300
San Francisco, CA 94107
Tel: (415) 438-5565
Fax: (415) 591-2436
www.chwHEALTH.org/privacy
CHW General Information Tel:
415-438-5700
Version effective: December 17,
2004
