Joint Notice of Privacy Practices

Version 1. Effective Date: 4-14-2003

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.

Our duty to safeguard your protected health information:

Your present, past and future individually identifiable health information is considered "Protected Health Information" (PHI). PHI includes information about your health or condition(s), the health care services we provide to you, or payment for healthcare. We are required to extend certain protections to your PHI and to give you this Notice about our privacy practices that explains how, when, and why we may use or disclose your PHI. Except in specified circumstances, we must use or disclose only the minimum necessary PHI to accomplish the intended purpose of the use or disclosure.

We reserve the right to change our privacy practices and the terms of the Notice at any time but must abide by the one currently in effect. However, if there’s a change, a new Notice will be posted at the Admissions desk.

We use and disclose PHI for a variety of reasons. We have a limited right to use and/or disclose your PHI for purposes of treatment, payment, or our healthcare operations. For uses beyond that, we must have your written authorization unless the law permits or requires us to use or disclosure without your authorization. If we disclose your PHI to an outside entity in order for that entity to perform a function on our behalf, we must have in place an agreement with that entity that they will extend the same degree of privacy protection to your information that we must apply.

• FOR TREATMENT: We may use or disclose your PHI to doctors, nurses, or other healthcare personnel who are involved in providing your health care. For example, information obtained by nurses, physicians, or other members of our healthcare team will be recorded in your record and shared with our healthcare team members who have a need to know in order to diagnose and treat your condition, to provide care for you, and to help determine your best course of treatment. If necessary, your PHI may be shared with healthcare providers outside our facility so that they can help treat you.
• FOR PAYMENT: We may use or disclose your PHI in order to bill and collect payment for your healthcare service. For example, we may release PHI to your insurance company, Medicare, or other third party payers in order for them to consider payment of your bill.
• FOR HEALTHCARE OPERATIONS: We may use or disclose your PHI to help our facility improve the quality and effectiveness of the healthcare services that we provide. For example, patient’s PHI is often used by Quality, Risk, Medical Staff, and/or Safety committees to help them assess the performance of our staff, or the care and outcomes of your case and others like it.
• AS REQUIRED BY LAW: We may use or disclose your PHI when a law requires us to do so. For example, the Law requires us to report information about suspected abuse, neglect, domestic violence or suspected criminal activity. It requires some diseases or injury, or vital statistics information to be reported. It requires us to report for some types of legal investigations, research, or government functions for military personnel or veterans operations or to protect national security or avert threats to public health or safety. It requires us to report information relating to a patient’s death to coroners, medical examiners, funeral directors, and/or organ procurement organizations.
• FOR NOTIFICATION OF SERVICES AND APPOINTMENTS: We may use or disclose your PHI to contact you to provide appointment reminders or to provide information about treatment alternatives or other health-related benefits that may be of interest to you.
• FOR FUNDRAISING OR MARKETING: We may use or disclose your PHI, including certain demographic information and dates of service, to contact you to raise funds for the hospital. We may use or disclose your PHI for limited marketing activities without a written authorization, including face-to-face communication with you about our services. If you do not want to receive communications about fundraising, please contact the Privacy Officer, listed on Page 2 of this notice.

YOUR RIGHTS REGARDING YOUR PHI:

You have the right to object to uses and disclosures of the following:

• Patient Directories:
Your name and location in the facility may be put into our patient directory for disclosure to callers or visitors who ask for you by name. Additionally your religious affiliation may be shared with clergy.
• FAMILY OR FRIENDS or others involved in your care: We may share with the people, identified by you, information directly related to their involvement in your care, or payment for your care. We may also share PHI with these people to notify them about your location, general condition, or death.

YOUR RIGHTS REGARDING YOUR PHI:

YOU HAVE THE FOLLOWING RIGHTS CONCERNING YOUR PHI. TO EXERCISE ANY OF THESE RIGHTS, YOU MUST SUBMIT A REQUEST IN WRITING TO THE PRIVACY OFFICER IDENTIFIED BELOW:

You have the right to request restrictions on uses/disclosures: You have the right to request that we limit how we use or disclose your PHI. We will consider your request, but are not legally bound to agree to the restriction. To the extent that we do agree to an restriction on our use/disclosure of your PHI, we will put the agreement in writing and abide with it except in emergency situations. We cannot agree to limit uses/disclosures that are required by law.

You have the right to receive confidential communications and to choose how we contact you: You have the right to request that we send your information to an alternative address or by an alternative means. We must agree to your request as long as it is reasonably easy for us to do so.

You have the right to inspect and copy your PHI: Unless your access is restricted for clear and documented treatment reasons, or for specific regulatory exceptions, you have the right to see your protected health information upon your written request. We will respond to your request within 30 days. If we deny your access, we will give you written reasons for the denial and explain any right to have the denial reviewed. If you want copies of your PHI, a charge for copying may be imposed, depending on the circumstances. You have a right to choose what portions of your information you want copied and to have prior information at the cost of copying.

You have the right to request amendment of your PHI: If you believe that there is a mistake or missing information in our record of your PHI, you may request, in writing, that we correct or add to the record. We will respond within 60 days of receiving your request. We may deny the request if we determine that the PHI is 1) correct and complete; 2) not created by us and/or not part of our records, or 3) not permitted to be disclosed. Any denial will state the reasons for denial and explain your rights to have the request and denial, along with any statement in response that you provide, appended to your PHI. If we approve the request for amendment, we will addend the PHI, inform you, and make reasonable efforts to inform others who need to know, about the change in PHI.

You have a right to find out what disclosures have been made, when, to whom, for what purpose, and what content of your PHI has been released other than instances of disclosure; for treatment, payment, and operations; to you, your family, or the facility directory; or pursuant to your written authorization. The list also will not include any disclosures made for national security purposes, to law enforcement officials, correctional facilities, or disclosures made before April 2003. We will respond to your written request for such a list within 60 days of receiving it. Your request can relate to disclosures going back as far as six years, beginning from April14, 2003 prospectively. There will be no charge for one such list per year.

You have a right to receive this notice: You have a right to receive a paper copy of this Notice and any new Notices in the future upon request to the Privacy Officer, listed below.

You have a right to complain about our privacy practices: If you think we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a complaint with the Privacy Officer at 354-2383 or write to Teton Valley Hospital, Privacy Officer, 120 East Howard Avenue, Driggs, Idaho 83422. You may also file a written complaint with the Secretary of The U.S. Department of Health and Human Services; 200 Independence Avenue, S.W.; Washington, D.C. 20201; Telephone: 202-619-0257. We will take no retaliatory action against you if you make such complaints.

You have the right to ask questions. Please direct questions to the Privacy Officer listed in the above paragraph.

ENTITIES COVERED BY THIS NOTICE: This Joint Notice of Privacy Practices applies to Teton Valley Hospital (including its departments and units wherever located); its employees, staff, and other hospital personnel; and all volunteers whom we allow to help you while you are in the hospital. This also applies to all the members of the Medical Staff of Teton Valley Hospital concerning the services they perform at the hospital or at a hospital department. This Joint Notice of Privacy Practices also allows all members of the Medical Staff, who have agreed to form an Organized Healthcare Arrangement (OHCA) with us, in regards to our HIPAA privacy practices, to utilize our Joint Notice of Privacy Practices, if you are initially seen by them at our hospital. However, if you are seen at a later date at their offices or clinics, they may have different privacy practices relating to their use and disclosure of PHI and may request your signature on their Privacy Notice at that time. We are not responsible for our OCHA partners’compliance to HIPAA privacy practices when they are practicing outside our facility.