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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.
Understanding your Health Record/Information
Each time you visit any of our facilities, a record of your
visit is made. Our facilities include: Graham Hospital, Graham
Wellness Center, Extended Care, Spoon River Hospice of Graham
Hospital, Graham Medical Equipment, Graham Home Care and
Graham Hospital Adult Life Center. Our delivery sites include
Canton, Farmington and Havana locations. We share protected
health information with each other for treatment, payment
or healthcare operations. Typically, this record contains
your symptoms, examination and test results, diagnoses, treatment,
a plan for future care or treatment, and billing information.
This information, often referred to as your health or medical
record, 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.
- Tool in education for health professionals.
- Source of data for medical research.
- Source of information for public health officials.
- Source of data for facility planning and marketing.
- 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 your health
information is used helps you to: ensure its accuracy, better
understand who, what, when, where, and why others may access
your health information, and make more informed decisions
when authorizing disclosure to others.
Our Responsibilities
Our facility is required to:
- Maintain the privacy of your health information.
- Provide you with this 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 your requested
restriction.
- Accommodate reasonable requests you may have to communicate
health information by alternative means or to an alternative
location.
We reserve the right to change our practices and to make
the new provisions effective for all protected health information
we maintain. Should our information practices change, the
current Notice reflecting these changes will be posted in
a clear and prominent location where it is expected that
individuals seeking service will be able to read the Notice
and will be available to you upon your request. We will not
use or disclose your health information without your authorization,
except as described in this notice.
How We Will Use or Disclose Your Health Information
(1) Treatment: We will use your health information
for treatment. For example, information obtained by a nurse,
physician, or other members of your healthcare team will
be recorded in your record and used to determine the course
of treatment that should work best for you. Your physician
will document in your record his or her expectations of
the members of your healthcare team. Members of your healthcare
team will then record the actions they took and their observations.
In that way, the physician will know how you are responding
to treatment. Once you are discharged from our facility,
copies of various reports may be sent to healthcare providers
involved in your treatment.
(2) Payment: We will use your health information
for payment. For example, a bill may be sent to you, your
insurance carrier, or Medicare or Medicaid. The information
on or accompanying the bill may include information that
identifies you, as well as your diagnosis, procedures,
and supplies used.
(3) Healthcare Operations: We will use your health
information for regular health operations. For example,
members of the medical staff, the risk or quality improvement
manager, or members of the quality improvement team may
use information in your health record to assess the care
and outcomes in your case and others like it. This information
will then be used in an effort to continually improve the
quality and effectiveness of the healthcare and service
we provide.
(4) Business Associates: There are some services
provided in our organization through contacts with business
associates. Examples include our accountants, medical or
non-medical consultants and attorneys. When these services
are contracted, we may disclose your health information
to our business associates so that they can perform the
job we’ve asked them to do. To protect your health
information, however, we required the business associates
to appropriately safeguard your information.
(5) Directory: Unless you notify us that you object,
we may use your name, location in the facility, 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 also use your name on a
nameplate next to or on your door in order to identify
your room.
(6) Notification: We may use or disclose information
to notify or assist in notifying a family member, personal
representative, or another person responsible for your
care, of your location, general condition, or death. If
we are unable to reach your family member or personal representative,
then we may leave a message for them at the phone number
that they have provided us, e.g., on an answering machine.
(7) Communication with Family: Health professionals,
using their best judgment, may disclose health information
to a relative, close personal friend or any other person
you identify to have access to that information.
(8) Appointment Reminders: We will call you for pre-registration
information and appointment reminders unless we receive
notification of your objection to do so.
(9) Funeral Directors: We may disclose health information
to funeral directors and coroners to carry out their duties
consistent with applicable law.
(10) Organ Procurement Organizations: Consistent
with applicable 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.
(11) Marketing: We may contact you to provide information
about treatment alternatives or other health-related benefits
and services that may be of interest to you.
(12) 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.
(13) 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
or other similar programs established by law.
(14) 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.
(15) 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.
(16) Law Enforcement: We may disclose health information
for law enforcement purposes as required by law or in response
to a valid subpoena or court order.
(17) Reports: 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.
Your Health Information Rights
Although your health record is the physical property of
Graham Hospital, the information in your health record belongs
to you. You have the following rights:
- You may request that we not use or disclose your health
information for a particular reason related to treatment,
payment, our facility’s general healthcare operations,
and/or to a particular family member, other relative or
close personal friend. We ask that such requests be made
in writing on a form provided by our facility. Although
we will consider your request, please be aware that we
are under no obligation to accept it or to abide by it.
For a Restriction request form, please contact the Patient
Registration Department.
- If you are dissatisfied with the manner in which or
the location where you are receiving communications from
us that are related to your health information, you may
request that we provide you with such information by alternative
means or at alternative locations. Such a request must
made in writing, and submitted to “Cashier, Graham
Hospital, 210 W. Walnut Street, Canton, IL 61520, ATTN:
HIPAA”. We will attempt to accommodate all reasonable
requests.
- You may request to inspect and/or obtain copies of health
information about you, which will be provided to you in
the timeframes established by law. If you request copies,
we will charge you a fee prescribed by law. We ask that
you use the form provided by our facility to request access
to your health information. To obtain a Request for Health
Information Access form, please contact the Medical Records
Department.
- If you believe that any health information in your record
is incorrect or if you believe that important information
is missing, you may request that we amend the existing
information or add the missing information. All requests
will be reviewed for approval or denial. Such requests
must be made in writing, and must provide a reason to support
the amendment. We ask that you use the form provided by
our facility to make such requests. For an Amendment request
form, please contact the Graham Hospital Medical Records
Department.
- You may request that we provide you with a written accounting
of all disclosures made by us during the time period for
which you request (not to exceed 6 years). We ask that
such requests be made in writing on a form provided by
our Medical Records Department. Please note that an accounting
will not apply to any of the following types of disclosures:
disclosures made for reasons of treatment, payment or healthcare
operations; disclosures made to you or your legal representative,
or any other individual involved with your care; disclosures
to correctional institutions or law enforcement officials;
and disclosures for national security purposes. You will
not be charged for your first accounting request in any
12-month period. However, for any requests that you make
thereafter, you will be charged a reasonable, cost-based
fee.
- You have the right to obtain a paper copy of this Notice
of Information Practices upon request.
- You may revoke an authorization to use or disclose health
information, except to the extent that action has already
been taken. Such a request must be made in writing.
For More Information or to Report a Problem
If you have questions and would like additional information,
you may contact our facility’s Privacy Officer at (309)
647-5240.
If you believe that your privacy rights have been violated,
you may file a complaint with us. These complaints must be
filed in writing on a form provided by our facility. The
complaint form may be obtained from Patient Registration,
Switchboard, Business Services, or Medical Records Department.
When completed please return the form to the Graham Hospital
Privacy Officer at “Graham Hospital, 210 W. Walnut
Street, Canton, IL 61520 ATTN: Privacy Officer.”
You may also file a complaint with the secretary of the Federal
Department of Health and Human Services. There will be no
retaliation for filing a compliant.
Effective Date: April 14, 2003
Click here for a printable version
of the Notice of Information Practices
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