NOTICE OF PRIVACY PRACTICES
EFFECTIVE DATE: April 2015
This notice describes how medical information tungkol sa you may be used at disclosed at how you can get access to this information.
This notice will explain how Jordan Valley Community Health Center (JVCHC) may use and disclose your medical information, the obligations related to the use and disclosure of your medical information and your rights related to any medical information that JVCHC has about you. This notice applies to the medical records that are generated in or by JVCHC clinics, school services, mobile services, home services, and nursing home services known hereafter as Jordan Valley entities. Please note that behavioral health records are considered part of the medical record and will be released as such.
This notice also describes the practices of JVCHC and that of any service provider acting on behalf of the organization with regards to your Protected Health Information (PHI) created while you are a patient of Jordan Valley entities. All providers and personnel acting on behalf of JVCHC are also subject to this notice. In addition, providers and staff working collaboratively may share medical information with each other for treatment, payment, or health operations described in this notice. As required by law, JVCHC ensures that medical information that identifies you is kept private, that you have access to privacy policies regarding JVCHC legal duties, and that these policies are current.
As a patient of Jordan Valley entities, you understand that the providers participating in your care at JVCHC may not be employees or agents of Jordan Valley entities and may not be acting for or on behalf of JVCHC, but are independent providers who have been granted privileges to use JVCHC facilities for the care of our patients. As a patient of Jordan Valley entities, you understand that medical decisions regarding your care and treatment may be made by such physicians and not by JVCHC.
If you have any questions about the contents of this Notice of Privacy Practices, or if you need to contact someone at this site about any of the information contained in this Notice of Privacy Practices, please contact:
Privacy Officer, PO Box 5681, Springfield, MO 65801 Phone: (417) 851-1556.
In addition to clinic departments, employees, physicians, dentists, and other JVCHC personnel, the following persons will also follow the practices described in this Notice of Privacy Practices:
- Any health care professional who is authorized to enter information in your medical record.
- Any member of a volunteer group that we allow to help while you are within our facilities, any student, resident, or intern.
USE AND DISCLOSURE OF MEDICAL INFORMATION
JVCHC can use or disclose medical information about you regarding treatment, payment for services or for health care operations. JVCHC may also disclose your protected health information (PHI) for the treatment activities of another provider, the payment activities of another provider, and certain limited health care operations of another collaborative entity.
For Treatment: To provide you with medical treatment or services, JVCHC may need to use or disclose information about you to doctors, dentists, nurses, technicians, health care students, or other personnel who are involved in your treatment. Departments within JVCHC’s operations may share medical information about you to coordinate your care. JVCHC may also disclose medical information about you to people who may be involved in your medical care after you leave JVCHC facilities such as home health agencies, your family, emergency personnel, or long-term care facilities.
For Payment: JVCHC may use and disclose your medical information to bill and receive payment for the treatment that you receive from JVCHC.
For Health Care Operations: JVCHC may use and disclose your medical information for health care operations. Medical information about you and other JVCHC patients may be combined to evaluate the quality or effectiveness of JVCHC’s operations, to compare information to other health care organizations, or to improve JVCHC services. To protect your privacy, when combining information, we will remove any information that identifies you, known as “facially de-identified information.”
Related Benepisyo at Mga serbisyo: JVCHC may use and disclose Health Information to contact you to remind you that you have an appointment with us. JVCHC also may use and disclose Health Information to tell you about treatment alternatives or health-related benefits and services that may be of interest to you.
Individuals Involved in Your Care or Payment for Your Care. When appropriate, JVCHC may share health Information with a person who is involved in your medical care or payment for your care, such as your family or a close friend. We also may notify your family about your location or general condition or disclose such information to an entity assisting in a disaster relief effort.
For Research: JVCHC may share your PHI with researchers with your authorization or when their research has been approved by an institutional review board (IRB) that has reviewed the research proposal and established protocols (waiver of permission) to ensure the privacy of your protected health information.
USES AND DISCLOSURES OF MEDICAL INFORMATION THAT DO NOT REQUIRE YOUR AUTHORIZATION:
JVCHC can use or disclose your medical information without authorization when there is an emergency, when JVCHC is required by law to use or disclose certain information, or when there are substantial communication barriers to obtaining authorization from you. The following circumstances may require that JVCHC use or disclose your health information without your authorization:
- When it is required by international, federal, state, or local law.
- When it involves use or disclosure for public health activities such as mandated disease reporting, etc;
- When reporting information about victims of abuse, neglect, or domestic violence
- When disclosing information f or the purpose of health oversight activities such as audits, investigations, licensure or disciplinary actions or legal proceedings or actions
- When as a result of a data breach, we may use or disclose your Protected Health Information to provide legally required notices of unauthorized access to or disclosure of your health information.
- When working with business associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. All of our business associates are obligated to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
- When disclosing information to collaborative organizations for the purposes of creating a limited data set which may include zip codes, dates of birth, or dates of service but may not contain patient identifiers such as name, address, phone number or social security number.
- When disclosing or using information for law enforcement purposes
- When disclosing or using information for organ and tissue donation purposes
- When we believe in good faith that the disclosure is necessary to avert a serious health or safety threat to you or the public’s safety
- When disclosure is necessary to comply with Worker’s Compensation laws or purposes
- When required by law to notify a person subject to the jurisdiction of the FDA for public health purposes related to the quality, safety or effectiveness of FDA regulated products or activities?
- When disclosure is necessary for specialized government functions
- When required by military command authorities; when you are a prison inmate, information can be released to the correctional facility in which you reside for the following purposes: for the institution to provide you with health care, to protect the safety of others, for the safety and security of the correctional facility.
PLANNED USES OR DISCLOSURES TO WHICH YOU MAY OBJECT:
JVCHC will use or disclose your health information for any of the purposes described in the previous section unless you affirmatively object to or otherwise restrict a particular release. You must direct your written objections or restrictions to: Privacy Officer, PO Box 5681, Springfield, MO 65801.
JVCHC may release health information about you to a friend and/or family member who is involved in your care. JVCHC can also give this information to someone who will or is helping to pay for your care.
JVCHC can disclose health information about you to a public or private entity that is authorized by law or its charter to assist in disaster relief efforts for the purpose of notification of family and/or friends of your where-abouts and condition.
OTHER USES OR DISCLOSURES:
The following uses and disclosures of your Protected Health Information will be made only with your written authorization:
- Uses and disclosures of Protected Health Information for marketing purposes; at
- Disclosures that constitute a sale of your Protected Health Information. Other uses and disclosures of Protected Health Information not covered by this Notice or the laws that apply to JVCHC will be made only with your written authorization. If you provide JVCHC written authorization to use or disclose information, you can change your mind and revoke your authorization in writing at any time. If you revoke your authorization, JVCHC will no longer use or disclose your private information. However, JVCHC will not be able to take back any disclosures that JVCHC made prior to the date of your written notice of revocation.
YOUR HEALTH INFORMATION RIGHTS
Although your health record is the property of Jordan Valley Community Health Center, you have the right to:
- Request restrictions: You have the right to request that JVCHC restrict any use or disclosure of your health information. However, JVCHC is not required to agree to any request unless you are asking JVCHC to restrict the use and disclosure of your Protected Health Information to a health plan for payment or health care operation purposes and such information you wish to restrict pertains solely to a health care item or service for which you have paid JVCHC “out-of- pocket “In full. If restriction is agreed upon, JVCHC will comply with your request unless the information is needed to provide you with emergency treatment. Any request to restrict uses or disclosures must be made in writing to the Privacy Officer at JVCHC. Your request must indicate what information you want limited; whether you want to limit JVCHC’s use, disclosure, or both; and to whom you want the limits to apply.
- Request Confidential Communications: You have the right to request that JVCHC communicate with you about medical matters in a certain way or at a certain location. To request confidential communications, you must make your request, in writing, to the Privacy Officer at JVCHC. Your request must specify how or where you wish to be contacted. We will accommodate reasonable requests.
- Notice of Breach: You have the right to be notified upon a breach of any of your unsecured Protected Health Information.
- An Electronic Copy of Electronic Medical Records: If your Protected Health Information is maintained in an electronic format (known as an electronic medical record or an electronic health record), you have the right to request that an electronic copy of your record be given to you or transmitted to another individual or entity. JVCHC will make every effort to provide access to your Protected Health Information in the form or format you request if it is readily producible in such form or format. If the Protected Health Information is not readily producible in the form or format you request, your record will be provided in either the JVCHC standard electronic format or if you do not want this form or format, a readable hard copy form. JVCHC may charge you a reasonable, cost-based fee for the labor associated with transmitting the electronic medical record.
- Inspect and Copy your Protected Health Information (PHI): You have the right to inspect and copy your protected health information that may be used to make decisions about your care, except for psychotherapy notes. If you want to see or copy your medical information, you must submit your request in writing to Jordan Valley’s privacy Officer. If you request copies, the state-allowed fee will be assessed for the cost associated with your request, including the cost of copies, mailing or other supplies.
Tandaan: In limited circumstances JVCHC may deny access to your health information. If access is denied, you can request that the denial be reviewed. Another licensed health care professional chosen by JVCHC will review your request and the denial. JVCHC will adhere to the decision of the reviewer.
Request Amendment to your Protected Health Information (PHI): You have the right to request that your health information be amended (changed) if you believe that it is incorrect or incomplete. You have a right to request changes for as long as the information is retained by JVCHC. To request a change in your PHI, you must submit in writing a request to JVCHC’s Privacy Officer which includes the reason you think the information is incorrect or incomplete and specification as to whom you want notified of the change. JVCHC must notify you within 60 days upon receipt of your written request. This period may be extended by 30 days provided we notify you of our reason for the delay and the expected date of completion.
Tandaan: JVCHC may deny your request if it is not in writing and if it does not include a reason the information should be changed. JVCHC can also deny your request for the following reasons: the information in question was not created by JVCHC or the individual or outside entity is no longer available; the information is not maintained as part of your medical records at JVCHC; the information is not part of the information that you would be permitted to inspect or copy; or JVCHC has reason to believe that the information is accurate and complete.
Accounting of Disclosures: You have the right to receive an accounting of disclosures of medical
information that we have made, with some expectations. You must submit a written request to JVCHC’s Privacy Officer the specific time period of the request and how you want the information reported to you. Re-quests cannot be made for periods longer than six years and may not include dates prior to January 1, 2003. You have the right to receive a free accounting of disclosures every twelve months. If you request more than one accounting in a single twelve-month period, the state-allowed fee will be assessed for the cost associated with your request including the cost of copies, mailing, or other supplies. JVCHC will notify you of the charge for such a request and you will have the opportunity to withdraw or change your request before any cost is incurred. Disclosures made prior to an authorization signed by you or your representatives are exempt from the accounting or disclosures policy.
Receive a Copy of this Notice of Privacy Practices: Even if you have agreed to receive this notice in another form, you can still have a paper copy of this notice. To obtain a paper copy of this notice, contact the medical records department or the Privacy Officer. You can also obtain a copy of this notice at our website: www.jordanvalley.org.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a written complaint with the JVCHC Privacy Officer at PO Box 5681, Springfield, MO 65801, or by completing a Feedback Form located on the Jordan Valley website, www.jordanvalley.org. You may also contact the Jordan Valley Privacy Officer at 417-851-1556. You may file a complaint with the Secretary of the US Department of Health and Human Services, 200 Independence Avenue, Washington, D.C. 20201 or by calling the Office of Civil Rights at 1(800) 368-1019, 1(800) 537-7697 (TDD). Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
According to the law, you will not be retaliated against nor intimidated for filing a complaint with any Jordan Valley entity or the U.S. Department of Health and Human Services.
CHANGES TO THIS NOTICE OF PRIVACY PRACTICES
JVCHC reserves the right to change or modify this Notice of Privacy Practices. Any changes can be made effective for any health information that JVCHC has or might obtain about you. Each time you receive services from Jordan Valley entities, you will have the opportunity to review the most current version of our Notice of Privacy Practices. The most current version of our Notice of Privacy Practices will be posted in JVCHC clinics or may be obtained from the Privacy Officer.