CHI ST. ALEXIUS HEALTH - WILLISTON MEDICAL CENTER NOTICE OF PRIVACY PRACTICES
Effective Date: 04/13/2003
Revision Date: 10/2006
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.
For all written correspondence, please specify the department to mail to:
CHI St. Alexius Health - Williston Medical Center
1301 15th Ave W
Williston, ND 58801
If you have any questions about this notice, please contact CHI St. Alexius Health - Williston Medical Center's Privacy Officer at (701) 774-7400.
CHI St. Alexius Health - Williston Medical Center is 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 CHI St. Alexius Health - Williston Medical Center, 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 CHI St. Alexius Health - Williston 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
This Notice of Privacy Practices applies to all records generated by CHI St. Alexius Health - Williston Medical Center, including departments, medical staff, clinics, employees, volunteers, and affiliated programs and services.
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 CHI St. Alexius Health - Williston Medical Center Admissions Department at 701.774.7400 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 CHI St. Alexius Health - Williston 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 Williston Medical Foundation (701.774.7404) 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 and 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.