GOLDEN UMBRELLA
Joint Notice of Privacy Practices for Medical Information
THIS NOTICE DESCRIBES HOW PERSONAL HEALTH 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?
Golden Umbrella provides you (the client) 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:
Ø any health care provider who comes to Golden Umbrella to care for you. These professionals include doctors, nurses, technicians, physician assistants and others.
Ø
all departments and units of our organization,
including nursing,
Ø our
employees, contractors, students and volunteers, including regional support
offices and affiliates.
OUR PLEDGE TO YOU
We understand that
health 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 Golden Umbrella
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:
Ø keep personal health information
about you private.
Ø give you this notice describing our
legal duties and privacy practices for healthcare information about you.
Ø 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 healthcare 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 healthcare information. You can later cancel your permission by
notifying us in writing.
We
will protect healthcare information as much as we can under the law. Sometimes state law gives more protection
to healthcare information than federal law.
Sometimes federal law gives more protection than state law. In each case, we will apply the laws that
protect healthcare information the most.
Catholic Healthcare West is a large
health system. We may use or share
healthcare 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
healthcare 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 healthcare 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 healthcare 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.
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.
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
• 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 personal 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 personal
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 healthcare 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.goldenumbrella.org. 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.
Golden
Umbrella
Facility
Privacy Office
200
Mercy
Redding,
CA 96003
(530)
223-6034(530) 223-0658
www.goldenumbrella.org
Golden Umbrella : (530)
223-6034
Version effective: December
31, 2004