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.
This notice will tell you how we may use and disclose protected health information about you. Protected health information means any health information about you that identifies you or for which there is a reasonable basis to believe the information can be used to identify you.
In this notice, we call all protected health information, “medical information.” Medical information includes medical insurance and payment information, such as your diagnosis, medications or medical payment history, which identifies you. Where state or federal law restricts one of the described uses or disclosures, we follow the requirements of such state and federal law.
These are general descriptions only. They do not cover every example of disclosure within a category. This notice will also tell you about your rights and our duties with respect to medical information about you. In addition, it will tell you how to file a complaint if you believe we have violated your privacy rights.
This notice describes the privacy practices of Mahaska Health Partnership and all of its programs and Departments.
This notice also describes the privacy practices of an “organized health care arrangement” or “OHCA” between MHP and eligible providers on our medical staff. Because MHP is a clinically-integrated care setting, our patients receive care from our staff and from independent practitioners on the medical staff. MHP and its medical staff must be able to share your medical information freely for treatment, payment and healthcare operations as described in this notice. Because of this, MHP and all eligible providers on the medical staff have entered into the OHCA under which MHP and the eligible providers will:
a. Use this notice as a joint notice of privacy practices for all inpatient and outpatient visits and follow all
b. Obtain a single, signed acknowledgement of receipt; and,
c. Share medical information from inpatient and outpatient visits with eligible providers so they can help
The OHCA does not cover the information practices of practitioners in their private offices or at other practice locations.
Uses and Disclosures without your authorization
The following are the types of uses and disclosures we may make of your medical information without your permission:
We may use medical information about you to provide, coordinate or manage your healthcare and related services by both us and other healthcare providers. We may disclose medical information about you to doctors, nurses, hospitals, pharmacies, DME companies and other health facilities who become involved in your care. We may consult with other healthcare providers concerning you and as part of the consultation share your medical information with them. Similarly, we may refer you to other healthcare providers and as part of the referral
share medical information about you with that provider. For example, we may conclude you need to receive services from a physician, we will contact that physician’s office and provide medical information about you to them so they have information they need to provide services to you.
We may use and disclose medical information about you so we can be paid for the services we provide to you. This can include billing you, your insurance company or a third party payor. For example, we may need to give your insurance company information about the healthcare services we provide to you so your insurance company will pay us for those services or reimburse you for amounts you have paid. We may also need to provide your insurance company or a government program, such as Medicare or Medicaid, with information about your
medical condition and the healthcare you need to receive to determine if you are covered by that insurance or program.
For Healthcare Operations
We may use and disclose medical information about you for our own healthcare operations. These are necessary for us to operate MHP and to maintain quality healthcare for our clients. For example, we may use medical information about you to review the services we provide and the performance of our employees in caring for you. We may disclose medical information about you to train our staff, volunteers and students working at MHP. We may also use the information to study ways to more effectively manage our organization.
How We Will Contact You
Unless you tell us otherwise in writing, we may contact you by either telephone or by mail at either your home or your workplace. At either location, we may leave messages for you on the answering machine or voice mail. If you want to request that we communicate with you in a certain way or at a certain location, see “Right to Receive Confidential Communications” later in this Notice.
We may use and disclose medical information about you to remind you of an appointment you have with us.
We may use and disclose medical information about you to contact you about treatment alternatives that may be of interest to you.
We may include your name, location in the hospital, general condition and religious affiliation in a hospital directory. 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 will not include your information in the directory if you object or if we are prohibited by state or federal law.
We may use and disclose medical information about you to communicate with you about a product or service to encourage you to purchase the product or service. This may be:
• To describe a health-related product or service that is provided by us;
• For your treatment;
• For case management or care coordination for you;
• To direct or recommend alternative treatments, therapies, healthcare providers or settings of care.
We may communicate to you about products and services in a face-to-face communication by us to you. We may also communicate about products or services in the form of a promotional gift of nominal value.
All other use and disclosure of medical information about you by us to make a communication about a product or service to encourage the purchase or use will be done only with your written authorization.
Health-Related Benefits and Services
We may use and disclose medical information about you to contact you about health-related benefits and services that may be of interest to you.
Family, Friends and Individuals Involved in Your Care
We may disclose your location or general condition to a family member or your personal representative. If any of these individuals are involved in your care, we may disclose to a family member, other relative, a close personal friend or any other person identified by you; medical information about you that is directly relevant to that person’s involvement with your care or payment related to your care. We may also use or disclose medical information about you to notify, or assist in notifying, those persons of your location, general condition or death.
If there is a family member, other relative or close personal friend that you do not want us to disclose medical information about you to, please notify the MHP Health Information Department.
We may use or disclose medical information about you to a public or private entity authorized by law or by its charter to assist in disaster relief efforts. This will be done to coordinate with those entities in notifying a family member, other relative, close personal friend or other person identified by you of your location, general condition or death.
Required by Law
We may use or disclose medical information about you when we are required to do so by law.
Public Health Activities
We may disclose medical information about you for public health activities and purposes. This includes reporting medical information to a public health authority that is authorized by law to collect or receive the information for purposes of preventing or controlling disease that is authorized to receive reports of child abuse and neglect. It also includes reporting for purposes of activities related to the quality, safety or effectiveness of a United States Food and Drug Administration regulated product or activity.
Victims of Abuse, Neglect or Domestic Violence
We may disclose medical information about you to a government authority authorized by law to receive reports of abuse, neglect or domestic violence, if we believe you are a victim of abuse, neglect or domestic violence. This will occur to the extent the disclosure is: (a) required by law; (b) authorized by law and we believe the disclosure is necessary to prevent serious harm to you or to other potential victims, or, if you are incapacitated and certain other conditions are met, a law enforcement or other public official represents that immediate enforcement activity depends on the disclosure.
Health Oversight Activities
We may disclose medical information about you to a health oversight agency for activities authorized by law, including audits, investigations, inspections, licensure or disciplinary actions. These and similar types of activities are necessary for appropriate oversight of the healthcare system, government benefit programs and entities subject to various government regulations.
We may use certain information (name, address, telephone numbers, dates of service, age, gender and insurance status) to contact you in the future to raise money for Mahaska Health Partnership. We may also provide this name to our institutionally-related foundation only, for the same purpose. The money raised will be used to expand and improve the services and programs we provide the community. If you do not wish to be contacted for fundraising efforts or wish to have your name removed from the list to receive fundraising requests supporting Mahaska Health Partnership in the future, please notify our Marketing and Development Director at 1229 C Avenue East, Oskaloosa, Iowa 52577 in writing.
If memorials are established for donations to our agency, the memorial may be published in a newsletter.
Judicial and Administrative Proceedings
We may disclose medical information about you in the course of any judicial or administrative proceedings in response to an order of the court or administration tribunal. We also may disclose medical information about you in response to a subpoena, discovery request or other legal process but only if efforts have been made to tell you about the request or to obtain an order protecting the information to be disclosed.
Disclosures for Law Enforcement Purposes
We may disclose medical information about you to a law enforcement official for law enforcement purposes:
• As required by law
• In response to a court, grand jury or administrative order, warrant or subpoena
• To identify or locate a suspect, fugitive, material witness or missing person
• About an actual or suspected victim of a crime and that person agrees to the disclosure. If we are unable
• To alert law enforcement officials to a death if we suspect the death may have resulted from criminal
• About crimes that occur at our facility
• To report a crime in emergency circumstances
Coroners and Medical Examiners
We may disclose medical information about you to funeral directors as necessary for them to carry out their duties.
Organ, Eye or Tissue Donation
To facilitate organ, eye or tissue donation and transplantation, we may disclose medical information about you to organ procurement organizations or other entities engaged in the procurement, banking
or transplantation of organs, eyes or tissue.
Under certain circumstances, we may use or disclose medical information about you for research. Before we disclose medical information for research, the research will have been approved through an approval process that evaluates the needs of the research project with your needs for privacy of your medical information. We may, however, disclose medical information about you to a person who is preparing to conduct research to permit them to prepare for the project, but no medical information will leave MHP during that person’s review of the information.
To Avert Serious Threat to Health or Safety
We may use or disclose protected health information about you if we believe the use or disclosure is necessary to prevent or lessen serious or imminent threat to the health or safety of a person or the public. We also may release information about you if we believe the disclosure is necessary for law enforcement authorities to identify or apprehend an individual who admitted participation in a violent crime or who is an escapee from a correctional institution or from lawful custody.
National Security and Intelligence
We may disclose medical information about you to authorized federal officials for the conduct of intelligence, counter-intelligence and other national security activities authorized by law.
Protective Services for the President
We may disclose medical information about you to authorized federal officials so they can provide protection to the President of the United States, certain other federal officials or foreign heads of state.
Inmates and/or Persons in Custody
We may disclose medical information about you to a correctional institution or law enforcement official having custody of you. The disclosure will be made if the disclosure is necessary: (a) to provide healthcare to you; (b) for the health and safety of others, or; (c) the safety, security and good order of the correctional institution.
We may disclose medical information about you to the extent necessary to comply with workers’ compensation and similar laws that provide benefits for work-related injuries or illness without regard to fault.
Other Uses and Disclosures
Other uses and disclosures will be made only with your written authorization. You may revoke such an authorization at any time by notifying MHP in writing of your desire to revoke it. However, if you revoke such an authorization, it will not have any effect on actions taken by us in reliance on it.
Your Rights With Respect to Medical Information About You
You have the following rights with respect to medical information that we maintain about you:
Right to Request Restriction
You have the right to request that we restrict the uses or disclosure of medical information about you to carry out treatment, payment or healthcare operations. You also have the right to request that we restrict the uses of disclosures we make to: (a) a family member, other relative, a close personal friend or any other person identified by you; or, (b) public or private entities for disaster relief efforts. For example, you could ask that we not disclose medical information about you to your brother or sister.
To request a restriction, you may do so at the time you complete your consent form or at any time after that time. If you request a restriction after that time, you should do so in writing to the MHP Health Information Department and tell us: (a) what information you want to limit; (b) whether you want to limit use or disclosure or both; and, (c) to whom you want the limits to apply (for example, disclosures to your spouse).
We are not required to agree to any requested restriction. However, if we do agree, we will follow that restriction unless the information is needed to provide emergency treatment. Even if we agree to a restriction, either you or we can later terminate the restriction.
Right to Receive Confidential Communications
You have the right to request that we communicate medical information about you to you in a certain way or at a certain location. For example, you can ask that we only contact you by mail or at work. We will not require you to tell us why you are asking for the confidential communication.
If you want to request confidential communication, you must do so in writing to the MHP Health Information Department. Your request must state how or where you can be contacted.
We will accommodate your request. However, we may, when appropriate, require information from you concerning how payment will be handled. We may also require an alternate address or other method to contact you.
Right to Inspect and Copy
With a few very limited exceptions, such as psychotherapy notes, you have the right to inspect and obtain a copy of medical information about you.
To inspect or copy medical information about you, you must submit your request in writing to the MHP Health Information Department. Your request should state specifically what medical information you
want to inspect or copy. If you request a copy of the information, we may charge a fee for the costs of copying and, if you ask that it be mailed to you, the cost of mailing.
We will act on your request within 30 calendar days after we receive your request. If we grant your request, in whole or in part, we will inform you of our acceptance of your request and provide access and copies.
We may deny your request to inspect and copy medical information if the medical information involved is:
• Psychotherapy notes
• Information compiled in anticipation of, or use in, a civic, criminal or administrative action or
• “Protected Health Information” subject to the Clinical Laboratory Improvements Amendments
If we deny your request, we will inform you of the basis for the denial, how you may have our denial reviewed and how you may complain. If you request a review of our denial, it will be conducted by a licensed healthcare professional designated by us who was not directly involved in the denial. We will comply with the outcome of that review.
Right to Amend
You have the right to ask us to amend medical information about you. You have this right for so long as the medical information is maintained by us.
To request an amendment, you must submit your request in writing to the MHP Health Information Department. Your request must state the amendment desired and provide a reason in support of that amendment.
We will act on your request within 60 calendar days after we receive your request. If we grant your request, in whole or in part, we will inform you of our acceptance of your request and provide access and copying.
If we grant the request, in whole or in part, we will seek your identification of and agreement to share the amendment with relevant other persons. We also will make the appropriate amendment to the
medical information by appending or otherwise providing a link to the amendment.
We may deny your request if it is not in writing and does not provide a reason in support of the amendment. In addition, we may deny your request to amend medical information if we determine that the information:
• Was not created by us, unless the person or entity that created the information is no longer available to act on
• Is not part of the medical information maintained by us
• Would not be available for you to inspect or copy
• Is accurate and complete
If we deny your request, we will inform you of the basis for the denial. You will have the right to submit a statement of disagreeing with our denial. Your statement may not exceed one page. We may prepare a rebuttal to that statement. Your request of re-amendment, our denial of the request, your statement of disagreement, if any, and our rebuttal, if any, will then be appended to the medical information involved or otherwise linked to it. All of that will then be included with any subsequent disclosure of the information, or, at our election, we may include a summary of any of that information.
If you do not submit a statement of disagreement, you may ask that we include your request for amendment and our denial with any future disclosures of the information. We will include your request for amendment and our denial (or summary of that information) with any subsequent disclosure of the medical information involved.
You also have the right to complain about our denial of your request.
Right to an Accounting of Disclosures
You have the right to receive an accounting of disclosures of medical information about you. The accounting may be for up to six years prior to the date on which you request the accounting but not before April 14, 2003.
Certain types of disclosures are not included in such an accounting:
• Disclosures to carry out treatment, payment and healthcare operations
• Disclosures of your medical information made to you
• Disclosures that are incident to another use or disclosure
• Disclosures that you have authorized
• Disclosures for our facility or the persons involved in your care
• Disclosures for disaster relief purposes
• Disclosures for national security or intelligence purposes
• Disclosures to correctional institutions or law enforcement officials having custody of you
• Disclosures that are part of a limited data set of purposes of research, public health or
• Disclosures made prior to April 14, 2003
Under certain circumstance your right to an accounting of disclosures to a law enforcement official or a health oversight agency may be suspended. Should you request an accounting during the period of time your right is suspended, the accounting would not include the disclosure or disclosures to a law enforcement official or a health oversight agency.
To request an accounting of disclosure, you must submit your request in writing to the MHP Health Information Department. Your request must state a time period for the disclosures. It may be no longer than six years from the date we receive your request and may not include dates before April 14, 2003.
Usually, we will act on your request within 60 calendar days after we receive your request. Within that time, we will either provide the accounting of disclosure to you or give you a written statement of whenwe will provide that accounting and why the delay is necessary.
There is no charge for the first accounting we provide to you in any 12 month period. For additional accountings, we may charge you for the cost of providing the list. If there will be a charge, we will notify you of the cost involved and give you an opportunity to withdraw or modify your request to avoid or reduce the fee.
Right to Copy of this Notice
This is your paper copy of our Notice of Privacy Practices.
We are required by law to maintain the privacy of medical information about you and to provide individuals with notice of our legal duties and privacy practices with respect to medical information.
We are requested to abide by the terms of Notice of Privacy Practices in effect at that time.
Our Right to Change Notice of Privacy Practices
We reserve the right to change this Notice of Privacy Practices. We reserve the right to make the new notice’s provisions effective for all medical information that we maintain, including that created or received by us prior to the effective date of the new notice.
Availability of Notice of Privacy Practices
A copy of our current Notice of Privacy Practices will be posted at mahaskahealth.org. At any time, you may obtain a copy of the current Notice of Privacy Practices by contacting the MHP Health Information Department.
Effective Date of Notice
The effective date of notice will be stated on the first page of this notice.
You may file a complaint with us and to the United State Secretary of Health and Human Services if you believe your privacy rights have been violated by us.
To file a complaint with us, contact Mahaska Health Partnership at 641-672-3100 and ask for the compliance hotline at extension 2111. You will need to leave your name, address and phone number and then you will be mailed a form to complete. All complaints must be submitted in writing.
To file a complaint with the United States Secretary of Health and Human Services, send your complaint to him or her in care of: Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue SW, Washington D.C. 20201
You will not be retaliated against for filing a complaint.
Questions and Information
If you have any questions or want more information concerning this Notice of Privacy Practices, please contact the Privacy Officer at MHP.
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1229 C Avenue East
Oskaloosa, Iowa 52577
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