EFFECTIVE DATE: APRIL 14, 2003
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.
Who will follow this notice
This notice describes our practices and that
of:
> Any health care professional authorized to enter information into your
chart.
> All departments and units of each health care provider listed below.
> Any member
of a volunteer group we allow to help you while you are a patient of the
health care providers listed below.
> All employees, staff and other personnel of the health care providers
listed below.
Hill Country Memorial Hospital
1020 South State Highway 16
Fredericksburg, Texas
Hill Country Memorial Wellness Center
1006 South State Highway 16
Fredericksburg, Texas
Hill Country Community Health Center
Fredericksburg, Texas 78624
All medical clinics and other health care providers owned and/or operated by
a legal entity owned or controlled by Hill Country Memorial Health System.
The entities, sites and locations listed above are treated as a single
affiliated covered entity, are referred to in this notice as the "Health
System", and follow the terms of this notice. These entities, sites and
locations may share medical information with each other for treatment,
payment or health care purposes and as otherwise allowed by Texas and
federal law.
In addition, for purposes of this notice and compliance with federal and
state confidentiality laws, we have designated all members of the Hill
Country Memorial Hospital Medical Staff and all physicians who provide
services at a clinic owned and/or operated by the Health System as
participants in an organized health care arrangement.
When you receive services at a site or location operated by the Health
System, all participants in the organized health care arrangement may share
medical information with each other to carry out treatment, payment or
health care operations.
Please note that this designation is for privacy practices only. The
physicians on the medical staff are independent practitioners and are not
employees or agents of the Health System.
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Our
pledge regarding medical information
We understand that medical information about you
and your health is personal. We are committed to protecting medical
information about you. We create a record of the care and services you
receive from the Health System. We need this record to provide you with
quality care and to comply with certain legal requirements.
This notice applies to all of the records of your care generated by any
health care provider in the Health System, whether made by hospital/clinic
personnel or your personal doctor. Your other health care providers may have
different policies or notices regarding the use and disclosure of your
medical information created in their office or clinic.
This notice will tell you about the ways in which we may use and disclose
medical information about you. We also describe your rights and certain
obligations we have regarding the use and disclosure of medical information.
We are required by law to:
> maintain the privacy of the medical information that identifies you
> give you this notice of our legal duties and privacy practices with
respect to medical information we collect and/or maintain about you
> follow the terms of the notice that is currently in effect
> notify you if we are able to agree to a requested restriction and
> accommodate reasonable requests to communicate medical information by
alternative means or at alternative locations
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How we may use and disclose medical
information about you
The following categories describe different ways that we use and disclose
medical information. For each category of uses or disclosures, we will
explain what we mean and try to give some examples. Not every use or
disclosure in a category will be listed. However, all of the ways we are
permitted to use and disclose information will fall within one of the
categories.
For treatment
We may use medical information about you to provide you with medical
treatment or services. We may disclose medical information about you to any
health care provider or professional, including doctors, nurses,
technicians, medical students and personnel who are involved in taking care
of you while you are receiving services from the Health System. For example,
a doctor treating you for a broken leg may need to know if you have
diabetes, because diabetes may slow the healing process. In addition, the
doctor may need to tell the dietitian if you have diabetes so we can arrange
for appropriate meals.
Different departments and health care providers in the Health System also
may share medical information about you in order to coordinate the different
things you need, such as prescriptions, lab work and x-rays. We also may
disclose medical information about you to people outside the Health System
who may be involved in your medical care after you leave the Health System,
such as family members, clergy or others we use to provide services that are
part of your care.
For payment
We may use and disclose medical information about you so that the treatment
and services you receive from the Health System may be billed to and payment
may be collected from you, an insurance company or a third party. For
example, we may need to give your health plan information about surgery you
received at Hill Country Memorial Hospital so your health plan will pay us
or reimburse you for the surgery. We also may tell your health plan about a
treatment you are going to receive to obtain prior approval or to determine
whether your plan will cover the treatment.
For health care operations
We may use and disclose medical information about you for health care
operations.
These uses and disclosures are necessary to run the Health System and its
health care providers and make sure that all of our patients receive quality
care.
For example, we may use medical information to review our treatment and
services and to evaluate the performance of our staff in caring for you. We
also may combine medical information about many Health System patients to
decide what additional services the Health System should offer, what
services are not needed and whether certain new treatments are effective.
We also may disclose information to doctors, nurses, technicians, medical
students and other personnel for review and learning purposes. We also may
combine the medical information we have with medical information from other
hospitals or health systems to compare how we are doing and see where we can
make improvements in the care and services we offer.
We may remove information that identifies you from this set of medical
information so others may use it to study health care and health care
delivery without learning who the specific patients are.
Appointment reminders
We may use and disclose medical information to contact you as a reminder
that you have an appointment for treatment or medical care with one of the
health care providers in the Health System.
Treatment alternatives
We may use and disclose medical information to tell you about or recommend
possible treatment options or alternatives that may be of interest to you.
Health-related benefits and services
We may use and disclose medical information to tell you about health-related
benefits or services that may be of interest to you.
Fundraising activities
We may use medical information about you to contact you in an effort to
raise money for the Health System and its operations. We may disclose
medical information to a business associate or a foundation related to the
Health System so that the entity may contact you in raising money for the
Health System.
Facility directory
We may include certain limited information about you in a facility
directory while you are a patient in the facility. This information may
include your name, location in the facility, your general condition (e.g.
fair, good, serious, critical, undetermined, deceased, etc.) and your
religious affiliation.
The directory information, except for your religious affiliation, may also
be released to people who ask for you by name. Your 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. This is so your family, friends and clergy
can visit you in the facility and generally know how you are doing.
If you do not want the Health System to include such information in a
facility directory or release your information as described above, you must
notify the Health System Privacy Manager, in writing, at Hill Country
Memorial Hospital, P.O. Box 835, Fredericksburg, Texas 78624.
Individuals involved in your care or payment for your care
We may release medical information about you to a friend or family member
who is involved in your medical care. We may give information to someone who
helps pay for your care. In addition, we may disclose medical information
about you to an entity assisting in a disaster relief effort so that your
family can be notified about your condition, status and location.
Research
Under certain circumstances, we may use and disclose medical information
about you for research purposes. For example, a research project may involve
comparing the health and recovery of all patients who received one
medication to those who received another for the same condition.
All research projects, however, are subject to a special approval process.
This process evaluates a proposed research project and its use of medical
information, trying to balance the research needs with patients' need for
privacy of their medical information.
Before we use or disclose medical information for research, the project will
have been approved through this research approval process; however, we may
disclose medical information about you to people preparing to conduct a
research project, for example, to help them look for patients with specific
medical needs so long as the medical information they review does not leave
the Health System facility.
We will almost always ask for your specific permission if the researcher
will have access to your name, address or other information that reveals who
you are, or will be involved in your care at a Health System facility.
As required by law
We will disclose medical information about you when required to do so by
federal, state or local law.
To avert a serious threat to health or safety
We may use and disclose medical information about you when necessary to
prevent a serious threat to your health and safety or to the health and
safety of the public or another person. Any disclosure, however, would only
be to someone in a position to help prevent the threat.
Special
Situations
Organ and tissue donation
If you are an organ donor, we may release medical information to
organizations that handle organ procurement or organ, eye or tissue
transplantation or to an organ donation bank as necessary to facilitate
organ or tissue donation and transplantation.
Military and veterans
If you are a member of the armed forces, we may release medical information
about you as required by military command authorities. We may also release
medical information about foreign military personnel to the appropriate
foreign military authority.
Workers' compensation
We may release medical information about you for workers' compensation or
similar programs. These programs provide benefits for work-related injuries
or illness.
Public health risks
We may disclose medical information about you for public health activities.
These activities generally include the following:
> to prevent or control disease, injury or disability
> to report births and deaths
> to report child abuse or neglect
> to report reactions to medications or problems with products
> to notify people of recalls of products they may be using
> to notify a person who may have been exposed to a disease or may be at
risk for contracting or spreading a disease or condition
> to notify the appropriate government authority if we believe a patient has
been the victim of abuse, neglect or domestic violence. We will only make
this disclosure if you agree or when required or authorized by law.
Health oversight activities
We may disclose medical information to a health oversight agency for
activities authorized by law. These oversight activities include, for
example, 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.
Lawsuits and disputes
If you are involved in a lawsuit or a dispute, we may disclose medical
information about you in response to a court or administrative order. We
also may disclose medical information about you in response to a subpoena,
discovery request or other lawful process by someone else involved in the
dispute, but only if efforts have been made to tell you about the request or
to obtain an order protecting the information requested.
Law enforcement
We may release medical information if asked to do so by a law enforcement
official:
> in response to a court order, subpoena, warrant, summons or similar
process
> to identify or locate a suspect, fugitive, material witness or missing
person
> about the victim of a crime if, under certain limited circumstances, we
are unable to obtain the person's agreement
> about a death we believe may be the result of criminal conduct
> about criminal conduct at the hospital and
> 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
Coroners, medical examiners and funeral directors
We may release medical information to a coroner or medical examiner. This
action may be necessary, for example, to identify a deceased person or to
determine the cause of death. We also may release medical information about
patients of the Health System to funeral directors as necessary to carry out
their duties.
National security and intelligence activities
We may release medical information about you to authorized federal officials
for intelligence, counterintelligence and other national security activities
authorized by law.
Protective services for the President and others
We may disclose medical information about you to authorized federal
officials so they may provide protection to the President or other
authorized persons or foreign heads of state or conduct special
investigations.
Inmates
If you are an inmate of a correctional institution or under the custody of a
law enforcement official, we may release medical information about you to
the correctional institution or law enforcement official. This release would
be necessary
1. for the
institution to provide you with health care;
2. to protect your health and safety or the health and safety of others; or
3. for the safety and security of the correctional institution.
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Your rights regarding medical information about you
You have the following rights regarding medical information we maintain
about you.
Right to inspect and copy
You have the right to inspect and copy medical information that may be used
to make decisions about your care. Usually, this includes medical billing
records but does not include psychotherapy notes.
To inspect and copy medical information that may be used to make decisions
about you, you must submit your request in writing to the Health System
Privacy Manager at Hill Country Memorial Hospital, P.O. Box 835,
Fredericksburg, Texas 78624. If you request a copy of the information, we
may charge a fee for the costs of copying, mailing or other supplies
associated with your request.
We may deny your request to inspect and copy in certain very limited
circumstances. If you are denied access to medical information, you may
request that the denial be reviewed. Another licensed health care
professional chosen by the hospital will review your request and the denial.
The person conducting the review will not be the person who denied your
request. We will comply with the outcome of the review.
Right to amend
If you feel that medical information we have about you is incorrect or
incomplete, you may ask us to amend the information. You have the right to
request an amendment for as long as the information is kept by or for the
Health System.
To request an amendment, your request may be made in writing and submitted
to the Health System Privacy Manager at Hill Country Memorial Hospital, P.O.
Box 835, Fredericksburg, Texas 78624. In addition, you must provide a reason
that supports your request.
We may deny your request for an amendment if it is not in writing or does
not include a reason to support the request. In addition, we may deny your
request if you ask us to amend information that:
> was not created by us, unless the person or entity that created the
information is no longer available to make the amendment;
> is not part of the medical information kept by or for the Health System;
> is not part of the information which you would be permitted to inspect and
copy; or
> is accurate and complete.
Right to obtain an 'accounting of disclosures'
You have the right to request an "accounting of disclosures".
This is a list of certain, but not all, disclosures we made of medical
information about you.
To request this list or accounting of disclosures, you must submit your
request in writing to the Health System Privacy Manager at Hill Country
Memorial Hospital, P.O. Box 835, Fredericksburg, Texas 78624. Your request
must state a time period which may not be longer than six years prior to the
date of the request. Your request should indicate in what form you want the
list (for example, on paper or electronically). The first list you request
within a 12-month period will be free. For additional lists, we may charge
you for the costs of providing the list. We will notify you of the cost
involved and you may choose to withdraw or modify your request at that time
before any costs are incurred.
Right to request restrictions
You have the right to request a restriction or limitation on the medical
information we use or disclose about you for treatment, payment or health
care operations. You also have the right to request a limit on the medical
information we disclose about you to someone who is involved in your care or
the payment for your care, like a family member or friend. For example, you
could ask that we not use or disclose information about a surgery you had.
We are not required to agree to your request. If we do agree, we will comply
with your request unless the information is needed to provide you with
emergency treatment.
To request restrictions, you must make your request in writing to the Health
System Privacy Manager at Hill Country Memorial Hospital, P.O. Box 835,
Fredericksburg, Texas 78624. In your request, you must tell us the
following:
1. what information you want to limit
2. whether you want to limit our use, disclosure, or both
3. to whom you want the limits to apply (for example, disclosures to your
spouse)
Right to request alternative communications
You have the right to request that we communicate with you about medical
matters in a certain way or at a certain location. For example, you can ask
that we contact you only at work or by mail.
To request alternative communications, you must make your request in writing
to the Health System Privacy Manager at Hill Country Memorial Hospital, P.O.
Box 835, Fredericksburg, Texas 78624. We will not ask you the reason for
your request. We will accommodate all reasonable requests. Your request must
specify how or where you wish to be contacted.
Right to a paper copy of this notice
You have the right to a paper copy of this notice. You may ask us to give
you a copy of this notice at any time. Even if you have agreed to receive
this notice electronically, you are still entitled to a paper copy of this
notice.
You may obtain a copy of this notice at our website,
www.hcmhs.org.
To obtain a paper copy of this notice, please contact the Health System
Privacy Manager at 830-990-6629.
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Changes to this notice
We reserve the right to change this notice. We reserve the right to make the
revised or changed notice effective for medical information we already have
about you, as well as any information we receive in the future.
We will post a copy of the current notice at each health care provider
location listed on the first page of the notice. The notice will contain on
the first page in the top right-hand corner the effective date. In addition,
each time you receive treatment or health care services at one of the health
care providers in the Health System, a copy of the current notice will be
available.
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Complaints
If you believe your privacy rights have been violated, you may file a
complaint with the Health System or with the Secretary of the Department of
Health and Human Services. To file a complaint with the Health System,
contact the Health System Privacy Manager at 830-990-6629. All complaints
must be submitted in writing. You will not be penalized for filing a
complaint.
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Other uses of medical information
Other uses and disclosures of medical information
not covered by this notice or the laws that apply to us will be made only
with your written permission. If you provide us permission to use or
disclose medical information about you, you may revoke that permission, in
writing, at any time. If you revoke your permission, we will no longer use
or disclose medical information about you for the reasons covered by your
written authorization. You understand that we are unable to take back any
disclosures we have already made with your permission and that we are
required to retain our records of the care that we provided to you.
If you have any questions about this notice, please contact the Health
System Privacy Manager at 830-990-6629.
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