NEW ENGLAND SINAI HOSPITAL
150 YORK STREET
STOUGHTON, MA 02072
PATIENT NOTICE OF PRIVACY PRACTICES
Effective 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.
NEW ENGLAND SINAI HOSPITAL’S
COMMITMENT TO OUR PATIENTS:
New England Sinai Hospital cares
about you, our patient, and your privacy. We understand
that medical information about you is personal, and protecting
that information is important. We create records of the
care and services you receive here so that we can continue
to provide you with quality care and so that we can comply
with certain legal and accreditation requirements.
This notice tells you the ways in
which we may use and disclose your personal information,
and our obligations to keep your information private. This
notice also describes your privacy rights.
We are required by law to keep your
personal health information private; to give you this notice
of our legal duties and our privacy practices; and to follow
the terms of the notice currently in effect.
WHO WILL FOLLOW THIS NOTICE:
This notice applies to the New England
Sinai Hospital, all its departments and units, including
satellite units at New England Medical Center and Waltham
Hospital and the New England Sinai Hospital Foundation.
It applies to our workforce (employees, volunteers, agency
and contracted staff, physicians and students).
HOW WE MAY USE AND DISCLOSE YOUR
MEDICAL INFORMATION:
The following categories show the
different ways we may use and disclose to others your medical
information. For each category we give you some examples,
but not every use or disclosure in a category is listed.
Your medical information will not be used or disclosed for
purposes other than those described in this notice without
your authorization.
For Treatment: Your medical information
may be used or released to other healthcare professionals
to provide you with medical treatment or services, as well
as emergency care provided in another facility. We may share
information about you with doctors, nurses, technicians,
or other healthcare professionals involved in taking care
of you. For example, a doctor treating you following surgery
may need to know if you have diabetes since that could affect
the healing process. Other health care professionals may
need to share your information to coordinate your care with
people outside the Hospitals such as for prescriptions,
laboratory work and x-rays. And, we may disclose information
about you to people outside the Hospital who may be involved
in your medical care after you leave the Hospital.
For payment: Your medical information
may be used and disclosed by the Hospital so that the Hospital
can receive payment from you, your insurance company or
a third party for providing you with needed healthcare services.
For example, your insurance company may need to know about
the therapies you received so that they will pay us or reimburse
you. The Hospital may also disclose your information to
obtain prior approval for your care or to determine if your
insurance policy will cover the treatment.
For Other Hospital Functions Other
than Treatment and Payment: Your medical information may
be used or disclosed for a variety of healthcare-related
purposes which are necessary for the Hospital to function.
We may use your information to ensure that all our patients
receive quality care and to ensure that the Hospital continues
to earn professional accreditation. For example, we may
use your information so that the Hospital can evaluate the
performance of our staff in care for you.
In addition, we may utilize your
information to contact you for purposes such as the following:
Appointment reminders: We may use
and disclose your information to contact you as a reminder
that you have an upcoming appointment for an office visit
or other treatment.
Health-related services: We may use
and disclose your information to tell you about health-related
services that may be of interest to you.
Fundraising: We may use certain information
(name, address, telephone number, dates of service, age
and gender) to contact you in the future to raise money
for New England Sinai Hospital. We may also provide this
information to the New England Sinai Hospital Foundation,
which is our institutionally related foundation, for the
same purposes. The money raised will be used to support
the services and programs we provide to Sinai patients and
the community.
Hospital patient directory: With
your permission we may list limited information about you
(name, room number, general condition such as “good”)
in our directory while you are a patient in the Hospital.
We will give this information to anyone who asks for you.
In this way family and friends can visit or check on your
progress while the Hospital still keeps your medical information
private. In addition, if you choose, you may provide us
with your religious affiliation so that clergy can identify
their congregants who are hospitalized.
Individuals involved in your care:
With your permission we may release information about you
to a family member or friend who is involved in your care.
We may also release information about you to such an individual
in a medical emergency.
Special situations: In addition to
the above, there may be times when we use or disclose your
medical information for the following reasons:
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 your medical information
when necessary to prevent a serious threat to your health
or safety or to the health and safety of the public or another
person. Any disclosure, however, would only be to someone
able to help prevent the threat. This may include disaster
relief agencies.
Research: We may use and disclose
medical information about you for officially-approved research
as permitted by law, or through a limited set of information.
Otherwise, we will only use or disclose your information
for research with your specific authorization.
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 and 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 authorities.
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 child
or elder abuse or neglect, to report reactions to medications
or problems with products; to notify people of recalls of
products that 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
an employer about a workforce member when necessary to evaluate
a work-related illness or injury, when we notify you of
this disclosure.
Abuse, Neglect or Domestic Violence:
We may disclose medical information about you to social
service or government authorities if we believe you have
been the victim of abuse, neglect or domestic violence if
you agree or if we are required by law and we believe it
is necessary to prevent serious harm.
Health Oversight Activities: We may
disclose medical information about you 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 laws.
Lawsuits and Disputes: We may disclose
medical information about you in response to a subpoena,
discovery request or other lawful order from a court.
Law Enforcement: We may release medical
information about you if asked to do so by a law enforcement
official as part of law enforcement activities; in investigations
or criminal conduct or of victims of crime; in response
to court orders; in emergency circumstances; or when required
to do so by law.
Coroners, Medical Examiners and Funeral
Directors: We may release medical information to a coroner
or medical examiner. This may be necessary, for example,
to identify a deceased person or to determine the cause
of death. We may also release medical information about
patients of the hospital to funeral directors as necessary
to carry out their duties.
National Security: We may release
medical information about you to authorized federal officials
so they may provide protection to the President, other authorized
persons or foreign heads of state or conduct special investigations,
or for intelligence, counterintelligence, and other national
security activities authorized by law.
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; (3) for the
safety and security of the correctional institution.
OTHER USES AND DISCLOSURES OF MEDICAL
INFORMATION:
Other uses and disclosures of medical
information not covered by this notice or the laws that
apply to use will be made only with your prior written permission.
If you give 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, thereafter we will
no longer use or disclose medical information about you
for the reasons covered by your written authorization. You
must 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 we provided to
you.
YOUR RIGHTS REGARDING MEDICAL INFORMATION
ABOUT YOU:
You have the following rights regarding
the medical information about you:
Right to Inspect and Copy: You have
the right to inspect and have copied by the Hospital the
medical information that may be used by the Hospital to
make decisions about your care. Usually, this includes medical
and billing records, but it does not include psychotherapy
notes.
To inspect the medical information
that may be used to make decisions about you, and to have
this information copied by the Hospital, you must submit
your request in writing to the Medical Records Department
of the Hospital. If you request a copy of the information,
we may charge a fee for the costs of copying and postage.
We may deny your request to inspect and copy your information
in certain very limited circumstances. If so, we will inform
you of the denial, the reason for it, and how to request
a review of the denial, if review if permitted by law. A
licensed health care professional or team of health care
professionals will review your request and the denial. We
will comply with the outcome of the review.
Right to Request Amendment: 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 the Hospital (30 years from date
of service as of this notice).
To request an amendment, your request
must be made in writing and submitted to our Privacy Officer;
Susan Marre, RHIA, Director of Medical Records and Privacy
Officer, New England Sinai Hospital, 150 York Street, Stoughton,
MA 02072. In addition, you must provide a reason that supports
your request.
We may deny your request for an amendment
if it 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 created by another hospital or healthcare
provider. But we will inform you of the source of that information
if we know it.
Right to an Accounting of Disclosures:
You have the right to an “accounting of certain disclosures.”
This is a list or report of the disclosures we made of medical
information about you for reasons other than your care,
payment or other Hospital purposes for which you did not
sign an authorization.
To request a list or accounting of
disclosures, you must submit your request in writing to
our Privacy Officer (see name and address above). Your request
must state a time period that may not be longer than six
years prior to the request and may not include dates before
April 14, 2003. The first list you request within a 12-month
period will be free. For additional lists during the same
12-month period, we may charge you for the cost of providing
the list. We will notify you of the cost involved and you
may choose to withdraw or modify your request at the time
before any costs are incurred. We may also provide a summary
list as an option.
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 of your care, such as a family member
or friend.
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 our Privacy Officer (see
name and address above). In your request, you must state
(1) what use or disclosure you want to limit, (2) what information
you want to limit, and/or (3) to whom you want the limits
to apply.
Right to Request Confidential 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 only contact you at work
or by mail.
To request confidential communications,
you must make your request in writing to our Privacy Officer
(see name and address above). 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 request a paper copy of this notice
at any time after the initial issuance. To request a paper
copy of this notice, please notify our Privacy Officer (see
name and address above) or pick one up in the Hospital’s
Admitting Office or Outpatient Department.
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. The notice will
contain the effective date in top center portion of the
first page.
COMPLAINTS:
If you believe your privacy rights
have been violated or the Hospital is not in compliance
with these privacy practices, you may file a complaint with
the New England Sinai Hospital or with the Secretary of
the Department of Health and Human Services. To file a complaint
with the New England Sinai Hospital, write to Privacy Officer,
New England Sinai Hospital, 150 York Street, Stoughton,
MA 02072 All complaints must be submitted in writing.
All complaints will be investigated
by the Hospital. You will not be penalized in any way for
filing a complaint.
Complaints filed with the Secretary
of Health and Human Services, (Hubert H. Humphrey Bldg,
Room 425A, 200 Independence Avenue, SW, Washington, DC 20201)
must be in writing and must be sent within 180 days of when
you knew or should have known that the act or omission occurred.
Your letter must include the following points:
The name of the hospital; and
A description of the acts or omissions that you believe
are in violation of privacy requirements.
PRIVACY OFFICER:
To request any of the above rights,
or for further information about this Privacy Notice, please
contact:
Susan M. Marre, RHIA
Director of Medical Records and Privacy Officer
New England Sinai Hospital and Rehabilitation Center
150 York Street
Stoughton, MA 02072
Telephone: 781-297-1185
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