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Privacy Statement |
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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.
If you have any questions about this notice, please contact
Privacy Officer @ this HELPLINE (888) 30-2HELP
WHO WILL FOLLOW THIS NOTICE
This notice describes our hospital’s practices and that of:
Any health care professional authorized to enter information
into your hospital chart.
All departments and units of the hospital.
Any member of a volunteer group we allow to help you while you
are in the hospital.
All employees, staff and other hospital personnel.
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
at the hospital. 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 the
hospital, whether made by hospital personnel or your physician.
Your physician may have different policies or notices regarding
the doctor’s use and disclosure of your medical information
created in the doctor’s 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:
make sure that medical information that identifies you is kept
private (with certain exceptions);
give you this notice of our legal duties and privacy practices
with respect to medical information about you;
and follow the terms of the notice that is currently in effect.
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 doctors, nurses, technicians,
medical students, or other hospital personnel who are involved
in taking care of you at the hospital. 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 that we can arrange for appropriate meals. Different departments
of the hospital 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 hospital who may
be involved in your medical care after you leave the hospital,
such as skilled nursing facilities or home health agencies
For Payment. We may use and disclose medical information
about you so that the treatment and services you receive at
the hospital 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 the hospital so your health plan will pay us
or reimburse you for the surgery. We may also 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 hospital 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 may also combine medical information about many hospital
patients to decide what additional services the hospital should
offer, what services are not needed, and whether certain new
treatments are effective. We may also disclose information to
doctors, nurses, technicians, medical students, and other hospital
personnel for review and learning purposes. We may also combine
the medical information we have with medical information from
other hospitals 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 at the hospital.
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 Products and Services. We may use and
disclose medical information to tell you about our health-related
products or services that may be of interest to you.
Hospital Directory. We may include certain limited information
about you in the hospital directory while you are a patient
at the hospital. This information may include your name, location
in the hospital, your general condition (e.g., fair, stable,
etc.) and your religious affiliation. Unless there is a specific
written request from you to the contrary, this 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 information
is released so your family, friends and clergy can visit you
in the hospital and generally know how you are doing.
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 also
give information to someone who helps pay for your care. Unless
there is a specific written request from you to the contrary,
we may also tell your family or friends your condition and that
you are in the hospital. 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.
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 the health
and safety of the public or another person. Any disclosure,
however, would only be to someone able to help prevent the threat.
SPECIAL SITUATIONS
Organ and Tissue Donation. 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 the abuse or neglect of children, elders and dependent
adults;
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 may also
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 (which may include written notice to you)
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 may be necessary, for example, to identify a deceased person
or 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 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, 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.
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 and billing
records, but may not include some mental health information.
To inspect and copy medical information that may be used to
make decisions about you, you must submit your request in writing
to 531 W. College Street, Los Angeles, CA 90012 Attn: Medical
Records. 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 hospital.
To request an amendment, your request must be made in writing
and submitted to Medical Records. 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 hospital; Is not
part of the information which you would be permitted to inspect
and copy; or Is accurate and complete. Even if we deny your
request for amendment, you have the right to submit a written
addendum, not to exceed 250 words, with respect to any item
or statement in your record you believe is incomplete or incorrect.
If you clearly indicate in writing that you want the addendum
to be made part of your medical record we will attach it to
your records and include it whenever we make a disclosure of
the item or statement you believe to be incomplete or incorrect.
Right to an Accounting of Disclosures. You have the right
to request an “accounting of disclosures.” This is a list of
the disclosures we made of medical information about you other
than our own uses for treatment, payment and health care operations,
(as those functions are described above) and with other expectations
pursuant to the law. To request this list or accounting of disclosures,
you must submit your request in writing to Medical Records.
Your request must state a time period which may not be longer
than six years and may not include dates before April 14, 2003.
Your request should indicate in what form you want the list
(for example, on paper, 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 emergency treatment. To
request restrictions, you must make your request in writing
to Medical Records. In your request, you must tell us (1) what
information you want to limit; (2) whether you want to limit
our use, disclosure or both; and (3) to whom you want the limits
to apply, for example, disclosures to your spouse.
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 Medical Records. 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: http://www.pamc.net. To obtain a paper copy
of this notice: Admitting 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 in the hospital. The notice will contain on the first
page, in the top right-hand corner, the effective date. In addition,
each time you register at or are admitted to the hospital for
treatment or health care services as an inpatient or outpatient,
we will offer you a copy of the current notice in effect.
COMPLAINTS
If you believe your privacy rights have been violated, you may
file a complaint with the hospital or with the Secretary of
the Department of Health and Human Services. To file a complaint
with the hospital, contact Privacy Officer, at this HELPLINE
(888) 30-2HELP. All complaints must be submitted in writing.
You will not be penalized for filing a complaint.
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, this will stop any further use or disclosure of
your medical information for the purposes covered by your written
authorization, except if we have already acted in reliance on
your permission. 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. |
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