Notice of Privacy Practices

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Selected Topics

• Purpose
• Who Will Follow This Notice?
• Our Legal Responsibilities
• Revisions To This Notice
• How JHSMH Will Use And Disclose Your Health Information
• Other Uses And Disclosure Required By HIPAA
• Uses And Disclosures To Which You May Object
• Uses And Disclosures You Must Authorize
• Your Individual Rights
• If You Have A Problem

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 the Jewish Hospital & St. Mary’s HealthCare, Inc., Privacy Officer at (502) 560-8404

PURPOSE

Jewish Hospital & St. Mary’s HealthCare, Inc. (JHSMH), its team members, medical staff, employed physicians, residents, fellows, students, contractors and volunteers follow the privacy practices described in this Notice of Privacy Practices (Notice). This Notice describes the ways in which we may use and disclose your health information within JHSMH and with other entities. We also describe your rights and certain obligations we have regarding the use and disclosure of your health information. JHSMH participates in an Organized Health Care Arrangement (OHCA) with its Medical Staff and will share your health information with the arrangement's participants to carry out treatment, payment or health care operations related to the OHCA. This Notice does not cover the privacy practices of your physician when you see him or her in a private office. JHSMH facilities are committed to protecting your health information in a confidential manner.

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WHO WILL FOLLOW THIS NOTICE?

JHSMH includes, but is not limited to, the following facilities: Jewish Hospital, Jewish Hospital Medical Center East, Jewish Hospital Medical Center South, Jewish Hospital Medical Center Southwest, Jewish Hospital Shelbyville, Sts. Mary & Elizabeth Hospital, Our Lady of Peace, VNA Nazareth Home Care; Frazier Rehabilitation Institute and its outpatient locations, Jewish Hospital Health Center-Meade County, The Physician Group and all JHSMH employed physicians and their practice locations.

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OUR LEGAL RESPONSIBILITIES

JHSMH is required by law to protect the privacy of your health information that can identify you, inform you about our legal duties and privacy practices with respect to your health information, and follow the terms of this Notice. This Notice applies to all of your health information held by JHSMH.

• JHSMH must abide by the terms of this Notice.
• JHSMH must notify you if we are unable to agree to a restriction that you request about the use and disclosure of your protected health information.
• JHSMH must accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.
• JHSMH will not use or disclose your health information without your authorization, except as described in this Notice.

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REVISIONS TO THIS NOTICE

JHSMH may change its Notice at any time and make the new provisions effective for all health information JHSMH maintains. Upon your request, JHSMH will provide you with information about how to obtain a revised Notice of Privacy Practices by accessing our web site, www.jhsmh.org, by calling the JHSMH Privacy Officer at (502) 560-8404 to request a revised copy be mailed to you or by requesting one at the time of your next visit.

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HOW JHSMH WILL USE AND DISCLOSE YOUR HEALTH INFORMATION

Treatment, Payment and Health Care Operations (TPO). JHSMH will use or disclose your health information for treatment, to obtain payment for treatment and for health care operations. The examples below are not meant to be exhaustive, but describe common types of disclosures JHSMH may make.

Examples of Uses and Disclosures for Treatment
JHSMH will use and disclose your health information to:

• Anyone involved in your treatment, including physicians, nurses, therapists, pharmacists, radiologists, discharge planners, dietitians, laboratory and others who need access to your health information to assist in your diagnosis and treatment.
• Anyone necessary to provide or manage your health care treatment, including the coordination or management of your care with a provider outside JHSMH, such as a home health agency that is evaluating your need for home health services.
• The physician who referred you to JHSMH or who will provide follow-up care to you after you are discharged from JHSMH.

Examples of Uses and Disclosures for Payment
JHSMH will use and disclose your health information to:

• Obtain payment for the services and treatment you receive.
• Communicate with your health insurance plan to obtain approval for the health care services JHSMH recommends for you.
• Request a determination from your health insurance plan of your eligibility or coverage for insurance benefits.
• Obtain payment from your employer when your treatment involves a work-related injury.
• Other health care providers so they can receive payment for health care services that they provided to you, such as ambulance services.
• Review the care you received to ensure the costs associated with it were appropriate for your diagnosis.

Examples of Uses and Disclosures for Health Care Operations
JHSMH will use and disclose your health information to support JHSMH business activities. These activities include:

• Conducting quality assessment and improvement activities in an effort to continually improve the quality and effectiveness of the health care services we provide
• Developing clinical guidelines
• Evaluating clinical outcomes
• Reviewing the competence or qualifications of health care professionals
• Evaluating physician and employee performance
• Conducting training programs in which residents, students, trainees or practitioners in areas of health care learn under supervision to improve their skills as health care providers
• Participating in accreditation, certification, licensing or credentialing activities
• Conducting or arranging for medical review, legal services and auditing functions
• Sharing information with medical students and residents who see patients at a JHSMH facility
• Calling your name in a waiting area or over the overhead paging system
• Contacting you by mail or phone to remind you of a scheduled appointment, procedure or test
• Sharing information with volunteers who help family and friends locate you in the facility, deliver mail and other items to you
• Providing information to the Chaplain who may visit you while you are in the facility
• Planning for the organization's future operations
• Complying with this Notice and applicable laws.

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OTHER USES AND DISCLOSURES REQUIRED BY HIPAA

JHSMH may use and disclose your health information in the following situations without your authorization. These situations include:

Business Associates of JHSMH: Some services are provided through contracts with business associates. Examples include certain laboratory tests and the service JHSMH uses when making copies of your medical record. When these services are contracted, JHSMH may disclose your health information to our business associates so that they can perform the job JHSMH has asked them to do and bill you or your insurance carrier for services rendered. To protect your health information, however, JHSMH requires the business associate to appropriately safeguard your information.

Research: JHSMH may disclose your health information for medical research when the Institutional Review Board or Privacy Board approves the research study and the use of your health information.

Marketing: JHSMH may use and disclose health information to contact you with information about treatment, services, products or health care providers that may be of interest to you.

Fundraising: JHSMH may use your demographic information (such as your name, address, phone number and the dates that you received treatment or services from us) for fundraising efforts to support the educational and medical research mission of JHSMH. JHSMH may disclose the information to the Jewish Hospital & St. Mary’s Foundation so that it may contact you about its fundraising efforts. If you do not want to be contacted for fundraising, please contact the JHSMH Privacy Officer at (502) 560-8404.

Funeral Directors, Coroners and Medical Examiners: JHSMH may disclose health information to a coroner, medical examiner or funeral directors consistent with applicable law to carry out their duties.

Organ procurement organizations: Consistent with applicable law, JHSMH may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

Food and Drug Administration (FDA): JHSMH may disclose health information to the FDA relative to adverse events with respect to food, supplements, product and product defects or post marketing surveillance information to enable product recalls, repairs or replacement.

Public Health: As required by law, JHSMH may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability. These activities include but are not limited to reporting births, deaths, disease, injury, child abuse or neglect and domestic violence.

Inmates: If you are an inmate of a correctional institution, or under the custody of a law enforcement official, JHSMH may disclose your health information to the institution or law enforcement official as may be necessary for your health and the health and safety of other individuals.

Legal Proceedings: If you are involved in a lawsuit or dispute, JHSMH may disclose your health information in response to a HIPAA-compliant subpoena, valid court or administrative order, or discovery request. JHSMH also may disclose your health information in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute.

Law Enforcement: JHSMH may disclose health information as required by law or in response to a HIPAA-compliant subpoena, valid court or administrative order, warrant, summons, or other lawful process. We must provide information about someone who is suspected of being a victim abuse, neglect or domestic violence; to provide information about a crime that occurs at a JHSMH facility or to identify or locate a suspect, fugitive, material witness or missing person.

Health Oversight Activities: JHSMH may disclose your health 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.

Military Activity and National Security: JHSMH may release your health information to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law, including providing protection to the President, other authorized persons or foreign heads of state or to conduct special investigations.

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USES AND DISCLOSURES TO WHICH YOU MAY OBJECT

Unless you notify us in writing that you object, JHSMH may use or disclose your health information in the following circumstances:

• Each JHSMH facility maintains a facility directory. JHSMH will include your name, location in the JHSMH facility, general condition (e.g. good, fair, serious or critical) if available, and religious affiliation in the facility 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. Your name and religious affiliation may be given to a member of the clergy, such as a priest or rabbi, with the same religious affiliation even if they don’t ask for you by name. The facility directory is available so your family, friends and clergy can visit you and generally know how you are doing. If you do not want information released in the facility directory, we cannot tell members of the public, flower or other service persons and organizations, and even your friends and family that you are here and your general condition. (At Our Lady of Peace, we have no open facility directory. Each patient is provided an Access Number to be shared with family and friends whom the patient chooses to have know of his/her presence in the facility. Only with that Access Number will those patient contacts be allowed.)
• JHSMH may disclose to a member of your family, a relative, a close friend or any other person you identify as your emergency contacts, your health information that relates to that person's involvement in your care or payment related to your care. JHSMH may use or disclose your health information to notify or assist in notifying a family member, personal representative or another person responsible for your care, about your location, general condition or death.
• JHSMH may use and disclose your health information to a public or private entity (such as the American Red Cross) assisting in disaster relief efforts so that your family can be notified about your condition, status and location.
• JHSMH may use and disclose your health information for the above activities when you are unable to agree or object to the use or disclosure because of your incapacity or an emergency treatment circumstance, if such disclosure is consistent with a prior expressed preference and if we determine such disclosure is in your best interest. When it becomes practical to do so, we must provide you with an opportunity to object to the uses or disclosures of your health information as described above.

To object to these uses or disclosures, please contact the JHSMH Privacy Officer at (502) 560-8404.

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USES AND DISCLOSURES YOU MUST AUTHORIZE

Except as described above, JHSMH will not use or disclose your protected health information unless you give written authorization to JHSMH to do so. You may revoke your permission, which will be effective only after the date of your written authorization. If you revoke your authorization in writing, JHSMH will not disclose health information about you after JHSMH receives your revocation except for disclosures that were being processed prior to receipt of your request.

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YOUR INDIVIDUAL RIGHTS

Below is a statement of your rights with respect to your health information and a brief description of how you may exercise these rights. For more information about your rights, please contact the JHSMH Privacy Officer at (502) 560-8404.

Right of Access. You have the right to access, inspect and obtain a copy of your health information that is contained in a designated record set for as long as we maintain the health information. A "designated record set" contains medical and billing records and any other records that are used by JHSMH or its Medical Staff to make decisions about you. Your request must be in writing. JHSMH must act on your request no later than 30 days after receipt of the request. If the protected health information is not maintained or accessible on-site, JHSMH must take action no later than 60 days from receipt of your request. JHSMH also may extend the time for such actions by no more than 30 days. JHSMH must provide you with a written statement of the reasons for the delay and the date by which it will complete your request. In Kentucky, you may receive one free copy of your medical record. Additional copies are made at a rate of $1 per page. Under federal law, however, you may not access, inspect or copy the following records: psychotherapy notes; information compiled in reasonable anticipation of, or for use in, a civil, criminal or administrative action or proceeding and health information that is subject to law that prohibits access to health information. JHSMH may deny your request to inspect and copy in certain circumstances. If you are denied access to health information, you may request that the denial be reviewed. Another licensed health care professional chosen by JHSMH will review your request and the denial. The person conducting the review will not be the person who denied your request. JHSMH will comply with the outcome of the review.

Right to request restrictions. You have the right to request restrictions on certain uses or disclosures of your health information for the purposes of treatment, payment or health care operations. You also may request limits on the health information JHSMH discloses about you to family members, friends or other individuals identified by you who may be involved in your care or for notification purposes as described in this Notice. JHSMH is not required to agree to your request. If JHSMH agrees, JHSMH will comply with the requested restriction unless it is needed to provide emergency treatment. Your request must be in writing and state the specific restriction requested and to whom you want the restriction to apply.

Confidential Communications. You have the right to request that we communicate with you about health care matters in a certain way or at a certain location. For example, you can ask that we only contact you at an alternative location from your home address, such as work, or only contact you by mail instead of by phone. Your request must be in writing. JHSMH will accommodate reasonable requests. JHSMH also may condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. JHSMH will not request an explanation from you as to the basis for the request.

Right to Amend. If you believe the health information JHSMH has about you is incorrect or incomplete, you may request the information be amended. You have the right to request an amendment for as long as the information is kept by or for the JHSMH facility that maintains the record. Your request must be in writing and must explain the reason for the requested amendment. JHSMH must act on your request for an amendment no later than 60 days after receipt of such a request. In certain cases, JHSMH may deny your request for an amendment. If JHSMH denies your request for amendment, you have the right to file a statement of disagreement with JHSMH and JHSMH may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.

Right to an Accounting of Disclosures. You have the right to request a list of the disclosures JHSMH made of your health information for purposes other than treatment, payment or health care operations as described in this Notice. It excludes disclosures JHSMH may have made to you, requested by you or that you authorized, as well as for a facility directory, to family members or friends involved in your care, or for notification purposes. Your request must be in writing. JHSMH must act on your request for an accounting no later than 60 days after receipt of such a request. You have the right to receive specific information regarding these disclosures made up to six (6) years before your request (not including disclosures made before April 14, 2003). You may request a shorter timeframe. The right to receive this information is subject to certain exceptions, restrictions and limitations. If you request a list of disclosures more than once in 12 months, JHSMH may charge you a reasonable fee.

Right to a Copy of this Notice. On your first visit to a JHSMH facility, you will be given a copy of this Notice. You also may request a summary of this Notice. You may obtain a copy of this Notice at the JHSMH web site, www.jhsmh.org. To obtain a paper copy of this Notice, visit the Registration Department of the JHSMH facility where you are receiving services.

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IF YOU HAVE A PROBLEM

If you believe your privacy rights have been violated, you may file a complaint with the JHSMH Privacy Officer, with the Secretary of the U.S. Department of Health and Human Services or with the U.S. Department of Health and Human Services Office of Civil Rights. JHSMH will not retaliate against you for filing a complaint. To file a complaint, contact the Privacy Officer at (502) 560-8404 or send correspondence to:

Privacy Officer
Jewish Hospital & St. Mary’s HealthCare
200 Abraham Flexner Way
Louisville, KY 40202-1886

Revised: July 2008

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