Cooley Dickinson Hospital (CDH) will record and communicate your personal health information to make sure that your doctor, your insurance company and other people involved with your care can make good decisions about your treatment and get payment for the care you receive.
Under federal law, CDH has the right to use and communicate this information to those that need to know, for example, your doctor; and we may also need to give your personal health information when the law requires to government agencies and other organizations that regulate hospitals and health care.
The information below explains your rights and informs you about the way CDH may use and share your personal health information. We will ask you to sign a form that says that you have received this notice. You may ask us questions about your rights and CDH’s use of your information. You can also request this information in writing.
We may use your information
- to provide care, to get payment from your insurance, and for other CDH activities including review of our quality and service;
- to contact you to remind you of appointments for testing or treatment;
- as federal or state laws require or under a valid subpoena or court order;
- if we believe your health or safety is in danger, or that another person is harming you we may be required to give your information to state agencies;
- to communicate with organ and tissue banks;
- if you are in the military, we can give information about you to military authorities, if asked;
- for public health reporting of contagious disease and other conditions and situations that we must report;
- if you are an inmate we can give information to correctional authorities;
- for other reasons as described in this notice.
You have the right to
- a copy of your medical information we have on file;
- change the information we have on file, if you think the information is incorrect;
- ask us not to tell family, friends or the public that you are being treated at CDH;
- ask us for a list of who we have given your information to and for what reason.
CDH is committed to protecting your privacy. If you feel your privacy rights have been violated, you may file a complaint with CDH or with the Department of Health and Human Services. See page 8 of this pamphlet for more information.
Cooley Dickinson Hospital Privacy Officer
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 believe your privacy rights have been violated, you may file a complaint with CDH or with the Secretary of the Department of Health and Human Services. To file a complaint with CDH, call the Cooley Dickinson Hospital Privacy Officer at (413) 582-2281, or email Karen_Kuhr@cooley-dickinson.org.
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 authorization. For example, your authorization is required for uses and disclosures of psychotherapy notes or if we seek to use or disclose your medical information to market our services to you. Also, most disclosures of your medical information for which CDH receives payment will require your authorization.
If you authorize CDH to use or disclose your medical information, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose your medical information 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 authorization, and that we are required to retain our records of the care that we provided to you.
You may obtain a copy of this notice of privacy practices at our website. Visit www.cooley-dickinson.org
If you have any questions about this notice, please call the Privacy Officer at (413) 582-2281 or
WHO WILL FOLLOW THIS NOTICE
This notice describes CDH’s practices and that of
- all departments and units of CDH and its Medical Staff who care for you at CDH;
- any member of a volunteer group we allow to help you while you are at CDH;
- all employees, staff, students and other CDH personnel;
- all these entities, sites and locations follow the terms of this notice. In addition, these entities, sites and locations may share medical information with each other for treatment, payment or hospital operations purposes described in this notice.
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 CDH. 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 related to your treatment here generated by CDH in any form, whether made by CDH personnel or your personal doctor. 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;
- 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 YOUR MEDICAL INFORMATION
The following paragraphs describe ways that we use and disclose medical information. 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 CDH personnel who are involved in taking care of you at CDH. We also may disclose medical information about you to people outside CDH who may be involved in your medical care after you leave CDH, such as a visiting nurse agency.
- For Payment. We may use and disclose medical information about you so that the treatment and services you receive at CDH may be billed and payment may be collected from you, an insurance company or a third party. 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 CDH operations. These uses and disclosures are necessary to run CDH 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 CDH patients to decide what additional services CDH 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 and Pre-Admission Information. Subject to certain limitations imposed by law as of February, 2010, we may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at CDH. We may contact you by telephone and may leave a message on your voicemail or answering machine. We may also contact you by mail to remind you of your appointment.
- Fundraising Activities. We may use medical information about you to contact you in an effort to raise money for CDH and its operations. We may disclose medical information to our development office so that the foundation may contact you in raising money for CDH. We only would release contact information, such as your name, address and phone number and the dates you received treatment or services at CDH. Our fundraising communications will contain a clear and conspicuous notice of your right to opt out of receiving charitable solicitations. In order to exercise your right to not receive fundraising communications, you must notify the Cooley Dickinson Hospital Development Office in writing at 30 Locust Street, Northampton, MA 01060.
- Marketing. We may provide communications that encourage you to use or purchase products or services as long as the communications (i) describe health-related products or services that we provide or include in a plan or benefits (or payment for such products or services); (ii) relate to treatment; or (iii) relate to case management, care coordination or the recommendation of alternative therapies, treatments, health care providers or settings. We will only accept direct or indirect payment from third parties for making these communications as permitted by law. If you do not wish to receive communications for which we have received payment, you may opt out by contacting The Privacy Officer, Cooley Dickinson Hospital, 30 Locust Street, Northampton, MA 01060.
- Hospital Directory. We may include certain limited information about you in the hospital directory while you are a patient at CDH. This information may include your name, location within the hospital, your general condition (e.g., fair, stable, 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. You may request that your information be excluded from the directory.
RESTRICTION ON DISCLOSURE
You have the right to restrict information disclosure by following the appropriate item below.
- 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.
We must agree to certain requests for restrictions. We must agree to your request to restrict the use or disclosure of your health information to a health plan for payment or health care operations when the health information relates to health care for which we have been paid out of pocket in full. We are not required to agree to other requests. 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 the Health Information Management Department. In your request, you must tell us 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: Privacy Officer, Cooley Dickinson Hospital, 30 Locust Street, Northampton, MA 01060. 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 ACCESS MEDICAL INFORMATION
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 Information Management Department, Cooley Dickinson Hospital, 30 Locust Street, Northampton, MA 01060. 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.
You may request an electronic copy of information that we maintain in an electronic health record (EHR). You may also ask that we transmit an electronic copy of such health information to a person or entity that you specify. Your request must be clear, conspicuous and specific. We may charge a reasonable fee for sending the electronic copy to you.
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 CDH 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 CDH.
To request an amendment, your request must be made in writing and submitted to the Health Information Management Department, Cooley Dickinson Hospital, 30 Locust Street, Northampton, MA 01060. In addition, you must provide the reason for 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;
- is not part of the medical information kept by or for CDH;
- is not part of the information which you would be permitted to inspect and copy, or;
- is accurate and complete.
- Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is a list of certain disclosures we made of medical information about you.
To request this accounting of disclosures, you must submit your request in writing to the Health Information Management Department, Cooley Dickinson Hospital, 30 Locust Street, Northampton, MA 01060. Except as provided below, the accounting will exclude disclosures for treatment, payment and health care operations. The accounting will also exclude disclosures we have made directly to you, disclosures to friends, family members involved in your care, disclosures made pursuant to a valid authorization, and disclosures for notification purposes. Your request must state a time period which may not be longer than six years, except as provided below. Your request should also indicate in what form you want the list (for example, on paper or electronically.)
You have the right to receive an accounting of all disclosures of your medical information - including treatment, payment and health care operations - if these disclosures were made through an electronic health record (“EHR”). If we had an EHR in place as of January 1, 2009, this expanded accounting right will apply to disclosures made after January 1, 2014.
The first accounting you request within a 12 month period will be free. We may charge you the costs of additional accountings during this same time period. 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. If your request involves disclosures made through an EHR, we will include disclosures for treatment, payment and health care operations, but will only account for disclosures within the three (3) years prior to your request. We may also provide you with a list of our business associates and their contact information so that you may request an accounting directly from them. OTHER PURPOSES FOR WHICH WE MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION WITHOUT YOUR AUTHORIZATION
The following paragraphs describe ways that the law allows or requires us to use and disclose your information for purposes beyond treatment, payment or health care operations:
- 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, unless you ask us not to. We may also give information to someone who helps pay for your care. We may also tell your family or friends your condition and that you are in CDH. 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 bout your condition, status and location.
- Research. Under certain circumstances, we may use and disclose medical information about you for research purposes when the research has been approved by an institutional review board.
- 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.
- Abuse or Neglect. We may disclose your pers
onal health information to a government authority if we reasonably believe you are a victim of abuse or neglect. We will only disclose this type of information to the extent required by law, if you agree to the disclosure, or if the disclosure is allowed by law and we believe it is necessary to prevent serious harm to you or someone else.
- 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 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 that requires mandatory reporting to public health officials;
- 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.
- 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 valid subpoena, or other lawful process by someone else involved in the dispute.
- Law Enforcement. We may release medical information if asked to do so by a law enforcement official in response to a valid court order or valid subpoena or similar valid legal process.
- 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 CDH patients to funeral directors as necessary to carry out their duties.
- 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.
- Food and Drug Administration (FDA). We may disclose to the FDA or those under its jurisdiction (such as drug or medical device manufacturers) your medical information as it relates to adverse events with respect to drugs, foods, supplements, products and product defects or post-marketing surveillance information to enable product recalls, repairs or replacements.
- Business Associates. Some of our services and products are provided through contracts with other companies or “business associates” so that they may perform the job we have asked them to do. To protect your personal health information, however, we require that the business associate safeguard your personal health information. As of February 17, 2010, business associates are also directly responsible for compliance with the federal security standards and certain provisions of the federal privacy law in order to further protect your medical information.
We may keep your records in printed form, microfilm, or in electronic digital media, or a combination of all of those. CDH maintains medical records for at least 20 years after a patient’s discharge or final treatment, as required by state law. The destruction of records will be consistent with CDH policy and applicable law which includes notifying the Department of Public Health at the time the records are destroyed. A copy of CDH’s medical record retention policy is available upon request.
We are required to notify you and certain government authorities in the event that Unsecured Personal Health Information or certain other personal information of yours is breached. “Unsecured Personal Health Information” is information that is not secured in accordance with standards of the U. S. Department of Health and Human Services. “Personal information” includes your name in combination with your driver’s license or social security number, or other financial account information. Breach notification will be provided in accordance with legal requirements and will include a description of the breach, including the dateof its occurrence or discovery; a description of the type of information involved; steps that affected individuals should take to protect themselves from being harmed by the breach; and steps that we are taking to investigate and remedy the breach.
YOUR RIGHTS REGARDING MEDICAL INFORMATION
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 your medical information. Usually, this includes medical and billing records, but in certain limited circumstances, may not include psychotherapy notes.
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. You may request a copy of the current notice in effect at any time.
- Compliance with Laws. If more than one law applies to this notice we will follow the more stringent law.
CDH updated 5/25/12