NOTICE OF PRIVACY PRACTICES – Oaklawn Hospital
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 our Privacy Officer at (269) 789-4399.
PROVIDERS COVERED BY THIS NOTICE
Oaklawn Hospital is required by law to maintain the privacy of your health information, to provide you with this Notice of our legal duties and privacy practices for protected health information, and to abide by the terms of this Notice that is currently in effect.
In addition, Oaklawn Hospital offers you care in an integrated setting with area physicians who serve on its medical staff. While working at the hospital, these medical staff members will follow Oaklawn’s privacy practices described in this Notice. Please note that the independent doctors and independent health professional affiliates of the medical staff are not employees or agents of Oaklawn Hospital and they may have different notices, duties or privacy practices when not working at Oaklawn Hospital.
We, and the medical staff physicians, may share your health information for purposes of providing you with treatment, obtaining payment for medical services, and for health care business operations. Examples of sharing information for purposes of treatment, payment, and health care operations are described in this Notice.
OUR PLEDGE TO YOU:
We understand that health information about you and your health care is personal. We are committed to protecting health information about you. We create a record of the care and services you receive from us. We need this record to provide you with quality care, bill for your care, and comply with legal requirements. This Notice applies to all of the records of your care that we maintain, whether made by our staff, by the physicians, or other health care professionals working with us.
HOW WE MAY USE AND DISCLOSE HEALTH INFORMATION ABOUT YOU.
Our doctors, nurses, pharmacists, laboratory technicians, and other health care professionals may use health information about you to provide you with health care treatment or services. We may also disclose health information about you to others who are involved in taking care of you. For example, we may send health information about you to a physician specialist as part of a referral. Or, we may share information with a local nursing home in order to continue your care.
We may use and disclose health information about you to obtain payment for the treatment and services you receive from us or from the doctors and other health care professionals that treat you at the hospital. For example, we may send billing information to your insurance company or Medicare.
We may use and disclose health information about you to support our health care operations. For example, we may use health information to review the treatment and services we provide to you and to evaluate the performance of our staff in caring for you. You may also receive a telephone call asking if you were satisfied with the care you received.
In addition, we may contact you to raise funds and you have the right to opt out of receiving such communications. If we do not use protected health information (PHI) to send fundraising materials, the notice and opt out requirements do not apply. Most uses and disclosures of psychotherapy notes, uses and disclosures of PHI for marketing purposes, and disclosures that constitute a sale of PHI require an authorization. Other uses and disclosures not described in this document will be made only with your authorization.
Unless you object, we may disclose information to a family member or other person responsible for your care about your condition, status, and location.
Unless you tell us otherwise, we will include your name, location in the hospital, your general condition (good, fair, etc.), and religious affiliation in our patient directory and make this information available to anyone who asks for you by name. Unless you object, we may disclose this information to a member of the clergy.
We may use and disclose health information to contact you for an appointment reminder, to tell you about health-related services or to recommend possible treatment options or alternatives that may be of interest to you.
Subject to certain requirements, we may use or disclose health information about you without your authorization for other reasons. We may disclose health information about you: for public health purposes; to report abuse or neglect; for health oversight reviews; for research studies, so long as provision is made for the protection of your health information; to medical examiners; for funeral arrangements and organ donation; in response to special law enforcement requests, valid judicial or administrative orders, or for authorized national security and intelligence activities; for workers’ compensation purposes; to avert a serious threat to your health or safety or those of the public or another person; and when required by law (for example, state law requires certain reports to cancer registries). If you are or were a member of the armed forces, we may release information about you as required by military command authorities or the Department of Veterans Affairs. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health information about you to the correctional institution or law enforcement official. We must also release your health information when required by the Department of Health and Human Services to investigate our compliance with privacy laws.
Both federal and state laws protect your health information. In situations where both laws apply, we will comply with the law that is most protective of your health information and/or gives you additional rights. For example, in some situations Michigan law gives more protection to information contained in mental health records. We will notify you if a breach occurs that compromises the privacy and security of your information.
For any other purpose not covered by this Notice, we will ask for your written authorization before using or disclosing your health information. Except for matters where we have taken an action in reliance on your authorization, we will not make further disclosures of authorized matters if at any time you notify us in writing that you have revoked your authorization. .
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU.
If you make a request in writing, you have the right to inspect and obtain a copy of your health information we maintain. We may charge a fee for the costs of copying, mailing or other supplies and services associated with your request. In certain circumstances, your request may be denied. You may request that this denial be reviewed.
If you believe that health information we have about you is incorrect or incomplete, you may ask us to amend your health information. Your request must be in writing, and should state the reason for the amendment and the specific information to be amended.
You have the right to make a written request for a list of disclosures of your health information we have made to others. This list will not include disclosures made for treatment, payment, and health care operations, to your family, or those disclosures authorized by you.
You have the right to restrict certain disclosures of PHI to a health plan where you pay out of pocket in full for the health care item or service.
You have the right to be notified following a breach of your unsecured PHI. This right includes the right to receive, and the healthcare providers obligation to provide, notification following such a breach.
You have the right to request a restriction on the health information we use or disclose about you, including a right to request restrictions on disclosures to family members or friends. You must submit this request in writing. We are not required to agree to your request for restrictions. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment, or we are otherwise required by law to make a disclosure.
You have the right to request that confidential communications with you be made in an alternative manner or location. This request must be in writing and must specify how or where you wish to be contacted, but you do not need to state the reason for your request. For example, you may ask us to send information to your work address instead of your home address, or in a blank envelope with no distinguishing marks. We will accommodate all reasonable requests. .
All written requests should be submitted to our Privacy Officer at 200 N. Madison, Marshall, MI 49068.
COPIES OF NOTICE AND CHANGES
You have the right to obtain a paper copy of this Notice at any time, upon request, even if you have agreed to accept this Notice electronically. You may also obtain a copy of this Notice at our website: www.oaklawnhospital.org
We reserve the right to revise this Notice, and to make the revised Notice effective for information about you we already possess as well as any information about you that we receive in the future. Upon your written request, we will provide you with any revised Notice. A revised Notice will also be posted in waiting areas throughout our facilities and at our website, www.oaklawnhospital.org
If you are concerned that your privacy rights may have been violated or you disagree with a decision we make about your health information, you may file a complaint with our Privacy Officer. You may also send a written complaint to the U.S. Department of Health and Human Services whose address our Privacy Officer can provide to you.
Under no circumstances will we ask you to waive your rights described in this Notice or retaliate against you in any manner for filing a complaint.
Oaklawn Non-Discrimination Notice
Oaklawn complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Oaklawn does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
• Provides free aids and services to people with disabilities to communicate effectively with us, such as:
○ Qualified sign language interpreters
○ Written information in other formats (large print, audio, accessible electronic formats, other
• Provides free language services to people whose primary language is not English, such as:
○ Qualified interpreters
○ Information written in other languages
If you believe that Oaklawn has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with the Patient Advocate at 269-789-8286: If you need help filing a grievance, the Patient Advocate is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
KUJDES: Nëse flitni shqiptar, për ju ka në dispozicion shërbime të asistencës gjuhësore, pa pagesë.
Telefononi në 1-800-532-1786 (TTY: 269-789-7039).
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ܙܘܼܗܵܪܵܐ: ܐܸܢ ܐܲܚܬܘܿܢ ܟܹܐ ܗܲܡܙܸܡܝܼܬܘܿܢ ܠܸܫܵܢܵܐ ܐܵܬܘܿܪܵܝܵܐ، ܡܵܨܝܼܬܘܿܢ ܕܩܲܒܠܝܼܬܘܿܢ ܚܸܠܡܲܬܹܐ ܕܗܲܝܲܪܬܵܐ ܒܠܸܫܵܢܵܐ ܡܲܓܵܢܵܐܝܼܬ. ܩܪܘܿܢ ܥܲܠ ܡܸܢܝܵܢܵܐ
1-800-523-1786 (TTY: 269-789-7039)
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1-800-523-1786 (TTY: 269-789-7039)
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Rufnummer: 1-800-523-1786 (TTY: 269-789-7039).
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Chiamare il numero 1-800-523-1786 (TTY: 269-789-7039)
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Llame al 1-800-523-1786 (TTY: 269-789-7039).
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bayad. Tumawag sa 1-800-523-1786 (TTY: 269-789-7039).
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This Notice was published and became effective on January 13. 2017