PRIVACY
NOTICE (HIPAA)
THIS NOTICE DESCRIBES HOW MEDICAL
INFORMATION ABOUT YOU MAY BE
USED AND DISCLOSED AND HOW YOU CAN GET ACCESS
TO THIS INFORMATON.
PLEASE REVIEW IT CAREFULLY.
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, and
are required by law to do so. 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, anesthesiologists or your
personal doctor. Your personal doctor 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. Please review it carefully
and let us know if you have questions.
HOW WILL WE USE AND DISCLOSE YOUR MEDICAL
INFORMATION?
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.
Treatment: We may use your medical information
to provide you with medical services and supplies.
We may also disclose your medical information
to others who need that information to treat you,
such as doctors, physician assistants, nurses,
medical and nursing students, technicians, therapists,
emergency service and medical transportation providers,
medical equipment providers, and others involved
in your care. For example, we will allow your
physician to have access to your Hospital medical
record to assist in your treatment at the Hospital
and for follow-up care.
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, x-rays and anesthesiology.
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 family members, clergy or
others we use to provide services that are part
of your care.
Appointments: We also may leave a message
of an upcoming appointment on your answering machine
or voicemail, or contact you to inform you about
possible treatment options or alternatives, or
to tell you about health-related services available
to you.
Patient Directory: In order to assist
family members and other visitors in locating
you while you are in the Hospital, the Hospital
maintains a patient directory. This directory
includes your name, room number, your general
condition (such as fair, stable, or critical),
and your religious affiliation (if any). We will
disclose this information to someone who asks
for you by name, although we will disclose your
religious affiliation only to clergy members.
This is so your family, friends, and clergy can
visit you in the hospital and generally know how
you are doing. If you do not want to be included
in the Hospital's patient directory, please make
the registrar aware and they will assist you with
the documentation on your admission/treatment
consent form.
Family Members and Others Involved in Your
Care: We may disclose your medical information
to a family member or friend who is involved in
your medical care, or to someone who helps to
pay for your care. We also may disclose your medical
information to disaster relief organizations to
help locate a family member or friend in a disaster.
If you do not want the Hospital to disclose your
medical information to family members or others
who will visit you, please make the registrar
or your nurse aware and they will document this
on your admission or your consent for treatment
form.
Payment: We may use and disclose your
medical information to get paid for the medical
services and supplies we provide to you. For example,
your health plan or health insurance company may
ask to see parts of your medical record before
they will pay us for your treatment.
Hospital Operations: We may use and disclose
your medical information if it is necessary to
improve the quality of care we provide to patients
or to run the Hospital. We may use your medical
information to conduct quality improvement activities,
to obtain audit, accounting or legal services,
or to conduct business management and planning.
For example, we may look at your medical record
to evaluate whether Hospital personnel, your doctors,
or other health care professionals did a good
job.
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.
Research: We may use or disclose your
medical information for research projects, such
as studying the effectiveness of a treatment you
received. These research projects must go through
a special process that protects the confidentiality
of your medical information.
Required by Law: Federal, state, or local
laws sometimes require us to disclose patients'
medical information. For instance, we are required
to report child abuse or neglect and must provide
certain information to law enforcement officials
in domestic violence cases. We also are required
to give information to the State Workers' Compensation
Program for work-related injuries.
Public Health: We also may report certain
medical information for public health purposes.
We may need to report patient problems with medications
or medical products to the Federal Drug Administration,
or may notify patients of recalls of products
they are using. Additional public health reporting
includes information in regards to births, deaths,
prevention or control of disease, injury or disability
and to notify a person that may have been exposed
to a disease or may be a risk for contracting
or spreading a disease or condition.
Public Safety: We may disclose medical
information for public safety purposes in limited
circumstances. We may disclose medical information
to law enforcement officials in response to a
search warrant or a grand jury subpoena. We also
may disclose medical information to assist law
enforcement officials in identifying or locating
a person, to prosecute a crime of violence, to
report deaths that may have resulted from criminal
conduct, and to report criminal conduct at the
Hospital. We also may disclose your medical information
to law enforcement officials and others to prevent
a serious threat to health or safety.
Health Oversight Activities: We may disclose
medical information to a government agency that
oversees the Hospital or its personnel, such as
the State Department of Health and Welfare, Federal
agencies that oversee Medicare, the Board of Medical
Examiners or the Board of Nursing. These agencies
need medical information to monitor the Hospital's
compliance with state and federal laws.
Coroners, Medical Examiners and Funeral Directors:
We may disclose medical information concerning
deceased patients to coroners, medical examiners
and funeral directors to assist them in carrying
out their duties.
Organ and Tissue Donation: We may disclose
medical information to organizations that handle
organ, eye or tissue donation or transplantation.
Military, Veterans, National Security and
Other Government Purposes: If you are a member
of the armed forces, we may release your medical
information as required by military command authorities
or to the Department of Veterans Affairs. The
Hospital may also disclose medical information
to federal officials for intelligence and national
security purposes, or for Presidential Protective
Services.
Judicial Proceedings: The Hospital may
disclose medical information if ordered to do
so by a court or within certain limits to a subpoena,
a search warrant, or other lawful process.
Information with Additional Protection:
Certain types of medical information have additional
protection under state or federal law. For instance,
medical information about HIV/AIDS, mental health,
and alcohol and drug abuse treatment information
has more protection in Maine. For those types
of information, the Hospital is required to get
your permission before disclosing that information
to others in many circumstances.
Other Uses and Disclosures: If the Hospital
wishes to use or disclose your medical information
for a purpose that is not discussed in this Notice,
the Hospital will seek your permission. If you
give your permission to the Hospital, you may
take back that permission any time, unless we
have already relied on your permission to use
or disclose the information. If you ever would
like to revoke your permission, please notify
us in writing at Health Record Services, Redington-Fairview
General Hospital, 46 Fairview Avenue, P.O. Box
468, Skowhegan, ME 04976, (207) 474-5121.
WHAT ARE YOUR RIGHTS?
Right to Request Your Medical Information:
You have the right to look at your own medical
information and to get a copy of that information.
(The law requires us to keep the original record.)
This includes your medical record, your billing
record, and other records we use to make decisions
about your care, defined as your designated record
set. To request your medical information, write
to or call and ask for an authorization form from
Health Record Services, Redington-Fairview General
Hospital, 46 Fairview Avenue, P.O. Box 468, Skowhegan,
ME 04976, (207) 474-5121. If you request a copy
of your information, we will charge you for our
costs to copy the information. We will tell you
in advance what this copying will cost. You can
look at your record at no cost.
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 Submit Corrections or Clarifications
of Medical Information: If you examine your
medical information and believe that some of the
information is wrong or incomplete, you may submit
a correction/clarification amendment. To submit
a correction or clarification amendment, write
to Health Record Services Redington-Fairview General
Hospital, 46 Fairview Avenue, P.O. Box 468, Skowhegan,
ME 04976, (207) 474-5121. We will respond no later
than 60 days from the date of your request.
We may deny your request for a correction/clarification
amendment 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 designated record set which you would be
permitted to inspect and copy; or
• Is accurate and
complete.
Right to Get a List of Certain Disclosures
of Your Medical Information: You have the
right to request a list of many of the disclosures
we make of your medical information. If you would
like to receive such a list, write to Health Record
Services, Redington-Fairview General Hospital,
46 Fairview Avenue, P.O. Box 468, Skowhegan, ME
04976, (207) 474-5121. We will provide the first
list to you free, but we may charge you for any
additional lists you request during the same year.
We will tell you in advance what this list will
cost.
Right to Request Restrictions on How the Hospital
Will Use or Disclose Your Medical Information
for Treatment, Payment, or Health Care Operations:
You have the right to request us not to
make uses or disclosures of your medical information
to treat you, to seek payment for care, or to
operate the Hospital. We are not required to
agree to your request, but if we do agree
to a reasonable request, we will comply with that
agreement. If you want to request a restriction,
submit your request in writing to Health Record
Services, Redington-Fairview General Hospital,
46 Fairview Avenue, P.O. Box 468, Skowhegan, ME
04976, (207) 474-5121 and describe your request
in detail.
Right to Request Confidential Communications:
You have the right to ask us to communicate with
you in a way that you feel is more confidential.
For example, you can ask us not to call your home,
but to communicate only by mail. To do this, write
to Health Record Services, Redington-Fairview
General Hospital, 46 Fairview Avenue, P.O. Box
468, Skowhegan, ME 04976, (207) 474-5121, we will
accommodate reasonable requests. You can also
ask to speak with your health care providers in
private outside the presence of other patients—just
ask them!
Right to a Paper Copy: You have the right
to a paper copy at any time. You may obtain a
paper copy of this notice at Redington-Fairview
General Hospital, Health Record Services or any
registration area, 46 Fairview Avenue, P.O. Box
468, Skowhegan, ME 04976, (207) 474-5121 or you
may download a paper copy of the notice from our
Web site at http://www.rfgh.net/Notice_of_Privacy_Practices.pdf.
CHANGES TO THIS NOTICE
From time to time, we may change our practices
concerning how we use or disclose patient medical
information, or how we will implement patient
rights concerning their information. We reserve
the right to change this Notice and to make the
provisions in our new Notice effective for all
medical information we maintain. If we change
these practices, we will publish a revised Notice
of Privacy Practices. You can get a copy of our
current notice of Privacy Practices by calling
or writing Redington-Fairview General Hospital,
Health Record Services, 46 Fairview Avenue, P.O.
Box 468, Skowhegan, ME 04976, (207) 474-5121 or
downloading a paper copy from our Web Site, at
http://www.rfgh.net/Notice_of_Privacy_Practices.pdf.
DO YOU HAVE CONCERNS OR COMPLAINTS
Please tell us about any problems or concerns
you have with your privacy rights or how the Hospital
uses or discloses your medical information. If
you have a concern, please contact the privacy
officer, Kim Gray, Redington-Fairview General
Hospital, Health Record Services, 46 Fairview
Avenue, P.O. Box 468, Skowhegan, ME 04976, (207)
474-5121.
If for some reason the Hospital cannot resolve
your concern, you may also file a complaint with
the federal government, Region I, Office for Civil
Rights, U.S. Department of Health and Human Services,
Government Center, J.F. Kennedy Federal Building--Room
1875, Boston, Massachusetts 02203. Voice phone
(617) 565-1340. FAX (617) 565- 3809. TDD (617)
565-1343, or go to www.hhs.gov/ocr/hipaa/.
We will not penalize you or retaliate against
you in any way for filing a complaint with the
federal government.
DO YOU HAVE QUESTIONS?
The Hospital is required by law to give you this
Notice and to follow the terms of the Notice that
is currently in effect. If you have any questions
about this Notice, or have further questions about
how the Hospital may use and disclose your medical
information, please contact the privacy officer,
Kim Gray, Redington-Fairview General Hospital,
Health Record Services, 46 Fairview Avenue, P.O.
Box 468, Skowhegan, ME 04976, (207) 474-5121
Effective date: April 14, 2003
Revision date: June 10, 2003
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