Patient Notice Of Privacy Practices
NEW ENGLAND SINAI HOSPITAL AND REHABILITATION CENTER
150 YORK STREET
STOUGHTON, MA 02072
PATIENT NOTICE OF PRIVACY PRACTICES
Effective 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.
NEW ENGLAND SINAI HOSPITAL’S COMMITMENT TO OUR PATIENTS:
New England Sinai Hospital cares about you, our patient, and your privacy. We understand that medical information about you is personal, and protecting that information is important. We create records of the care and services you receive here so that we can continue to provide you with quality care and so that we can comply with certain legal and accreditation requirements.
This notice tells you the ways in which we may use and disclose your personal information, and our obligations to keep your information private. This notice also describes your privacy rights.
We are required by law to keep your personal health information private; to give you this notice of our legal duties and our privacy practices; and to follow the terms of the notice currently in effect.
New England Sinai Hospital maintains medical records for at least 20 years after the patient’s discharge or after the final treatment, as required by state law; a copy of the hospital’s medical record retention policy is available upon request [from the Health Information Management Department].
WHO WILL FOLLOW THIS NOTICE:
This notice applies to the New England Sinai Hospital, all its departments and units, including satellite units at Tufts Medical Center and Caritas Carney and the New England Sinai Hospital Foundation. It applies to our workforce (employees, volunteers, agency and contracted staff, physicians and students).
HOW WE MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION:
The following categories show the different ways we may use and disclose to others your medical information. For each category we give you some examples, but not every use or disclosure in a category is listed. Your medical information will not be used or disclosed for purposes other than those described in this notice without your authorization.
For Treatment: Your medical information may be used or released to other healthcare professionals to provide you with medical treatment or services, as well as emergency care provided in another facility. We may share information about you with doctors, nurses, technicians, or other healthcare professionals involved in taking care of you. For example, a doctor treating you following surgery may need to know if you have diabetes since that could affect the healing process. Other health care professionals may need to share your information to coordinate your care with people outside the Hospitals such as for prescriptions, laboratory work and x-rays. And, we may disclose information about you to people outside the Hospital who may be involved in your medical care after you leave the Hospital.
For payment: Your medical information may be used and disclosed by the Hospital so that the Hospital can receive payment from you, your insurance company or a third party for providing you with needed healthcare services. For example, your insurance company may need to know about the therapies you received so that they will pay us or reimburse you. The Hospital may also disclose your information to obtain prior approval for your care or to determine if your insurance policy will cover the treatment.
For Other Hospital Functions Other than Treatment and Payment: Your medical information may be used or disclosed for a variety of healthcare-related purposes which are necessary for the Hospital to function. We may use your information to ensure that all our patients receive quality care and to ensure that the Hospital continues to earn professional accreditation. For example, we may use your information so that the Hospital can evaluate the performance of our staff in care for you.
In addition, we may utilize your information to contact you for purposes such as the following:
Appointment reminders: We may use and disclose your information to contact you as a reminder that you have an upcoming appointment for an office visit or other treatment.
Health-related services: We may use and disclose your information to tell you about health-related services that may be of interest to you.
Fundraising: We may use certain information (name, address, telephone number, dates of service, age and gender) to contact you in the future to raise money for New England Sinai Hospital. We may also provide this information to the New England Sinai Hospital Foundation, which is our institutionally related foundation, for the same purposes. The money raised will be used to support the services and programs we provide to Sinai patients and the community.
Hospital patient directory: With your permission we may list limited information about you (name, room number, general condition such as “good”) in our directory while you are a patient in the Hospital. We will give this information to anyone who asks for you. In this way family and friends can visit or check on your progress while the Hospital still keeps your medical information private. In addition, if you choose, you may provide us with your religious affiliation so that clergy can identify their congregants who are hospitalized.
Individuals involved in your care: With your permission we may release information about you to a family member or friend who is involved in your care. We may also release information about you to such an individual in a medical emergency.
Special situations: In addition to the above, there may be times when we use or disclose your medical information for the following reasons:
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 your medical information when necessary to prevent a serious threat to your health or safety or to the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat. This may include disaster relief agencies.
Research: We may use and disclose medical information about you for officially-approved research as permitted by law, or through a limited set of information. Otherwise, we will only use or disclose your information for research with your specific authorization.
Organ and Tissue Donation: If you are an organ donor 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 and 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 authorities.
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 child or elder abuse or neglect, to report reactions to medications or problems with products; to notify people of recalls of products that 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 an employer about a workforce member when necessary to evaluate a work-related illness or injury, when we notify you of this disclosure.
Abuse, Neglect or Domestic Violence: We may disclose medical information about you to social service or government authorities if we believe you have been the victim of abuse, neglect or domestic violence if you agree or if we are required by law and we believe it is necessary to prevent serious harm.
Health Oversight Activities: We may disclose medical information about you 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 laws.
Lawsuits and Disputes: We may disclose medical information about you in response to a subpoena, discovery request or other lawful order from a court.
Law Enforcement: We may release medical information about you if asked to do so by a law enforcement official as part of law enforcement activities; in investigations or criminal conduct or of victims of crime; in response to court orders; in emergency circumstances; or when required to do so by law.
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 to 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: We may release 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, or for intelligence, counterintelligence, and other national security activities authorized by law.
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; (3) for the safety and security of the correctional institution.
OTHER USES AND DISCLOSURES OF MEDICAL INFORMATION:
Other uses and disclosures of medical information not covered by this notice or the laws that apply to use will be made only with your prior written permission. If you give 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, thereafter we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You must 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 we provided to you.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU:
You have the following rights regarding the medical information about you:
Right to Inspect and Copy: You have the right to inspect and have copied by the Hospital the medical information that may be used by the Hospital to make decisions about your care. Usually, this includes medical and billing records, but it does not include psychotherapy notes.
To inspect the medical information that may be used to make decisions about you, and to have this information copied by the Hospital, you must submit your request in writing to the Medical Records Department of the Hospital. If you request a copy of the information, we may charge a fee for the costs of copying and postage. We may deny your request to inspect and copy your information in certain very limited circumstances. If so, we will inform you of the denial, the reason for it, and how to request a review of the denial, if review if permitted by law. A licensed health care professional or team of health care professionals will review your request and the denial. We will comply with the outcome of the review.
Right to Request Amendment: 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 the Hospital (30 years from date of service as of this notice).
To request an amendment, your request must be made in writing and submitted to our Privacy Officer; Susan Marre, RHIA, Director of Medical Records and Privacy Officer, New England Sinai Hospital, 150 York Street, Stoughton, MA 02072. In addition, you must provide a reason that supports your request.
We may deny your request for an amendment if it 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 created by another hospital or healthcare provider. But we will inform you of the source of that information if we know it.
Right to an Accounting of Disclosures: You have the right to an “accounting of certain disclosures.” This is a list or report of the disclosures we made of medical information about you for reasons other than your care, payment or other Hospital purposes for which you did not sign an authorization.
To request a list or accounting of disclosures, you must submit your request in writing to our Privacy Officer (see name and address above). Your request must state a time period that may not be longer than six years prior to the request and may not include dates before April 14, 2003. The first list you request within a 12-month period will be free. For additional lists during the same 12-month period, we may charge you for the cost of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at the time before any costs are incurred. We may also provide a summary list as an option.
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 of your care, such as a family member or friend.
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 with emergency treatment.
To request restrictions, you must make your request in writing to our Privacy Officer (see name and address above). In your request, you must state (1) what use or disclosure you want to limit, (2) what information you want to limit, and/or (3) to whom you want the limits to apply.
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 our Privacy Officer (see name and address above). 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 request a paper copy of this notice at any time after the initial issuance. To request a paper copy of this notice, please notify our Privacy Officer (see name and address above) or pick one up in the Hospital’s Admitting Office or Outpatient 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. The notice will contain the effective date in top center portion of the first page.
COMPLAINTS:
If you believe your privacy rights have been violated or the Hospital is not in compliance with these privacy practices, you may file a complaint with the New England Sinai Hospital or with the Secretary of the Department of Health and Human Services. To file a complaint with the New England Sinai Hospital, write to Privacy Officer, New England Sinai Hospital, 150 York Street, Stoughton, MA 02072 All complaints must be submitted in writing.
All complaints will be investigated by the Hospital. You will not be penalized in any way for filing a complaint.
Complaints filed with the Secretary of Health and Human Services, (Hubert H. Humphrey Bldg, Room 425A, 200 Independence Avenue, SW, Washington, DC 20201) must be in writing and must be sent within 180 days of when you knew or should have known that the act or omission occurred. Your letter must include the following points:
- The name of the hospital; and
- A description of the acts or omissions that you believe are in violation of privacy requirements.
PRIVACY OFFICER:
To request any of the above rights, or for further information about this Privacy Notice, please contact:
Susan M. Marre, RHIA
Director of Medical Records and Privacy Officer
New England Sinai Hospital and Rehabilitation Center
150 York Street
Stoughton, MA 02072
Telephone: 781-297-1185