NOTICE OF PRIVACY PRACTICES
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.
Cavalier County Memorial Hospital (CCMH) is required by law to protect the privacy of your health information. We call this information “protected health information” or “PHI”. PHI refers to health and individual information created or received by CCMH which contains details that could identify you, such as your name, address, social security number, etc. CCMH is committed to protecting your privacy. Any protected health information will be kept confidential to the full extent required by law. The law requires us to maintain the privacy of protected health information, to provide you with this notice and to abide by what this notice says. We may change our privacy practices, but we will provide you with information about any changes in a revised notice if you are then receiving services from CCMH or upon your request.
HOW CCMH MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
CCMH uses and discloses PHI for many different reasons. CCMH will use and disclose your PHI only with your written authorization, except as explained in this notice. In most cases, if we use your PHI without your authorization, it is for treatment, payment, public health purposes or as required by law. However, PHI may sometimes be used for other purposes. We will use and disclose only the minimum amount of information needed when ever possible. All uses and disclosures are described below.
For Treatment: We may provide your PHI to health care personnel who provide you with health care services or who are involved in your care. For example, health care information will be shared with those individuals who are directly involved in your health care for purposes such as appointment reminders, treatment alternatives or services which may be of interest to the individual.
For Payment: We may use and disclose your PHI in order to bill and collect payment for the treatment and services provided to you.
For Health Care Operations: We may use and disclose your PHI to ensure the quality and effectiveness of our services or to assess your satisfaction with our services.
As Required by Law: We may disclose your PHI when a discloser is required by federal or state law.
For Public Health Purposes: We may use and disclose your PHI for public health purposes such as to prevent and control disease.
For Health Oversight Activities: We may use and disclose your PHI to health oversight agencies as needed to determine compliance with inspections certification and licensure.
For Judicial and Administrative Proceedings: We may disclose your PHI to health oversight agencies as needed to determine compliance with inspections, certification and licensure.
For Law Enforcement Purposes: We may disclose your PHI when the information is needed for law enforcement.
For Fund Raising: We may contact you in an attempt to raise funds for the facility.
For Workers’ Compensation: We may disclose PHI in order to comply with workers’ compensation laws.
To Report Suspected Abuse, Neglect or Domestic Violence: We may disclose your PHI if needed for reporting abuse, neglect or domestic violence.
To Avert a Serious Threat to Health or Safety: We may disclose your PHI to avert a threat to the safety or health of you and others.
In the Event of a Death: We may disclose your PHI to a coroner, medical examiner, funeral director or organ procurement organizations to carry out duties as necessary.
- The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask that we limit how we use and disclose your PHI. We consider your request but are not legally required to accept it. If we accept your request, we will abide by it except in an emergency treatment situation or as required by law.
- The Right to Choose How We Sent PHI to You. You have the right to receive confidential communication of your PHI and to ask that we send information to an alternate address or by alternate means.
- The Right to Inspect and Copy Your PHI. You have the right to inspect and obtain a copy of your PHI in our possession. We may limit or deny you access in some circumstances.
- The Right to Correct or Update Your PHI. You have the right to request that we correct your PHI that you feel is wrong. We may not honor your request if the PHI is correct and complete, not created by us, not allowed to be disclosed or not part of our records.
- The Right to Receive a List of Disclosures We Have Made. You have the right to request a listing of the disclosures of PHI that we have made. The list will not include uses or disclosures for treatment, payment, healthcare operations, information which you have authorized us to disclose, national security or law enforcement as required by law or information released prior to April 14, 2003.
- The Right to Obtain a Paper Copy of This Notice. You have the right to request a paper copy of the CCMH Notice of Privacy Practices.
- The Right to Authorize Use or Release of PHI or to Revoke such Authorization. You have the right to authorize release of your PHI or to upon your request revoke that authorization.
FOR MORE INFORMATION OR TO REPORT A PROBLEM
If you have questions and/or would like additional information regarding any rights included in this notice, you may contact the Cavalier County Memorial Hospital Privacy Officer at 701-256-6100 or at Cavalier County Memorial Hospital, 909 2nd street, Langdon ND 58249.
If you believe your privacy rights have been violated, you may file a complaint by contacting the Cavalier County Memorial Hospital Privacy Officer at 701-256-6100 or at Cavalier County Memorial Hospital, 909 2nd street, Langdon ND 58249.
You may also file a complaint with the Region VIII Office for Civil Rights, Department of Health and Human Services, 1961 Stout Street, Room 1185 FOB, Denver, CO 80294-3538.
There will be no retaliation against you for filing a complaint.
Effective: April 14, 2003.
Revised: September 15, 2009