Carthage Area Hospital
1001 West Street
Carthage, NY 13619
Effective date of this notice: 05/01/2003
If you have questions about this notice , please contact the person listed under "Whom to Contact" at the end of this notice
This Notice applies to the following facilities: Carthage Area Hospital and Carthage Area Hospital Clinics (Cape Vincent and Philadelphia). These facilities are referred to jointly in this Notice as "Carthage Area Hospital".
In the course of receiving services from Carthage Area Hospital, you will provide us with personal information about your health, with the understanding that this information will be kept confidential. We may also obtain information about your health from examinations, tests, or from others who have provided you with care. This Joint Notice of Privacy Practices is intended to inform you of the ways we may use your information and the occasions on which we may disclose this information to others.
We use patients' information when providing treatment, we disclose patients' information to other health care providers to assist them to provide you with treatment, we may disclose information to insurance companies as necessary to receive payment, we may use the information within our organization to evaluate quality and improve health care operations, and we may make other uses and disclosures of patients' information as required by law or as permitted by Carthage Area Hospital policies.
Information about HIV, alcohol and substance abuse treatment, mental health, and genetics is very sensitive and has additional protections under federal and state law. You may request a copy of our policy regarding disclosure of such information.
You will be asked to sign a consent allowing us to use and disclose your health information to provide you with treatment, obtain payment for our services, and run our health care operations. Here are examples of how we may use and disclose your health information with your consent.
We will use your health information to provide you with medical care and services. This means that our employees, staff, students, volunteers and others whose work is under our direct control, may read your health information to learn about your medical condition and use it to make decisions about your care. For instance, a hospital nurse may read your medical chart in order to care for you properly. We will also disclose your information to others who need it in order to provide you with medical treatment or services. For instance, we may send your doctor the results of laboratory tests we perform.
We will use your health information, and disclose it to others, as necessary to obtain payment for the services we provide to you. For instance, an employee in our business office may use your health information to prepare a bill. And we may send that bill, and any health information it contains, to your insurance company. We may also disclose some of your health information to companies with whom we contract for payment-related services. For instance, we may give information about you to a collection company that we contract with to collect bills for us. We will not use or disclose more information for payment purposes than is necessary.
We may use your health information for activities that are necessary to operate this organization. This includes reading your health information to review the performance of our staff. We may also use your information and the information of other patients to plan what services we need to provide, expand, or reduce. We may also provide health information to students who are authorized to receive training here. We may disclose your health information as necessary to others who we contract with to provide administrative services. They are called business associates and include our lawyers, auditors, accreditation services, and consultants, for instance. Any arrangements with business associates that allow disclosure of your health information will be subject to a written agreement that protects your privacy rights.
Below are examples of other uses and disclosures of health information we may make without your authorization.
We will disclose your information when we are required by law to do so. This includes reporting information to government agencies that have the legal responsibility to monitor the health care system. For instance, we may be required to disclose your health information, and the information of others, if we are audited by Medicare or Medicaid. We will also disclose your health information when we are required to do so by a court order or other judicial or administrative process.
We will disclose your health information when required to do so for public health purposes. This includes reporting certain diseases, births, deaths, and reactions to certain medications. It may also include notifying people who have been exposed to a disease.
We may disclose your health information when the information relates to a victim of abuse, neglect or domestic violence. We will make this report only in accordance with laws that require or allow such reporting, or with your permission.
We may disclose your health information for law enforcement purposes. This includes providing information to help locate a suspect, fugitive, material witness or missing person, or in connection with suspected criminal activity. We must also disclose your health information to a federal agency investigating our compliance with federal privacy regulations.
We may disclose the health information of members of the armed forces as authorized by military command authorities. We may disclose your health information for a number of other specialized purposes. We will only disclose as much information as is necessary for the purpose. For instance, we may disclose your information to coroners, medical examiners and funeral directors; to organ procurement organizations (for organ, eye, or tissue donation); or for national security, intelligence, and protection of the president. We also may disclose health information about an inmate to a correctional institution or to law enforcement officials, to provide the inmate with health care, to protect the health and safety of the inmate and others, and for the safety, administration, and maintenance of the correctional institution. We may also disclose your health information to your employer for purposes of workers' compensation and work site safety laws (OSHA, for instance).
We may disclose your health information if we decide that the disclosure is necessary to prevent serious harm to the public or to an individual. The disclosure will only be made to someone who is able to prevent or reduce the threat.
We may disclose your health information to a member of your family or to someone else who is involved in your medical care or payment for care. We may notify family or friends if you are in the hospital, and tell them your general condition. In the event of a disaster, we may provide information about you to a disaster relief organization so they can notify your family of your condition and location. We will not disclose your information to family or friends if you object. However, in an emergency, we may disclose information that we determine is in your best interest.
We may list you in our directory if you are admitted to the hospital. The directory listing will include your name, general condition, and location in the hospital. We will also list your religion in the directory, but will disclose that information only to members of the clergy. Except for members of the clergy, we will only disclose the information in the directory to visitors who ask for you by name. If you ask, we will not list you in the directory, or we will omit any information you ask us to omit.
We may use your health information to provide you with additional information. This may include sending appointment reminders to your address. This may also include giving you information about treatment options or other health-related services that we provide.
We may contact you when we are raising money for our hospital, or we may share information about you with our related Foundation that may contact you to raise money on our behalf.
We may use or disclose your health information for any purpose that is listed in this Notice without your written authorization. We will not use or disclose your health information for any other reason without your authorization. If you authorize us to use or disclose your health information, you have the right to revoke the authorization at any time. For information about how to authorize us to use or disclose your health information, or about how to revoke an authorization, contact the person listed under "Whom to Contact" at the end of this notice. You may not revoke an authorization for us to use and disclose your information to the extent that we have taken action in reliance on the authorization. If the authorization is to permit disclosure of your information to an insurance company, as a condition of obtaining coverage, other laws may allow the insurer to continue to use your information to contest claims or your coverage, even after you have revoked the authorization.
You have the right to ask us to restrict how we use or disclose your health information. We will consider your request. But we are not required to agree. If we do agree, we will comply with the request unless the information is needed to provide you with emergency treatment. Also, we cannot agree to restrict disclosures that are required by law.
You have the right to ask us to communicate with you at a special address or by a special means. For example, you may ask us to send mail to a different address rather than to your home. Or you may ask us to speak to you personally on the telephone rather than sending your health information by mail. We will not ask you to explain why you are making the request. We will agree to any reasonable request.
You have a right to inspect the health information about you that we have in our records, and to receive a copy of it. This right is limited to information about you that is kept in records that are used to make decisions about you. For instance, this includes medical and billing records. If you want to review or receive a copy of these records, you must make the request in writing. We may charge a fee for the cost of copying and mailing the records. To ask to inspect your records, or to receive a copy, contact the person listed under "Whom to Contact" at the end of this notice. We will respond to your request to inspect your records within 10 days, and to your request to receive a copy of your records within 30 days.
You have the right to ask us to amend health information about you, which you believe is not correct, or not complete. You must make this request in writing, and give us the reason you believe the information is not correct or complete. We will respond to your request in writing within 30 days. We may deny your request if we did not create the information, if it is not part of the records we use to make decisions about you, if the information is something you would not be permitted to inspect or copy, or if it is complete and accurate.
You have a right to receive an accounting of certain disclosures of your information to others. This accounting will list the times we have given your health information to others. The list will include dates of the disclosures, the names of the people or organizations to whom the information was disclosed, a description of the information, and the reason. We will provide the first list of disclosures you request at no charge. We may charge you for any additional lists you request during the following 12 months. You must tell us the time period you want the list to cover. You may not request a time period longer than six years. We cannot include disclosures made before April 14, 2003. Disclosures for the following reasons will not be included on the list: disclosures for treatment, payment, or health care operations; disclosures of information in a facility directory ; disclosures for national security purposes; disclosures to correctional or law enforcement personnel; disclosures that you have authorized; disclosures made directly to you; disclosures made to your family and friends included in your care; disclosures incidental to permissible uses and disclosures; disclosures of limited portions of your health information that do not directly identify you; and disclosures made before April 14, 2003.
You have a right to receive a paper copy this Notice. If you have received this notice electronically, you may receive a paper copy by contacting the person listed under "Whom to Contact" at the end of this Notice.
You have a right to complain about our privacy practices, if you think your privacy has been violated. You may file your complaint with our Patient Services Department, or with the person listed under "Whom to Contact" at the end of this notice. You may also file a complaint directly with the Secretary of the U. S. Department of Health and Human Services. All complaints must be in writing. We will not take any retaliation against you if you file a complaint.
We reserve the right to change our privacy practices, as described in this Notice, at any time. We reserve the right to apply these changes to any health information, which we already have, as well as to health information we receive in the future. Before we make any change in the privacy practices described in this Notice, we will write a new notice that includes the change. We will post the new notice in the Registration and Switch Board Lobby Areas and on our Web site. We will give you a copy of our revised Notice if you ask. The new Notice will include an effective date.
Contact the person listed below:
1001 West Street
Carthage, NY 13619