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Policy on Privacy Practices
THE NOTICE BELOW DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy Practices (Notice) describes how your medical record will be used and your rights to access and control your medical information. When you established care at Penobscot Community Health Care (PCHC), you gave us your consent to treat you and to make a record of that care. Your medical record contains your symptoms, test results, diagnoses, treatment and a plan of care for any health service you receive at PCHC, including primary and preventive medical care, care management, mental health, physical therapy, speech therapy and audiology and dental care. This record also contains demographic information about you, such as your name, address, telephone number and family. We refer to this record as your medical information. In providing your consent to provide care to you, you also consented to PCHC making certain uses and disclosures of your medical information which are necessary to provide care to you, seek payment for the services you receive and support the legitimate health care operations of PCHC, which are described in this Notice. This Notice also describes the uses and disclosures of your medical information which are not covered by the consent you already provided and which you may be asked to authorize in the future and those uses and disclosures which are permitted or required by law. It also describes the rights you have concerning your own medical information. We are required by law to provide you with this Notice, and we are required to follow the terms of the Notice that is currently in effect. Please review this Notice carefully and let us know if you have any questions.
How We May Use And Disclose Your Medical Information. The following categories describe different ways we may use and disclose your medical information that do not require your authorization. The situations that require your written authorization are described in the next section. For each category, we say what we mean and give examples (note: not every use or disclosure is listed).
• Treatment: We will use and release your medical information to provide, coordinate and manage your health care and related services. Your medical information will be contained in an electronic health record which may include information about your physical and mental health, HIV/AIDS, and substance abuse treatment, among other things. This record will be available to all providers, nurses, technicians and medical students or others involved in your care, even if those providers or staff are at different physical locations. For example, your medical information may help a PCHC physician at one location and a PCHC specialist at another location reach a diagnosis. This may include a licensed mental health provider, if applicable. PCHC providers may also speak with Care Managers to identify patients who may benefit from care management. Additionally, we may disclose your medical information to a family member or friend who is involved in your medical care, or to someone who helps pay for your care. Finally, we may also disclose your medical information to other health care providers for purposes related to your treatment.
• Payment: We may use and disclose your medical information to get paid for the medical services and supplies we provide 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. Please let us know if you would rather pay for a procedure privately rather than have sensitive information sent to your insurance company.
• Health Care Operations: We may use or disclose your medical information to make sure you are receiving quality care. These uses are needed to run our facilities and make sure that all patients receive quality care. For example, we may use your medical information to review our treatment and services and to evaluate our staff who is taking care of you. We may also combine medical information about many patients to decide what other services we should offer, what services may not be needed and whether certain treatments are effective. As a teaching health center, we may release information to providers, students and other staff for review and teaching lessons.
• Treatment Alternatives, Appointment Reminders and Health-Related Benefits: In the course of providing treatment to you, we may use your medical information to inform you about possible treatment options or alternatives, or to tell you about health-related services available to you. For example, we may suggest care management services to you if you have a condition that would benefit from care management or if you have a history of avoidable emergency room visits or hospitalizations. We may also use and disclose your medical information to contact you and remind you of an upcoming appointment.
• Fundraising: We are permitted to use your contact information and age (but not the details of your care) to raise funds for PCHC. For example, we may contact you to request a tax-deductible contribution to support important activities of PCHC. If you do not wish to be contacted for this purpose, please write to Penobscot Community Health Care, Attn: Development Department, 103 Maine Avenue, Bangor, Maine 04401.
• Health Information Exchanges: We participate in a state-wide health information exchange (operated HealthInfoNet) with other providers and hospitals in the State of Maine. This exchange is a secure health information network which makes available certain limited health information that may be relevant to your care, such as allergies, prescription medications, laboratory test results, diagnostic study results, and medical and clinical conditions and diagnoses. For example, if you are hurt in a car accident and treated at a hospital that participates in HealthInfoNet, your care providers will have electronic access to certain information in your PCHC medical records. When your medical information is needed, ready access means better care for you. Mental health, substance abuse and HIV information is not shared with HealthInfoNet at this time and is not made available to other participants in the exchange. You may choose to not make your information available through the health information exchange by completing an “opt-out” election form available at all points of registration within PCHC. In addition, you can go to the Internet at the web address of https://www.hinfonet.org/optoutand electronically fill out the form for immediate action on your choice. Completing an opt-out form online is the quickest way to opt-out.
• Individuals Authorized By Law to Act on Your Behalf: We may disclose your medical information to persons authorized by law or designated by you to act on your behalf, such as a guardian, health care power of attorney, or health care surrogate or proxy agent. Parents or guardians generally have the authority to act on behalf of minor patients, unless the law authorizes the minor to act for him or herself.
• Disclosures Required By Law: We will disclose medical information about you when required to do so by federal, state or local law. We will notify you of these uses and disclosures if notice is required by law. We will release information to the Workers Compensation Program or similar programs which provide benefits for work-related injuries.
• Public Health Activities: We may report to government agencies certain medical information for public health purposes, such as preventing the spread of disease, to report certain medical conditions, or to report abuse and neglect. We may also need to report patient problems with medications or medical products to the FDA, or may notify patients of recalls of products they are using.
• Legal Proceedings: If you are involved in a lawsuit or dispute, we may disclose your medical information if we are ordered to do so by a valid court or administrative order. We may also disclose your medical information in response to a lawful subpoena or discovery request from a government entity legally entitled to such information.
• Mandatory Reporting of Abuse & Neglect: We may disclose medical information in connection with state mandatory reporting laws, such as those requiring reporting of suspected abuse and neglect of children and incapacitated adults.
• Third Parties: We may disclose your medical information to third parties who provide services on our behalf. These third parties may be known as “Business Associates” or a “Qualified Service Organization.” For example, we may share your medical information with an accounting or law firm that provides professional advice to us about how to improve our health care services or comply with the law. If we disclose your information to these entities, we will have an agreement with them to safeguard your information.
• Special Circumstances:
o Organ and Tissue Donation: We may release your medical information to an organization that handles organ, eye or tissue procurement and transplantation, including organ donation banks, to facilitate organ and tissue donation and transplantation if you are an organ donor.
o Military & Veterans: If you are a member of the armed forces, we may release medical information about you as required by the military. We may also release health information about foreign military staff to the appropriate foreign military agency.
o Health Oversight Activities: We may disclose medical information to a government agency that is charged with monitoring our compliance with certain laws and regulations, and which may conduct inspections, audits, or investigations. For example, where appropriate, we may disclose your information to the Medicare or Medicaid (MaineCare) programs for their review, or to the Maine Department of Health and Human Services. These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.
o Correctional Institution and Other Law Enforcement Custodial Situations: If you are in the custody of a correctional institution or detained by a law enforcement officer, we may disclose medical information to the correctional institution or law enforcement officers, if necessary, to provide you with health care or to maintain the safety and security at the place where you are confined.
o Deceased Patients: We may disclose medical information concerning deceased patients to coroners and medical examiners to identify a deceased individual or to assist in identifying the cause of death. If necessary, we may also release information about such patients to funeral directors to assist them in carrying out their duties.
Uses and Disclosures Requiring Your Authorization. If we wish to use or disclose your medical information for a purpose that is not discussed in this Notice, we will seek your written permission. If you give your permission to PCHC, you can withdraw it at any time, unless we have already relied on your permission to use or disclose the information. If you ever would like to withdraw or revoke your written permission, please contact PCHC, Attn: Medical Records, P.O. Box 1599, Bangor ME 04401.
Certain laws provide greater protection about the following categories of information about you, including part of your medical information about mental health, substance abuse treatment and HIV/AIDS testing, diagnosis and treatment. These categories of information in your medical record are available to all PCHC providers, nurses, technicians and specialists involved in your care, even if they are located at different physical locations, as described above. These providers work as a team to provide the best possible care. These categories of information will only be released outside of PCHC as follows.
• Mental Health: Information that you receive mental health services provided by a licensed mental health professional at PCHC will only be released to people you allow to have it by signing a written authorization form or as required by law or a court order.
• Substance Abuse Disorder Situations: If you are a person with a substance abuse disorder and receive treatment in our Addictions Medicine Program, or at the Hope House Shelter, the confidentiality of those records is protected by Federal law and regulations. Generally, PCHC may not say to a person outside the Addictions Medicine Program or the Hope House Shelter that you attend either program or identify you as a patient in either program, unless (1) you consent in writing, (2) the disclosure is allowed by a court order, or (3) the disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit or program evaluation. Federal law and regulations do not protect information about a crime committed by a patient at either program, about a crime committed against any person who works for either program or about any threat to commit such a crime. Federal law and regulations also do not protect any information about suspected child abuse or neglect from being reported under Maine law to appropriate authorities.
• HIV and AIDS-Related Information: Information about you indicating that you have had an HIV-related test, have an HIV-related illness or AIDS, or have an HIV-related infection, as well as any information which could reasonably identify you as a person who has had a test or has HIV infection, will not be released to an external individual unless required by law or unless you have provided written authorization.
Your Rights Regarding Your Health Information. You have the following rights regarding medical information we maintain about you:
• Right to See and Copy Your Medical Record: You have a right to look at your own medical information and to get a copy of that information. This includes your medical record, your billing record, and other records we use to make decisions about your care. To do this, write to PCHC, Attn: Medical Records Department, P.O. Box 1599, Bangor, ME 04401. 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 for free by arranging an appointment with the department listed above.
• Right to Append (Update) Your Medical Record: If you review your medical information and believe that some of the information is wrong or incomplete, you may submit a written amendment or clarification. To do so, please write to PCHC, Attn: Medical Records Department, P.O. Box 1599, Bangor, ME 04401. We will comply with your request unless you ask us to amend information we believe is (i) accurate and complete; (ii) was not completed by us, unless you provide us with a reason to believe that the person who created the information is no longer available; (iii) is not part of the information that you would be permitted to copy or inspect; or (iv) is not part of the information kept by PCHC.
• Right to a List of Certain Disclosures of Your Medical Record: After April 14, 2003, you have the right to request a list of certain disclosures we make of your medical information. This list does not include certain disclosures, such as medical information disclosed for treatment, payment or health care operations, or information you authorized us to disclose, or disclosures made directly to you. If you would like to receive such a list, please write to PCHC, Attn: Medical Records Department, P.O. Box 1599, Bangor, ME 04401. We will provide the first list to you for free, but we may charge for you any additional lists you request during the same year. We will tell you in advance what this list will cost. The list will not go back before April 14, 2003, when the HIPAA privacy regulations came into effect, or go back for more than six years.
• Right to Request Confidential Communications: You have the right to request that we communicate with you about your medical matters in a way that you feel is more confidential. For example, you may ask that we contact you at home instead of at work. To do this, please make a written request to the practice manager where you receive care. Please specify in your request how or where you wish to be contacted.
• Right to Request Restrictions: You have the right to request further restrictions on the way we use your medical information or share it with others. You may also request that we limit how we disclose information about you to family or friends involved in your care. For example, you could request that we not disclose information about a surgery you had. To request restrictions, please write to the PCHC, Attn: Medical Records Department, P.O. Box 1599, Bangor, ME 04401. We will consider your request carefully, but we are not required to agree to it. If we do agree to it, we will be bound by our agreement, unless information is needed to provide you with emergency treatment or comply with the law.
• Right to a Paper Copy of This Notice: You have the right to a paper copy of this Notice. You may request a paper copy at any time. To do so, please request one from any PCHC location where you receive care. You may also obtain a copy of this Notice from our website at www.pchc.com or by requesting a copy at your next visit.
Changes to This Notice. We may change the terms of this Notice at any time. If we change this Notice, we may make the new notice terms effective for all medical information we maintain, including any information created or received prior to issuing the new notice. If we change this Notice, we will post the new notice in waiting areas around PCHC and on our website at www.pchc.com.
Who This Notice Applies To. This Notice applies to PCHC and its workforce, including all personnel, volunteers, students, and trainees, as well as third parties who provide services to PCHC, as discussed above.
Do You Have Concerns or Complaints? Please tell us about any problems or concerns you have with your privacy rights or how PCHC uses or discloses your medical information. If you have a concern, please contact the Privacy Officer, whose contact information is listed at the end of this Notice. If for some reason PCHC cannot resolve your concern, you may also file a complaint with the Office of Civil Rights, United States Department of Health & Human Services. We will not penalize you or retaliate against you in any way for filing a complaint with the federal government.
Do You Have Questions? If you have questions about this Notice, or further questions about how PCHC may use and disclose your medical information, please contact the Privacy Officer at:
Penobscot Community Health Care
103 Maine Avenue
P.O. Box 2100
Bangor, ME 04402-2100
Tel. (207) 992-9200