Understanding Your Health Record/Information

Good Hope Hospital Inc. creates records of the care and services you will receive at Good Hope Hospital, Inc.   These records contain certain health information about you and your health. In this Notice, we call this information “protected health information.” We are committed to protecting the confidentiality of this information about you, as required by federal and state law. 

This Notice describes the practices of Good Hope Hospital, Inc. with respect to protected health information about you (such as information in a medical chart) that is created, used or disclosed while you are a patient at Good Hope Hospital, Inc.  Good Hope Hospital, Inc. physicians with staff privileges, non-physician staff, and any other hospital personnel authorized to have access to your protected health information are subject to this Notice.

This Notice will also tell you about the ways in which we may use and disclose protected health information about you, sometimes without your prior permission, and describes your rights and certain obligations we have regarding the use and disclosure of such information.

Your Protected health information Rights

Although your actual health record is the physical property of Good Hope Hospital, Inc., the protected health information in the record belongs to you.  You have the right to

• Request a restriction on certain uses and disclosures of your protected health information for various treatment, payment, health care operations.  However, we are not required by law to agree to a requested restriction;

• Obtain a paper or electronic copy of this Notice of Privacy Practices, as applicable;

• Except in certain special circumstances, inspect and request a copy of your protected health information in a health record, as provided by law;

• Request that we amend your protected health information in a health record, as provided by law.  We will notify you if we are unable to grant your request to amend your health record;

• Obtain an accounting of disclosures of your protected health information, as provided by law;

• Request communication of your protected health information by alternative means or at alternative locations.  We are not required to abide by these requests, but will accommodate them if they are reasonable; and

• Revoke your authorization to use or disclose protected health information except to the extent that action has already been taken in reliance on your authorization.

You may exercise your rights set forth in this Notice by providing a written request to the Health Information Management Service or Compliance Officer at Good Hope Hospital, using the address above.

Our Responsibilities

In addition to the responsibilities set forth above, we are also required by law to:

• Make sure that your protected health information is kept private;

• Give you this Notice of our legal duties and privacy practices with respect to protected health information about you;

• Abide by the terms of the Notice that is currently in effect;

• Notify you if we are unable to agree to a requested restriction on certain uses and disclosures or to amend your protected health information;

• We reserve the right to change revise this Notice and to make the new provisions effective for all protected health information we maintain, including information created or received before the change.  We will post any revised notice and make it available for you on request at Good Hope Hospital, Inc.  The revised notice also will be posted at Good Hope Hospital, Inc. web page at http://goodhopehospital.org; and

• We will not use or disclose your protected health information without your written authorization, except as described in this Notice.

Examples of Uses and Disclosures for Treatment, Payment, Health Care Operations and As Otherwise Required or Permitted by Law

The following sections describe all of the different ways that we may use and disclose protected health information about you without your prior authorization (although not every possible use or disclosure falling within a category will be listed).  All other uses and disclosures will be made only with your authorization.

We will use your protected health information for treatment. For example: We may disclose protected health information about you to doctors, nurses, technicians, health care students, or other personnel who are involved in taking care of you at Good Hope Hospital, Inc.  We may share protected health information about you in order to coordinate different treatments, such as prescriptions, lab work and x-rays.  We may also provide your physician or the subsequent health-care provider with copies of various reports to assist in treating you once you are discharged from care at Good Hope Hospital, Inc.

We will use your protected health information for payment.  For example: We may send a bill to you, your insurance company, or some other third-party payer responsible for paying for your hospital care.  The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.  Information may also be sent to your health plan about a treatment you are going to receive, in order to obtain prior approval of the treatment or determine if your plan will cover the treatment.  However, these uses or disclosures may be limited by certain laws governing records relating to communicable diseases.

We will use your protected health information for health care operations. For example: We may use or disclose the information in your health record to assess the care and outcome in your case and others like it.  This information will then be used in an effort to continually improve the quality and effectiveness of the health care and services we provide.  However, these uses or disclosures may be limited by certain laws governing mental health, nursing facility and hospital records, or records related to communicable diseases.

We will use your protected health information as otherwise allowed by law (The following are some examples of how we may use or disclose protected health information about you)

Business associates: There are some services provided in our organization through agreements with business associates.  Examples include reference laboratories and consultant companies.  However, federal and state law requires that we insist that business associates sign specialized agreements designed to safeguard your information in their hands.

Directory: We will use your name and location in our facility for census and directory purposes while you are a patient at Good Hope Hospital, Inc.  This information may be provided to members of the clergy and to other people who ask for you by name.  However, you have the right to object to or restrict the use of your name for directory purposes by notifying the Health Information Management Service or Compliance Officer at Good Hope Hospital at the address and numbers above.  Moreover, these uses or disclosures may be limited by certain laws governing mental health and nursing facility records, or records related to communicable diseases or controlled substance abuse.

Individuals Involved in Your Care or Payment for Your Care or for Disaster Relief: We may release protected health information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may tell your family or friends your condition and that you are in the hospital. In addition, we may disclose protected health information about you to someone assisting in a disaster relief effort, so that your family can be notified of your conditions, status and location.  However, you have the right to object to or restrict the disclosure of your protected health information to a friend or family member who is involved in your medical care.  Also, these uses or disclosures may be limited by certain laws governing mental health and nursing facility records, or records related to communicable diseases.

Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, general condition or death.  However, you have the right to object to or restrict the use of your name for these notification purposes by notifying the Health Information Management Service or Compliance Officer at Good Hope Hospital at the address and numbers above.  Also, these uses or disclosures may be limited by certain laws governing mental health and nursing facility records, or records related to communicable diseases.

Coroners, Medical Examiners and Funeral directors: We may disclose protected health information to coroners, medical examiners funeral directors consistent with applicable law to carry out their duties.  However, these disclosures may be limited by certain laws governing pharmacy or nursing facility records, or records related to communicable diseases.

Organ and Tissue Donation: Consistent with applicable law, we may disclose protected health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs, eyes or tissue for the purpose of organ, eye or tissue donation and transplant. However, these disclosures may be limited by certain laws governing nursing facility records, or records related to communicable diseases.

Appointment Reminders and Treatment Alternatives: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Fundraising: A hospital-affiliated foundation may contact you as part of a fundraising effort on the hospital’s behalf.  If you are sent fundraising information that you do not wish to receive, you may contact the hospital foundation at ____________.   Moreover, these uses or disclosures limited by certain laws governing pharmacy, mental health or nursing facility records, or records related to communicable diseases.

Worker’s compensation: We may disclose protected health information to the extent authorized by and to the extent necessary to comply with laws relating to worker’s compensation or other similar programs established by law that provide benefits for work-related injuries or illness.  However, these disclosures may be limited by certain laws governing pharmacy, mental health and nursing facility records, or records related to communicable diseases.

Public health: We may disclose your protected health information to public health or legal authorities for public health activities, including, but not limited to, the following: (1) to prevent or control disease, injury or disability; (2) to report births or deaths; (3) required by the FDA for purposes of regulating products subject to its jurisdiction; (4) to report child abuse or neglect; or (5) to notify a person who might have been exposed to a disease or might be at risk for getting or spreading a disease or condition. However, these disclosures may be limited by certain laws governing pharmacy or nursing facility records, or records related to communicable diseases or cancer.

Abuse, neglect or domestic violence: As required by law, we may disclose protected health information to a governmental authority authorized by law to receive reports of abuse, neglect, or domestic violence.  However, these disclosures may be limited by certain laws governing pharmacy or nursing facility records, or records related to communicable disease or controlled substance abuse.

Judicial, administrative and law enforcement purposes:  Consistent with applicable law, we may disclose protected health information about you for judicial, administrative and law enforcement purposes.  However, these disclosures may be limited by certain laws governing mental health, pharmacy or nursing facility records, or records related to communicable diseases or controlled substance abuse.

Threat to Health or Safety:  Consistent with applicable law, we will disclose information about you when necessary to prevent or lessen a serious threat the health and safety of the public or another person. Any disclosure, however, would only be to someone who is reasonably able to prevent or lessen the threat.  However, these disclosures may be  limited by certain laws governing pharmacy or nursing facility records, or records related to communicable diseases or controlled substance abuse.

Required or allowed by law: We will disclose protected health information about you when required or allowed to do so by applicable federal, state or local law.

Marketing: We may disclose protected health information about you for marketing purposes if the marketing communication (i) occurs in a face-to-face meeting with you or (2) concerns promotional gifts of a nominal value.  However, these disclosures may be limited by certain laws governing mental health, pharmacy or nursing facility records, or records related to communicable diseases.

Military: If you are a member of the armed forces, we may release protected health information about you as required by military command authorities. We may also release protected health information about foreign military personnel to the appropriate foreign military authority.

Health Oversight: We may disclose protected health information to a health oversight agency for oversight activities authorized by law, including audits, investigations, inspections and licensure. However, these disclosures may be limited by certain laws governing pharmacy, nursing, or ambulatory surgical facilities, nursing pools or cardiac rehabilitation program records, or records related to communicable diseases.

National Security and Other Government Functions: We may disclose protected health information about you to authorized federal officials for intelligence and national security activities authorized by law. We may also share your protected health information with authorized federal officials in order to protect the President or other officials, or, subject to laws governing substance abuse records, to conduct investigations.

Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release protected health information about you to the correctional institution or the law enforcement official where necessary: (1) for the correctional institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution. However, these disclosures may be limited by certain laws governing pharmacy, nursing facility or mental health facility records, or records related to communicable diseases or substance abuse.

For more Information or to Report a Problem

If you believe your privacy rights have been violated, you can file a complaint with Good Hope Hospital, Inc. HIM Manager/Privacy Officer, Compliance Officer at the phone number provided above, or the Secretary of Health and Human Services using the contact information below.  There will be no retaliation for filing a complaint.   

Secretary of Health and Human Services Contact Information:
Region IV, Office of Civil Rights
US Department of Health and Human Services
Atlanta Federal Center
Suite 3B70
61 Forsyth Street, SW
Atlanta, Georgia  30303-8909

Effective Date:  4/14/03