Notice of Privacy Practices for Protected Health Information (PHI)

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!

The hospital is permitted by Federal Privacy laws to make uses and disclosures of your health information for purposes of treatment, payment, and health care operations. Protected health information (PHI) is the information we create and obtain in providing our services to you. Such information may include documenting your symptoms, examination and test results, diagnoses, treatment, and applying for future care or treatment. It also includes billing documents for those services.

Examples of uses of your health information for treatment purposes are:

• A nurse obtains treatment information about you and records it in a health record (medical record or chart).
• During the course of your treatment, the physician determines s/he will need to consult with a specialist in the area. S/he will share the information with such specialists and obtain his/her input.

An example of use of your health information for payment purposes:

• We submit a request for payment to your health insurance company. The health insurance company requests information from us regarding medical care given to you. We will provide information to them about you and the care given.

An example of use of your health information for health care operations:

• The state licensing authority wants to review records to assure that we have acted consistent with state law regarding your care. In doing so, it wants to take a sampling which includes review of your chart (health/medical record). At the licensing authority’s request, we will provide a copy of your record.

Your Health Information Rights

The health record we maintain and billing records are the physical property of the hospital. The information contained in the health record, however, belongs to you. You have a right to:

• Request, in writing, a restriction on certain uses and disclosures of your health information by delivering the request in writing to our hospital (to the Health Information Management or HIM/Medical Records Department). We are not required to grant the request but we will comply with any request granted;
• Obtain a paper copy of the Notice of Privacy Practices for Protected Health Information (“Notice”) by making a request at our hospital (attn: HIM/Medical Records Dept.);
• Request that you be allowed to inspect and copy your health /medical record and billing record – you may exercise this right by delivering your request in writing to our hospital (attn: HIM/Medical Records Dept.) using the form we provide to you upon request;
• Appeal, in writing, a denial of access to your protected heath information except in certain circumstances;
• Request, in writing, that your health record be amended to correct incomplete or incorrect information by delivering a written request to our hospital (attn: HIM/Medical Records Dept.) using the form we provide to you upon request;
• File a written statement of disagreement if your amendment is denied, and require that the request for amendment and any denial be attached in all future disclosures of your protected health information (PHI). [the length of this statement is defined in RMH Policy and Procedure for Processing Amendments to Protected Health Information]
• Obtain an accounting of disclosures of your health information as required to be maintained by law by delivering a written request to our hospital using the form we provide to you upon request; an accounting will not include internal uses of information for treatment, payment, or operations, disclosures of limited data sets (such as statistical data transmitted to the State of Kansas as required by law), incidental disclosures (those disclosures which occur incidental to our provision of care which are unintended and not preventable), disclosures made to you or made at your request, or disclosures made to family members or friends in the course of providing care;
• Request that communication of your health information be made by alternative means or at an alternative location by delivering the request in writing to our hospital (attn: HIM/Medical Records Dept.) using the form we provide to you upon request – we will consider your request and follow your wishes whenever reasonable and possible; and,
• Revoke authorizations that you made previously to use or disclose information except to the extent information or action has already been taken by delivering a written revocation to our hospital (attn: HIM/Medical Records Dept.).

If you want to exercise any of the above rights, please contact the Director of HIM/Medical Records and HIPAA Compliance, Ransom Memorial Hospital, 1301 S. Main Street, Ottawa, KS, 66067, 785-229-8250 in writing or during normal business hours (8:00-4:30, M-F). This person will provide you with assistance on the steps to be taken to exercise your rights.

Our Responsibilities

The hospital is required to:

• Maintain the privacy of your health information as required by law;
• Provide you with a notice as to our duties and privacy practices as to the information we collect about you;
• Abide by the terms of this notice;
• Notify you if we cannot accommodate a requested restriction or request; and,
• Accommodate your reasonable requests regarding methods to communicate health information with you.

We reserve the right to amend, change, or eliminate provisions in our privacy practices and access practices, and to enact new provisions regarding the protected health information we maintain. If our information practices change, we will amend our Notice. You are entitled to receive a revised copy of the Notice by calling and requesting a copy of our “Notice” or by visiting our hospital and picking up a copy. It is also available on the internet at www.ransom.org

To Request Information or File a Complaint

If you have questions, would like additional information, or want to report a problem regarding the handling of your information, you may contact the Director of Health Information Management/Medical Records/HIPAA Compliance, Ransom Memorial Hospital, 1301 S. Main Street, Ottawa, KS, 66067, 785-229-8250.

Additionally, If you believe your privacy rights have been violated, you may file a written complaint at our hospital by delivering the written complaint to the Director of Health Information Management/Medical Records/HIPAA Compliance, Ransom Memorial Hospital, 1301 S. Main Street, Ottawa, KS, 66067. You may also file a complaint by mailing it or e-mailing it to the Secretary of the U.S.Department of Health And Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20201 or by email to: HHS.Mail@hhs.gov

We cannot, and will not, require you to waive the right to file a complaint with the Secretary of the U.S. Department of Health and Human Services (HHS) as a condition of receiving treatment from the hospital.

We cannot, and will not, retaliate against you for filing a complaint with the Secretary of HHS.

Other Disclosures and Uses

Business Associates
We have business associates with whom we may share your protected health information. For example, in preparing our annual financial statement, auditors may need to review samples of the medical care given at our facility. We may disclose your health information to the accounting firm to prepare this material.

Directory
Unless you notify us in writing that you object , we will use and disclose your name, location, general condition, and religious affiliation in a hospital directory. This information may be provided to members of the clergy, and except for religious affiliation, to other people who ask for you by name.

Notification
Unless you object, we may use or disclose your protected health information to notify, or assist you in notifying, a family member, personal representative, or other person responsible for your care, about your location, and about your general condition, or your death.

Communications with Family
Using our best judgment, we may disclose to a family member, other relative, close personal friend, or any other person you identify, health information relevant to that person’s involvement in your medical care or in payment for such care if you do not object, OR in an emergency.

Research
We may disclose information to researchers when their research has been approved by an institutional review board (IRB) that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.

Disaster Relief
We may use and disclose your protected health information to assist in disaster relief efforts.

Funeral Directors/Coroners
We may disclose your protected health information to funeral directors or coroners consistent with applicable law to allow them to carry out their duties.

Organ Procurement Organizations (ex: Midwest Transplant Network)
Consistent with applicable law, we may disclose your protected health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

Marketing
We may share information with you about products or services provided by Ransom Memorial Hospital at either of its two sites (RMH and Gollier Center) and its Home Health Services which may be of interest to you, but only in face-to-face communications with you and involving items of nominal value. We must inform you if we are receiving payment for our role in marketing.

Fund Raising
We, and our Charitable Foundation, may use information about you such as your name, address, and phone Number, insurance status, age and gender and the dates you received services here in order to contact you in the future to raise money for our organization. The money raised through these activities is used to expand and support the healthcare services and educational programs we provide to the community. No information about your health or health care may be used or disclosed for fundraising purposes. If you do not wish to be contacted as part of our fundraising efforts, please notify Kelly McDermeit, Director of Business Development and Marketing Ransom Memorial Hospital/Gollier Center, 1301 S. Main Street, Ottawa, KS, 66067.

Food and Drug Administration (FDA)
We may disclose to the FDA your protected health information relating to adverse events with respect to food, supplements, products and product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacements.

Workers Compensation
If you are seeking compensation through Workers Compensation, we may disclose your protected health information to the extent necessary to comply with laws relating to Workers Compensation.

Public Health
As required by law, we may disclose your protected health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

Abuse and Neglect
We may disclose your protected health information to public authorities as allowed by law to report abuse and neglect.

Correctional Institutions
If you are an inmate of a correctional institution, we may disclose to the institution or agents there of your protected health information necessary for your health and safety of other individuals.

Law Enforcement
We may disclose your protected health information for law enforcement purposes as required by law, such as when required by a court order, or in cases involving felony prosecutions, or to the extent an individual is in custody of law enforcement.

Health Oversight
Federal Law allows us to release your protected health information to appropriate health oversight agencies or for health oversight activities.

Judicial/Administrative Proceedings
We may disclose your protected health information in the course of any judicial or administrative proceeding or as allowed or required by law, with your consent, or as directed by a proper court order. To avert a serious threat to health and/or safety, we may disclose your protected health information consistent with applicable law to prevent or lessen a serious, imminent threat to the health and/or safety of a person or the public.

For Specialized Government Functions
We may disclose your protected health information for specialized government functions as authorized by law such as to Armed Forces personnel, fro national security purposes, or to public assistance program personnel.

Other Uses
Other uses and disclosures besides those identified in this notice will be made only as otherwise authorized by law or with your written authorization and you may revoke the authorization as previously provided.

Website
We maintain a website that provides information about our hospital. This “Notice” is on the website. The website address is: www.ransom.org