THIS NOTICE DESCRIBES HOW PROTECTED MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

  1. Gunnison Valley Hospital, Provider Offices and Home care agency is permitted to make use and disclosure of protected health information for treatment, payment, and healthcare operations, as described in the following examples:
    • Treatment i.e. X-rays, laboratory testing, surgeries, etc.
    • For payment i.e. charges to insurance companies, co-payments, Medicare/Medicaid, etc.
    • For healthcare operations i.e. Health Information Management, Information Systems, etc.
  2. Gunnison Valley Hospital, Provider Offices and Home care agency are permitted or required, under specific circumstances, to use or disclose protected health information without the individual's written authorization. [If a use or disclosure for any purpose prescribed in the Privacy Regulation is prohibited or materially limited by other applicable State law, the description of such use or disclosure must reflect the more stringent law.]
  3. Other uses and disclosures will be made only with the individual's written authorization, and the individual may revoke such authorization.
  4. Gunnison Valley Hospital, Provider Offices and Home care agency intends to engage in one or more of the following activities:
    • Gunnison Valley Hospital, Provider Offices and Home care agency may contact the individual to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to the individual or patient.
    • Gunnison Valley Hospital, Provider Offices and Home care agency may contact the Individual/Patient to raise funds for Gunnison Valley Hospital, or
    • A group health plan, or a health insurance issuer, or HMO with respect to a group health plan, may disclose protected health information to the sponsor of the plan.
  5. The Individual has the following rights regarding protected health information:
    • The right to request restrictions on certain uses and disclosures of protected health information. Gunnison Valley Hospital, Provider Offices and Home care agency are not required to agree to a requested restriction, however.
    • The right to receive confidential communications of protected health information, as applicable.
    • The right to inspect and copy protected health information, as provided in the Privacy Regulation.
    • The right to amend protected health information, as provided in the Privacy Regulation.
    • The right to receive an accounting of disclosures of protected health information.
    • The right to obtain a paper copy of the Notice from the covered entity upon request. This right extends to an individual who has agreed to receive the Notice electronically.
  6. Gunnison Valley Hospital, Provider Offices and Home care agency are required by law to maintain the privacy of protected health information and to provide individuals with notice of its legal duties and Privacy Practices with respect to protected health information.
  7. Gunnison Valley Hospital, Provider Offices and Home care agency are required to abide by the terms of the Notice currently in effect.
  8. Gunnison Valley Hospital, Provider Offices and Home care agency reserve the right to change the terms of this Notice. The new Notice provisions will be effective for all protected health information that it maintains.
  9. Gunnison Valley Hospital, Provider Offices and Home care agency will provide Individuals or Patients with a revised Notice by posting the new notice, and replacing with an updated notice and also being distributed to the Patient at time of admission.
  10. Individuals may complain to Gunnison Valley Hospital, Provider Offices and Home care agency and to the Secretary of the Department of Health and Human Services, without fear of retaliation by the organization, if they believe their privacy rights have been violated. A brief description of how the individual may file a complaint follows: There are two ways that the complaint could be filed:
    • The first option being the patient or Individual may contact the Privacy Officer listed in number 11.
    • The second option is for the patient or individual to request a grievance form, which may be obtained from any admissions personnel. The grievance form may then be returned to the admissions personnel or mailed to Gunnison Valley Hospital at the address provided in number 11.
  11. Gunnison Valley Hospital, Provider Offices and Home care agency contact person for matters relating to complaints is:
    • Shelly Lemon, 435-528-2138
  12. This Notice is first in effect on April 14, 2003. The effective date must not be earlier than the date on which the Notice is printed or otherwise published.
  13. Gunnison Valley Hospital, Provider Offices and Home care agency elect to limit the uses or disclosures that it is permitted to make, in accordance to the policy.