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.
Gunnison Valley Hospital, which includes Gunnison Valley Home Health, Gunnison Valley Hospice, Gunnison Valley Hospital Ambulance and its professional staff, employees, volunteers, and Medical Staff follow the privacy practices described in this Notice. This Notice, which was developed to comply with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), describes the general ways your protected health information (“PHI”) may be used and disclosed in order for Gunnison Valley Hospital to provide you with medical treatment, to collect payment for the services rendered to you by Gunnison Valley Hospital, and to facilitate Gunnison Valley Hospital’s health care operations. PHI, as defined by HIPAA, means your personal health information, including genetic information, which is found in your medical and billing records and which relates to your past, present, or future physical or mental health conditions or the provision of payment for services related to those health conditions. During the course of treatment, payment, and health care operation activities, this may include information created or received by health care providers, insurance companies, and/or your employer.
Your Health Information Rights
You have the following rights regarding your PHI. Forms may be obtained by contacting Gunnison Valley Hospital’s Privacy Officer at (435) 528-7246.
- A copy of this Notice. You may obtain a paper copy of this Notice at any time, even if you have been provided with an electronic copy. You do not have to submit a written request to obtain the Notice. Paper copies of this Notice may be obtained from the admissions desk. You may obtain an electronic copy of this Notice on our web site, http://www.gvhospital.org.
- Inspect and copy. You may inspect and/or receive a copy of your PHI maintained by Gunnison Valley Hospital. If we maintain your medical records in an Electronic Health Record (EHR) system, you may obtain an electronic copy of your medical records. You may also instruct us in writing to send an electronic copy of your medical records to a third party. Gunnison Valley Hospital may charge you a reasonable fee for copying your information. You must make this request in writing. We may deny your request in certain circumstances. If we deny your request, we will explain our reason for doing so in writing. We will also inform you in writing if you have the right to have our decision reviewed by another person.
- Request amendment. If you believe your PHI maintained by Gunnison Valley Hospital is incorrect or incomplete, you may request an amendment to your information. Gunnison Valley Hospital is not required to agree to your request. This request must be in writing and you must provide a reason for the request.
- Request restriction. You may request limitations on how Gunnison Valley Hospital uses and/or discloses your PHI. Once we agree to your request, we must follow your restrictions (except if the information is necessary for emergency treatment). You may cancel the restrictions at any time. In addition, we may cancel a restriction at any time as long as we notify you of the cancellation and continue to apply the restriction to information collected before the cancellation. You have the right to request that we restrict disclosures of your medical information and healthcare treatment(s) to a health plan (health insurer) or other party, when that information relates solely to a healthcare item or service for which you, or another person on your behalf (other than a health plan), has paid us for in full. Once you have requested such restriction(s), and your payment in full has been received, we must follow your restriction(s).
- Receive confidential communications.You may request communications from Gunnison Valley Hospital regarding your PHI be provided to you in a certain way or at a certain location. For example, you may prefer to receive mail regarding your PHI at an address other than your usual mailing address. You must specify how or where you wish to be contacted. You must make this request in writing.
Gunnison Valley Hospital Responsibilities
Gunnison Valley Hospital is required by law to ensure your PHI is kept private in accordance with federal and state law and provide you with notice of Gunnison Valley Hospital legal duties and privacy practices with respect to your PHI. Gunnison Valley Hospital is required to abide by the terms of this Notice as long as it is in effect. If Gunnison Valley Hospital revises this Notice, Gunnison Valley Hospital will follow the terms of the revised Notice as long as it is in effect.
Gunnison Valley Hospital will notify you if there is a breach of your unsecured PHI. If a breach of your medical information occurs, and if that information is unsecured (not encrypted), we will notify you promptly with the following information:
- A brief description of what happened;
- A description of the health information that was involved;
- Recommended steps you can take to protect yourself from harm;
- What steps we are taking in response to the breach; and,
- Contact procedures so you can obtain further information
Use and Disclosure of Your Protected Health Information
The following is a list of ways Gunnison Valley Hospital may use and disclose your PHI. Not every possible use or disclosure in any given section is listed. However, all of the ways Gunnison Valley Hospital is permitted to use and disclose your PHI will fall within one of the bold-faced print sections below. Your PHI may be disclosed electronically.
- Treatment. Gunnison Valley Hospital may use your PHI to provide you with medical treatment or services. Gunnison Valley Hospital may disclose your PHI to doctors, nurses, technicians, medical students, or other members of your health care team at Gunnison Valley Hospital to keep them informed about your care status or condition as necessary. For example, a doctor treating you for diabetes may need to tell a dietitian that you have diabetes so appropriate meals can be arranged. Gunnison Valley Hospital also may disclose your PHI to people outside Gunnison Valley Hospital who may be involved in your medical care, such as health care providers who will provide follow-up care after hospitalization, physical therapy organizations, medical equipment suppliers, laboratories, or pharmacies (verbal or electronic).
- Payment. Gunnison Valley Hospital may use and disclose your PHI to obtain payment from your insurance company or a third party. For example, Gunnison Valley Hospital may need to provide your health plan with information about treatment you received for an ear infection so that your health plan will pay us or reimburse you for the treatment. Also, Gunnison Valley Hospital may disclose your PHI to your other health care providers to assist those providers in obtaining payment from your insurance company or a third party.
- Health Care Operations. Gunnison Valley Hospital may use and disclose your PHI for routine health care operations. Health care operations at Gunnison Valley Hospital include, but are not limited to, training and education programs; reviewing the quality of care provided by health care professionals; obtaining health insurance or stop-gap insurance; conducting legal services and auditing services; conducting business planning and development activities; conducting risk management activities and investigations; and managing the business and general administrative activities of Gunnison Valley Hospital. Gunnison Valley Hospital may also disclose your PHI to your other health care providers to assist them in their health care operations.
- Appointments and Alternatives Gunnison Valley Hospital may use and disclose your PHI to contact you to provide appointment reminders, prescription refill reminders, information about disease management or wellness programs, and other communications regarding your case management or health care coordination.
- Business Associates Gunnison Valley Hospital may disclose your PHI to Gunnison Valley Hospital business associates in order to carry out treatment, payment, or health care operations.
- Coroners, Medical Examiners and Funeral Directors. Gunnison Valley Hospital may disclose PHI to a coroner or medical examiner to identify a deceased person or to determine the cause of death, or as otherwise permitted by law. Gunnison Valley Hospital may also disclose PHI about patients of Gunnison Valley Hospital to funeral directors as necessary to carry out their duties.
- Correctional Institutions. If you are an inmate of a correctional institution or under the custody of a law enforcement official, Gunnison Valley Hospital may disclose your PHI to the correctional institution or law enforcement official to provide you with health care, to protect your health and safety or the health and safety of others, or for the safety and security of the correctional institution or law enforcement official.
- Essential Government Functions Gunnison Valley Hospital may disclose your PHI for essential government functions, such as conducting intelligence and national security activities that are authorized by law or providing protective services to the President and others.
- Fundraising Activities Gunnison Valley Hospital may use certain portions of your PHI, including your name, address, phone number, email address, age, gender, date of birth, the dates you received treatment or services at Gunnison Valley Hospital, department(s) of service, treating physician(s), outcome information, and health insurance status to contact you regarding efforts to raise funds to support hospital programs and operations. You have the right to opt out of receiving these communications. If you do not want Gunnison Valley Hospital to contact you about a contribution or fundraising program, please contact the Privacy Officer at 435-528-7246.
- Group Health Plan Gunnison Valley Hospital maintains a group health plan for its employees, and may disclose PHI of individuals covered under this plan to the sponsor of the group health plan, as permitted by law.
- Health Oversight Activities Gunnison Valley Hospital may disclose your PHI to a health oversight agency or entity for activities authorized by law, such as audits, investigations, inspections, and licensure.
- Health-Related Benefits and Services. Gunnison Valley Hospital may use and disclose your PHI to inform you about health-related benefits or services that may be of interest to you or to provide you a promotional gift of nominal value.
- Hospital Directory Gunnison Valley Hospital may use your PHI to maintain a hospital directory while you are a patient at Gunnison Valley Hospital. This information includes your name, your location in the Hospital, your general condition, and your religious affiliation (“directory information”). Directory information, except for your religious affiliation, may be disclosed to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if the clergy member does not ask for you by name. In the event that you do not wish your directory information to be available, you may notify the Hospital at the time of your admission or at any time during your admission.
- Individuals Involved in Your Care or Payment for Your Care. Gunnison Valley Hospital may disclose your PHI to a family member, other relative, or close personal friend who is involved in your medical care or to someone who helps pay for your care if the PHI disclosed is directly relevant to such person’s involvement with your care, unless you tell us otherwise.
- Law Enforcement. Gunnison Valley Hospital may disclose your PHI for law enforcement purposes, as required by law or in response to a valid subpoena.
- Lawsuits and Disputes. Gunnison Valley Hospital may disclose your PHI in response to a court or administrative order. In addition, Gunnison Valley Hospital may disclose your PHI in response to a valid subpoena, discovery request, or other lawful process provided that efforts have been made to tell you about the request or to obtain an order protecting the information requested, as required by law.
- Legal Requirements. Gunnison Valley Hospital may use and/or disclose your PHI when required to do so by federal, state, and/or local law.
- Limited Data Set. Gunnison Valley Hospital may disclose your PHI as part of a limited data set after it removes certain specified direct identifiers of individuals and their relatives, household members, and employers. Gunnison Valley Hospital may use or disclose the limited data set for research, health care operations, and public health purposes. Gunnison Valley Hospital must enter into a data use agreement promising specified safeguards for the protected health information within the limited data set.
- Military and Veterans. If you are a member of the United States Armed Forces or of a foreign military service, Gunnison Valley Hospital may use and/or disclose your PHI as required by United States military command authorities or appropriate foreign military authority.
- Organ and Tissue Donation. Gunnison Valley Hospital may disclose PHI to organizations that handle organ procurement or organ, eye, or tissue transplantation or to an organ donation bank to facilitate organ or tissue donation and transplantation.
- Public Health Activities. As required by law, Gunnison Valley Hospital may disclose your PHI for public health activities, including, but not limited to, the prevention of disease, injury, or disability; reporting births and deaths; reporting child abuse or neglect; reporting reactions to medications or product problems; notification of recalls; infectious disease control; notifying government authorities of suspected abuse, neglect or domestic violence. Gunnison Valley Hospital may disclose portions of your PHI to local, state, and/or federal registry programs as required.
- Research. Gunnison Valley Hospital may disclose your PHI to researchers when the research has been approved in compliance with HIPAA regulations and protocols have been established to ensure the privacy of your PHI.
- Schools (including Child-Care Facilities, Early Childhood Programs, Primary and Secondary Schools). Gunnison Valley Hospital may disclose your immunization records to a school if the school is required by law to have proof of immunization prior to admitting the student and you or your authorized representative verbally agree to the disclosure.
- Serious Threat to Health or Safety. Gunnison Valley Hospital may use and disclose your PHI when Gunnison Valley Hospital deems it necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
- Workers’ Compensation Gunnison Valley Hospital may disclose your PHI to workers’ compensation or similar programs to the extent necessary to comply with laws relating to worker’s compensation or similar programs.
Except as described above, Gunnison Valley Hospital will not use or disclose your PHI unless you authorize Gunnison Valley Hospital to do so, using a valid, written authorization. Most uses and disclosures of psychotherapy notes, which are kept separate from the rest of your medical record, will only occur with your written authorization. Gunnison Valley Hospital will not use or disclose your PHI for marketing purposes, including subsidized treatment communications, without a written authorization. Gunnison Valley Hospital will not sell your protected health information without a written authorization. If you wish to revoke a prior authorization, you must do so in writing. A written revocation will not apply to any previous use or disclosure of PHI made in good faith under a prior authorization.
An Authorization form and Revocation of Authorization form are available by contacting the Gunnison Valley Hospital Privacy Office at (435) 528-7246.
Changes to This Notice
Gunnison Valley Hospital reserves the right to change this Notice and to make the revised Notice effective for PHI Gunnison Valley Hospital already has about you as well as any information Gunnison Valley Hospital receives in the future. A copy of the current Notice or a summary of the current Notice will be posted at patient service locations throughout Gunnison Valley Hospital and on our website, http://www.gvhospital.org. The effective date of the Notice will appear on the first page of the Notice or summary. In addition, each time you register at or are admitted to any Gunnison Valley Hospital entity for treatment or health care services as an inpatient or outpatient, Gunnison Valley Hospital will have available for you, at your request, a copy of the current Notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with the Gunnison Valley Hospital Privacy Officer at (435) 528-7246. You may also file a complaint with the Secretary of the United States Department of Health and Human Services. You will not be penalized or retaliated against in any way for making a complaint. Gunnison Valley Hospital may not require you to waive your right to file a complaint as a condition of the provision of treatment, payment, enrollment in a health plan, or eligibility for benefits.
If you have any questions about this Notice or your privacy rights, or wish to obtain a form to exercise your rights as described above, you may contact Gunnison Valley Hospital Privacy Officer at (435) 528-7246.