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Summary of Privacy Practices

DuBois Regional Medical Center
Notice of Privacy Practices Summary
Revision #2 – December 2012

This notice describes the information in your health record is used and shared, and how you can get access to your
health information. We will not use or disclose your health information without your authorization, except as
described in this notice and permitted by law.

UNDERSTANDING YOUR HEALTH RECORD INFORMATION
Each time you visit the hospital, a physician, or other healthcare provider details of your visit are documented. This
information may include your symptoms, test results, diagnoses, treatments and a plan for future care and
treatment. This information is your "health record" or "medical record". Your health record may be stored in a paper
chart or electronically in a computer system. The computerized record is called an Electronic Health Record or
EHR. DRMC is working towards computerizing all healthcare records including the hospital records, our physician
practices and outpatient clinics and treatment centers. Electronic Health Records is also a goal of the Federal
Government.

DRMC may use the information in your health record as follows.
 For planning your care and treatment
 To communicate among the many health care professionals who contribute to your care
 As a legal document describing the care you received
 Supports the bills we submit for payment of services provided
 Educating health professionals
 Source of data for medical research
 Source of information for public health officials charged with improving the health of the nation
 Source of data for the medical center’s planning and marketing
 A source used to improve the care we give and the outcomes we achieve

Understanding what is in your health record and how your health information is used helps you to:
 Ensure its accuracy
 Better understand who, what, when, where, and why others may access your health information
 Make more informed decisions when authorizing disclosure to others

Although your health record is the physical property of DRMC, the information in the record belongs to you.
You have the right to:
 Request a restriction on certain uses and disclosures of your information
 Obtain a paper copy of this Notice of Privacy Practices upon request
 Inspect and request a copy of your health record
 Request amendments or changes to your health record
 Obtain an accounting of disclosures of your health information
 Have your health information delivered to an address you provide or a phone number that only you access.
 Revoke your authorization to use or disclose your health information. The information already disclosed is
not affected by the withdrawal. A new authorization is required before any new information is released.

DRMC is required to:
 Abide by the terms of this Notice
 Maintain the privacy of your health information
 Provide this Notice explaining DRMC’s responsibility on the use and disclosure of your health information.
 Notify you if we are unable to agree to a requested restriction of use or disclosure.
 Accommodate reasonable requests you may have to communicate health information by alternative means
or at alternative locations

We reserve the right to change our practices and to make the new provisions effective for all protected health
information we maintain. Should our information or practices change, an updated Notice will be provided to you.
We will not use or disclose your health information without your authorization, except as described in this Notice.
Additional consumer information on HIPAA privacy regulations is available at the following website.
http://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html

If you have questions about this Notice or want to report a problem please contact
Compliance and Privacy Officer at 814.375.6160
Health Information Management Director at 814.375.3429 or
Call the Compliance and Privacy Message line at 1-855-REPORT8 (1-855-737-6788)

DISCLOSURES FOR TREATMENT, PAYMENT, AND HEALTH OPERATIONS:

TREATMENT: DRMC will use your health information for treatment. For example, information obtained by a nurse,
physician, or other member of your healthcare team is recorded in your record and used to determine the course
of treatment that should work best for you. Your physician documents his or her plans, orders tests and services
and provides instructions for your healthcare team. This team could include nurses, therapists, Laboratory and
Radiology staff, medical assistants, consulting physicians, social workers, clerical support staff and others who
have a role in your care. Team members record monitoring activities, their observations and treatments such as
when a medicine is given. Your physician uses all of this information to know that you are responding to
treatment.

You may have records at one or more DRMC’s doctors’ offices, the hospital and a clinic such as the Pain Clinic or
Wound Care Clinic. All of these records make up you entire medical record here at DRMC. If you received
treatment at other hospitals and/or independent physician practices, those health records are another part of your
records. Those records are not combined with the DRMC records. However, we may either provide copies of our
records to or request records from others to provide you with the care you need.

PAYMENT: DRMC will use your health information for payment. After a treatment or service, a bill is sent to you or
your health insurance. The information on or accompanying the bill may include information that identifies you, as
well as your diagnosis, the procedures or services provided, and supplies used.

HEALTH CARE OPERATIONS: We will use your health information for regular health care operations. For example:
Members of the medical staff, the risk management, or members of the quality improvement team may use
information in your health record to assess the care and outcomes in your case and others like it. This information
will then be used in an effort to continue improving the quality and effectiveness of the healthcare and service we
provide. These teams take numerous precautions to protect your identity.

OTHER WAYS YOUR HEALTH CARE RECORDS MAY BE USED OR DISCLOSED BY DRMC
HOSPITAL DIRECTORY is a list of people who are inpatients at DRMC and includes your name, location and bed
assignment. During the registration process for admission, you may choose either Public or Restricted Access.
Public Access lists your name in the directory. Nursing staff is permitted to give a general update on your
condition (i.e. improving, resting comfortably) to anyone asking for you by name. Your religious affiliation is
also listed in the directory and provided to members of the clergy.

Restricted Access means that we will not tell anyone that you are a patient. You are not listed in the
directory and only the DRMC employees and Doctors that participate in your care will know you are a patient.
No one at DRMC will release any information about you to anyone. We will return any cards or flowers
delivered to you because to accept these acknowledges that you are a patient. You may call your family and
friends and they may call or visit you, as long as they call or go directly into your room.

NOTIFICATION: We may use or disclose your information to notify or assist in notifying a family member, personal
representative, or other person you identify or list as an emergency contact.

COMMUNICATION WITH FAMILY OR FRIEND: Health care providers, using their professional judgment, may discuss
information about your treatment and care with your family, relative, close friend, or any other person you identify
who is involved with your ongoing care. With your verbal approval or lack of objection physicians, nurses and
other professionals may discuss your ongoing care (such as medications, exercise instructions, wound care) to
those involved with your care.

BUSINESS ASSOCIATES: Outside services or businesses provide some of DRMC’s services. We share your health
information with these businesses, called Business Associates, so they can do the job they are hired to do
Examples are commercial laboratory services that does specialized testing. Business Associates are required to
follow the same privacy and security rules as DRMC or any other health care provider.

RESEARCH: We may disclose information to researchers when an institutional review board has reviewed the
research proposal and established protocols to ensure the privacy of your health information.

FUNERAL DIRECTORS: We may disclose to funeral directors health information consistent with applicable law.

ORGAN PROCUREMENT ORGANIZATIONS: Consistent with applicable law, for the purpose of tissue donation and
transplant, we may disclose health information to organ procurement organizations or other entities engaged in
the procurement, banking, or transplantation of organs.

MARKETING: 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.

FUND-RAISING: We may contact you as part of a fund-raising effort.

DISCLOSURES REQUIRED BY LAW:
 Food and Drug Administration (FDA): harmful events with respect to food, medicines, product and product
defects,
 Workers' Compensation: We may disclose health information to the extent necessary to comply with workers'
compensation or other similar programs established by law.
 Public Health: As required by law, we may disclose your health information to public health or legal
authorities charged with preventing or controlling disease, injury, or disability.
 Correctional Institution: We may disclose an inmate’s health information to a correctional institution or agents
thereof as may be necessary for your health and the health and safety of other individuals.
 Law Enforcement: We may disclose health information for law enforcement purposes as required by law or in
response to a valid court ordered subpoena.
 Federal Law: Your health information may be released to an appropriate health oversight agency, public
health authority, or attorney, provided that a workforce member or business associate believes in good faith
that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and
are potentially endangering one or more patients, workers, or the public.

If You Have Questions About This Notice Please Contact
Compliance & Privacy Officer at 814.375.6160
Health Information Management 814.375.3246

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