Effective Date: April 14, 2003 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.
Understanding Your Health Record/InformationEach time you visit a hospital, physician, or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, a plan for future care or treatment, and billing-related information. This notice applies to all of the records of you care generated by Sumner Community Hospital personnel, its agents or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor's use and disclosure of our medical information created in the doctor's office or clinic.
Our ResponsibilitiesWe are required by law to maintain the privacy of your health information and provide you a description of our privacy practices with respect to information we maintain about you. We will abide by the terms of this notice and notify you if we cannot agree to a requested action. We will accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.
Uses and Disclosures - How we may use or disclose Medical Information about you.The following categories describe examples of the way we use and disclose medical information:
We may use medical information about you to provide you with treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you. For example: a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. Different departments of the hospital also may share medical information about you in order to coordinate the different things you may need, such as prescriptions, lab work, meals, and x-rays. We may also provide your physician or a subsequent healthcare provider with copies of health information that should assist him or her with treating you for continuations of care from Sumner Community Hospital.
We may use or disclose medical information about your treatment and services to bill and collect payment from you, your insurance company or a third party payer. For example, we may need to give your insurance company information about your surgery so they will pay us or reimburse you for the treatment. We may also tell your health plan about treatment you are going to receive to determine whether your plan will cover the treatment.
For Health Care Operations:
We may use and disclose health information about you for hospital operations as necessary to run the hospital and make sure that all of our patients receive quality care. Members of the medical staff and/or quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. The results will then be used to continually improve the quality of care for all patients we serve. For example, we may combine medical information about many patients to evaluate the need for new services or treatment. We may disclose information to doctors, nurses, and other students for educational purposes. And we may combine medical information we have with that of other health care facilities to see where we can make improvements. We may remove information that identifies you from this set of medical information to protect your privacy.
We may also use and disclose medical information:
●To business associates we have contracted with to perform the agreed upon service and billing for it;
●To remind you that you have an appointment for medical care;
●To assess your satisfactions with our services;
●To tell you about possible treatment alternatives;
●To tell you about health-related benefits or services;
●To contact you as part of fund raising efforts;
●To inform Funeral Directors consistent with applicable law;
●For protocol development and/or care management;
●For conducting or arraigning legal services for the hospital, its staff or personnel;
●For medical review and auditing functions, including fraud and abuse detection and compliance programs;
●For Population based activities relating to improving health or reducing health care costs; and
●For training, accreditation, certification, licensing, credentialing or reviewing competence of health care professionals.
There are some services provided in our organization through contracts with business associates. Examples certain laboratory tests and pathology resulting, respiratory therapy services, behavioral health services, and a copy service we use when making copies of your heath record. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we've asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.
We may include certain limited information about you in the hospital directory while you are a patient at Sumner Community Hospital. The information may include your name, location in the hospital, your general conditions (e.g., fair, stable, etc.) and your religious affiliation. This information may be provided to members of the clergy and, except for your religious affiliation, to other people who ask for you by name. If you would like to opt out of being in the facility directory, please request the Opt Out Form from the admission staff or the Sumner Community Hospital Privacy Officer.
Individuals Involved in Your Care or Payment for Your Care:
We may release information about you to a friend or family member who is involved in your medical care or who helps pay for your care. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.
We may communicate to you via newsletters, mail outs or other means regarding treatment options, health related information, disease-management programs, wellness programs, or other community based initiatives or activities our facility is participating in.
Organized Health Care Arrangement:
This facility and its medical and allied staff members have organized and are presenting you this document as a joint notice for services obtained at Sumner Community Hospital. Information will be shared as necessary to carry out treatment, payment and health care operations. Physicians and caregivers may have access to protected health information in their offices to assist in reviewing past treatment as it may affect treatment at the time.
As required by law, we may also use and disclose health information for the following types of entities, including but not limited to:
●Food and Drug Administration
●Public Health or Legal Authorities charged with preventing or controlling disease, injury or disability and reporting births or deaths
●Workers Compensation Agents
●Organ and Tissue Donation Organizations
●Military Command Authorities
●Health Oversight Agencies
●Funeral Directors, Coroners and Medical Directors
●National Security and Intelligence Agencies
●Protective Services for the President and Others
Law Enforcement/Legal Proceedings:
We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena, court orders or search warrant.
Many states have requirements for reporting including population-based activities relating to improving health or reducing health care costs.
Your Health Information RightsAlthough your health record is the physical property of Sumner Community Hospital, the information belongs to you. You have a right to:
Inspect and Obtain a Copy:
You have the right to inspect and obtain a copy of the medical information that may be used or has been used to make decisions about your care. Usually, this includes medical and billing records, but does not include psycho-therapy notes. To inspect and copy medical information that may be used or has been used to make decisions about you, you must submit a written request to:
Health Information Management Department Sumner Community Hospital 1323 North A Street Wellington , KS 67152
SCH will charge $15 for supplies and labor plus $.50 per paper copy for the first 250 pages and $.35 per paper copy for additional pages. If a copy of an X-ray or other image related material is needed, there is a $5.00 charge per copy. There may also be postage charges if sending copies by mail. We may deny your request to inspect and obtain a copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Requesting that a denial be reviewed will be considered but not always granted depending on the circumstances. If your denial is reviewed, another licensed health care professional chosen by Sumner Community Hospital will review your request and the denial. The person conduction the review will not be the person who denied your request. We will comply with the outcome of the review.
If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request and amendment for as long as the information is kept by Sumner Community Hospital. If a correction or amendment is made to your medical information, Sumner Community Hospital will share this information with business associates and others that acted on the information. We may deny your request for an amendment and if this occurs, you will be notified of the reason for the denial.
Accounting of Disclosures:
You have the right to request an accounting of disclosures. This is a list of the disclosures we make of medical information about you. The list of accounting of disclosures will exclude disclosures for specific reasons as allowed or authorized by law. The first accounting of disclosures to an individual in a 12 month period is provided without charge. If more than one request for accounting is received in the 12 month period, a fee for this service will be charged.
You have the right to request restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment of your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment. Sumner Community Hospital may subsequently terminate any agreed to restrictions by following the process required by law.
Request Confidential Communications:
You have the right to request that we communicate with you about medicinal matters in a certain way or at a certain location. We will agree to the request to the extent that it is reasonable for us to do so. For example, you can ask that we use an alternative address for billing purposes.
A Paper Copy of This Notice:
You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. Please ask the registration desk or the Sumner Community Hospital Privacy Officer for a copy of the notice.
To exercise any of your rights, please obtain the required forms from the Sumner Community Hospital Privacy Officer and submit your request in writing. To contact the Privacy Officer, use the information below:
Privacy Officer Sumner Community Hospital 1323 North A Street Wellington, KS 67152
Changes To This Notice
We reserve the right to change this notice and the revised or changed notice will be effective for information we already have about you as well as any information we receive in the future. The current notice will be posted in SCH and will include the effective date. In addition, each time you register at or are admitted to SCH for treatment or health care services as an inpatient or outpatient, we will offer you a copy of the current notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with SCH by contacting the main hospital number (620) 326-7451 and asking for the Privacy Officer or you may file a complaint with the Secretary of the Department of Health and Human Services. You will not be retaliated against for filing a complaint. All complaints to Sumner Community Hospital must be submitted in writing.