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NOTICE OF PRIVACY PRACTICES
SAN JUAN HEALTH SERVICES
This notice will tell you about the ways in which SAN JUAN HEALTH SERVICES DISTRICT may use and disclose medical information about you. It also describes your rights and certain obligations we have regarding the use and disclosure of medical information.
PLEASE REVIEW THIS CAREFULLY
Uses and Disclosures
For Treatment:
Your health information may be used by staff members or disclosed to other health care professionals for the purpose of evaluating your health, diagnosing medical conditions, and providing treatment. For example, results of laboratory tests and procedures will be available in your medical record to all health professionals who may provide treatment or who may be consulted.
For Payment:
Your health information may be used to seek payment from your health plan, from other sources of coverage such as an automobile insurer, or from credit card companies that you may use to pay for services. For example, your health plan may request and receive information on dates of service, the services provided, and the medical condition being treated.
For Health Care Operations:
Your health information may be used as necessary to support the day-to-day activities and management of San Juan Health Services District. For example, information on services you received may be used to support budgeting and financial reporting, and activities to evaluate and promote quality.
For Other Uses and Disclosures:
Disclosures of your health information that can be made without your specific written authorization are as follows:
Hospital Directory
We may include certain limited information about you in the hospital directory while you are a patient at the hospital. This information may include your name, location in the hospital, your general condition (e.g. fair, stable, etc.) and your religious affiliation. The directory information, except for your religious affiliation may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, even if they don’t ask for you by name. If you do not want information about you included in the Hospital Directory you must notify a hospital representative.
Health Oversight Activities
We may disclose health information to a health oversight agency for activities authorized by law. These oversight activities include audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
For Law Enforcement:
We may disclose health information if asked to do so by law enforcement officials for the following reasons:
- · In response to a court order, subpoena, warrant, summons or similar process.
- · To identify or locate a suspect, fugitive, material witness or missing person.
- · To identify the victim of a crime if, under certain circumstances, we are unable to obtain the persons authorization.
- · To release information about a death we believe may be the result of criminal conduct.
- · Criminal conduct at our facility.
- · Emergency circumstances, to report a crime, the location of the crime or victims, or the identity, description or location of the person who committed the crime.
- For Public Health Reporting:
We may disclose health information about you for public health activities. These generally include the following:
- · To prevent or control disease, injury or disability
- · To report births and deaths.
- · To report child and adult abuse or neglect.
- · To report reactions to medications, problems with products or other adverse events.
- · To notify people of recalls of products they may be using.
- · To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition.
- Additional Uses of Information:
Other disclosures of your health information will be made only with your specific written authorization. You may revoke such authorization with written revocation.
Your Individual Rights:
You have the following rights regarding protected health information:
- · The right to request restrictions on certain use and disclosure of your protected health information.
- · The right to receive confidential communications concerning your medical condition and treatment.
- · The right to inspect and copy your protected health information.
- · The right to amend or submit corrections to your protected health information if you feel it is incorrect or incomplete. Your request must be made in writing and it must include a reason that supports the request.
- · The right to receive an accounting of disclosures of your protected health information (limited to disclosures made on or after April 14, 2003, other than for treatment, payment, health care operations, or disclosures made with your written authorization).
- · You have the right to revoke your authorization for the use or disclosure of your health information except to the extent that action has already been taken.
- · The right to receive a printed copy of this notice.
- SAN JUAN HEALTH SERVICES DISTRICT is required by law to maintain the privacy of protected health information and to provide you with this notice.
Right to Revise Privacy Practices:
As permitted by law, we reserve the right to amend or modify our privacy policies and practices. These changes in our policies and practices may be required by changes in federal and state laws and regulations, and will be applied to all protected health information we maintain. Upon request, we will provide you with the most recently revised notice on any visit to our facilities.
Requests to Inspect or Copy:
As permitted by federal regulation, we require that requests to inspect or copy protected health information be submitted in writing. You may obtain a form to request access to your records by contacting the entity maintaining the records you wish to inspect (i.e., hospital or clinic). We will respond to your request within 30 days (60 days if the record is over 5 years old). There is a retrieval fee of $15.00 plus a copying charge of $.50 per page.
Complaints:
Individuals may complain to SAN JUAN HEALTH SERVICES DISTRICT and to the Secretary of the Department of Health and Human Services, without fear or retaliation by the organization, if they believe their privacy rights have been violated. To file a complaint with us, put your complaint in writing and address it to:
Compliance Officer
SAN JUAN HEALTH SERVICES DISTRICT
P.O. Box 308
Monticello, UT 84535
(435) 587-2116
We elect to limit the uses or disclosures of protected health information by releasing only that part necessary to fill each legitimate request or obligation.
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