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HIPAA
Effective Date: 04.14.2003
Revised Date: 02.24.2009
JOINT NOTICE OF PRIVACY PRACTICES
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.
If you have any questions specifi cally about this Joint Notice, please contact:
Rutherford Hospital Privacy Offi cer
288 South Ridgecrest Avenue
Rutherfordton, NC 28139
phone: (828) 286-7292
e-mail: privacyofficer@rutherfordhosp.org
OUR LEGAL DUTY TO SAFEGUARD
YOUR MEDICAL INFORMATION.
Under federal law, your Protected Health Information (PHI) has been determined to be
confi dential, requiring appropriate protections. Your PHI includes information about
(1) your treatment . symptoms, test results, diagnosis, etc., (2) payment activities .
billing, insurance information, etc., and (3) health care operations . administrative
oversight activities concerning the quality of care and services you receive, etc.
We are required to provide you with this Joint Notice of Privacy Practices (Joint Notice).
It outlines our privacy policies and practices and explains how, when, and why we use and
disclose your PHI. With some specifi c exceptions, we may not use or disclose any more of
your PHI than is necessary to accomplish the intended purpose of the use or disclosure.
We are also required to make a good faith effort to obtain your written acknowledgement
that you are in receipt of our Joint Notice.
WHO WILL FOLLOW THIS JOINT NOTICE.
The terms of this Joint Notice of Privacy Practices (Joint Notice) apply to Rutherford
Hospital, Inc., (RHI), and to the services provided by its clinically integrated health
care system made up of Rutherford Hospital, its medical staff while in the hospital, and
all RHI entities and programs regardless of site or location.
This Joint Notice describes the policies and practices governing how your PHI is
gathered, utilized, and maintained, not only by RHI, but also by the physicians and other
licensed professionals rendering your care. (NOTE: Your personal physician may have
different notices and policies in force at their private offi ce or clinic that govern their use
and disclosure of your PHI).
Specifi cally, our policies and practices regarding your PHI will be followed by:
Any health care provider authorized to enter information into your health care record.
All employees and staff of RHI.
All others that have been requested by RHI to perform services on RHI's behalf.
Any member of a volunteer group that is allowed to assist you while you are in
the hospital.
Any student who, as part of their approved clinical program, is permitted to access
your healthcare record
HOW WE MAY USE AND DISCLOSE MEDICAL
INFORMATION ABOUT YOU.
The following categories describe different ways that we, or our business associates acting on
our behalf, may use and disclose medical information without further written authorization from
you. For each category of uses or disclosures we will explain what we mean and try to give
some examples. Not every use or disclosure in a category will be listed. However, all of the
ways we are permitted to use and disclose information will fall within one of the categories.
ROUTINE SITUATIONS.
In order to effi ciently coordinate the treatment, payment, and health care operations
aspects of your care, we may disclose your PHI with others involved in your care in any
format that we determine is secure and expeditious, e.g., verbally, electronically, via fax,
and/or in paper form for the following:
For Treatment. We may use and disclose your PHI to provide you with medical treatment
or services. For example, doctors, nurses, technicians, and other members of your treatment
team will record information in your record and use it to determine the most appropriate
course of care. We may also disclose the information 1) to other health care providers who
are participating in your treatment, e.g. to pharmacists who are fi lling your prescriptions,
home health agencies, etc., 2) to people outside the hospital who may be involved in your
medical care after you leave the hospital, e.g. family members, clergy, etc. or 3) to others
we contact that will provide necessary services related to your care.
For Payment. We may use and disclose your PHI so that the treatment services you
received may be appropriately billed and payment received from you, an insurance
company, or other third party. For example, we may need to give your health plan specifi c
information about your care so that your health plan can determine the correct payment
amount. We may also tell your health plan about a recommended treatment for you in order
to receive their prior approval or to determine whether or not they will cover the treatment.
For Health Care Operations. We may use and disclose your PHI for those health
care operations purposes that are necessary to ensure that all of our patients receive
quality care and services. For example, we may use your PHI to review our treatment
and services and to evaluate the performance of our staff in caring for you. We may
disclose information to doctors, nurses, technicians, medical students, and other hospital
personnel for quality review and learning purposes. We may also remove information
that identifi es you from aggregate data that is to be used to study health care trends and
health care delivery alternatives without learning who the specifi c patients are.
Appointment Reminders. We may use and disclose your PHI to contact you as a reminder that
you have an appointment for treatment or medical care or to gather information from you about
the quality of the medical care you received and/or the manner in which that care was provided.
Treatment Alternatives. We may use and disclose your PHI to tell you about or
recommend possible treatment options or alternatives that may be of interest to you.
Health-Related Benefits and Services. We may use and disclose your PHI to tell you
about health-related benefi ts or services that may be of interest to you.
Hospital Directory. Unless you object, we may include certain limited PHI about you in the
hospital directory while you are a patient. This information may include your name, location
in the hospital, your general condition (e.g., good, stable, etc.), and your religious affi liation.
The directory information, except for your religious affi liation, may be released to people
who ask for you by name, whether by phone or in person. Your religious affi liation may be
given to a member of the clergy, such as a priest or rabbi, even if they don't ask for you by
name. This is so your family, friends, and clergy can contact and/or visit you in the hospital
and generally know how you are doing. Should you so desire, you may request not to be
included in the facility directory in order to limit either of these disclosures.
Individuals Involved in Your Care or Payment for Your Care. Unless you object, we
may release your PHI to a friend or family member who is involved in your medical care.
We may also give information to someone who helps pay for your care. We may also
tell your family or friends your condition and that you are in the hospital. In addition,
we may disclose medical information about you to an entity assisting in a disaster relief
effort so that your family can be notifi ed about your condition, status and location.
DISCLOSURE IN SPECIAL SITUATIONS.
As Required By Law. We will disclose your PHI when required to do so by federal,
state, or local law.
Fundraising Activities. We may, on a limited basis, disclose your PHI to Rutherford
Hospital Foundation to secure contributions for RHI and the services it offers to the
community. In such cases, we would limit your PHI to demographic information only,
such as your name, address, and phone number and the dates you received treatment
or services. We would not release information which would identify the reasons you
were receiving treatment, e.g. diagnosis, etc. If you do not want the Rutherford Hospital
Foundation to receive your contact information for fundraising purposes, you may so
notify the Rutherford Hospital Privacy Offi cer in writing.
Research. In limited circumstances, we may use and disclose your PHI for research
purposes. For example, a research project may involve comparing the health status
and recovery of all patients who received one medication to those who, for the same
condition, received another. In all cases where your specifi c authorization has not been
obtained, your privacy will be protected by the strict confi dentiality requirements applied
by an independent Institutional Review Board (or other offi cially recognized independent
privacy board) that oversees the research that is conducted at RHI.
To Avert a Serious Threat to Health or Safety. We may use and disclose your PHI
when necessary to prevent a serious threat to your health and safety or the health and
safety of the public or another person. Any disclosure, however, would only be to
someone able to help prevent such a threat.
Organ and Tissue Donation. If you are an organ donor, we may disclose your PHI to the
organizations that handle organ procurement or organ, eye, or tissue transplantation or to an
organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
Military and Veterans. If you are a member of the armed forces, we may disclose your
PHI as required by military command authorities. We may also release the PHI about
foreign military personnel to the appropriate foreign military authority.
Workers' Compensation. We may disclose your PHI for workers' compensation or
similar programs. These programs provide benefi ts for work-related injuries or illness.
Public Health Risks. We may disclose your PHI for public health activities. These
activities generally include the following:
- to prevent or control disease, injury, or disability;
- to report births, deaths, and immunizations;
- to report abuse or neglect or child in need of protective services;
- to report reactions to medications or problems with products;
- 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.
Victims of Abuse. We may disclose your PHI to notify the appropriate government
authority if we believe a patient has been the victim of abuse, neglect, or domestic
violence. We will only make this disclosure if you agree, or when required or
authorized by law.
Health Oversight Activities. We may disclose your PHI to a health oversight agency
for activities authorized by law. These oversight activities include, for example,
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.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose
your PHI in response to a court or administrative order. We may also disclose medical
information about you in response to a subpoena, discovery request, or other lawful
process by someone else involved in the dispute, but only if efforts have been made to
tell you about the request or to obtain an order protecting the information requested and
only as permitted by State law.
Law Enforcement. We may disclose your PHI as permitted by State law if asked to do
so by a law enforcement official:
- In response to a court order, subpoena, warrant, summons, or similar process;
- To identify or locate a suspect, fugitive, material witness, or missing person;
- About the victim of a crime if, under certain limited circumstances, we are
unable to obtain the person's agreement;
- About a death we believe may be the result of criminal conduct;
- About criminal conduct at the hospital; and
- In 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.
Coroners, Medical Examiners and Funeral Directors. We may disclose your PHI to a
coroner or medical examiner. This may be necessary, for example, to identify a deceased
person or determine the cause of death. We may also release medical information about
patients of the hospital to funeral directors, as necessary to carry out their duties
.
National Security and Intelligence Activities. We may disclose your PHI to authorized
federal officials for intelligence, counterintelligence, and other national security activities
authorized by law.
Protective Services for the President and Others. We may disclose your PHI to
authorized federal officials so they may 1) provide protection to the President, other
authorized persons or foreign heads of state or 2) conduct special investigations related
to such protection.
Inmates. If you are an inmate of a correctional institution or under the custody of a
law enforcement offi cial, we may disclose your PHI to the correctional institution or
law enforcement official. This disclosure of information would be necessary (1) for the
institution to provide you with health care; (2) to protect your health and safety or the
health and safety of others; or (3) for the safety and security of the correctional institution.
SPECIAL PROTECTIONS.
In some cases, North Carolina or Federal law may provide additional protection for your PHI.
In the following situations, we will follow the practices specifi ed in this section before using
or disclosing the PHI affected in accordance with the remainder of this Joint Notice.
Treatment for Drug Dependence. If you request treatment and rehabilitation for
drug dependence, we will not disclose your name to any police offi cer or other lawenforcement
offi cer unless you consent to our sharing of it.
Communicable Diseases. If you suffer from a communicable disease (for example,
tuberculosis, syphilis or HIV/AIDS), information about your disease will be treated as
confi dential. We will only release such information under the following circumstances:
1) with your written authorization; 2) for statistical purposes in a way that does not
identify you; 3) to other health care personnel providing you with treatment; 4) to
protect the public health and as provided by regulation; 5) to report as required by law;
6) pursuant to a subpoena or court order; 7) as otherwise specifi cally authorized or
required by law.
Mental Health Services. One or more of the facilities covered by this Joint Notice
may be required to keep confi dential information relating to mental health services,
including treatment for mental illness, developmental disability or substance abuse.
Such information will not be disclosed without your written consent, except in certain
circumstances, potentially including the following: 1) to individuals within our facility
involved in your treatment or habilitation, 2) to other facilities when necessary to
coordinate appropriate and effective care, treatment or habilitation, 3) to your next of kin
upon your request if the next of kin plays a legitimate role in your treatment, 4) when in
our opinion there is an imminent danger to the health or safety of another individual, 5)
to a provider of support services, 6) to a State or governmental agency when we believe
you may be eligible for fi nancial benefi ts through such agency, 7) to report suspected
neglect or abuse as required by law, 8) to make other reports to the State as required
by law, 9) upon court order, 10) to a court of competent jurisdiction that has ordered a
mental examination of you as a criminal defendant, 11) to the Attorney General's office
when the information is necessary for performance of the statutory responsibilities of
the Attorney General, 12) to our attorney if such information is relevant to litigation
involving our facility, and 13) to an attorney upon your written request. Furthermore, if
we determine that the disclosure is in your best interest, we may 1) disclose the fact of
your admission or discharge to your next of kin, and 2) disclose confi dential information
for purposes of fi ling a petition for involuntary commitment or a petition for adjudication
of incompetency. To the extent that any PHI can identify you as a substance abuse
patient, such information may be entitled to stricter protection, and we will comply with
any applicable law restricting the disclosure of such information.
OTHER USES OF MEDICAL INFORMATION.
All other uses and disclosures of your PHI not covered by this Joint Notice or the laws
that apply to us will be made only with your written authorization. If you authorize us
to use or disclose your PHI for specifi c purposes, you may revoke that authorization, in
writing, at any time. If you revoke your authorization, we will no longer use or disclose
your PHI for the purposes covered by your written authorization. You understand that we
are unable to retract any disclosures we have already made with your authorization.
YOUR RIGHTS REGARDING YOUR PHI.
Right to Inspect and Copy. You have the right to inspect and copy your PHI that is a part
of our Designated Record Set . records that are used to make decisions about your care.
Usually, this includes medical and billing records, but does not include psychotherapy notes.
To inspect and copy your Designated Record Set, you must submit your request in writing to:
Director - Medical Records Department
Rutherford Hospital, Inc.
288 South Ridgecrest Avenue
Rutherfordton, NC 28139
If you request a copy of the information, we may charge a fee for the costs of copying,
mailing, or other supplies associated with your request. We may deny your request to
inspect and copy in certain very limited circumstances.
If you are denied access to medical information, you may request that our privacy offi cer
arrange for a review of that denial. Another licensed health care professional chosen by our
privacy offi cer will review your request and the denial. The person conducting the review will
not be the person who denied your request. We will comply with the outcome of the review.
Right to Amend. If you feel that any of the PHI we have about you is incorrect or
incomplete, you may ask us to amend the information. You have the right to request
an amendment for as long as we keep the information. To request an amendment, you
must submit your request in writing to: Director - Medical Records Department (address
noted, above). In addition, you must provide a reason that supports your request.
We may deny your request for an amendment if it is not in writing or does not include
a reason to support the request. In addition, we may deny your request if you ask us to
amend information that:
- Was not created by us, unless the person or entity that created the information
is no longer available to make the amendment;
- Is not part of the Designated Record Set kept by or for RHI;
- Is not part of the information which you would be permitted to inspect and copy or
- Is accurate and complete.
We will inform you in writing for the reasons of the denial and describe your rights to
file a written statement in disagreement.
Right to an Accounting of Disclosures. You have the right to request an accounting of
disclosures. This is a list of the disclosures we have made of your PHI that were 1) not
related to your treatment, payment or health care operations and certain other instances in
which disclosure is permitted or 2) not authorized by you or your personal representative.
To request this list or accounting of disclosures, you must submit your request in writing to:
Director - Medical Records Department (address noted, above). Your request must state a time
period (which may not be longer than six years and may not include dates before April 14, 2003).
Your request should indicate in what form you want the list (for example, on paper, electronically).
The first list you request within a 12-month period will be free. For additional lists, we may
charge you for the costs of providing the list. We will notify you of the cost involved and you
may choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions. You have the right to request a restriction or limitation on
the PHI we use or disclose about you. You also have the right to request a limit on the PHI we
disclose about you to someone who is involved in your care or the payment for 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. We are not required to grant your request. However, if we do agree,
we will comply with your request unless the information is needed to provide you emergency
treatment or in certain instances in which a full disclosure is legally required or permitted.
To request restrictions, you must make your request in writing to: Director - Medical
Records Department (address noted, above). In your request, you must tell us (1) what
information you want to limit; (2) whether you want to limit our use, disclosure, or both;
and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
Right to Request Confi dential Communications. You have the right to request that we
communicate with you about medical matters in a certain way or at a certain location.
For example, you can ask that we only contact you at work or by mail.
To request confi dential communications, you must make your request in writing to
Director - Medical Records Department (address noted, above). We will not ask you the
reason for your request and we will accommodate all reasonable requests. Your request
must specify how or where you wish to be contacted.
Right to a Paper Copy of This Joint Notice. You have the right to a paper copy of this Joint
Notice. You may ask us to give you a copy of this Joint Notice at any time. Even if you have
agreed to receive this Joint Notice electronically, you are still entitled to a paper copy of this Joint
Notice. You may obtain a copy of this Joint Notice at our website, www.rutherfordhosp.org. To
obtain a paper copy of this Joint Notice, please contact the Rutherford Hospital Privacy Offi cer
(address and phone number noted on pg.1 of this document).
WHO MAY EXERCISE RIGHTS UNDER THIS NOTICE.
In most situations, the rights set forth in this Joint Notice may be exercised by you or your
personal representative on your behalf. If you are an unemancipated minor, the rights set
forth in this Joint Notice may be exercised on your behalf by your parent or parents, or your
legal guardian in most situations with some exceptions. For example, you have the right to
consent to services for the prevention, diagnosis and treatment of certain illnesses, including
venereal disease and other diseases that must be reported to the State, pregnancy (except
abortion), abuse of controlled substances or alcohol, and emotional disturbance, and therefore
only you may exercise the rights set forth in this Joint Notice on your own behalf with respect
to information pertaining to those illnesses. Abortion services do require the consent of a
parent, legal guardian, or grandparent in some situations, absent a court order.
CHANGES TO THIS JOINT NOTICE.
We reserve the right to change this Joint Notice and reserve the right to make the revised
or changed Joint Notice effective for PHI we already have about you as well as such PHI
we receive in the future. We will prominently post a copy of the current Joint Notice in
public areas of Rutherford Hospital and its affi liates. The Joint Notice will contain on the
fi rst page, in the top left-hand corner, its effective date.
COMPLAINTS CONCERNING PRIVACY RIGHTS VIOLATIONS.
If you believe your privacy rights have been violated, you may fi le a formal complaint
with RHI and/or with the Secretary of the Department of Health and Human Services.
You may fi le a formal complaint concerning your privacy rights with RHI by contacting
the Rutherford Hospital Privacy Offi cer at:
Rutherford Hospital Privacy Offi cer
288 South Ridgecrest Avenue
Rutherfordton, NC 28139
Phone: (828) 286-7292
e-mail: privacyofficer@rutherfordhosp.org
You may fi le a formal complaint concerning your privacy rights with the U.S.
Department of Health and Human Services at:
Offi ce for Civil Rights
U.S. Department of Health and Human Services
Atlanta Federal Center, Suite 3B70
61 Forsyth Street, S.W.
Atlanta, GA 30303-8909
(404) 562-7886 (Voice Phone)
(404) 331-2867 (TDD)
(404) 562-7881 (FAX)
www.hhs.gov/ocr/privacy/
Please note that you may be asked to submit your complaint in writing. You will not be
penalized for filing a complaint.
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