Notice of Privacy Practices

Effective July 22, 2009
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 about this notice, please contact our
Privacy Officer
Pinnacle Hospital
9301 Connecticut Drive
Crown Point, IN 46307
219-756-2100
 
 
WHO WILL FOLLOW THIS NOTICE
This notice describes Pinnacle Hospital practices regarding the use of your medical information and applies to:
 
  • Any health care professional authorized to enter information into your medical record.
  • All employees, staff and other personnel who may need access to your information.
  • All entities, sites and locations of Pinnacle Hospital follow the terms of this notice. In addition, these entities, sites and locations may share medical information with each other for treatment, payment or health care operations described in this notice.
OUR PLEDGE REGARDING MEDICAL INFORMATION
We understand that medical information about you and your health is personal. Protecting medical information about you is important. We create a record of the care and services you receive. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by Pinnacle Hospital, whether made by health care professionals or other personnel.
 
This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information..
 
We are required by law to:
  • keep private medical information that identifies you;
  • give you this notice of our legal duties and privacy practices with respect to medical information about you; and
  • follow the terms of the notice that is currently in effect.  
 
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
Disclosures Related to Treatment, Payment or Health Care Operations
The following categories describe different ways that we may use and disclose medical information without an authorization from you. Not every use or disclosure in a category will be listed.
 
For Treatment We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, training doctors, or other health care professionals who are involved in taking care of you.  Different health care professionals also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work and x-rays. We also may disclose medical information about you to people outside the Hospital who may be involved in your medical care after you leave the Hospital or who provide services that are part of your care.
For Payment We may use and disclose medical information about you so that the treatment and services you receive at Pinnacle Hospital and by other direct or indirect health care providers may be billed to and payment may be collected from you, an insurance company or a third party. For example, your insurance company may need to know about surgery you received so they will pay us or reimburse you for the surgery. We may also use and disclose medical information about you to obtain prior approval or to determine if your insurance will cover the treatment.
 
For Health Care Operations We may use and disclose medical information about you for health care operations. These uses and disclosures are necessary to ensure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also disclose information to doctors, nurses, technicians, and training doctors, for review and learning purposes.  If we do use or disclose this information, we may remove or omit any information which identifies you specifically.
 
Appointment Reminders We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care.
 
Treatment Alternatives We may use and disclose medical information 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 medical information to tell you about health-related benefits or services that may be of interest to you.
 
Uses and Disclosures You May Agree or Object To
Patient DirectoryThe patient directory is a list of patients who are currently receiving care at the Hospital. We keep this directory so that your family, friends and clergy may visit you in the Hospital and generally know how you are doing. Unless you object, we will include your name, location, general condition (such as fair or stable) and your religious affiliation. Your location and general condition will be released to people who ask for you by name. Your religious affiliation will only be given to a member of the clergy.
 
Individuals Involved in Your Care or Payment for Your Care We may disclose medical information to a family member, relative, close personal friend or any other person identified by you, only to the extent the medical information is relevant to that person's involvement with your care or payment for your health care.  If you object to such uses or disclosures, please notify us.  If you are not present, you are incapacitated or in an emergency circumstance, we may exercise our professional judgment to determine whether a disclosure is in your best interests.  In addition, we may also disclose medical information so that your family members, other relatives or close personal friends can be notified about your condition, status and location.
 
Surveys As part of an ongoing national effort to understand how patients view their hospital experience, you may receive a survey regarding your stay at Pinnacle Hospital.  Your participation in this survey is completely voluntary and will not affect you care or benefits.  If you prefer that no survey is mailed to you, please indicate your desire to the admissions representative.
 
Hospital results will be publicly reported and made available on the Internet at www.hospitalcompare.hhs.gov
 
Other Uses and Disclosures of Your Medical Information 
The following are other ways we may use or disclose your information without an authorization.
 
As Required by Law We will use or disclose medical information about you when required to do so by federal, state or local law.
 
Abuse, Neglect and Domestic Violence If we reasonably believe you are a victim of abuse, neglect or domestic violence, to the extent the law requires, medical information may disclosed to an agency authorized by law to receive such reports.
 
Health Oversight Activities We may disclose medical information to a health oversight agency for oversight 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 We may disclose medical information about you in the course of any judicial or administrative proceeding in response to a subpoena, discovery request, or other lawful process or order from a court or administrative tribunal.
 
Law Enforcement We may disclose medical information to law enforcement officials as part of law enforcement purposes; in investigations of criminal conduct or of victims of crime; in response to court orders; in emergency circumstances; or when required or permitted to do so by law.
 
To Avert a Serious Threat to Health or Safety We may use and disclose medical information about you when necessary to prevent or lessen 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 the threat.
 
Research We may use or disclose medical information about you if an institutional review board has reviewed and approved a researcher's proposal and has established protocols to ensure the privacy of your information.
 
Coroners, Medical Examiners and Funeral Directors  We may disclose medical information 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 disclose medical information about patients of Pinnacle Hospital to funeral directors so they can carry out their duties.
 
Organ and Tissue Procurement We may disclose medical information to organizations that facilitate organ, eye or tissue procurement, banking or transplantation.
 
Protective Services for the President, National Security and Intelligence Activities  We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations, or for intelligence, counterintelligence, and other national security activities authorized by law.
 
Workers' Compensation We may disclose medical information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.
 
Public Health Activities We may disclose medical information about you for public health activities. These activities generally include the following:
  • to prevent or control disease, injury or disability;
  • to report births and deaths;
  • to report child abuse or neglect;
  • to report information about products and services under the jurisdiction of the U.S. Food and Drug Administration (such as 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;
  • to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence;
  • to report information to your employer as required by laws addressing work-related injuries or workplace medical surveillance. 
Military and Veterans If you are a member of the military or a veteran, we may disclose your medical information to the proper authorities under certain circumstances required by law so they may carry out their duties.
 
Inmates If you are an inmate in a correctional facility or in the custody of a law enforcement official, we may disclose your medical information to the correctional facility or law officer so duties can be carried out under the law.
 
 
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You have the following rights regarding medical information we maintain about you:
 
Right to Inspect and Copy You have the right to inspect and copy medical information that may be used to make decisions about your care (including medical records and billing records, but not psychotherapy notes) for a period of seven years as required by state law. To inspect and copy your medical information, you must submit your request in writing to the Medical Record Department at the address on the first page. You may be charged a fee for the cost 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 the denial be reviewed. Another licensed health care professional chosen by Pinnacle Hospital 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  You have the right to request an amendment to information that has been used to make health care decisions about you for a period of seven years as required by state law. To request an amendment, your request must be made in writing and submitted to our Privacy Officer. 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 medical information kept by Pinnacle Hospital;
  • is not part of the information which you would be permitted to inspect and copy; or
  • is accurate and complete.
 
Right to an Accounting of Disclosures You have the right to request an "accounting of disclosures." This is a list of certain disclosures we made of medical information about you. To request an accounting of disclosures, you must submit your request in writing to our Privacy Officer.
 
Right to Request Restrictions You have the right to request a 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 for your care, like a family member or friend.
 
We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment.
 
To request restrictions, you must make your request in writing to our Privacy Officer at the address on the first page. 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.
 
Right to Request Confidential 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 confidential communications, you must make your request in writing to our Privacy Officer. We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted. We will accommodate all reasonable requests.
 
Right to a Paper Copy of This Notice   You have the right to a paper 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. You may obtain a copy of this notice at our website www.pinnaclehealthcare.net. To obtain a paper copy of this notice, please request one in writing from our Privacy Officer at the address on the first page.
OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written authorization. You may revoke that authorization, in writing, at any time. If you revoke the authorization, your medical information will no longer be used or disclosed for the reasons covered by your written authorization; however, the revocation will not apply to any disclosures already made with your authorization.  
 
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice. The notice will contain the effective date in the top right-hand corner.
 
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint in writing with Pinnacle Hospital or with the U.S. Department of Health and Human Services Office for Civil Rights. To file a complaint with Pinnacle Hospital, contact our Privacy Officer at the address and phone number listed above. You will not be penalized for filing a complaint.