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.
Protected Health Information. While receiving care from our facility, information regarding your medical history, treatment, and payment for your health care may be originated and/or received by us. Information which can be used to identify you and which relates to your past, present or future medical condition, receipt of health care or payment for health care (“Protected Health Information”).
How Your Information Is Maintained. Information may be maintained by the facility in a variety of ways. This may include paper documents, electronic documents, data tapes and images of various types as well as the use of email, secure messaging systems, electronic systems, the internet, cloud providers and participation in third-party networks such as the Iowa Health Information Network.
Our Responsibilities. Federal law imposes certain obligations and duties upon us as a covered health care provider with respect to your Protected Health Information. Specifically, we are required to:
- Provide you with notice of our legal duties and our facility’s policies regarding the use and disclosure of your Protected Health Information;
- Maintain the confidentiality of your Protected Health Information in accordance with state and federal law;
- Honor your requested restrictions regarding the use and disclosure of your Protected Health Information unless under the law we are authorized or required to release your Protected Health Information without your authorization, in which case you will be notified within a reasonable period of time as allowed by law;
- Allow you to inspect and copy your Protected Health Information during our regular business hours;
- Act on your request to amend Protected Health Information within sixty (60) days and notify you of any delay which would require us to extend the deadline by the permitted thirty (30) day extension;
- Accommodate reasonable requests to communicate Protected Health Information by alternative means or methods; and
- Abide by the terms of this notice.
How Your Protected Health Information May be Used and Disclosed. Generally, your Protected Health Information may be used and disclosed by us only with your express written authorization. However, there are some exceptions to this general rule.
Treatment, Payment, or Health Care Operations.
General Use. As part of our treatment, payment and operations we may also release information to business associates who may perform various treatment, payment or operation functions. Information may also be exchanged, stored or listed with records locator services, record repositories, and other third-parties such as the Iowa Health Information Network. If information is provided to another person or entity, such as another facility or physician from whom you seek treatment, that facility or physician may treat the information received as part of its protected information.
Treatment Purposes. We may use or disclose your Protected Health Information for treatment purposes. During your care at our facility, it may be necessary for various personnel involved in your care to have access to your Protected Health Information in order to provide you with quality care. For example, we may inform dietary personnel of any condition which requires you have a special diet. In addition, we may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services which may be of interest to you.
Situations may also arise when it is necessary to disclose your Protected Health Information to health care providers outside our facility who may also be involved in your care or to facilitate referral to another provider or care facility. For example, we may inform your physician of medications you are currently taking, provide other information for continuity of care.
Payment Purposes. Your Protected Health Information may also be used or disclosed for payment purposes. It is necessary for us to use or disclose Protected Health Information so that treatment and services provided by us may be billed and collected from you, your insurance company, or other third party payor. For example, we may disclose your Protected Health Information to your health insurance carrier to obtain prior approval for a service. We may also release your Protected Health Information to another health care provider or individual or entity covered by the HIPAA regulations who has a relationship with you for their payment activities. For example, we may disclose information to your health insurance carrier upon its request for additional information necessary for it to determine whether a service is covered.
Health Care Operations. Your Protected Health Information may also be used for health care operations, which are necessary to ensure our facility provides the highest quality of care. For example, your Protected Health Information may be used for quality assurance or risk management purposes or disclosed to our accountant for auditing purposes. We may at times remove information which could identify you from your record so as to prevent others from learning who the specific patients are. In addition, we may release your Protected Health Information to another individual or entity covered by the HIPAA privacy regulations that has a relationship with you for their fraud and abuse detection or compliance purposes, quality assessment and improvement activities, or review, evaluation or training of health care professionals or students. For example, we may disclose information to another health care provider involved in your care if the provider requests the information is necessary for its evaluation of one of its medical students. We may also release information to business associates who may perform various treatment, payment or operation functions.
Patient Directory. Our facility maintains a patient directory. Unless you object, your name, location in the facility, general condition, and religious affiliation will be contained in the directory. The directory is disclosed to members of the clergy and except for religious affiliation, to other persons who specifically ask for the information by your name. You are not obligated, however, in any way, to consent to the inclusion of your information in the facility directory. Please notify facility personnel if you do not wish to be included in the directory or if you wish for information or disclosure to be limited in some way.
Notification and Communications to Individuals Involved in Your Care. Unless you have informed us otherwise, your Protected Health Information may be used or disclosed by us to notify or assist in notifying a family member or other person responsible for your care. In most cases, Protected Health Information disclosed for notification purposes will be limited to your name, location and general condition. In addition, unless you have informed us otherwise, Protected Health Information may be released to a family member, relative or close personal friend who is involved in your care to the extent necessary for them to participate in your care. In the event you wish for any of these uses or disclosures to be limited, please contact facility personnel.
Fundraising & Marketing Activities. We may use your Protected Health Information for the purpose of contacting you as part of a facility based fund-raising effort. Such contact could come from the facility, an affiliated organization such as a foundation or a business associate. Information used as part of this fundraising activity may include demographic information such as name, address, age, gender, date of birth, department of service, your treating physician, outcome information and your health insurance status. If you do not wish to be contacted for fundraising activities you may contact Marilyn Nichols at 319-257-3303 to have your name removed from our fundraising list or you may do so on our website at www.sunriseterracecc.com. You may receive information such as prescription or refill reminders from the facility; however, your information will not be provided to third-party marketers and the facility will not sell your information to others for use and marketing processes without your specific authorization.
Disaster Relief. In the event of a disaster we may provide information to public or private entities as needed to facilitate treatment, locate family members or caregivers, and to facilitate public health needs.
Psychotherapy Notes. In the event psychotherapy notes are maintained as part of your health information, those notes will not be used or disclosed except in limited circumstances without your authorization. Such authorization is not needed and will not be obtained if such notes are used by the person who created them, in a reasonable training program for the facility, or as otherwise allowed by law.
Research Purposes. In some instances, your Protected Health Information may be used or disclosed for research purposes. All research projects which use Protected Health Information are subject to a special approval process which will, among other things, evaluate the precautions used to protect patient medical information. In many cases, information which identifies you as the patient will be removed.
Authorized by Law. We may also use or disclosure your protected health information without your authorization as permitted or required by law. Examples include: public health activities, health oversight activities, judicial and administrative proceedings, abuse reporting, law enforcement, organ donation, medical examiners and coroners, workers compensation processes and research purposes. Information will only be used/disclosed without your authorization as permitted by the applicable state or federal law.
More Stringent Laws. Some of your Protected Health Information may be subject to other laws and regulations and afforded greater protection than what is outlined in this Notice. For instance, HIV/AIDS, substance abuse, mental health, information and genetic information are often given more protection. In the event your Protected Health Information is afforded greater protection under federal or state law, we will comply with the applicable law.
Other uses and disclosures of Protected Health Information not covered by this Notice or the laws that apply to us will be made only with your written permission. For example, we need your written authorization to disclose your entire medical record to a family member (other than personal representatives as allowed by law) although some information may be disclosed under limited circumstances without permission. We must also have your written authorization to disclose your Protected Health Information to an attorney who represents you. If you provide us permission to use or disclose Protected Health Information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose Protected Health Information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
Your Rights. Federal law grants you certain rights with respect to your Protected Health Information. Specifically, you have the right to:
- Receive notice of our policies and procedures used to protect your Protected Health Information;
- Request that certain uses and disclosures of your Protected Health Information be restricted; provided, however, if we may release the information without your consent or authorization, we have the right to refuse your request;
- You may restrict disclosure to a health plan of your information where you have paid the full out of pocket costs for the services rendered. This restriction would apply only to those services where you had paid the full out of pocket costs, it would not apply to other information relating to treatment which was paid for by or submitted to an insurer;
- Access to your Protected Health Information; provided, however, the request must be in writing and may be denied in certain limited situations;
- Request that your Protected Health Information be amended;
- Obtain an accounting of certain disclosures by us of your Protected Health Information for the past six years;
- Revoke any prior authorizations or consents for use or disclosure of Protected Health Information, except to the extent that action has already been taken;
- Request communications of your Protected Health Information are done by alternative means or at alternative locations; and
- Notification of any breach of unsecured Protected Health Information relating to you and actions you may take in relationship to such a breach.
Important Contact Information. This notice has been provided to you as a summary of how we will use your Protected Health Information and your rights with respect to your Protected Health Information. If you have any questions or for more information regarding your Protected Health Information, please contact Marilyn Nichols at 319-257-3303. Information can also be found on our website at www.sunriseterracecc.com.
If you believe your privacy rights have been violated, you may file a complaint with our office by contacting Marilyn Nichols at 319-257-3303. You may also file a complaint with the Secretary of Health and Human Services. There will be no retaliation for the filing of a complaint. The following website: www.HHS.gov contains most reporting instructions general information regarding these matters.
Effective Date. This notice become effective on March 23, 2013. Please note, we reserve the right to revise this notice at any time. A current notice of our privacy practices may be obtained from the business office at 706 W. Central Ave. Winfield, IA.
Non-discrimination in Health Programs and Activities
Itis the policy of this organization not to discriminate on the basis of race, color, national origin, sex, age, or disability. This organization has adopted an internal grievance procedure providing for prompt and equitable resolution of complaints alleging any action prohibited by Section 1557 of the Affordable Care Act (42 U.S.C. 18116) and its implementing regulations at 45 CFR part 92, issued by the U.S. Department of Health and Human Services. Section 1557 prohibits discrimination on the basis of race, color, national origin, sex, age, and disability in certain health programs and activities.
Any person who believes someone has been subjected to discrimination on the basis of race, color, national origin, sex, age, or disability may file a grievance under this procedure. It is against the law for anyone in this organization to retaliate against anyone who opposes discrimination, files a grievance, or participates in the investigation of grievance.
For people who need help with language assistance or have Limited English Proficiency, Taglines in a variety of languages on the Nondiscrimination Law can be obtained through any staff member of this organization.
For people who need a translator or appropriate auxiliary aids, please contact any staff member of this organization.
Procedures for filing a grievance:
- Grievances must be submitted to the Section 1557 Coordinator within 60 days of the date the person filing the grievance becomes aware of the alleged discriminatory action.
- A complaint must be in writing, containing the name and address of the person filing it. The complaint must state the problem or action alleged to be discriminatory and the remedy or relief sought.
- The Section 1557 Coordinator shall conduct an investigation of the complaint.
- The Section 1557 Coordinator will issue a written decision on the grievance, based on the results of the thorough investigation, no later than 30 days after its filing.
- The person filing the grievance may appeal the decision of the Section 1557 Coordinator in writing, within 15 days of receiving the decision.
Complaint for are available at: