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Privacy Notice

Gifford Medical Center, the Menig Extended Care Facility, Bethel Health Center, Chelsea Health Center, Gifford Health Center at Berlin, Kingwood Health Center, Gifford Ob/Gyn and Midwifery,Gifford Primary Care, Gifford Specialty Care, Gifford Surgical Associates, Rochester Health Center, Sharon Health Center and Twin River Health Center. Joint Notice of Health Information 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.

The notice covers hospital, clinics and nursing home services provided to you by Gifford Medical Center and the members of its Medical Staff together as an organized health care arrangement pursuant to the Federal Privacy Rule. It applies to the medical record of all services provided to you in the hospital’s clinically integrated care setting, regardless of whether specific services are provided by hospital employees or by independent members of our Medical Staff.

Understanding Your Health Record/Information

Each time you visit a hospital, physician or other health care provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment and a plan for future care or treatment. This information, which we refer to as your health or medical record, is an essential part of the health care we provide for you. It serves as a:

  • Basis for planning your care and treatment.
  • Means of communication among the many health professionals who contribute to your care.
  • Legal document describing the care you received
  • Means by which you or a third-party payer can verify that services billed were actually provided.
  • Tool in educating health professionals.
  • Source of data for medical research.
  • Source of information for public health officials charged with improving the health of the nation.
  • Source of data for facility planning and marketing.
  • Tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.

Your health record contains personal health information, the confidentiality of which is protected under both state and federal law. Understanding how we expect to use and disclose your health information helps you to:

  • Ensure its accuracy;
  • Better understand who, what, when, where and why your health care providers and others may access your health information; and
  • Make more informed decisions when authorizing disclosure to others.

Your Health Information Rights

Although your health record is the physical property of the health care practitioner or facility that compiled it, the information belongs to you. Under the Federal Privacy Rules, 45 CFR Part 164, you have the right to:

  • Receive notice of the uses and disclosures we expect to make of your health information, including a paper copy of the notice if requested, as provided in Rule 520.
  • Request additional restrictions on uses and disclosures of your health information (though we are not required to agree to any such request), or request that we send you confidential communications by alternative means or at alternative locations, as provided in Rule 522.
  • Inspect and obtain a copy of your health record as provided in Rule 524.
  • Request that your health record be amended as provided in Rule 526.
  • Obtain an accounting of disclosures of your health information made after April 14, 2003, for purposes other than treatment, payment or health care operations, or as authorized by you, as provided in Rule 528.

Please direct requests to:

Health Information Management
44 South Main Street, Randolph, VT 05060
Phone: (802) 728-2223
E-mail: PrivacyOfficer@ Giffordmed.org

Our Responsibilities

We are required by the Federal Privacy Rules to:

  • Maintain the privacy of your health information;
  • Provide you with notice as to our legal duties and privacy practices with respect to health information we collect and maintain about you; and
  • Abide by the terms of this notice, subject to the following reservation of rights.
  • We reserve the right to change our health information practices and the terms of this notice, and to make the new provisions effective for all protected health information we maintain, including health information created or received prior to the effective date of any such revised notice.
  • Should our health information practices change, we will post and/or provide a revised notice. We will not use or disclose your health information without your consent or authorization, except as described in this notice.

Uses and Disclosures for Treatment, Payment and Health Operations Without Your Consent

We will use your health information for treatment. For example: Information obtained by a nurse, physician or other member of your health care team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your health care team. Members of your health care team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment.

We will also provide your primary care physician or a subsequent health care provider with copies of various reports that should assist him or her in treating you once you’re discharged from this hospital. We may also send relevant portions of your medical record to specialists to whom you are being referred for care, or to physicians whom your providers here may want to consult on a care issue.

We may use and disclose health information about you (for example, by calling you or sending you a letter) to remind you that you have an appointment with us for treatment or that it’s time for you to schedule a regular checkup with us or to provide you with information about treatment alternatives. We will use your health information for payment. For example: A bill may be sent to you or your insurance company or health plan. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures and supplies used.

We will use your health information for regular health operations. For example: Members of the medical staff, risk managers or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the health care and service we provide.

Business associates: We provide some services through business associates, who are independent professionals who use patient health information provided by us in order to perform these services. Examples include quality assurance consultants, transcription services, a copy service we may use when making copies of your health record or a billing service. 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 insurer for services rendered. Another example of a business associate is our state hospital associations to which we disclose comparative statistics as required by our certifying/accrediting agencies. To protect your health information, however, we require the business associate to appropriately safeguard your information.

Uses and Disclosures that We May Make Unless You Object

Directory: Unless you notify us that you object, we will use your name, location in the facility, general condition and religious affiliation in our facility directory. This information may be provided to members of your family, friends, members of the clergy and, except for religious affiliation, to other people who ask for you by name.

Family or friends involved in care: Unless you object, health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care.

Fundraising: We may use or disclose your health information in connection with limited fund-raising communications permitted under the Federal Privacy Rules. Any such communication addressed to you will contain instructions describing how you may “opt out” of receiving further such communications.

Required Disclosures

The Federal Privacy Rules require us to disclose your personal health information in two instances: to you at your request under Rule 524 or Rule 528, and to the Secretary of Health and Human Services when requested as part of an investigation or compliance review under Rule 502.

Disclosures Permitted Without Consent for National Priority Purposes

In addition, Rule 512 permits uses and disclosure of your health information without your consent or authorization for certain “national priority” purposes, including:

  • When required by state or federal law.
  • To state and federal public health authorities, including state medical officers, the Food and Drug Administration (FDA) and other agencies charged with preventing or controlling disease.
  • To government authorities, including protective service agencies, authorized to receive reports of abuse, neglect or domestic violence pursuant to state law.
  • To government health oversight agencies, such as the state and federal Departments of Health and Human Services; Medicare/Medicaid Peer Review Organizations (PRO’s); state Boards of Medicine, Nursing and Pharmacy; and other licensing authorities.
  • When required or court order in a judicial or administrative proceeding.
  • To law enforcement officials for certain law enforcement purposes, including the reporting of certain types of wounds or injuries; or pursuant to a warrant, subpoena or other legal process; or for the purpose of identifying or locating a subject, fugitive, material witness, missing person or victim, provided that the conditions in the rule are met and the disclosure is permitted under state law.
  • To coroners, medical examiners or funeral directors for purposes of identifying a deceased person or carrying out their duties as required by law.
  • To organ procurement organizations for purposes of organ or tissue donation and transplantation, consistent with applicable law.
  • For research approved by an Institutional Review Board (IRB) or Privacy Board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.
  • When required to avert a serious threat to health or safety.
  • When requested for certain specialized government functions authorized by law, including military and similar situations.
  • As authorized by law in connection with workers' compensation programs.

Uses and Disclosures Specifically Authorized By You

We expect to make other uses and disclosures of your protected health information only on the basis of specific written authorization forms signed by you. You have the right to revoke any such authorization at any time, except to the extent we have already relied on it in making an authorized use or disclosure.

For More Information or to Report a Problem

If you have questions you may contact the Privacy Officer/Manager of Health Information Management at Gifford Medical Center, 44 South Main Street, Randolph, VT 05060; by phone at (802) 728-2332; or by e-mail ctraegler@giffordmed.org.

If you believe your privacy rights have been violated, you can file a complaint with the Privacy Officer/Manager of Health Information Management at the above address or with the Secretary of Health and Human Services in Washington, D.C. There will be no retaliation for filing a complaint.

Effective Date: July 22, 2008

This (article) is Copyright© 2001 by NHVSHIP. It may be freely redistributed in part or in its entirety provided that this copyright notice is not removed. It may not be sold for profit or used in commercial documents without the written permission of the copyright holder. This article is provided “as is” without an express or implied warranty. While all information in this Article is believed to be correct at the time of writing, this article is for educational purposes only and does not purport to provide legal advice. If you require legal advice, you should consult with an attorney.

 


 

Online Donation Policy

Privacy Policy

Gifford Medical Center is committed to protecting your privacy. We use the information we collect about you only to process orders. We will never willfully sell, trade, rent, disclose or make available personally identifiable information about you to any third party without first receiving your permission, except when we believe that the law requires it, or to protect the rights or property of Gifford Medical Center.

Shipping & Delivery

There is no Shipping/Delivery Policy

Returns

There is no Returns Policy

Privacy Practices
Gifford Medical Center, the Menig Extended Care Facility, Bethel Health Center, Chelsea Health
Center, Gifford Health Center at Berlin, Kingwood Health Center, Gifford Ob/Gyn and Midwifery,
Gifford Primary Care, Gifford Specialty Care, Gifford Surgical Associates, Rochester Health
Center, Sharon Health Center and Twin River Health Center.
Joint Notice of Health Information 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.
The notice covers hospital, clinics and nursing home services provided to you by Gifford Medical
Center and the members of its Medical Staff together as an organized health care arrangement
pursuant to the Federal Privacy Rule. It applies to the medical record of all services provided to
you in the hospital’s clinically integrated care setting, regardless of whether specific services are
provided by hospital employees or by independent members of our Medical Staff.
Understanding Your Health Record/Information
Each time you visit a hospital, physician or other health care provider, a record of your visit is
made. Typically, this record contains your symptoms, examination and test results, diagnoses,
treatment and a plan for future care or treatment. This information, which we refer to as your
health or medical record, is an essential part of the health care we provide for you. It serves as a:
*    Basis for planning your care and treatment.
*    Means of communication among the many health professionals who contribute to
your care.
*    Legal document describing the care you received
*    Means by which you or a third-party payer can verify that services billed were actually
provided.
*    Tool in educating health professionals.
*    Source of data for medical research.
*    Source of information for public health officials charged with improving the health of
the nation.
*    Source of data for facility planning and marketing.
*    Tool with which we can assess and continually work to improve the care we render
and the outcomes we achieve.
Your health record contains personal health information, the confidentiality of which is protected
under both state and federal law. Understanding how we expect to use and disclose your health
information helps you to:
*    Ensure its accuracy;
*    Better understand who, what, when, where and why your health care providers and
others may access your health information; and
*    Make more informed decisions when authorizing disclosure to others.
Your Health Information Rights
Although your health record is the physical property of the health care practitioner or facility that
compiled it, the information belongs to you. Under the Federal Privacy Rules, 45 CFR Part 164,
you have the right to:
*    Receive notice of the uses and disclosures we expect to make of your health
information, including a paper copy of the notice if requested, as provided in Rule
520.
*    Request additional restrictions on uses and disclosures of your health information
(though we are not required to agree to any such request), or request that we send
you confidential communications by alternative means or at alternative locations, as
provided in Rule 522.
*    Inspect and obtain a copy of your health record as provided in Rule 524.
*    Request that your health record be amended as provided in Rule 526.
*    Obtain an accounting of disclosures of your health information made after April 14,
2003, for purposes other than treatment, payment or health care operations, or as
authorized by you, as provided in Rule 528.
Please direct requests to:
Health Information Management
44 South Main Street, Randolph, VT 05060
Phone: (802) 728-2223
E-mail: PrivacyOfficer@ Giffordmed.org
Our Responsibilities
We are required by the Federal Privacy Rules to:
*    Maintain the privacy of your health information;
*    Provide you with notice as to our legal duties and privacy practices with respect
to health information we collect and maintain about you; and
*    Abide by the terms of this notice, subject to the following reservation of rights.
We reserve the right to change our health information practices and the terms of this notice, and
to make the new provisions effective for all protected health information we maintain, including
health information created or received prior to the effective date of any such revised notice.
Should our health information practices change, we will post and/or provide a revised notice. We
will not use or disclose your health information without your consent or authorization, except as
described in this notice.
Uses and Disclosures for Treatment, Payment and Health Operations Without Your
Consent
We will use your health information for treatment.
For example: Information obtained by a nurse, physician or other member of your health care
team will be recorded in your record and used to determine the course of treatment that should
work best for you. Your physician will document in your record his or her expectations of the
members of your health care team. Members of your health care team will then record the actions
they took and their observations. In that way, the physician will know how you are responding to
treatment.
We will also provide your primary care physician or a subsequent health care provider with copies
of various reports that should assist him or her in treating you once you’re discharged from this
hospital. We may also send relevant portions of your medical record to specialists to whom you
are being referred for care, or to physicians whom your providers here may want to consult on a
care issue.
We may use and disclose health information about you (for example, by calling you or sending
you a letter) to remind you that you have an appointment with us for treatment or that it’s time for
you to schedule a regular checkup with us or to provide you with information about treatment
alternatives.
We will use your health information for payment.
For example: A bill may be sent to you or your insurance company or health plan. The information
on or accompanying the bill may include information that identifies you, as well as your diagnosis,
procedures and supplies used.
We will use your health information for regular health operations.
For example: Members of the medical staff, risk managers or members of the quality
improvement team may use information in your health record to assess the care and outcomes in
your case and others like it. This information will then be used in an effort to continually improve
the quality and effectiveness of the health care and service we provide.
Business associates: We provide some services through business associates, who are
independent professionals who use patient health information provided by us in order to perform
these services. Examples include quality assurance consultants, transcription services, a copy
service we may use when making copies of your health record or a billing service. 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 insurer for services
rendered. Another example of a business associate is our state hospital associations to which we
disclose comparative statistics as required by our certifying/accrediting agencies. To protect your
health information, however, we require the business associate to appropriately safeguard your
information.
Uses and Disclosures that We May Make Unless You Object
Directory: Unless you notify us that you object, we will use your name, location in the facility,
general condition and religious affiliation in our facility directory. This information may be provided
to members of your family, friends, members of the clergy and, except for religious affiliation, to
other people who ask for you by name.
Family or friends involved in care: Unless you object, health professionals, using their best
judgment, may disclose to a family member, other relative, close personal friend or any other
person you identify, health information relevant to that person’s involvement in your care or
payment related to your care.
Fundraising: We may use or disclose your health information in connection with limited fund-
raising communications permitted under the Federal Privacy Rules. Any such communication
addressed to you will contain instructions describing how you may “opt out” of receiving further
such communications.
Required Disclosures
The Federal Privacy Rules require us to disclose your personal health information in two
instances: to you at your request under Rule 524 or Rule 528, and to the Secretary of Health and
Human Services when requested as part of an investigation or compliance review under Rule
502.
Disclosures Permitted Without Consent for National Priority Purposes
In addition, Rule 512 permits uses and disclosure of your health information without your consent
or authorization for certain “national priority” purposes, including:
*    When required by state or federal law.
*    To state and federal public health authorities, including state medical officers, the
Food and Drug Administration (FDA) and other agencies charged with preventing
or controlling disease.
*    To government authorities, including protective service agencies, authorized to
receive reports of abuse, neglect or domestic violence pursuant to state law.
*    To government health oversight agencies, such as the state and federal
Departments of Health and Human Services; Medicare/Medicaid Peer Review
Organizations (PRO’s); state Boards of Medicine, Nursing and Pharmacy; and
other licensing authorities.
*    When required or court order in a judicial or administrative proceeding.
*    To law enforcement officials for certain law enforcement purposes, including the
reporting of certain types of wounds or injuries; or pursuant to a warrant,
subpoena or other legal process; or for the purpose of identifying or locating a
subject, fugitive, material witness, missing person or victim, provided that the
conditions in the rule are met and the disclosure is permitted under state law.
*    To coroners, medical examiners or funeral directors for purposes of identifying a
deceased person or carrying out their duties as required by law.
*    To organ procurement organizations for purposes of organ or tissue donation
and transplantation, consistent with applicable law.
*    For research approved by an Institutional Review Board (IRB) or Privacy Board
that has reviewed the research proposal and established protocols to ensure the
privacy of your health information.
*    When required to avert a serious threat to health or safety.
*    When requested for certain specialized government functions authorized by law,
including military and similar situations.
*    As authorized by law in connection with workers' compensation programs.
Uses and Disclosures Specifically Authorized By You
We expect to make other uses and disclosures of your protected health information only on the
basis of specific written authorization forms signed by you. You have the right to revoke any such
authorization at any time, except to the extent we have already relied on it in making an
authorized use or disclosure.
For More Information or to Report a Problem
If you have questions you may contact the Privacy Officer/Manager of Health Information
Management at Gifford Medical Center, 44 South Main Street, Randolph, VT 05060; by phone at
(802) 728-2332; or by e-mail ctraegler@giffordmed.org.
If you believe your privacy rights have been violated, you can file a complaint with the Privacy
Officer/Manager of Health Information Management at the above address or with the Secretary of
Health and Human Services in Washington, D.C. There will be no retaliation for filing a complaint.
 
Effective Date: July 22, 2008
This (article) is Copyright© 2001 by NHVSHIP. It may be freely redistributed in part or in its
entirety provided that this copyright notice is not removed. It may not be sold for profit or used in
commercial documents without the written permission of the copyright holder. This article is
provided “as is” without an express or implied warranty. While all information in this Article is
believed to be correct at the time of writing, this article is for educational purposes only and does
not purport to provide legal advice. If you require legal advice, you should consult with an
attorney.



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