This notice is required to be provided to you by the Health Insurance Portability and Accountability Act (HIPAA). It describes how we may use and disclose your protected health information and your rights to access and control this information. Your "protected health information" means any of your written and oral health information, including demographic data that can be used to identify you. This is health information that is created or received by your health care provider, and that relates to your past, present or future physical or mental health condition.
Uses and Disclsures of Protected Health Information
Libertas may use your protected health information for purposes of providing treatment, obtaining payment for treatment, and conducting health care operations. Your protected health information may be used or disclosed only for these purposes unless Libertas has obtained your authorization or the use or disclosure is otherwise permitted by the HIPAA Privacy Regulations or State Law.
Treatment
We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party for treatment purposes.
Payment
Your protected health information will be used, as needed, to obtain payment for the services that we provide. In order to get payment for your services, we may need to disclose your protected health information to your insurance company to demonstrate the medical necessity of the services, or, as required by your insurance company, for utilization review.
Operations
We may use or disclose your protected health information, as necessary, for our own health care operations in order to facilitate the function of Libertas and to provide quality care to all patients.
To Report Abuse, Neglect Or Domestic Violence
We may notify government authorities if we believe that a patient is the victim of abuse, neglect or domestic violence.
To Conduct Health Oversight Activities
We may disclose your protected health information to a health oversight agency for activities including audits; civil, administrative, or criminal investigations, proceedings, or actions, inspections, licensure or disciplinary actions; or other activities necessary for appropriate oversight as authorized by law.
Judicial And Administrative Proceedings
We may disclose your protected health information in the course of any judicial or administrative proceeding in response to an order of a court or administrative tribunal as expressly authorized by such order or in response to a signed authorization.
For Law Enforcement Purposes
We may disclosure your protected health information to a law enforcement official for law enforcement purposes.
Coroners, Funeral Directors, & for Organ DonationWe may disclose protected health information to a coroner or medical examiner for identification purposes, to determine cause of death or for the coroner or medical examiner to perform other duties authorized by law. Protected health information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.
For Research Purposes
We may use or disclose your protected health information for research when the use or disclosure for research has been approved by an institutional review board or privacy board that has reviewed the research proposal and research protocols to address the privacy of your protected health information.
Event of A Serious Threat To Health Or Safety
We may use or disclose your protected health information if we believe, in good faith, that such use or disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.
For Specified Government Functions
In certain circumstances, the Federal regulations authorize Libertas to use or disclose your protected health information to facilitate specified government functions.
For Worker's Compensation
Libertas may release your health information to comply with worker's compensation laws or similar programs.
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Our Duties
Libertas is required by law to maintain the privacy of your health information and to provide you with this Notice of our duties and privacy practices. We are required to abide by terms of this Notice as may be amended from time to time. We reserve the right to change the terms of this Notice and to make the new Notice provisions effective for all protected health information that we maintain.
Complaints
You have the right to express complaints to Libertas and to the Secretary of Health and Human Services if you believe that your privacy rights have been violated.
Contacts
Libertas' contact person for all issues regarding patient privacy and your rights under the Federal privacy standards is the Privacy Officer. Information regarding matters covered by this Notice can be requested by contacting the Privacy Officer by telephone at: 715.726.3233.
Patient Directory
Unless you object, we may use your health information, such as your name, location in our facility, and your religious affiliation for our Hospital patient directory. The information about you contained in our patient directory will be released to people who ask for you by name. However, the information about your religious affiliation will only be disclosed to clergy members.
Effective Date
This notice is effective April 14, 2003.
This privacy policy is in connection with that of St. Joseph's Hospital of Chippewa Falls. View the privacy notice of St. Joseph's Hospital.
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You have the following rights regarding your health information:
Request a restriction on uses and disclosures - You may ask us not to use or disclose certain parts of your protected health information for the purposes of treatment, payment or health care operations.
Request to receive confidential communications from us by alternative means - You have the right to request that we communicate with you in certain ways. We may condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact.
Have your physician amend your protected health information - You may request an amendment of protected health information about you in a designated record set for as long as we maintain this information.
Receive an accounting - You have the right to request an accounting of certain disclosures of your protected health information made by Libertas. This right applies to disclosures for purposes other than treatment, payment or health care operations as described in this notice.
Obtain a paper copy of this notice - Upon request, we will provide a separate paper copy of this notice even if you have already received a copy of the notice or have agreed to accept this notice electronically.
The right to inspect and copy your protected health information - You may inspect and obtain a copy of your protected health information that is contained in a designated record set for as long as we maintain the protected health information.
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Green Bay, WI 54303-3282 920.498.8600