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.
This document being supplied to you represents our compliance with the Health Insurance Portability and Accountability Act (HIPAA) passed by Congress and enacted into law in August 1996. If you have any questions about this notice, please contact Blythedale Children’s Hospital Privacy Officer at extension 381.
WHO WILL FOLLOW THIS NOTICE
This notice describes the privacy practices of every employee of Blythedale Children’s Hospital who is authorized to access information in your chart or medical record.
OUR PLEDGE REGARDING PATIENTS’ INFORMATION
Since its inception in 1900, Blythedale Children’s Hospital has worked to protect the confidentiality of our patients’ records. We understand that medical information about you and your health is highly personal. This notice applies to all records of your medical care provided by any Blythedale Children’s Hospital employee.
This notice informs you about the ways in which we may use and disclose your medical information. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.
Law requires us:
- To ensure that you’re medical information is kept private.
- To serve notice of our legal duties and privacy practices with respect to your medical information.
- To follow the terms of this notice.
HOW WE MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION
- Treatment
We may disclose medical information about you to physicians, nurses, technicians, or other individuals involved in the provision of medical care to you.
- Payment
We may use and disclose your medical information so that treatment and services you have received may be billed and payment collected from you, an insurance company, or a third party. Your medical information may be released to your insurance in order to obtain approval for treatment or to determine contractbenefit.
- Required By Law
We will disclose your medical information when required to do so by Federal, State or Local law.
- Research
Blythedale Children’s Hospital is a research institution. All research projects conducted by Blythedale Children’s Hospital must be approved through a special review to protect patient safety, welfare, and confidentiality. Your medical information may be important to further research efforts and the development of new knowledge. We may use and disclose medical information about our patients for research purposes, subject to the confidentiality provisions of state and federal law.
On occasion, researchers contact patients regarding their interest in participating in certain research studies. Enrollment in those studies can only occur after you have been informed about the study, had an opportunity to ask questions, and indicated your willingness to participate by signing a consent form. When approved through a special review process, other studies may be performed using your medical information without requiring your consent. These studies will not affect your treatment or welfare, and your medical information will continue to be protected. For example, a research study may involve a chart review to compare the outcomes of patients who receive different types of treatment.
YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION
- You have the right to access and or obtain a copy of your medical record. Please obtain a request form from the Medical Record Department.
- You have the right to request an “accounting of disclosures.” This is the list of disclosures we made of your medical information.
- Your request must state a time period that may not be longer than six (6) years and may not include dates prior to 04/14/03.
- You have the right to request a restriction or limitation on the disclosure of your medical information. To request a restriction, please obtain a request form from the Registrar. In your request, you must indicate what information to restrict and to whom the restriction is applicable.
- You may request to receive Protected Health Information by alternative means at an alternative location. We will accommodate reasonable requests for an alternative mailing address, or communicate with you in person under certain circumstances.
- You may always access the most current “Privacy Notice” on our website at www.Blythedale.org
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with Blythedale Children’s Hospital or the Secretary of the Department of Health and Human Services. To file a complaint with Blythedale Children’s Hospital, please contact the Privacy Officer at (914) 592-7138 ext. 381.
