Blythedale Children's Hospital
Notice of Privacy Practices
August 13, 2012
This Notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
WHO WILL FOLLOW THIS NOTICE
This Notice is being provided to you on behalf of Blythedale Children’s Hospital ("Blythedale” or "Hospital”) with respect to services provided by Hospital staff at the Hospital (referred to herein as "We” or "Our”). This notice describes our health information privacy practices. If you are a parent or legal guardian receiving this Notice because your child receives care at Blythedale, please understand that when we say "you” in this Notice, we are referring to your child. We are talking about the privacy of his or her health information.
OUR PLEDGE REGARDING YOUR HEALTH INFORMATION
We understand that health information about you and your health is personal. We are committed to protecting the health information about you. We create a record of the care and services you receive in our facility. 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. We are required by law to:
• Make sure that health information that identifies you is kept private.
• Give you this notice describing our legal duties and privacy practices with respect to health information about you; and
• Follow the terms of the notice that is currently in effect.
This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It also describes your rights to access and control your protected health information. "Protected health information” is information about you, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
CHANGES TO THIS NOTICE
We reserve the right to change the terms of this notice. We reserve the right to make the revised or changed notice provisions effective for protected health 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, which will contain the effective date in our facilities. In addition, each time you are in our facility for treatment, we will have available for you a copy of the current notice in effect, and, we will provide you with a copy of the notice at any time upon your request.
If you believe your privacy rights have been violated, you may file a complaint with our facility through the Hospital’s Privacy Officer at Blythedale Children’s Hospital, 95 Bradhurst Avenue, Valhalla, NY 10595 or with the Secretary of the U.S. Department of Health and Human Services. You must submit all complaints in writing. We will not retaliate against you for filing a complaint.
HOW WE MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION
The following categories describe different ways that we use and disclose health information. Each category of uses or disclosures will be explained, but not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories. When required by applicable law, we will obtain your authorization before disclosing any of your information, and you may revoke your authorization at any time unless we have taken action in reliance on such authorization. Except in limited circumstances, only the minimum necessary information will be disclosed.
For Treatment: We may use health information about you to provide you with medical treatment. We may disclose health information about you to doctors, residents, nurses, therapists, social workers, nurse practitioners, admissions and billing staff, health information management staff or other personnel who are involved in taking care of you.
Different departments of the Hospital also may share health information about you in order to coordinate the different things you need, such as prescriptions, or lab work. We also may disclose health information about you to people outside the Hospital who may be involved in your medical care, such as a designated family member in case of an emergency or others we use to provide services that are part of your care, such as your insurance company and your social service caseworker.
For Payment: We may use and disclose health information about you so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company, or a third party. For example, we may need to give information about treatment you received to your health plan so the plan will pay us or reimburse you. We may also tell you or your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
For Health Care Operations: Your protected health information will be used and disclosed, as necessary or appropriate, in order to support our business activities and health care operations, or, in certain circumstances, the health care operations of another person or entity also involved in your care. These health care operations activities may include, without limitation, quality assessment activities, employee review activities, and/or the training of nurses, therapists and other health care professionals.
• Appointment Reminders: We may also use and disclose health information to contact you as a reminder that you have an appointment or that you missed an appointment for treatment and need to reschedule the appointment.
• Treatment After-care Alternatives: We may use and disclose health information to tell you about or recommend possible treatment after-care options that will benefit you.
• Research: Under certain circumstances, we may use and disclose minimally necessary health information about you for research purposes. All research projects, however, are subject to a special approval process. Before we use or disclose health information for research, we will ask you to sign a research authorization form.
• Fundraising: We may use certain information (name, address, telephone number, date of service, age, and gender) to contact you in the future to raise money for Blythedale. The money we raise will be used to expand and improve the services and programs we provide. Please write to the Privacy Officer at Blythedale Children’s Hospital, 95 Bradhurst Avenue, Valhalla, NY 10595, if you wish to have your name removed from the list to receive fundraising requests supporting Blythedale.
• Business Associates: There are some services provided in our organization through contracts with business associates. We may disclose your health information to contracted health service providers involved in your care or to a copy service we use when making copies of your health record. When these services are contracted, we may disclose your health information to our business associates so that they can perform the job we’ve asked them to do and bill you or your third party payer for services rendered. So that your health information is protected, however, we require the business associates to be contractually obligated to appropriately safeguard your information.
Uses and Disclosures for De-Identification: We may use or disclose your protected health information to create, use or disclose health information that is not individually identifiable as your health information.
Disclosures for Limited Data Sets: We may use a limited data set, which contains protected health information about you, but excludes information directly identifying you, for the purposes of research, public health and our health care operations. We will execute a data use agreement, as required by law, with the recipient of the limited data set to establish the permitted uses and disclosures of your protected health information and to ensure that such information is only used and disclosed for limited purposes.
Directory: Unless you notify us that you object, we will use your name and location in the facility for directory purposes. This information may be provided to people who ask for you by name.
Others Involved in Your Health Care: Unless you object, we may disclose (to your family members, other relatives, close personal friends or any other person(s) you identify) your protected health information that directly relates to such person’s involvement in your health care or payment for such health care. If you are not present or are otherwise unable to agree or object to such a disclosure for any reason, we may disclose your protected health information as necessary if we reasonably determine, based on our professional judgment, that it is in your best interests. We may also use or disclose your protected health information to notify or assist in notifying a family member, personal representative or any other person who is responsible for your care of your location, general condition or death. Additionally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses of and disclosures to family or other individuals involved in your health care.
As Required by Law: We will disclose health information about you when required to do so by federal, state or local law.
To Avert a Serious Threat to Health or Safety: We may use and disclose health information about you when we believe that such disclosure is necessary to prevent 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.
Public Health Activities: We may disclose minimally necessary health information about you for public health activities. These activities generally include the following:
• To prevent or control disease, injury or disability;
• To report maltreatment of minors and maltreatment of vulnerable adults;
• To report reaction to medication or problems with products;
• 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; or
• To notify the appropriate government authority if we believe a client has been the victim of domestic violence. We will make this disclosure if you agree or when required or authorized by law.
Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, products and product defects or post-marketing surveillance information to enable product recalls, repairs or replacements.
Workers’ Compensation and No Fault Insurance: We may release minimally necessary health information about you in accordance with State and/or federal laws governing the release of information for these or similar programs.
Health Oversight Activities: We may disclose minimally necessary health information to a health oversight agency for 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.
Law Enforcement: We may release minimally necessary health information about you if asked to do so by a law enforcement official:
• In response to a proper court order or legal process;
• In response to a subpoena provided certain protections are in place;
• About criminal conduct involving our facility; and
• In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime if the crime is on Blythedale premises or against Blythedale personnel.
Medical Examiners: We may also release minimally necessary health information about you to a medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death.
Organ and Tissue Donation: If you are an organ donor, we may release health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
National Security and Intelligence Activities: We may release minimally necessary health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities in accordance with applicable law.
YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
You have the following rights regarding the health information we maintain about you:
Right to Inspect and Copy: You have the right to inspect and copy health information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to health information, you may request that the denial be reviewed. To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to the Health Information Management department. If you request a copy of the information, we may charge a fee for the costs of retrieving, copying, mailing, and obtaining any other supplies associated with your request.
Right to Amend: If you feel that any of the health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by our facility. To request an amendment, your request must be made in writing and submitted to the Health Information Management department. 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 health information kept by our facility;
• 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” that contains certain information regarding the disclosures we have made of your health information. We are not required to account for routine disclosures - for example, disclosures among Blythedale Children’s Hospital staff regarding your care. To request an accounting of disclosures, you must submit your request in writing to the Health Information Services department. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. The first accounting you request within a 12-month period will not include a cost for providing the information. For additional accountings, we may charge you for the cost of providing the accounting. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time, before any costs are incurred.
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 the Health Information Services department. Your request must specify how or where you wish to be contacted. We will not ask you the reason for your request. We will accommodate all reasonable requests.
Right to a Copy of This Notice: You have the right to a copy of this notice. You may ask us to give you a copy of this notice at any time.
Right to Request Restrictions: You have the right to request a restriction or limitation on the health 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 health information we disclose about you to someone who is involved in your care or the payment for your care. Finally, you have the right to request a restriction on the people who are able to obtain the information we disclose. However, 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 with emergency treatment. To request a restriction or limitation, your request must be made in writing and submitted to Blythedale’s Health Information Management Department.
If you have any questions about this notice, please contact the Hospital’s Privacy Officer: Blythedale Children’s Hospital, 95 Bradhurst Avenue, Valhalla, NY 10595, Attn: Privacy Officer, (Phone: 914-592-7138, ext. 71592; Fax: 914-592-0407)