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Privacy
Statement
This
notice describes the type of information we gather about
you, with whom that information may be shared and the safeguards
we have in place to protect it. You have the right to the
confidentiality of your health information and the right
to approve or refuse the release of specific information
except when the release is required by law.
OUR
PLEDGE REGARDING YOUR HEALTH INFORMATION: We understand
that information about you and your health is personal.
Protecting health information about you is important. We
create a record of the care and services you receive. We
need this record to provide you with consistent quality
care and to comply with regulatory agencies. This notice
applies to all of the records of your care generated by
Bradford Health Services. This notice will tell you about
the ways in which we may use and disclose health information
about you. We also describe your rights and certain obligations
we have regarding the use and disclosure of health information.
USES
AND DISCLOSURES OF YOUR HEALTH INFORMATION: We
will use and disclose elements of your protected health
information (PHI) in the following ways:
With
Your Signed Consent:
- Treatment:
Means the provision, coordination or management of your
medical and clinical health care, including consultations
between Bradford staff providers.
- Follow-up:
Means contact made after treatment for follow-up studies.
With
Your Signed Authorization:
- Payment:
Means activities we undertake to obtain reimbursement
for health care provided to you, including determinations
of eligibility and coverage and other utilization review
activities.
- Progress
Reporting: Means activities we undertake to keep
your employer informed of your progress. Authorization
is also required for any disclosure of your protected
health care information to any person(s) or agencies.
Except
for the special situations set forth below, we will not
use or disclose your protected health information for any
other purpose unless you provide written authorization.
You have the right to revoke that authorization at any time,
provided the revocation is in writing, except to the extent
that we have taken action in reliance on your authorization.
Special
Situations:
- Public
Health Risks: We may disclose protected health
information for public health activities such as: (1)
Prevention and control of disease; and /or (2) To report
child abuse or neglect.
- Law
Enforcement: We may release privileged health
information if asked to do so by law enforcement individual:
(1) In response to a court order; and/or (2) About criminal
conduct on our premises.
- Serious
Threats: As permitted by applicable law and standards
of ethical conduct, we may disclose protected health information
if we, in good faith, believe that the use or disclosure
is necessary to prevent or lessen a serious and imminent
threat to the health or safety of a person or the public.
- Emergency:
We may disclose protected health information in a care
situation where you are incapable of giving consent.
- Military:
If you are a member of the armed forces, we may release
information about you as required by military authorities.
- Coroners:
We may release information to a coroner or medical examiner
for identification or to determine the cause of death.
- National
Security: We may release information about you
to authorized officers so they may provide protection
to the president, as well as, other national security
activities authorized by law.
YOUR
RIGHTS:
-
You have the right to inspect and request copy health
care information that may be used to make decisions about
your care. Usually, this includes medical and billing
records, but may not include psychotherapy notes.
To inspect and request a copy of your health care information,
you must submit your request in writing to the Treatment
/ Clinical Director. If you request a copy of the information,
we will charge a fee for the cost of copying, mailing
or other supplies associated with your request.
-
If you feel that health care 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.
To request an amendment, your request must be made in
writing and submitted to the Treatment/Clinical Director.
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: (1) Was not created
by us, unless the person or entity that created the information
is no longer available to make the amendment; (2) Is not
part of the health information kept by Bradford Health
Services; or (3) Is accurate and complete.
-
You have the right to request an “accounting of
disclosures.” This is a list of the disclosures
we made of health information about you.
To request this list or accounting of disclosures, you
must submit your request in writing to the Treatment/Clinical
Director. Your request may not include dates before April
14, 2003.
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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 of your care, like a family member
or friend.
To request restrictions, you must make your request in
writing to the Treatment/Clinical Director. In your request,
you must tell us (1) what information you want to limit;
(2) whether you want to limit our use, disclosure or both;
and (3) to whom you want the limits to apply.
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You have the right to request that we communicate with
you about health care matters in a certain way or at a
certain location. For example, you can ask that we only
contact you at home or by mail.
CHANGES
TO THIS NOTICE: We reserve the right to change
this notice. We reserve the right to make the revised or
changed notice effective for 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. This
notice will contain on every page, in the bottom left hand
corner, the effective date.
COMPLAINTS:
If you believe your privacy rights have been violated, you
may file a complaint with Bradford Health Services. To file
a complaint with Bradford Health Services, contact our Privacy
Officer at the address and phone number below. All complaints
must be submitted in writing.
You
will not be penalized for filing a complaint.
PRIVACY
OFFICER:
Roger
D. Cain, Chief Privacy Officer
2101 Magnolia Avenue South, Suite 518
Birmingham, Alabama 35205
205-251-7753
OTHER
USES OF HEALTH INFORMATION: Other uses and disclosures
of medical information not covered by this notice or the
laws that apply to us will be made only with your written
permission. If you provide us permission to use or disclose
health information about you, you may revoke that permission,
in writing, at any time. If you revoke your permission,
thereafter we will no longer use or disclose medical 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 have
provided to you.
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