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.
If you have any questions about this notice, please contact the privacy officer at 660.890.7134.
This notice describes Golden Valley Memorial Healthcare (GVMH) practices regarding privacy and that of:
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at GVMH. 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 generated by GVMH, whether made by GVMH personnel or your personal physician.
Your personal physician may have different policies or notices regarding the physician’s use and disclosure of your medical information created in the physician’s office or clinic.
This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information. We are required by law to:
The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures, we will explain what we mean and try to give some examples. 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.
GVMH may participate in one or more health information exchanges (HIEs) and may electronically share your medical information for treatment payment, healthcare operations and other authorized purposes, to the extent permitted by law, with other participants in the HIEs. HIEs allow your healthcare provider, health plan, and other authorized recipients to efficiently access medical information necessary for your treatment, payment for your care and other lawful purposes. The types of medical information that may be shared through HIEs, includes, but is not limited to: diagnoses, medications, allergies, lab test results, radiology reports, health plan enrollment and eligibility. Such information may also include health information that may be considered particularly sensitive to you, including mental health information; HIV/AIDS information and test results; genetic information and test results; STD treatment and test results and family planning information. The inclusion of your medical information in an HIE is voluntary and subject to your right to opt–out. If you do not opt-out, we may provide your medical information in accordance with applicable law to the HIEs in which we participate. For more information on any HIE in which we participate and how you can exercise your right to opt-out, call us at 660-885-5511. If your choose to opt-out of data-sharing through HIEs, your information will no longer be shared through HIE, including in a medical emergency; however, your opt-out will not modify how your information is otherwise accessed and released to authorized individuals in accordance with the law, including being transmitted through other secure mechanisms (i.e., by fax or an equivalent technology).
For treatment: We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to physicians, nurses, technicians, medical students or other hospital personnel who are involved in taking care of you at the hospital. For example, a physician treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the physician may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments of GVMH also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work and x-rays. We also may disclose medical treatment information about you to people outside GVMH who may be involved in your medical care after you leave the hospital, such as family members, or others who provide services that are part of your care, such as HHA or consulting physicians.
For payment: We may use and disclose medical information about you so that the treatment and services you receive at GVMH 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 your health plan information about surgery you received at the hospital so your health plan will pay us or reimburse you for the surgery. We may also tell 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 healthcare operations: We may use and disclose medical information about you for GVMH operations. These uses and disclosures are necessary to run GVMH and make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical information about many GVMH patients to decide what additional services GVMH should offer and what services are not needed and to determine the effectiveness of certain treatments. We may also disclose information to physicians, nurses, technicians, medical students and other GVMH personnel for review and learning purposes. We may also compare our services with other healthcare facilities in order to make improvements in the care and services provided at GVMH. We may remove information that identifies you from this set of medical information so others may use it to study healthcare and healthcare delivery without knowing the identity of specific patients.
Appointment reminders: We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at GVMH.
Treatment alternatives: We may use and disclose medical information to tell you about, or recommend possible treatment options or alternatives.
Health-related benefits and services: We may use and disclose medical information to tell you about health-related benefits or services.
Fundraising activities: We may use medical information about you to contact you in an effort to raise money for GVMH and its operations. We may disclose medical information to a foundation related to GVMH so that the foundation may contact you in raising money for GVMH. If you do not want the hospital to contact you for fundraising efforts, you must notify the manager of social services in writing.
Hospital directory: We may include certain limited information about you in the hospital directory while you are a patient at the hospital. This information may include your name, location in the hospital, your general condition (e.g., fair, stable) and your religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, even if they don’t ask for you by name. This is so your family, friends and clergy can visit you in the hospital and generally know how you are doing.
Individual involved in your care or payment for your care: We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family or friends your condition and that you are in the hospital. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
Research: Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another for the same condition. All research projects, however, are subject to a special approval process. We will ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are or will be involved in your care at GVMH.
As required by law: We will disclose medical 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 medical information about you when 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.
Organ and tissue donation: If you are an organ donor, we may release medical 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.
Military and veterans: If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
Workers’ compensation: We may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
Public health risks: We may disclose medical information about you for public health activities. These activities generally include the following:
Health oversight activities: We may disclose medical 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 healthcare system, government programs and compliance with civil rights laws.
Lawsuits and disputes: If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request, or to obtain an order protecting the information requested.
Law enforcement: We may release medical information if asked to do so by a law enforcement agency official:
Coroners, medical examiners and funeral directors: We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients of the hospital to funeral directors as necessary to carry out their duties.
National security and intelligence activities: We may release medical counterintelligence and other national security activities authorized by law.
Protective services for the president and others: We may disclose medical information about you to authorized federal officials so they may provide protection to the president, other authorized persons or foreign heads of state or conduct special investigations.
Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with healthcare; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
You have the following rights regarding medical information we maintain about you:
Right to inspect and copy: You have the right to inspect and receive a copy of medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes.
To inspect and obtain a copy of medical information that may be used to make decisions about you, you must submit your request in writing to health information management personnel. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
GVMH has up to 30 days to comply with your request.
We may deny your request to inspect and obtain a copy in certain, very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed healthcare professional chosen by the hospital will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Right to amend: If you feel that medical 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 or for GVMH.
To request an amendment, your request must be made in writing and submitted to health information management personnel. 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:
Rights to an accounting of disclosures: You have the right to request an accounting of disclosures. This is a list of the people who have received information about you from your medical records. To request this list or accounting of disclosures, you must submit your request in writing to health information management personnel. Your request must state a time period that may not be longer than six years from the date of the request and may not include dates before April 14, 2003. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. 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 restrictions: You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or healthcare operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your case, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery you had.
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 emergency treatment.
To request restrictions, you must make your request in writing to health information management personnel. 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, for example, disclosures to your spouse.
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 health information management personnel. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right to a paper copy of this notice: You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. To obtain a paper copy of this notice, contact the admissions office at GVMH at 660.885.5511.
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we receive in the future. We will post a copy of the current notice. In addition, each time you register at or are admitted to GVMH for treatment or healthcare services as an inpatient or outpatient, we will offer you a copy of the current notice.
If you believe your privacy rights have been violated, you may file a complaint with GVMH or with the Secretary of the Department of Health and Human Services. To file a complaint with GVMH, contact the hospital Privacy Officer. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
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 medical information about you, you may revoke the permission, in writing, at any time. If you revoke your permission, 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 provided to you.
Golden Valley Memorial Healthcare complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability or sex.
The name and address of the person you can contact for further information concerning our privacy practices is:
HIPAA Privacy Officer
Golden Valley Memorial Healthcare
Clinton, Missouri 64735