Notice Of Privacy Practices
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.
Use this link to download a PDF version of the Privacy Practices.
This Notice of Privacy Practices describes how Southwest Community Health
System, Southwest General Health Center, Southwest Community Pharmacy,
and Southwest General Medical Group, Inc. (collectively referred to as
“Southwest”), including its volunteers and other members of
its workforce, physicians and other health care professionals caring for
you at Southwest may use and share your Protected Health Information (“PHI").
PHI is information in any form (paper, verbal, electronic, or recording
(audio, video, etc.)) that identifies you and that describes your physical
or mental health condition and your health care services (past, present
and future). Your health information is protected by law for up to 50
years after death. This Notice of Privacy Practices applies to members
of the Southwest Medical Staff when they provide care for you at Southwest
General Health Center, but does not apply to their private medical practices.
Southwest and its Medical Staff are cooperating in the protection of your
health information and privacy rights, but such cooperation should not
be construed to mean that the Health Center and members of its Medical
Staff are the agents or representatives of the other, or in any way are
responsible for each other’s actions or failure to act.
We are required by law to maintain the privacy of our patients’ PHI
and to provide you with this Notice of Privacy Practices (“Notice”)
of our legal duties and privacy practices. We are required to follow the
terms of this Notice, so long as it remains in effect. We reserve the
right to change the terms of this Notice as necessary and any new Notice
will be effective for all PHI maintained by Southwest. You have a right
to receive a copy of the currently effective Notice at any registration
area or information desk in a Southwest facility or medical office, by
downloading a copy from our website at
www.swgeneral.com, or by contacting the Southwest Privacy Officer at 440-816-4719.
HOW SOUTHWEST MAY USE AND DISCLOSE YOUR PHI
Authorization. The ways in which we may use or share your PHI without separate
authorization are listed below. We are prohibited from selling your PHI
without your authorization, as well as other uses and disclosures for
which the Privacy Rule requires your authorization (i.e., marketing purposes
and disclosure of psychotherapy notes, where appropriate). We will not
use your PHI for any
other purpose unless you have signed a form authorizing such use or disclosure.
When state or federal law requires a special consent or authorization,
we will make all reasonable efforts to obtain such consent or authorization.
At any time, you have the right to revoke an authorization to disclose
your information if you do so in writing, however, such revocation will
not apply to any action we have taken based on your original authorization.
Uses and Disclosures that Do Not Require Your Authorization
For Treatment. We may use and share your PHI as necessary to provide, coordinate or manage
your health care treatment. We may also share your PHI with another health
care provider who is not associated with us but who provides medical treatment
to you. For example, doctors and nurses involved in your care may use
your medical information to plan a course of treatment for you. This information
may also be shared with other health care providers, for instance, if
you are an inpatient at Southwest and you are to receive home health care
after being discharged, we may disclose your PHI to that home health care
agency so that a plan of care can be prepared for you. We may disclose
mental health PHI (with the exception of psychotherapy notes) as permitted
under HIPAA and state law, to other health care providers for purposes
of continuity of care.
For Payment. We may use and share your PHI as necessary to receive payent for the health
care services provided to you. For instance, we may forward information
regarding treatment you received to your insurance company to obtain payment
for the services provided to you, unless you have paid out of pocket in
full for your health care and have requested that we restrict disclosure
of your PHI to your health plan with respect to such information.
For Health Care Operations. We may use and share your PHI as necessary for our health care operations
which include clinical improvement, business management, accreditation
and licensing and defending ourselves in any legal action. For instance,
your care may be reviewed at one of our quality review committees where
we regularly review care rendered to patients. Under certain circumstances
and as permitted by law, we may also share your PHI with another health
care provider or health plan for their health care operations.
Health Information Exchange. To help enhance the quality of your care, Southwest participates in Health
Information Exchanges (HIE). Your healthcare providers can use this secure
electronic network to share your health records for a better picture of
your health needs. You may opt-out of having your PHI shared through the
HIE any time either during registration or by submitting a written request
to Medical Records. Opting out of HIE sharing means your providers will
need to obtain your records, as permitted or required by law and as described
in this Notice, by other means (e.g., fax, mail, secure email).
Patient Directory. If you are receiving emergency services or are an inpatient here, or if
you are at the Health Center for some lengthy outpatient procedures, we
may direct people to your room or give your room telephone number to anyone
who calls or visits the Health Center and asks for you by name. In some
circumstances, we may also give a general statement about your medical
condition (for instance “fair” or “critical”).
Your religious affiliation may also be provided to members of the clergy.
You have the right during registration to request that we not disclose
any of this information as part of our Patient Directory.
Family or Others Involved. Unless you object, we may from time to time disclose your PHI to family,
friends, and others whom you have designated, who are with you at Southwest,
or after your death. We would only disclose to those who are involved
and only relevant PHI to assist in their involvement in caring for you
or paying for your care. If you are unable or unavailable to agree or
object, or are facing an emergency medical situation or in the case of
a public disaster, we may share limited PHI with your family and friends
or to an organization that is involved in disaster relief efforts if we
believe such a disclosure is in your best interest.
Business Associates. Certain aspects of our services may at times be performed through arrangements
with outside persons or organizations, such as auditing services or billing
services; and at times, outside persons or organizations may assist us
in our care for you. At times, it may be necessary for us to provide your
PHI to these outside persons or organizations that assist us. In all cases,
these business associates are obligated to protect your PHI in the same
manner we are and we obtain written assurances from them stating their
agreement to protect your PHI.
Fundraising. From time to time we may use your PHI to contact you to raise money as
part of our charitable fundraising efforts. You have the right to opt
out of receiving fundraising communications and how to do this will be
described in the communications you receive.
Confidential Communication. You have the right to request we communicate with you by particular means
or locations, such as if you wish appointment reminders not to be left
on voice mail or if you wish for mail to be sent to a different address
than your home. We will honor reasonable requests for confidential communication.
You should make such requests by informing the Southwest General medical
professional during your next visit or when calling to make an appointment.
Research. In limited circumstances, we may use and disclose your PHI for research
purposes. For example, a research organization may wish to compare outcomes
of all patients who received a particular drug and will need to review
a series of medical records. In all cases, either your specific authorization
will be obtained or your privacy will be protected by strict confidentiality
requirements applied by the Institutional Review Board that reviews research
conducted at Southwest or by applicable law.
To Public Health Authorities and Government Oversight Agencies. We may disclose your PHI to public health authorities for any purpose required
by law such as reporting of certain diseases and injuries, births and
deaths, and for required health investigations. We may also disclose your
PHI if required by law to a government oversight agency conducting audits,
licensure review, or similar activities.
Abuse, Neglect, and Law Enforcement. We may disclose your PHI if such information causes us to suspect abuse
or neglect which we are required or permitted by law to report to authorities.
We may also disclose your PHI as required by law if we believe you are
a victim of abuse, neglect or violence. We may also disclose your PHI
to law enforcement officials as required or permitted by law to report
wounds, injuries, and suspicion of certain crimes, or with a court order
(or warrant) for a serious crime and law enforcement officials are seeking
your identification and location.
Food and Drug Administration. We may disclose your PHI to the Food and Drug Administration or its designee,
if necessary, to report such things as adverse reactions, product defects,
or to participate in product recalls.
Disclosures to Employers. We may disclose your PHI to your employer when we have provided services
to you at the request of your employer to determine workplace-related
illness or injury. We may also disclose your PHI to workers’ compensation
agencies, if necessary, for your workers’ compensation benefit determination.
Judicial and Administrative Activities. We may disclose your PHI if required to do so by court order or validly
issued subpoena or for any other official judicial or governmental administrative action.
Funeral Directors / Coroners / Organ Donation Agencies. We may disclose your PHI to coroners and/or funeral directors consistent
with law and we may also disclose your PHI, if necessary, to arrange an
organ or tissue donation from you or a transplant for you.
For Public Health Reasons or the Safety of Others. We may disclose your PHI in limited instances if we suspect a serious threat
to someone else’s or the public’s health or safety, such as
to notify persons that they have been exposed to a communicable disease
or are in danger, or in cases of investigating outbreaks of disease. We
may provide immunization records to schools when required for public health reasons.
Military / National Security. We may disclose your PHI as required by armed forces services if you are
a member of the military; we may also disclose your PHI if required by
law for national security or intelligence activities.
Required By Law. We may use and/or disclose your PHI if we are otherwise required by law
to disclose the information.
RIGHTS YOU HAVE REGARDING YOUR PHI
Access to Your PHI. You have the right to inspect and request copies of your PHI that we maintain
or to direct us to send a copy to a third party. You may request paper
or electronic copies. We may charge you a reasonable cost-based fee for
such copies and any postage. Request for records must be in writing and
sent to Medical Records. An Authorization form may be downloaded at www.swgeneral.com,
under Patients & Visitors. If you are denied access to your records,
you have the right to an explanation as to the legal basis for the denial
and to object to such denial by contacting the Privacy Officer. You may
also access a portion of your electronic medical record any time using
the Southwest General HealtheLife patient portal. Go to www.swgeneral.com
for more details on setting up an account or ask about HealtheLife at
the registration desk.
Amendments to Your PHI. You have the right to request changes or corrections to the PHI we maintain
about you. We are not obligated to make all requested changes but will
give each request careful consideration. All requests must be in writing
(signed and dated) and sent to Medical Records. The request must state
the reasons for the change requested. If a change you request is made
by us, we may also notify others who have copies of the uncorrected record
if we believe that such notification is necessary. An amendment request
form may be obtained by contacting Medical Records.
Accounting of Disclosures. You have the right to request an accounting of certain disclosures of your
PHI, which would not include disclosures made for treatment, payment,
or health care operations, or when an authorization form was obtained.
The first accounting in any 12-month period is free; you may be charged
a reasonable cost-based fee for each subsequent accounting you request
within the same 12-month period. Requests must be in writing (signed and
dated) and sent to Medical Records. A form may be obtained from the Privacy Officer.
Restrictions on Use and Sharing of Your PHI. You have the right to request us to restrict how we use and disclose your
PHI. We are not required to agree to your restriction request but will
attempt to accommodate reasonable requests, when appropriate. You have
the right to terminate any agreed-to restriction at any time. You also
have the right to restrict disclosures of your PHI to your health plan
with respect to health care for which you have paid out of pocket in full.
Breach Notification. You have the right to receive notification of breaches of your unsecured PHI.
Complaints. If you believe your privacy rights have been violated, you can file a complaint
with the Privacy Officer. You may also file a complaint with the Secretary
of the U.S. Department of Health and Human Services. in writing within
180 days of discovering a violation of your rights. There will be no retaliation
against you for filing a complaint.
Acknowledgment of Receipt of Notice. You will be asked to sign an acknowledgment form that you received this
Notice of Privacy Practices.
If you have questions or need further assistance regarding this Notice,
you may contact the Privacy Officer at 440-816-4719, 18697 Bagley Road/C-07,
Middleburg Hts., Ohio 44130.
This Notice of Privacy Practices is effective August 1, 2013
Form #163584 05/19