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 notice is provided to you on behalf of Daughters of Charity Health System.
If you have any questions about this notice, please contact the Privacy Official at the Local Health Ministry (“LHM”) where you received services. You can obtain the Privacy Official’s name by contacting the main number of the LHM.
WHO WILL COMPLY WITH THIS NOTICE:
This notice describes our LHM’s practices and that of:
OUR PLEDGE REGARDING MEDICAL INFORMATION
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 the LHM. We need this record to provide you with quality care and to comply with applicable legal requirements. This notice applies to all of the records of your care generated by the LHM, whether made by LHM personnel or your personal physician. Your personal physician may have different policies or notice 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:
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
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 provide 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.
SPECIAL SITUATIONS FOR RELEASING INFORMATION
YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION
You have the following rights regarding medical information we maintain about you:
To obtain a paper copy of this notice, you may request a copy in person at any of the Admitting or Registration areas, in the Health Information Management/Medical Records Department, or the Privacy Officer during regular business hours.
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 medical 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 in the LHM. The notice will contain the effective date. In addition, each time you register at or are admitted to the LHM for a new treatment or course of therapy as an inpatient or outpatient, we will offer you a copy of the current notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with the LHM or with the Secretary of the Department of Health and Human Services. To file a patient privacy complaint with the LHM, contact the LHM Privacy Officer. You can obtain the Privacy Officer’s name and contact information by calling the main number of the location where you received services. All complaints must be submitted in writing. You may also submit your complaints to the DCHS Corporate Responsibility Officer or DCHS Privacy Officer, 26000 Altamont Road, Los Altos Hills, CA 94022.
If you believe that your physician or another provider who is an independent contractor has violated your privacy, please contact that provider directly to file your complaint. The LHM is not authorized to investigate privacy violations of these providers.
You will not be penalized for filing a complaint.
PERMISSION FOR OTHER USES OF MEDICAL 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 medical information about you, you may revoke that 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 should 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.
EFFECTIVE DATE OF THIS NOTICE
Effective April, 2003
Revised August, 2012