TRI-STATE MEMORIAL HOSPITAL
NOTICE OF PRIVACY PRACTICES
FOR HEALTH INFORMATION

EFFECTIVE DATE: April 2003

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.

Understanding Your Health Record/Information
We keep a record of the healthcare services we provide you. You may ask us to see and copy that record. You may also ask us to correct that record. We will not disclose your record to others unless you direct us to do so or unless the law authorizes or compels us to do so. You may see your record or get more information about it by contacting the Medical Records Department or the Privacy Officer. The information contained in your medical record serves as a:

  • Basis for planning your care and treatment
  • Means of communication among health professionals who contribute to your care
  • Legal document describing the care you received
  • Means by which you or a third-party payer can verify that services billed were actually provided
  • A tool in educating health professionals
  • A source of data for medical research
  • A source of information for public health officials charged with improving the health of the nation
  • A source of data for facility planning and marketing
  • A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve
  • Understanding what is in your record and how your health information is used helps you to:
  • Ensure its accuracy
  • Better understand who, what, when, where and why others may access your health information
  • Make more informed decisions when authorizing disclosure to others

RCW 70.02.120

Your Health Information Rights

  • Request a restriction on certain uses and disclosures of your information or for additional confidential treatment of communications as provided by 45 CFR 164.522
  • Obtain a paper copy of this notice of information practices upon request. You may obtain a paper copy of this notice at the Admissions office or at www.tristatehospital.org.
  • Inspect and obtain a copy of your health record as provided for in 45 CFR 164.524. To inspect and copy medical information, you must submit your request in writing to Tri-State Memorial Hospital Medical Records.
  • Amend your health record as provided in 45 CFR 164.528. You may submit a request for an amendment to your medical records in writing to Tri-State Hospital Medical Records. There is a form to request an amendment to your medical records available in the Medical Records Department.
  • Obtain an accounting of disclosures of your health information to other locations. To request an accounting of disclosures, submit your request in writing to Tri-State Hospital Medical Records.
  • Revoke your authorization to use or disclose health information except to the extent that action has already been taken.
  • Receive confidential communications of your health information.

You have the right to request restrictions or limitations on the medical 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 medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could request that we not use or disclose information about a surgery you had. However, we are not required to agree to your request. To request restrictions, you must make your request in writing to Tri-State Memorial Hospital Medical Records.

Our Responsibilities

This organization is required to:

  • Maintain the privacy of your health information
  • Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
  • Abide by the terms of this notice
  • Notify you if we are unable to agree to a requested restriction
  • Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. We will post a copy of the current Notice in the hospital. Each time you register at the Hospital for treatment or health care services, you have the right to request a copy of this Notice. Should our information practices change, a revised copy of this Notice will be available upon request.

We will not use or disclose your health information without your authorization, except as described in this Notice.

Examples of Disclosures for Treatment, Payment and Health Operations

We will use your health information for treatment.

For example: Information obtained by a nurse, physician, or other member of your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your healthcare team. Members of your healthcare team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment.
We will also provide your physician or subsequent healthcare provider with copies of various reports that should assist him or her in treating you once you are discharged from this hospital.

We will use your health information for regular health operations.

For example: Members of the medical staff, the performance improvement supervisor, and other members of the performance improvement teams may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and services we provide.

We will use your health information for payment.

For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.

Business associates: There are some services provided in our organization through contacts with business associates. Examples include physician services in the emergency department and radiology, most laboratory tests, and 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 associate so that they can perform the job we have asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

Directory: Unless you notify us that you object, we will use your name, location in the facility, general condition and religious affiliation for directory purposes. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name.

Communication with family: Health professionals, using their best judgement, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care.

Funeral directors: We may disclose health information to funeral directors consistent with applicable law to carry out their duties.

Organ procurement organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

Marketing: We may contact you to provide information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Fundraising: We may contact you as part of a fundraising effort.

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 the hospital or to obtain information from you in preparation for your visit or stay at the Hospital.

Health Oversight Activities: We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, performance improvement activities, 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.

Workers Compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

Public health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability, to report births and deaths, to report child abuse or neglect, to report reactions to medications or problems with product, to notify people of recalls of 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 patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.

Correctional institution: Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and health and safety of other individuals.

Law enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.

For More Information or to Report a Problem

If you have questions and would like additional information, you may contact the Privacy Officer at Tri-State Memorial Hospital at (509) 758-5511

If you believe your privacy rights have been violated, you can file a complaint with the Privacy Officer or with the secretary of Health and Human Services. There will be no retaliation for filing a complaint.