Joint Notice of Privacy Practices

Effective Date:             April 1, 2015

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.

We are required by law to maintain the privacy of your medical information. We are also required to provide you this Notice about our privacy practices, our legal responsibilities and your rights concerning your medical information.  We must follow the privacy practices described in this Notice while it is in effect.

We reserve the right to change our privacy practices in this Notice at any time, provided these changes are permitted by law. We reserve the right to make changes in our privacy practices effective for all medical information that we maintain.  The amended Notice will identify the effective date on the initial page of the Notice.

You may request a paper copy of our Notice at any time. Our Notice is available on our Medical Center’s website and prominently displayed in certain areas.

For questions regarding your privacy rights or this Notice, please contact the Compliance/HIPAA Officer at (830) 401-7100.

Our Commitment Regarding Your Health Information

We understand that your health information is personal and sensitive in nature. We are committed to protecting the privacy of this information.  Each time you visit the medical center, we create a record of the care and services you receive.  Typically, this record contains your symptoms, examinations, test results, diagnoses, treatments, plans for future care, and billing record.

This information often referred to as your health or medical record serves as a:

  • Basis for planning your care and treatment
  • Means of communication among the many health professionals who contribute to your care
  • Legal document describing the care you received
  • Means by which you or a third-party payer (insurance company) can verify that services billed were actually provided;
  • Tool in educating healthcare professionals
  • Source of information for public health officials
  • Tool for assessing and continually improving the care rendered and the results achieved.

This notice applies to all records of your care generated by Guadalupe Regional Medical Center, regardless of whether the record is written, computerized, or in any other form.


 

Our Responsibilities

Guadalupe Regional Medical Center shall:

  • Make every effort to maintain the privacy of your health information
  • Provide you with a notice of our legal requirements and privacy practices with respect to your health information
  • Follow the terms of the most current Notice of Privacy Practices

 

Who Will Follow This Notice

This notice describes the practices of Guadalupe Regional Medical Centers and applies to the following:

  • All physicians with hospital privileges and other healthcare professionals under contract or under the direction of the hospital, including students, allowed to enter and access information in your medical record
  • All hospital employees and contracted personnel authorized to have access to your medical record.

 

How We May Use & Disclose Health Information

The following categories describe different ways in which Guadalupe Regional Medical Center may use your health information within the medical center and release your health information to individuals and organizations outside of the medical center. Examples provided serve only as illustrations and do not include every possible use or disclosure.

Treatment – We may use and disclose your health information to provide, coordinate, or manage your health care services. For example, we may share your health information with or request it from doctors, nurses, technicians, or others who are involved in taking care of you during your visit for continuity of care.
Payment – We may use or disclose your health information so the treatment and services you receive may be billed. For example, we may need to disclose your health information to a health plan (insurance company) in order for the health plan to pay us for the services we provided.  We may also inform your health plan about treatment or procedures you are going to receive in order to obtain prior approval and determine whether your plan will cover treatment/procedure costs.
Health Care Operations – We may use and disclose health information about you for health care operations. These uses or disclosures are necessary to operate our facility and make sure all our patients receive quality care.  For example, your health information may be used to evaluate our services and determine the appropriateness and quality of care provided.
Appointment Reminders – We may use and disclose health information to contact you and remind you that you have an appointment.
As Required By Law – We may use and disclose health information about you when required to do so by federal or state laws or regulations.
Averting a Serious Threat to Health or Safety – We may use and share your health information to medical or law enforcement personnel when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. This information would only be shared with someone able to help prevent the threat.
Business Associates – There are some services provided in our organization through contracts with third parties who are business associates of the hospital. We may share your health information with our business associates so that they can perform the job we have asked them to do. We require our business associates to sign a contract that states they will appropriately protect your information.  Examples of business associates include transcription services, quality assurance reviewers and auditors.
Coroners, Medical Examiners, and Funeral Directors – We may release health information to a coroner or medical examiner when authorized by law (e.g., to identify a deceased person or determine the cause of death). We may also release health information about patients to funeral directors.
Fundraising – We may use certain health information to support our fundraising efforts. This information may also be provided to the Guadalupe Regional Medical Foundation for this purpose.  The information used is limited and includes:  name, address, other contact information, age, gender, date of birth, dates of health care provided, department of service information, treating physician, outcome information, and health insurance status.  If we contact you for fundraising purposes, you will be provided with information on how to opt-out from receiving further fundraising communications.
Group Health Plans­ – We maintain a group health plan for our employees, and may disclose protected health information of individuals covered under this plan to the sponsor of this group health plan, as permitted by law.
Health Oversight Activities – We may disclose health 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 right laws.
Health Information Exchange (HIE) – I understand that an electronic health information exchange allows for physicians and other healthcare providers to access and share a patient’s vital medical information electronically. I understand that should Guadalupe Regional Medical Center participate in a health information exchange, my health information will be automatically included as part of the HIE.
Inmates – If you are an inmate of a correctional facility, we may release health information about you to the correctional facility so that the facility can provide you with treatment.
Law Enforcement – We may disclose your health information for law enforcement purposes, as required by law or in response to a subpoena.
Lawsuits & DisputesIf you are involved in a lawsuit or in an administrative dispute, we may disclose health information about you in response to court or administrative orders.
Military & Veterans – If you are a member of the armed forces, we may release health information as required by military or other authorities.
National Security and Intelligence Activities and Protective Services – We may release health information to authorized federal officials for intelligence, counter-intelligence, protective services, and other national security activities authorized by law.
Organ & Tissue Donation – If you are an organ donor, we may share your health information to organizations that handle procurement of organs, eyes, or tissue transplantations.
Public Health Risks – We may disclose health information for public health activities. These activities generally include the following:

  • To prevent or control disease, injury, or disability;
  • To report births and deaths;
  • To report child abuse or neglect;
  • To report reactions to medications or problems with products;
  • To notify people of recalls of products they may be using;
  • 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;
  • To notify the appropriate governmental authority if we believe a patient has been the victim of abuse, neglect, or domestic violence.

Research  – We may release health information about you for certain research purposes if an Institutional Review Board or privacy board has waived individual authorization.
Worker’s Compensation – We may release health information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.


 

Special Circumstances Or Situations Requiring Your Specific Written Authorization

Other uses of health information not covered by this notice or the laws that apply to us will be made only with your written permission (called “authorization”).  If you authorize us to use or share your health information, you may cancel that authorization in writing at any time.  If you cancel your authorization, we will no longer use or share health information about you for the reasons listed or covered by your written authorization.  We are unable to take back any information we have already made with your permission, and we are required to maintain the records of the care that we provided to you.

Some common situations requiring your authorization are as follows:

Directory Information
– Guadalupe Regional Medical Center has a “directory” of information about patients hospitalized or otherwise receiving services at our facilities. This directory is available to anyone who asks for a patient by name.  The law permits us to give out the following information:

  1. Patient name;
  2. General location within the hospital;
  3. General condition (“good, fair, serous, critical”)

We make this information available so that individuals can contact or visit you at Guadalupe Regional Medical Center. If you object to being included in the directory, we will not disclose your information to anyone who asks for you.

Religious Affiliation – We may provide information about your religious affiliation to members of the clergy, unless you specifically request that we not do so.

Individuals Involved In Your Care Or Payment For Your Care
We may share your health information with a friend or family member who is involved in your medical care, unless you tell us in advance not to do so. In addition, we may share your health information with an organization assisting in a disaster relief effort (such as the Red Cross) so that your family can be notified about your condition, status, and location.

Marketing Uses of InformationWe may not use or disclose your protected health information for marketing purposes without obtaining your consent or authorization, except if the communication is:

  • In the form of a face-to-face communication made by the hospital
  • In the form of a promotion gift of nominal value provided by the hospital

If we use your health information to send marketing materials through the mail, mailings will comply with regulatory requirements and provide you information on how to opt-out of future mailings.

Psychotherapy Notes – Guadalupe Regional Medical Center may not use or disclose an individual’s psychotherapy notes without your authorization, except:

  • To carry out the following treatment, payment, or health care operations:
  • Use by the originator of the psychotherapy notes for treatment;
  • Use or disclosure by the medical center for its own training programs as specified per law
  • Use or disclosure by the medical center to defend itself in a legal action or other proceeding brought by the individual; and
  • Use or disclosure allowed by law, e.g. subpoena, release to coroners, release to Secretary of Health and Human Services.

 

Sale of Electronic Health Records or Protected Health Information (PHI) Guadalupe Regional Medical Center may not sell protected health information unless authorized by you. An authorization is not needed if the purpose of the exchange is:

  • For treatment
  • For payment
  • For health care operations; or
  • For performing an insurance or health maintenance organization function
  • As otherwise authorized or required by state or federal law.

 

Your Rights Regarding Your Health Information

You have the following rights regarding the health information we maintain about you:

Right to Inspect and Copy – You have the right to inspect and obtain a copy of the medical records that the Guadalupe Regional Medical Center uses to make decisions about you and your treatment, subject to certain limited exceptions. These exceptions include:

  • Psychotherapy notes
  • Information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or proceeding
  • Protected health information maintained by the medical center that is subject to the Clinical Laboratory Improvement Amendments of 1998 (CLIA)
  • Other information as allowed by law.

 

 

 

 

Guadalupe Regional Medical Center may deny your request to inspect and copy your records due to special circumstances or as allowed by law. If you are denied access to health information, you may request that we review our denial.  Another licensed health care professional chosen by Guadalupe Regional Medical Center will review your request and our denial. The person conducting the review will not be the person who denied your initial request.  Guadalupe Regional Medical Center will comply with the outcome of the review.

You have the right to receive a copy of this information in an electronic format. We reserve the right to charge a fee to cover the cost of providing your records to you.

Right To Amend – If you feel that the health information we have is incorrect or incomplete; you may ask Guadalupe Regional Medical Center to amend your information as long as the information is kept by the hospital.

 To request an amendment, your request must be submitted in writing to the Director of Health Information Management. A form, “Patient Request for Amendment”, will be provided to you for completion.
Guadalupe Regional Medical Center may deny your request to amend your medical records if your request is incomplete or does not state the reason to support the request. In addition, the medical center may deny your request if you ask us to amend information that:

  • Was not created by Guadalupe Regional Medical Center unless the physician or other health care entity that created the information is no longer available to make the amendment for you
  • Is not part of the information which you would be permitted to inspect and copy
  • Is accurate and complete as is

Right to Accounting of Disclosures – You have the right to request an accounting of disclosures of your health information made by the hospital for purposes other than treatment, payment, or healthcare operations.
Your request for an accounting of disclosures must be made on the “Request for Accounting of Disclosures” form available through the Health Information Department at Guadalupe Regional Medical Center.
The list will include only the disclosures made for the time period indicated in your request, but may not exceed a six year period or include dates before April 14, 2003. The first list you request within a 12 month period will be free.  We may charge you for additional lists.  We will notify you of costs involved so that you may choose to withdraw or modify your request any time before costs are incurred.

Right to Request RestrictionsYou have the right to request a restriction or limitation on the health information the hospital uses or discloses for your treatment, payment, or health care. You have the right to request a limit on the health information Guadalupe Regional Medical Center discloses about you to someone outside the hospital for care or payment.  Guadalupe Regional Medical Center is not required to agree with your request.  If Guadalupe Regional Medical Center agrees to your request, we will comply with the request unless the information is needed to provide your emergency treatment.

To request restrictions, you must make your request in writing to the Director of Health Information Management at Guadalupe Regional Medical Center. In your request, you must indicate:

  • What information you want to limit
  • Whether you want to limit your information for our own use and disclosure
  • To whom you want the limits to apply

Guadalupe Regional Medical Center must agree to your request to limit disclosure of health information about you to a health plan (Insurance Company/Insurer) if:

    • The disclosure is for the purpose of carrying out payment or health care operations and is not otherwise required by law; and
  • The protected health information pertains to services or items for which you have paid Guadalupe Regional Medical Center out of pocket in full. Right to Request Confidential Communications – You have the right to request Guadalupe Regional Medical Center communicates with you about health information in a certain way or at a certain location. For example, you may ask that we contact you only by sending information to a P.O. Box instead of your home address.

To request confidential communication, you must make your request in writing to the Director of Health Information Management, Guadalupe Regional Medical Center, 1215 E. Court Street, Seguin, TX 78155.  You do not have to state a reason for your request.  We will accommodate all reasonable requests.  Your request must specify how or where you wish the communication to be directed.

 Right To Be Notified For A Breach In Your Health Information – You have the right to be notified when a breach of your unsecured protected health information has occurred.

 Right To Receive A Copy of This Notice – You have a right to receive a paper copy of Guadalupe Regional Medical Center’s Notice of Privacy Practices upon request. If agreeable to you, this notice may also be provided to you in an electronic format.


Complaints
If you believe your privacy rights have been violated, you may file a written complaint with Guadalupe Regional Medical Center or with the Office for Civil Rights, U.S. Department of Health and Human Services.
Complaints regarding privacy rights must be submitted in writing within 180 days of when you knew or should have known that the act occurred. Filing a complaint will not affect the treatments or services you receive from Guadalupe Regional Medical Center.

Guadalupe Regional Medical Center
To file a complaint with Guadalupe Regional Medical Center regarding your privacy rights, contact the Compliance/HIPAA Officer at (830) 401-7100.

Privacy complaint forms are available at the hospital, and on the hospital’s website at www.grmedcenter.com.

Office for Civil Rights
To file a complaint with the Office for Civil Rights, send information to the regional office at:

Office for Civil Rights
U.S. Department of Health and Human Services
1301 Young Street, Suite 1169
Dallas, TX 75202