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Any
health care professional authorized to enter information into your
hospital record. |
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All
departments and units of the hospital. |
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Any
member of a volunteer group we allow to help you while you are in
the hospital. |
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All
employees, staff and other hospital personnel. [top] |
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 Glens Falls Hospital and our clinics,
programs and our primary care physician offices.
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, whether made by Glens Falls Hospital
personnel or your personal doctor. Your personal doctor may have
different policies or notices regarding the doctor's use and disclosure
of your medical information created in the doctor'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.
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make
sure that medical information that identifies you is kept private; |
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give
you this notice of our legal duties and privacy practices with
respect to medical information about you; and |
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follow
the terms of the notice that is currently in effect. |
HOW
WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
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 doctors, nurses, technicians, health care students, or other
personnel who are involved in taking care of you at Glens Falls
Hospital. For example, a doctor treating you for a broken leg may need
to know if you have diabetes because diabetes may slow the healing
process. In addition, the doctor may need to tell the dietitian if you
have diabetes so that we can arrange for appropriate meals.
Different departments at Glens Falls Hospital also may share
health 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 information about you to people outside Glens Falls
Hospital such as a lab we send work out to or individuals who may be
involved in your medical care after you leave Glens Falls Hospital, such
as physicians that are following your progress, nursing homes, and
rehabilitation facilities.
For
Payment.
We may use and disclose medical information about you so that the
treatment and services you receive at Glens Falls Hospital may be billed
and paid by you, an insurance company or a third party. For example, we
may need to give your health plan information about surgery you received
at Glens Falls 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
Health Care Operations.
We may use and disclose medical information about you for Glens Falls
Hospital operations. These uses and disclosures are necessary to run
Glens Falls Hospital and make sure that all 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
hospital patients to decide what additional services Glens Falls
Hospital should offer, what services are not needed, and whether certain
new treatments are effective. We may also disclose information to
doctors, nurses, technicians, health care students, and other personnel
for review and learning purposes. We may also combine the medical
information we have with medical information from other hospitals to
compare how we are doing and see where we can make improvements in the
care and services we offer. We may remove information that identifies
you from this set of medical information so others may use it to study
health care and health care delivery without learning who the specific
patients are.
Research:
We
may use and disclose medical information as part of an approved research
program.
Treatment
Alternatives.
We may use and disclose medical information to tell you about or
recommend possible treatment options or alternatives that may be of
interest to you.
Health-Related
Benefits and Services.
We may use and disclose medical information to tell you about
health-related benefits or services that may be of interest to you.
Hospital
Directory.
We may include certain limited information about you in the
hospital directory while you are a patient at Glens Falls Hospital. This
information may include your name, location in the hospital, your
general condition (e.g., fair, stable, etc.) and your religious
affiliation. The directory information, except for your religious
affiliation, may also be released to people who ask for you by name
including family, friends and members of the media.
Your religious affiliation may be given to a member of the
clergy, such as a priest or rabbi, 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.
Individuals
Involved in Your Care or Payment for Your Care.
Unless precluded by state law, 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 Glens Falls 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.
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. [top]
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 deceased patients of
Glens Falls Hospital to funeral directors as necessary to carry out
their duties.
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
health care system, government programs, and compliance with civil
rights laws.
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 health care; (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.
Law
Enforcement.
We may release medical information if asked to do so by a law
enforcement official:
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In
response to a court order, subpoena, warrant, summons or similar
process; |
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To
identify or locate a suspect, fugitive, material witness, or missing
person; |
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About
the victim of a crime if, under certain limited circumstances, we
are unable to obtain the person's agreement; |
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About
a death we believe may be the result of criminal conduct; |
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About
criminal conduct at Glens Falls Hospital; and |
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In
emergency circumstances to report a crime; the location of the crime
or victims; or the identity, description or location of the person
who committed the crime. |
Lawsuits
and Disputes.
If you are involved in a lawsuit or a dispute, we may disclose medical
information about you in response to a 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.
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.
Minors.
We
may release medical information to a minor about his or her treatment
without parental authorization in certain circumstances such as
diagnosis and treatment of sexually transmitted diseases, or when the
minor is emancipated (not yet 18 years of age but married, pregnant or
self-supporting and living apart from parental residence).
National
Security and Intelligence Activities.
We may release medical information about you to authorized federal
officials for intelligence, counterintelligence, and other national
security activities authorized by law.
Organ
and Tissue Donation.
If you expire at Glens Falls Hospital, we release medical
information to our Federally Designated Organ Procurement Organization,
the Center for Donation and Transplant in Albany, NY.
Public
Health Risks.
We may disclose medical information about you for public health
activities. These activities generally include the following:
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to
prevent or control disease, injury or disability; |
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to
report births and deaths; |
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to
report child abuse or neglect; |
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to
report reactions to medications or problems with products; |
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to
notify people of recalls of products they may be using; |
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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; |
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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. |
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.
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.
YOUR
RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU.
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 receive a copy of medical information that may be used to
make decisions about you, you must submit your request in writing to
Medical Data Services Correspondence Office 100 Park Street Glens Falls,
NY 12801. If you
request a copy of the information, a statutory fee is charged to cover
the costs of copying, mailing or other supplies associated with your
request. We may deny your
request in certain very limited circumstances. If you are denied access
to medical information, you may request that the denial be reviewed.
Another licensed health care
professional chosen by Glens Falls Hospital will review your request and
the denial. The person conducting the review will not be the person who
denied your request. If they agree that it should be denied, it may be
appealed to the state’s medical records access committee.
If the Glens Falls Hospital decision is overturned by the appeal,
we will then release the records.
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 Glens Falls Hospital.
Your
requested amendment must be made in writing and submitted to Medical
Data Services, Attn: Privacy
Officer. 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:
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Was
not created by us, unless the person or entity that created the
information is no longer available to make the amendment; |
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Is
not part of the medical information kept by or for the hospital; |
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Is
not part of the information which you would be permitted to inspect
and copy; or |
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Is
accurate and complete. |
Right
to an Accounting of Disclosures.
You
have the right to request an "accounting of non-authorized
disclosures." This is a list of the disclosures we made of medical
information about you not as part of our normal operations or that you
did not authorize.
To
request this list of accounting of disclosures, you must submit your
request in writing to Medical Data Services Attn: Privacy Officer. Your
request must state a time period that may not be longer than six years
and may not include dates before April 14, 2003. Your request should
indicate in what form you want the list (for example, on paper,
electronically, etc.). 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 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 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 Medical
Data Services, Attn: Privacy Officer. Glens Falls Hospital, 100 Park
Street, Glens Falls, NY 12801. 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
Medical Data Services Attn: Privacy Officer. 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.
Marketing
and Fundraising.
We may use certain information (name, address, telephone number,
dates of service, age and gender) to contact you in the future for
marketing purposes and to raise money for Glens Falls Hospital.
We may also provide this information to the Glens
Falls Hospital Foundation, for the same purpose.
The Glens Falls Hospital Foundation may also contact past donors.
The money raised will be used to expand and improve the services
and programs we provide the community.
If you do not wish to be contacted for marketing or fund-raising
efforts, please notify the
Vice President of Glens Falls Hospital Foundation or the
Glens Falls Hospital Privacy Officer in Medical Data Services. [top]
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 hospital. The
notice will contain the effective date on the first page. [top]
If
you believe your privacy rights have been violated, you may file a
complaint with the hospital or with the Secretary of the Department of
Health and Human Services. All complaints must be submitted in writing
to Medical Data Services, Attn: Privacy Officer., Glens Falls Hospital,
100 Park Street, Glens Falls, NY 12801.
You will not be penalized for filing a complaint. [top]
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
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.
To revoke an authorization, notify the Glens Falls Hospital
Privacy Officer in Medical Data Services. [top]