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.

St. Anthony’s Memorial Hospital, its Medical Staff, and Allied Health Staff are an Organized Healthcare Arrangement (OHCA) pursuant to the federal Privacy Rule. The purpose is to allow sharing of protected health information within the OHCA and distribution of a joint Notice of Privacy Practices to patients seen in the hospital.

Our Pledge to You

We understand that medical information about you is personal. We are committed to protecting your medical information. We create a record of the care and services you receive in order to provide quality care and to comply with legal requirements. This notice applies to all of the records of your care that we maintain, whether created by facility staff or your personal doctor. The information privacy practices in this notice will be followed by:

  • Any healthcare professional who treats you at any of our locations.

  • All departments and units of our organization.

  • All employees, associates, staff, students or volunteers of our organization.

  • Any business associate or partner of St. Anthony’s Memorial Hospital.

We are required by law to:

  • Keep medical information about you private.

  • Give you this notice of our legal duties and privacy practices with respect to medical information about you.

  • Follow the terms of the notice that is currently in effect.

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.

Changes to this Notice

We may change our policies at any time. Changes will apply to medical information we already hold, as well as new information after the change occurs. Before we make a significant change in our policies, we will post the new notice in our registration areas and on our web site (www.stanthonyshospital.org.), where you can receive a copy of the current notice at any time. The effective date is listed on the front page.

How We May Use and Disclose Medical Information About You

We may use and disclose medical information about you for treatment (such as sharing medical information within our facility or sending or allowing access to medical information to another healthcare provider); to obtain payment for treatment (such as sending billing information to your insurance company or other providers participating in your care); and to support our healthcare operations (such as comparing patient data to improve treatment methods).

We may use or disclose medical information about you without other prior authorization for several other reasons. Subject to certain requirements, we may disclose your medical information without prior authorization for public health purposes, abuse or neglect reporting, health oversight audits or inspections, research studies, funeral arrangements and organ donation, workers’ compensation purposes, and emergencies. We also disclose medical information when required by law, such as in response to a request from law enforcement in specific circumstances, or in response to valid judicial or administrative orders.

We also may contact you for appointment reminders, or to tell you about or recommend possible treatment options, alternatives, health-related benefits or services that may be of interest to you, or to support fundraising efforts of the Friends of St. Anthony’s Memorial Hospital.

Patient Directories

If admitted as a patient, unless you tell us otherwise, we will list you in two directories. The patient directory will list your name and location in the hospital (room number), and will be available to anyone who asks about you by name. The religious directory will list your name, location in the hospital and religious affiliation, and will be available only to clergy members, even if they do not ask for you by name.

We may disclose medical information about you to a friend or family member that you have designated who is involved in your medical care, or to disaster relief authorities so that your family can be notified of your location and condition. Our staff will use their professional judgment in determining what they disclose, and to whom, based on their evaluation of your best interests.

Other Uses of Medical Information

In any other situation not covered by this notice, we will ask you for your written authorization before using or disclosing medical information about you. If you choose to authorize use or disclosure, you can later revoke that authorization by notifying us in writing of your decision.

Your Rights Regarding Medical Information About You

In most cases, you have the right to view or get a copy of medical information that we use to make decisions about your care, when you submit a written request. If you request copies, we may charge a fee for the cost of copying, mailing or other related supplies. In certain situations, we may deny your request to review or obtain a copy. If we do, we will tell you, in writing, our reasons for the denial and explain your right to have the denial reviewed.

If you believe that information in your record is incorrect or if important information is missing, you have the right to request that we amend the records, by submitting a request in writing that provides your reason for requesting the amendment. We could deny your request to amend a record if that information was not created by us; if it is not part of the medical information maintained by us; or if we determine that the record is accurate. You may appeal, in writing, a decision by us not to amend a record.

You have the right to a list of those instances where we have disclosed medical information about you, other than for treatment, payment, healthcare operations or where you specifically authorized a disclosure, when you submit a written request. The request must state the time period desired for the accounting, which must be less than a six-year period and starting after April 14, 2003. The first disclosure list request in a 12-month period is free; other requests will be charged according to our cost of producing the list. We will inform you of the cost before you incur any costs.

You have the right to request that medical information about you be communicated to you in a confidential manner, such as sending mail to an address other than your home, by notifying us in writing of the specific way or location for us to use to communicate with you.

You may request, in writing, that we not use or disclose medical information about you for treatment, payment or healthcare operations or to persons involved in your care except when specifically authorized by you, when required by law, or in an emergency. We will consider your request but we are not legally required to accept it. We will inform you of our decision on your request.

All written requests or appeals should be submitted to our Privacy Officer listed at the end of this notice.

Complaints

If you are concerned that your privacy rights may have been violated, or you disagree with a decision we made about access to your records, you may contact our Privacy Officer (listed at the end). You may also contact Corporate Compliance, a 24-hour hotline, at 217-347-1550.

Finally, you may send a written complaint to the U.S. Department of Health and Human Services Office of Civil Rights. Our Privacy Officer can provide you the address.

Under no circumstances will you be penalized or retaliated against for filing a complaint.

Effective: 4-14-2003
Revised 03-01-10

St. Anthony’s Memorial Hospital
Privacy Officer
503 North Maple Street
Effingham, IL 62401
217-342-2121, Extension 1378
tphillips@sae.hshs.org