Memorial Hospital Lafeyette CountyMemorial Hospital-Lafeyette CountyMemorial Healthcare Foundation
800 Clay Street, Darlington WI 53530 (608) 776-4466

Privacy Policy

This notice of Privacy Practices describes how Medical Information may be used and disclosed, and how you can get access to this information. Please review this notice carefully.

This notice describes the privacy practices of Memorial Hospital of Lafayette County (MHLC), its employees and staff. "We" and "MHLC" as used in this notice refers to Memorial Hospital of Lafayette County. All MHLC staff, affiliated physicians, and healthcare providers may have access to information in your chart for Treatment, Payment and Health Care Operations (TPO) and may use and disclose information as described in this notice. This notice also applies to any volunteer at MHLC that helps you while you receive services at MHLC.

This Notice of Privacy Practices is effective as of April 14, 2003.

This Notice of Privacy Practices ("Notice") is required by regulations established under federal law (the Health Insurance Portability and Accountability Act, or "HIPAA") MHLC is committed to protecting your medical information, including information protected by HIPAA and other federal and state laws. MHLC will also only use your health information appropriately and in this notice will inform you about the ways in which MHLC may use and disclose your protected health information and to describe your rights and other obligations MHLC has regarding the use and disclosure of your protected health information.

The Privacy Rule requires MHLC to make sure that your protected health information is kept confidential and not disclosed to anyone or used by anyone without your consent, authorization, or as specifically allowed by law. The Privacy Rule requires MHLC to give you this notice and to follow the terms of the notice that is currently in effect. The Privacy Rule is lengthy and extremely complex and this notice cannot be a complete account of the Privacy Rule. If you wish to have a copy of the Privacy Rule, or if you have any questions regarding this notice, please contact the MHLC Privacy Officer at (608) 776-4466.

USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION

The Privacy Rule allows MHLC to use or disclose protected health information about you for the purposes of treatment, payment and healthcare operations. Any other uses or disclosures for payment and health care operations must be limited to the minimum necessary to accomplish the purpose of the use or disclosure.

  1. Treatment – MHLC may use protected health information about you to provide you with medical treatment or services, to coordinate or manage your health care services, or to facilitate consultations or referrals as part of your treatment.

    For example, MHLC may disclose your medical records to doctors, nurses, or other MHLC personnel who are involved in your care. Doctors involved on your treatment will need access to your medical records to determine if you have any chronic conditions or medical history that would affect your treatment. Different MHLC departments also may share your medical records in order to coordinate your treatment and care, such as but not limited to prescriptions, lab work, and x-rays. MHLC may also disclose your medical records to such people who are located outside of the hospital but are involved with your direct care, such as EEG readings, x-ray readings, and pathology. MHLC may also disclose your medical records to such people outside MHLC who may be involved in your medical care after you leave our facility, such as family members, clergy or others MHLC uses to provide services that are part of your care.
  2. Payment – MHLC may use and disclose your medical records to send bills and collect payment from you, your insurance company or other third parties, for the treatment and other services you may receive from MHLC.
  3. Health Care Operations – MHLC may use and disclose protected health information about you for MHLC health care operations. These uses and disclosures are necessary to provide quality care to all patients and to facilitate the functioning of MHLC, including, among other things:
    • Quality assessment and improvement activities;
    • Protocol development;
    • Care management;
    • Case coordination and related functions;
    • Competence and performance reviews;
    • Training, accreditation, certification, licensing, credentialing or other related activities;
    • Underwriting and other insurance related activities;
    • Medical review and auditing functions, including fraud and abuse detection and compliance programs;
    • Conduction or arranging for legal services;
    • Business planning and development;
    • Internal grievance resolution;
    • Business management and general administrative activities;
    • Creating "de-identified" health information;
    • Activities relating to improving health or reducing health care costs;
    • Fundraising for MHLC´s benefit; and
    • Providing newsletters.
    For example, MHLC may:
    • Use medical records to review its treatment and services and to evaluate the performance of its staff in caring for you;
    • Combine medical records about many MHLC patients to decide what additional services MHLC should offer, what services are not needed, and to study the safety and effectiveness of treatments;
    • Disclose information to doctors, nurses, and other MHLC personnel for training purposes;
    • Combine its medical records with medical records from other hospitals and health care providers to compare how it is doing and find ways to make improvements in its care and services it offers;
    • Remove information that identifies you from a set of medical records so that others may use it to study health care and health care delivery without learning who specific patients are;
    • Use and disclose medical records to contact you as a reminder that you have an appointment;
    • Use and disclose medical records to tell you about or recommend possible treatment options or alternatives that may be of interest to you;
    • Use and disclose medical records to tell you about health-related benefits or services that may be of interest to you.

    Wisconsin law is more protective of certain information than the Privacy Rule. Accordingly, MHLC will not disclose your information relating to treatment for mental health, developmental disabilities, alcoholism, drug dependence, or information concerning the presence of HIV, antigen or non-antigen products of HIV or an antibody to HIV, without in each case obtaining your authorization unless otherwise permitted or required by Wisconsin or federal law.

MHLC may also use and disclose limited protected health information about you for directory purposes, to persons involved in your care or payment of your care, and for fundraising purposes, subject to your right to object to these uses or disclosures.

  1. Hospital Census Book – MHLC may list certain information about you (your name, room number, medical service area, admitting physician, town and state, and religious affiliation) in a Hospital Census Book while you are a patient. MHLC can disclose this information, except for your religious affiliation, to people who ask for you by name. Your religious affiliation may be given to members of the clergy even if they do not ask for you by name.
  2. Persons Involved in Your Care or Payment for Your Care – MHLC may release protected health information about you to a family member, friend, or someone you designate who is involved in your case or payment of medical bills. MHLC may also tell your family or friends your condition and you are in MHLC. MHLC may also disclose your health information to an entity authorized to assist in disaster relief so that those who care for you can receive information about your location or health status.
  3. Fundraising Activities – MHLC may use contact information (name, address, telephone number, dates of service, age and gender) to contact you in the future to raise money for MHLC. MHLC may also share this information with our related foundation and or auxiliary for the same purpose. The money raised will be used to expand and improve the services and programs we provide to the community. If you do not wish to be contacted for fundraising efforts, you must notify MHLC in writing at: Community Outreach Director, P.O. Box 70, Darlington, WI 53530.

Wisconsin law is more protective of certain information than the Privacy Rule. Accordingly, MHLC will not disclose your information relating to treatment for mental health, developmental disabilities, alcoholism, drug dependence, or information concerning the presence of HIV, antigen or non-antigen products of HIV or an antibody to HIV, without in each case obtaining your authorization unless otherwise permitted or required by Wisconsin or federal law.

The Privacy Rule and Wisconsin law allow MHLC to use or disclose your protected health information/patient health care records without your authorization or informed consent for a number of functions and activities described below.

  1. As Required by Law – MHLC is permitted to disclose your protected health information when required to do so by federal, state or local law.
  2. Public Health Risks – MHLC s permitted to disclose your protected health information for public health activities, including:
    • To prevent or control disease, injury or disability, to report births and deaths, and for public health surveillance or interventions;
    • To report child abuse or neglect;
    • To the FDA, to report adverse events or product defects, to track products, to enable product recalls, or to conduct post-market surveillance as required by the FDA;
    • 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.
  3. Victims of Abuse, Neglect, or Domestic Violence – The Privacy Rule authorizes MHLC to notify the appropriate government authority if MHLC believes a patient has been the victim of abuse, neglect or domestic violence. MHLC will only make this disclosure if you agree, or when MHLC is authorized to make this disclosure by law.
  4. Health Oversight Activities – MHLC is permitted to disclose protected health information to a health oversight agency for activities authorized by law, including audits, investigations, inspections, licensure or disciplinary activities, and other similar proceedings. MHLC may not disclose the protected health information of a person who is the subject of an investigation that is not directly related to that person´s receipt of health care or public benefits.
  5. Judicial and Administrative Proceedings – The Privacy Rule allows MHLC to disclose confidential protected health information in response to a court or administrative order. MHLC may also disclose your protected health information 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. Wisconsin law may require a court order for the release of patient health care records in these circumstances, and may be considered more protective of your privacy than the Privacy Rule.
  6. Law Enforcement – The Privacy Rule allows MHLC to disclose protected health information if asked to do so by a law enforcement official in the following circumstances:
    • In response to a court order, subpoena, warrant, summons or similar person;
    • To identify or locate a suspect, fugitive, material witness, or missing person;
    • About the victim of a crime if, under certain circumstances, MHLC is unable to obtain the person´s agreement;
    • About a death MHLC believes may be the result of a criminal act;
    • About a criminal act at MHLC; and
    • 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.

    Wisconsin law generally requires a court order for the release of patient health care records in these circumstances, and may be considered more protective of your privacy than the Privacy Rule. However, Wisconsin law does allow the release of confidential patient records when a crime occurs on the premises and a victim is threatened with bodily harm. Wisconsin law also requires that gunshot wounds or other suspicious wounds, including burns, that are reasonably believed to have occurred as the result of a crime must be reported to the local police or sheriff. The report must include the nature of the wound and the patient´s name.
  7. Coroners and Medical Examiners – MHLC may disclose protected health information to a coroner or medical examiner to identify a deceased person or to determine the cause of death. Organ and Tissue Donation – MHLC may disclose protected health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donor bank to facilitate organ or tissue donations and transplantation.
  8. Research – Under certain circumstances MHLC may use and disclose your protected health information for research purposes. However, Wisconsin law provides additional protections for information relating to treatment for mental health, developmental disabilities, alcoholism, drug dependence, or information concerning the presence of HIV, antigen or non-antigen products of HIV or an antibody to HIV.
  9. Serious Threat to Health or Safety – If there is a serious threat to your health and safety and the safety of the public or another person, MHLC may use and disclose your protected health information to someone able to help prevent the threat.
  10. Specialized Government Functions – In certain circumstances, the Privacy Rule authorizes MHLC to use or disclose your protected health information to facilitate specified government functions.
    • Military and Veterans. MHLC may disclose the protected health information of armed forces personnel as required by military command authorities for the proper execution of a military mission.
    • National Security and Intelligence Activities. MHLC may disclose your protected health information to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law.
    • Protective Services for the President and Others. MHLC may disclose your protected health information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
    • Medical Suitability Determinations. MHLC may disclose your protected health information to the Department of State for use in making medical suitability determinations.
    • Inmates and Law Enforcement Custody. If you are an inmate of a correctional institution or under the custody of a law enforcement official, MHLC may release the protected health information of inmates and others in law enforcement custody to the correctional institution or law enforcement official, where 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.
  11. Workers´ Compensation – MHLC may release your protected health information for worker´s compensation or similar programs. These programs provide benefits for work-related injuries or illness.

AUTHORIZATION TO USE OR DISCLOSE PROTECTED HEALTH INFORMATION Other uses and disclosures of protected health information not covered by this notice or the laws that apply to MHLC will be made only with your authorization. If you authorize MHLC to use or disclose your protected health information, you may revoke that authorization, in writing, at any time. If you revoke your authorization, MHLC will no longer use or disclose your protected health information as specified by the revoked authorization.

YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
You have several rights with regard to the protected health information MHLC maintains about you. If you wish to exercise any of the following rights please make requests in writing to the Health Information Management department at MHLC.

  1. Right to Request Restrictions – You have the right to request restrictions or limitations on MHLC´s uses or disclosures of protected health information about you for treatment, payment or health care operations. MHLC is not required by the Privacy Rule to agree to your request. If MHLC does agree, it will comply with your request unless the information is necessary to provide you with emergency treatment at MHLC or another healthcare facility. A request for restrictions should include (1) what information you want to limit; (2) whether you want to limit its use, disclosure or both; and (3) to whom you want the limits to apply.
  2. Right to Request Confidential Communications – You have the right to request that MHLC communicate with you about medical matters through specific channels, that is, in a certain way or at a certain location. For example, you can ask that MHLC only contact you at work, or only at your home, or only by mail. MHLC will not ask you the reason for your request, and will attempt to accommodate all reasonable requests.
  3. Right to Inspect and Copy – You have the right to inspect and copy a designated set of your medical records. This designated set typically includes medical and billing records, but may not include psychotherapy notes. Please note that a request to inspect your medical records means that you may examine at a mutually convenient time or place. If you request a copy of the information, MHLC may charge a reasonable fee for the costs of copying, mailing or other supplies associated with your request. MHLC may deny your request to inspect and copy in certain circumstances. If you are denied access to your medical records, you may have the denial reviewed by a licensed health care professional chosen by MHLC. The health care professional conducting the review will not be the same individual who denied the original request and MHLC will comply with the outcome of the review.
  4. Right to Amend – If, in your opinion, your medical records are incorrect or incomplete, you may request that MHLC amend your records. You have the right to request an amendment for as long as the information is kept by or for MHLC. A request to amend your medical records must give the reasons for the amendment. MHLC may deny your request for an amendment if it is not in writing or does not include a reason. MHLC may also deny your request for an amendment if it covers medical records that:
    • Were not created by MHLC, unless the person who actually created the information is no longer available to make the amendment;
    • Are not part of the medical records kept by or for MHLC;
    • Are not part of the information which you would be permitted to inspect and copy, as discussed above; or
    • Are accurate and complete.
  5. Right to an Accounting of Disclosures – You have the right to request an accounting of certain disclosures of your protected health information by MHLC. A request for accounting of disclosures must specify a time period, which may not be longer than six years, and which may not include dates before April 14, 2003. A request for accounting of disclosures should indicate in what form you want the disclosure (for example, on paper). The first accounting within a 12-month period will be free; for additional accountings, MHLC may charge for its costs after notifying you of the cost involved and giving you the opportunity to withdraw or modify your request before any costs are incurred.
  6. Right to a Paper Copy of This Notice – You have the right to a paper copy of this Notice at any time. To obtain a paper copy of this Notice, please contact the Privacy Officer from MHLC, and one will be sent to you. You also may obtain a copy of the current version of MHLC´s Notice of Privacy Practices at the following website, www.memorialhealthcarefoundation.org.
  7. Right to Complain – If you believe your privacy rights have been violated, you may file a complaint with MHLC and/or with the federal Department of Health and Human Services. MHLC will not retaliate against you for filing such a complaint.

AMENDMENTS TO THIS NOTICE
MHLC reserves the right to amend this Notice at any time. MHLC is required to amend this Notice as made necessary by changes in the Privacy Rule. Each version of the Notice will have an effective date on the first page. MHLC reserves the right to make the amended Notice effective for protected health information MHLC has at the time the amendment is made, as well as any protected health information MHLC may receive or create in the future.

MEMORIAL HOSPITAL OF LAFAYETTE COUNTY´S DUTIES
MHLC is required by the Privacy Rule to maintain the privacy of your protected health information. The Privacy Rule requires that MHLC provide notice of its privacy practices to all of its patients or clients. MHLC´s obligations to maintain your privacy, and the situations and circumstances, in which your protected health information may be used or disclosed, are described in more detail in this Notice of its legal duties and privacy practices. MHLC is required to comply with the terms and conditions of the Notice, and may not amend this Notice except as set forth above.

© 2008 Memorial Hospital of Lafayette County