Ball Memorial Hospital Patient Confidentiality

Patient Privacy Notice and CONFIDENTIALITY

Effective 4/14/03

This notice describes how protected health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Privacy Notice

Who Will Follow This Notice

Our Pledge Regarding Protected Health Information

How We May Use and Disclose Protected Health Information About You

For Treatment

For Payment

For Health Care Operations

Incidental Uses and Disclosures

Appointment Reminders

Treatment Alternatives

Facility Directory

Individuals Involved in Your Care or Payment for Your Care

Research

Suspected Abuse or Neglect

As Required By Law

To Avert a Serious Threat to Health or Safety

Fundraising Activities

Special Situations

Organ and Tissue Donation

Military and Veterans

Workers' Compensation

Public Health Risks

Health Oversight Activities

Lawsuits and Disputes

Law Enforcement

Coroners, Medical Examiners and Funeral Directors

National Security and Intelligence Activities

Inmates

Privacy Notice

This Notice of Privacy Practices describes how we may use and disclose your protected health information to carry out treatment, payment or health care operations and for other purposes that are permitted or required by law. It goes on to describe the types of information we gather about you, with whom that information may be shared and the safeguards we have in place to protect it. This notice also describes your rights to access and control your protected health information. You have the right to the confidentiality of your protected health information and the right to approve or refuse the release of specific information except when the release is required by law. If the practices described on this page meet your expectations, there is nothing you need to do. If you prefer that we not share information, we may honor your written request in certain circumstances described below.

Who Will Follow This Notice

This notice describes the privacy practices of Ball Memorial Hospital, which includes but is not limited to:

Physicians and healthcare professionals credentialed by Ball Memorial Hospital ("hospital") being participants in an Organized Health Care Arrangement (OHCA).
Affiliated Covered Entities (ACE) of Ball Memorial Hospital.
Any healthcare professional authorized to document protected health information.
All departments and units of the hospitals, clinics or doctor's offices and affiliated entities you may visit or receive care or services from.
Any member of a volunteer group we allow to help you while you are receiving care or services.
All employees, staff, residents or student trainees and other personnel who may need access to your information.
All individuals and entities of Ball Memorial Hospital follow the terms of this notice. In addition, these individuals and entities will share protected health information as necessary to carry out treatment, payment or health care operations relating to use and disclosures as described more specifically in this JOINT NOTICE.

Our Pledge Regarding Protected Health Information

We understand protected health information about you and your health is personal. We are committed to protecting health information about you. We create a record of the care and services you receive. 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 by Ball Memorial Hospital whether made by healthcare professionals or your personal doctor.

We are required by law to:

to maintain the privacy of the protected health information that identifies you;
give you this notice of our legal duties and privacy practices with respect to protected health information about you; and
follow the terms of the notice that is currently in effect.

How We May Use and Disclose Protected Health Information About You

The following categories describe different ways that we may use and disclose protected health information. We will explain what we mean and try to give examples for each category of uses and disclosures. Not every use or disclosure in a category will be listed.

For Treatment

We may use and disclose your protected health information to provide you with medical treatment or services. We may disclose protected health information about you to doctors, nurses, technicians, training doctors, medical students or other healthcare professionals who are involved in taking care of you. We may also share your protected health information with participants in the hospital’s OHCA for treatment of you by them. 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 healthcare professionals also may share protected health information about you to coordinate the different things you need, such as prescriptions, lab work and X-rays. We also may disclose protected health information about you to people, such as family members or others who may be involved in your medical care or provide services that are part of your care.

For Payment

We may use and disclose your protected health information so we can be paid for the services we provide to you. This can include billing you, your insurance company or a third party. For example, your insurance may need to know about surgery you received so they will pay us or reimburse you for the surgery. We may also use and disclose protected health information about you to obtain prior approval or to determine whether your insurance will cover the treatment. We may also disclose your PHI to other providers or health plans for their payment activities as they relate to your treatment.

For Health Care Operations

We may use or disclose protected health information about you for Ball Memorial Hospital operations. These uses and disclosures are necessary in order for us to run our system business and make sure that all of our patients receive quality health care. For example, we may use protected health information to review our treatment and services and to evaluate our staff in caring for you. We may also combine the protected health information we have with information from other health care providers to compare how we are doing and see where we can make improvements in the care and services that we offer. We may also disclose information to doctors, nurses, technicians, training doctors, medical students, and other personnel for review and learning purposes. We may remove information that identifies you specifically so that others may use the information to study health care without learning who the specific patients are.

Incidental Uses and Disclosures

We may occasionally inadvertently use or disclose your protected health information when such use of disclosure is incidental to another use or disclosure permitted by law. For example, while we have safeguards in place to protect against others overhearing our conversations that take place between doctors, nurses, and other personnel, there may be times that such conversations are overheard by others. Please be assured that we will avoid such situations as much as possible.

Appointment Reminders

We may use and disclose protected health information to contact you as a reminder that you have an appointment for treatment or medical care.

Treatment Alternatives

We may use and disclose protected health 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 protected health information to tell you about health-related benefits or services that may be of interest to you.

Facility Directory

We may include certain limited information about you in the facility directory or patient census information while you are receiving healthcare and services. This information may include your name, location in the facility, 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. 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. You have the right to object to being included in the facility directory.

Individuals Involved in Your Care or Payment for Your Care

We may release protected health 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 the hospital. In addition, we may disclose protected health 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. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment.

Research

Under certain circumstances, we may use and disclose protected health information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of protected health information, trying to balance the research needs with patients' need for privacy of their protected health information. Before we use or disclose protected health information for research, the project will have been approved through this research approval process, but we may, however, disclose protected health information about you to people preparing to conduct a research project, for example, to help them look for patients with specific medical needs, so long as the protected health information they review does not leave the hospital. We will almost always ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at the hospital.

Suspected Abuse or Neglect

We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.

As Required By Law

We will disclose protected health 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 protected health 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.

Fundraising Activities

We may use protected health information about you to raise money for Ball Memorial Hospital and its operations. We may disclose protected health information to a foundation related to the hospital so the foundation may raise money for the hospital. We would only release demographic information, such as your name, address, phone number and the dates you received treatment or services from Ball Memorial Hospital. If you do not want Ball Memorial Hospital to contact you for fundraising efforts, you must notify our privacy officer in writing at the address below.

Special Situations

Organ and Tissue Donation

If you are an organ donor, we may release protected health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

Military and Veterans

If you are a member of the armed forces, we may release protected health information about you as required by military command authorities.

Workers' Compensation

We may release protected health information about you for workers' compensation or similar programs. These programs provide bene1fits for work-related injuries or illness.

Public Health Risks

We may disclose protected health information about you 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 government authority if we believe a patient has been the victim of abuse, neglect or domestic violence.

Health Oversight Activities

We may disclose protected 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 health care system, government programs, and compliance with civil rights and privacy laws.

Lawsuits and Disputes

We may disclose protected health information about you in response to a subpoena, discovery request, or other lawful order from a court.

Law Enforcement

We may release protected health information if asked to do so by a law enforcement official as part of law enforcement activities; in investigations of criminal conduct or of victims of crime; in response to court orders; in emergency circumstances; or when required to do so by law.

Coroners, Medical Examiners and Funeral Directors

We may release protected health 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 protected health information about patients of the hospital to funeral directors as necessary to carry out their duties.

National Security and Intelligence Activities

We may release protected health 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, or for intelligence, counterintelligence, and other national security activities authorized by law.

Inmates

If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release protected health 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.

To request patient representative services, call (765) 747-4488 or (765) 747-8420.

Ball Memorial Hospital Patient Representative

2401 University Ave.

Muncie, IN 47303

(765) 747-4488