This notice describes how Mary Free Bed Rehabilitation Hospital may use and disclose your health information and how you can get access to this information. Please review this notice carefully.
Using and Disclosing Your Health Information
Whenever you visit a hospital, physician or other health care provider, a record of your visit and the care provided to you during that visit is made. Typically, this record contains information regarding your symptoms, examinations, tests performed including the results, diagnoses, treatment and any plan for future care.This information is often referred to as your medical record or “protected health information” commonly referred to as PHI. We use it for current and future treatment purposes, to obtain payment for treatment provided to you, for administrative purposes and to evaluate the quality of the care provided to you.
Specifically, we may use or disclose certain identifiable health information about you for reasons such as:
Treatment: A means of communication with other health professionals who contribute to or participate in your care while you are a patient, including doctors, nurses, technicians, medical students, therapists and other clinical personnel involved in your care, as well as those outside of our organization who may be involved in your medical care after you leave our facilities, such as family members, clergy or others who provide services that are part of your care. For example, we may need to disclose information about whether you have diabetes to a doctor treating you for a broken bone or an infection because of the implications.
Payment: A means by which you or your insurance company can verify services provided to you so that we may receive payment for those services provided. For example, we may need to give your health care provider information about your therapy treatments so the plan will pay us for the care provided.
Health Care Operations: A source of data in our daily operations as a health care provider. For example, we may need to use your health information and record as a tool in educating and assessing the competency of doctors, nurses and technicians who provide care here.
Other Uses and Disclosures: As part of treatment, payment and health care operations, Mary Free Bed Rehabilitation Hospital may also use your PHI for the following purposes:
- Fundraising Activities: Mary Free Bed may use or disclose some of your PHI to our Advancement and Development Department for certain fundraising activities. For example, Mary Free Bed may use your demographic information (e.g., name, address, other contact information, age, gender and insurance status) and the dates you were provided service. Any communications sent to you will let you know how you may opt out of receiving similar communications in the future.
- Medical Research: Mary Free Bed will use and disclose your PHI to medical researchers who request it for approved medical research projects and are required to protect the privacy of your information.
At times, information may be released from your medical record that is not for the purposes of treatment, payment or hospital operations. You have the right to agree to or restrict/prohibit these disclosures. These situations include the following:
- Mary Free Bed may contact you by phone to provide appointment reminders, or offer you information about treatment alternatives, or other health related benefits and services that may be of interest to you.
- You may be included in a Mary Free Bed facility directory while you are an inpatient, including your name and room number. This information may be released to people who ask about you by name including members of the clergy. You have a right to request that your name not be included in our facility directory. If you request to opt out of the directory, we cannot inform visitors or callers of your presence or location.
At times Mary Free Bed is required by law to release your health information. These situations include the following:
- Release of information to public health officials charged with improving the health of our city, state and nation, or responsible for averting a serious threat to health or safety to you, another person, or the public.
- Release of information required by federal, state, or local law, or in response to a court order, subpoena or other discovery request, as permitted by law.
- Release of information requested by members of domestic or foreign armed forces, to comply with the requirements of domestic or foreign military command authorities.
- Release of information for purposes of national security.
- Release of information to health oversight agencies in connection with legally authorized activities related to the investigation, inspection and licensure of health care providers.
- Any other release of information required by law.
In situations not outlined above, we will ask you for written authorization before using or disclosing any of your identifiable health information. If you choose to sign an authorization, it can later be revoked to stop future use and disclosure without your consent.
In addition, Mary Free Bed will make reasonable efforts when using, disclosing or requesting patient health information to limit information to the minimum necessary to accomplish the intended purpose of the use, disclosure or request. This applies for all situations outlined above.
Your Health Information Rights
You have the following individual rights concerning your PHI:
Right to Inspect and Copy: Subject to certain limited exceptions, you have the right to an opportunity to access your PHI and to inspect and copy your PHI as long as we maintain the data. This usually includes clinical and billing records. You have the right to request your PHI in electronic format in cases where Mary Free Bed utilizes electronic health records. If you request a copy of the information, you will be charged a reasonable copying fee in accordance with applicable federal or state law.
Right to Amend: Although your health record is the physical property of Mary Free Bed, the information contained within your health record belongs to you. You have the right to request an amendment to the information contained within your health record. To request an amendment, you must complete a written request and tell us why you believe the information is incorrect or inaccurate. We may deny your request to amend or change your record, if it:
- Is not in writing
- Does not include a reason to support the request
- Was created by another health care provider
- Is not part of the health information kept by or for our organization
- Is not part of the health information you would be permitted to inspect or copy
- Your health information is accurate and complete as is
In the event that Mary Free Bed exercises our right to deny your request, you will receive a detailed explanation of the reasons for the denial in writing. You have the right to complain about this denial as outlined in the “Your Complaints” section of this notice.
- Right to an Accounting of Disclosures: You have the right to receive an accounting of disclosures of your PHI that Mary Free Bed has made. This list of disclosures will not include those we have made for purposes of treatment, payment and health care operations. You must make your request for an accounting of disclosures in writing. You must include the time period of the accounting, which may not be longer than 6 years. In any given 12-month period, Mary Free Bed will provide you with an accounting of disclosures of your PHI at no charge. Any additional requests will be subject to a reasonable fee for preparing the accounting.
- Right to Request Restrictions: You may request, in writing, that we not use or disclose your information for treatment, payment or administrative purposes except when specifically authorized by you, when required by law or in emergency circumstances. We will consider your request, but you should be aware that we are not legally required to accept it and may, if we deem your request too restrictive, elect not to treat you or to disregard it in an emergency.
- Right to Request Restrictions to a Health Plan: You have the right to request a restriction on disclosure of your PHI to a health plan (for purposes of payment or healthcare operations) in cases where you paid out of pocket, in full, for the items received or services rendered.
- Right to Confidential Communications: You also have the right to request that we communicate with you about medical matters in certain ways (home phone/cell phone) or at certain locations. Again, this request should be in writing and should be specific as to how and where you wish to be contacted. We do not need to know the reasons for your request.
- Right to Receive a Copy of this Notice: You have the right to receive a paper copy of this Notice of Privacy Practices, upon request.
Joint Commission Public Notice
The Joint Commission will conduct an unannounced accreditation survey of Mary Free Bed Rehabilitation Hospital anytime from January 1, 2016 to July 1, 2016.
The purpose of the survey will be to evaluate the organization’s compliance with nationally established Joint Commission standards. The survey results will be used to determine whether, and the conditions under which, accreditation should be awarded to the organization. Joint Commission standards deal with the organization quality, safety-of-care issues, and the safety of the environment in which care is provided.
Anyone believing that he or she has pertinent and valid information about such matters may request a public information interview with the Joint Commission’s field representatives at the time of the survey. Information presented at the interview will be carefully evaluated for relevance to the accreditation process. Requests for a public information interview must be made in writing and should be sent to the Joint Commission no later than 5 working days before the survey begins. The request must also indicate the nature of the information to be provided at the interview. Such requests should be addressed to:
The Joint Commission
Office of Quality Monitoring
One Renaissance Boulevard
Oakbrook Terrace, IL 60181
– or –
Faxed to 630.792.5636
– or –
Emailed to firstname.lastname@example.org
– or –
Website: www.jointcommission.org click on “Report Complaint”
The Joint Commission’s Office of Quality Monitoring will acknowledge in writing or by telephone, requests received 10 days before the survey begins. An Account Representative will contact the individual requesting the public information interview prior to survey, indicating the location, date, and time of the interview and the name of the surveyor who will conduct the interview. This notice is posted in accordance with the Joint Commission’s requirement and may not be removed before survey is complete.
Date Posted: January 4, 2016
We’re required by law to maintain the privacy of your health information, provide you with this notice of our legal duties and privacy practices and to abide by the terms of this notice.
If you are concerned that we have violated your privacy rights, our own policies as summarized in this notice, or if you disagree with a decision we made about your records, you may file a complaint with Mary Free Bed’s Privacy Officer. You may also send a written complaint to the United States Department of Health & Human Services. You will not suffer any retaliation for filing a complaint.
You may file a written complaint by contacting:
Mary Free Bed Hospital
235 Wealthy St SE
Grand Rapids, MI 49503
– or –
Region V, Office for Civil Rights
U.S. Department of Health and Human Services
233 N. Michigan Ave., Suite 240
Chicago, IL 60601
Mary Free Bed Responsibilities
We are required by law to protect the privacy of your information and to provide you with this notice about our information practices. We are also required to abide by the terms of this notice and to notify you if we are unable to agree to a requested restriction you have made relative to the use or disclosure of your information. In addition, we are required to accommodate reasonable requests you make regarding the communication of your health information by alternate means or at alternative locations.
We may change our policies or practices regarding the use of your health information from time to time. Before we make a significant change we will post the new notice in waiting areas, in our exam rooms, and on our website at www.maryfreebed.com. You have the right to a written copy and can always request a copy of our current notice at any time. You have the right to paper copies of this notice if you received this notice electronically.
If you have any questions regarding this notice or our use or disclosure of your health information, or wish to file a complaint regarding our use or disclosure of your health information, please contact the Privacy Officer at Mary Free Bed Hospital and Rehabilitation Center.