Good Samaritan Hospital Los Angeles
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 this notice carefully.
If you have any questions about this notice, please contact the Good Samaritan Hospital Privacy Officer at 213.482.2767
Who Will Follow this Notice q
This notice describes Good Samaritan Hospital’s practices and that of
· any healthcare professional authorized to enter information into your hospital chart;
· all departments and units of the hospital;
· any member of a volunteer group we allow to help you while you are in the hospital;
· all employees, staff and other hospital personnel, including our medical staff; and,
· our home health service.
All these entities, sites and locations follow the terms of this notice. In addition, these entities, sites and locations may share medical information with each other for treatment, payment or hospital operations purposes described in this notice.
Our Pledge Regarding Medical Information q
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 the hospital. 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 the hospital, whether made by hospital personnel or your personal physician. Your personal physician may have different policies regarding his/her use and disclosure of your medical information created in his/her 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.
We are required by law to
- make sure that medical information that identifies you is kept private with certain exceptions;
- give you this notice of our legal duties and privacy practices with respect to medical information about you; and,
- follow the terms of the notice that is currently in effect.
How We May Use and Disclose Medical Information About You
The following categories describe different ways that Good Samaritan Hospital uses and discloses medical information. For each category of uses or disclosures we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the categories.
For Treatment q
Good Samaritan Hospital 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, medical students, or other hospital personnel who are involved in taking care of you at the 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 dietician if you have diabetes so that we can arrange for appropriate meals. Different departments of the hospital also may share medical information about you in order to coordinate different things you need, such as prescriptions, lab work and x-rays. We also may disclose medical information about you to people outside the hospital who may be involved in your medical care after you leave the hospital, such as family members, clergy or others we use to provide services that are part of your care.
For Payment q
We may use and disclose medical information about you so that the treatment and services you receive at Good Samaritan Hospital may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan information about surgery you received at the 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 cost of the treatment.
For Healthcare Operations q
We may use and disclose medical information about you for hospital operations. These uses and disclosures are necessary to run Good Samaritan Hospital and make sure that all of our 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 the hospital should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, medical students, and other hospital 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 healthcare and healthcare delivery without learning who the specific patients are.
Appointment Reminders q
We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at the hospital.
Treatment Alternatives q
We may use and disclose medical information to tell you about or recommend possible treatment alternatives that may be of interest to you.
Health-Related Products and Services q
We may use and disclose medical information to tell you about health-related products or services that may be of interest to you.
Fundraising Activities q
We may use medical information about you to contact you in an effort to raise money for the hospital and its operations. We may disclose medical information to a foundation related to Good Samaritan Hospital so that the foundation may contact you in raising money for the hospital. We only would release contact information, such as your name, address and telephone number and the dates you received treatment or services at the hospital. If you do not want the hospital to contact you for fundraising efforts, you must notify our Development Department in writing.
Hospital Directory q
We may include certain limited information about you in the hospital directory while you are a patient in the hospital. This information may include your name, location in the hospital, your general condition (e.g., fair stable, etc.) and your religious affiliation. Unless there is a specific written request from you to the contrary, this directory information, except 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 do not ask for you by name. This information is released 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 q
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. Unless there is a specific written request from you to the contrary, we may also tell your family or friends your condition and that you are in the 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.
Under certain circumstances, we may use and disclose medical 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 medical information, trying to balance the research needs with patients’ needs for privacy of their medical information. Before we use or disclose medical information for research, the project will have been approved through this research approval process, but we may, however, disclose medical 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 medical 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 Good Samaritan Hospital.
As Required by Law q
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 q
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.
Special Circumstances Organ and Tissue Donation q
If you are an organ donor, we may release medical 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 q
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.
Workers’ Compensation q
We may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illnesses.
Public Health Risks q
We may disclose medical information about you for public health activities. These activities generally include the following:
to prevent or control disease
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; we will only make this disclosure if you agree or when required or authorized by law
Health Oversight Activities q
We may disclose medical information to health oversight agencies 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 healthcare system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes q
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.
Law Enforcement q
We may release medical information if asked to do so by a law enforcement official:
in response to a court order, subpoena, warrant, summons or similar process;
to identify or locate a suspect, fugitive, material witness or missing person;
about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person
about a death we believe may be the result of criminal conduct;
about criminal conduct at the hospital; 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.
Coroners, Medical Examiners and Funeral Directors qWe 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 patients of the hospital to funeral directors as necessary to carry out their duties.
National Security and Intelligence Activities q
We may release medical information about you to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law.
Protective Services for the President and Others q
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.
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 healthcare; (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.
Your Rights Regarding Medical Information About You
You have the following rights regarding medical information that Good Samaritan Hospital maintains about you.
Right to Inspect and Copy q
You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but may not include some mental health records.
To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to our Health Information Management Department Director. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request.
We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed healthcare professional chosen by the hospital will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
Right to Amend q
If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. In addition, you must provide a reason that supports your request.
To request an amendment, your request must be made in writing to the Director of Health Information Management. In addition, you must provide a reason that supports
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
was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
is not part of the medical information kept by or for the hospital;
is not part of the information which you would be permitted to inspect or copy; or,
is accurate and complete.
Even if we deny your request for an amendment, you have the right to submit a written addendum, not to exceed two hundred and fifty (250) words, regarding any item you think is incorrect or incomplete and, if you so request, we will disclose your addendum together with the information you wanted amended when it is disclosed in the future.
Right to an Accounting of Disclosures q
You have the right to request an “accounting of disclosures”. This is a list of disclosures we made of medical information about you other than our own uses for treatment, payment and healthcare operations and certain other exceptions set by law.
To request this list or accounting of disclosures, you must submit your request in writing to the Director of Health Information Management. Your request must state a time period which may not be longer than six years and may not include dates before 14 April 2003. Your request should indicate in what form you want the list (e.g., on paper, electronically, etc.). The first list you request within a twelve (12) month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify your of the cost involved and you may choose to withdraw or modify your request at that time before any costs
Right to Request Restrictions q
You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or healthcare 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 of 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 the Director of the Health Information Management Department. 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 limitation to apply (e.g., disclosures to your spouse).
Right to Request Confidential
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 the Health Information Management Department Director. 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.
Right to a Paper Copy
of this Notice q
You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain a copy of this notice on our website, www.goodsam.org. You may obtain a paper copy of this notice from our Admitting Department.
Changes to this Notice
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 and on our website. The notice will contain on the first page, in the top right hand corner, the effective date. In addition, each time you register at or are admitted to Good Samaritan Hospital for treatment or healthcare services as an inpatient or outpatient, we will offer you a copy of the current notice in effect.
If you believe your privacy rights have been violated, you may file a complaint with Good Samaritan Hospital or the Secretary of the Department of Health and Human Services. To file a complaint with the hospital, contact
GSH Privacy Officer
GOOD SAMARITAN HOSPITAL
1225 Wilshire Boulevard
All complaints must be submitted in writing. You will not be penalized for filing a complaint.
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 you.