Gracie Square Hospital
420 East 76th Street
New York ,
GRACIE SQUARE HOSPITAL
The New York Gracie Square Hospital, Inc.
420 East 76th Street New York, NY 10021
NOTICE OF PRIVACY PRACTICES
Effective Date: September 23, 2013
THIS NOTICE DESCRIBES HOW YOUR PROTECTED HEALTH INFORMATION MAY BE USED AND DISCLOSED AND HOW
YOU CAN GET ACCESS TO THIS INFORMATION.
Please review it carefully.
WHO WILL FOLLOW THIS NOTICE
All of the employees, staff, including medical and psychiatry staff, as well as other personnel of the New York Gracie Square Hospital, Inc. (the "Hospital¨), will follow these privacy practices.
ABOUT THIS NOTICE
This notice will tell you about the ways we may use and disclose your protected health information. We also describe your rights and certain obligations we have regarding the use and disclosure of protected health information. We are required by law to make sure that protected health information that identifies you is kept private; give you this notice of our legal duties and privacy practices with respect to your protected health information; and follow the terms of the notice that is currently in effect. Our organization is dedicated to preventing, detecting, containing, and correcting security violations.
HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION
The following categories describe different ways that we use and disclose protected health information. Protected health information includes medical, mental health, and alcohol and substance abuse information. For each category of uses or disclosures we will explain what we mean and give 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 or more one of the categories.
Treatment: We may use your protected health information to provide you with diagnosis or treatment. We may disclose your protected health information to doctors, psychiatrist, nurses, social workers, technicians, medical students, or other Hospital personnel who are involved in taking care of you. 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 your protected health information in order to coordinate the different things you need, such as prescriptions, lab work and x-rays. We may also disclose your protected health information to people outside the Hospital who may be involved in your treatment.
Payment: We may use and disclose your protected health information so that we may bill for treatment and services you receive at the Hospital and can collect payment from you, an insurance company or another party. For example, we may need to give information about the treatment you received at the Hospital to your health plan so that the plan will pay us or reimburse you for the treatment. We may also tell your health plan about a treatment you are going to receive in order to obtain prior approval or to determine whether your plan will cover the treatment. We may also disclose information about you to other healthcare facilities for purposes of payment as permitted by law.
Health Care Operations: We may use and disclose your protected health information for operations of the Hospital. These uses and disclosures are necessary to run the Hospital and make sure that all of our patients receive quality care. For example, we may use protected health information to evaluate the performance of our staff in caring for you. We may also combine protected health information about many 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 combine protected health information we have with protected health information from other hospitals to compare our performance and to make improvements in the care and services we offer. We may also disclose information to doctors, psychiatrist, nurses, social workers, technicians, medical students, and other Hospital personnel for educational purposes. We may also disclose information about you to other healthcare facilities as permitted by law.
Treatment Alternatives: We may use and disclose protected health information to tell you about possible treatment options 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.
Inpatient Directory: We may include certain limited information about you in the Hospital's directory while you are a patient at the Hospital so that your family and friends can visit you in the Hospital. This information may include your name and location in the Hospital. This information will be used by Hospital personnel to obtain your consent to the visit and to direct your visitors to the appropriate location within the Hospital. Without your consent, requesting parties will be told that there is no information available, Hospital personnel will neither confirm nor deny if you have been admitted to the Hospital.
Individuals Involved in Your Care or Payment for Your Treatment: We may release your protected health information, with your consent, to a friend, family member or personal representative who is involved in your treatment or to someone who helps pay for your treatment. In addition, we may disclose your protected health information to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location. Uses, disclosures or sale of your health information that involve psychotherapy notes, marketing, payments from a third party, or any other use or disclosure not described in this notice or required by law will only be made with your written authorization . You have the right to withdraw your authorization, except when we have already relied on it, by contacting our privacy official provided below.
In a Medical Emergency: We may use and disclose your protected health information to medical personnel of the Hospital and other licensed emergency service providers in a medical emergency.
To Avert a Serious Threat to Health or Safety: We may use and disclose your protected health information when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
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.
Public Health Risks: We may disclose to authorize public health or government officials your protected health information for public health activities. These activities generally include the following: To a person subject to the jurisdiction of the Food and Drug Administration (FDA) for purposes related to the quality, safety or effectiveness of an FDA-regulated product or service; to prevent or control disease, injury or disability; to report: disease or injury, births and deaths, child abuse or neglect, reactions to medications and food or problems with products; to notify: people of recalls or replacements of products they may be using, people who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition; or with your authorization, to the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence.
Organ and Tissue Donation: If you are an organ or tissue donor, we may release your protected health information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank.
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 to funeral directors so they can carry out their duties.
Workers' Compensation: We may release your protected health information for workers' compensation or similar programs.
Military and Veterans: If you are a member of the armed forces of the United States or another country, we may release your protected health information as required by military command authorities.
As Required by Law: We may use and disclose your protected health information when required to do so by federal, state or local law. We are required by federal and state law to keep the privacy and security of health information that may tell your identity. If there is a breach of privacy that compromises your identifiable health information we will notify you.
Health Information: Health information of a deceased individual is no longer considered protected after fifty years.
Law Enforcement: We may release protected health 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 circumstances, we are unable to obtain the person's agreement; about a death we believe may be the result of criminal conduct; about criminal conduct at the Hospital; 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; or to authorized federal officials so they may provide protection for the President and other authorized persons or conduct special investigations.
National Security and Intelligence Activities: We may release your protected health information to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose your protected health information in response to a court or administrative order. We may also disclose your protected health information in response to a subpoena, discovery request, or other legal demand 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.
Research: Under certain circumstances, we may use and disclose your protected health information 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, to balance research needs with a patient's need for privacy of their protected health information. Before we use or disclose protected health information for research, the project will be approved through this process. However, we may disclose your protected health information 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. When required by law, we will ask for your specific written authorization if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your treatment at the Hospital.
HIV-Related Information: Confidential HIV-related information is any information indicating that you had an HIV-related test, have HIV-related illness or AIDS, or have an HIV-related infection, as well as any information which could reasonably identify you as a person who has had a test or has HIV infection. Under New York State law, confidential HIV-related information can only be given to persons allowed to have it by law, or persons you have allowed to have it by signing a specific authorization form.
YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
You have the following rights regarding protected health information we maintain about you:
Right to Inspect and Copy: You have the right to inspect and copy protected health information that may be used to make decisions about your care. Usually, this includes medical and billing records. This right does not include psychotherapy notes; information compiled for use in a legal proceeding; or certain information maintained by laboratories. In order to inspect and copy protected health information that may be used to make decisions about you, you must submit your written request to the Director of Medical Records; see address on the first page of this Notice. If you request an electronic or paper 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 limited circumstances. If you are denied access to protected health information, you may request that the denial be reviewed by writing to the Director of Medical Records. A licensed healthcare professional will conduct the review. We will comply with the outcome of the review.
Right to Amend: If you think that protected health information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the Hospital. To request an amendment, your request must be made in writing and submitted to the Director of Medical Records; see address on the first page of this Notice. In addition, you must give a reason that supports your request. 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 protected health information kept by or for the Hospital; is not part of the information that you would be permitted to inspect and copy; or is accurate and complete. We will provide you with written notice of action we take in response to your request for amendment.
Right to an Accounting of Disclosures: You have the right to request an "accounting of disclosures.¨ This is a list of certain disclosures we made of your protected health information. We are not required to account for any disclosures you specifically requested or for disclosures related to treatment, payment, healthcare operations, or made pursuant to an authorization signed by you. To request an accounting of disclosures, you must submit your request in writing to the Director of Medical Records; see address on the first page of this Notice. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. We will attempt to honor your request. If you request more than one accounting in any 12-month period, we may charge you for our reasonable retrieval, list preparation, and mailing costs. We will notify you of the costs involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions: You have the right to request a restriction or limitation on the protected health information we use or disclose about you for treatment, payment or health care operations. You also have a right to request a limit on other disclosures of protected health information that you have otherwise authorized. To request a restriction, you must submit your written request to the Patient Relations Department; see address on the first page of this Notice. We are not required to agree to your request, except when you pay for services out-of-pocket, in full and request us not to share the health information with your health insurance plan. If we agree to your request, we will comply with your request unless the information is needed to provide you emergency treatment.
Right to Request Confidential Communications: You have the right to request that we communicate with you about treatment 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 submit your written request to the Patient Relations Department; see address on the first page of this Notice. We will not ask you the reason for your request. Your request must specify how or where you wish to be contacted. We will accommodate reasonable requests.
Right to a Copy of This Notice: You have the right to a paper copy of this Notice at your first treatment encounter at the Hospital. You may get an additional copy of this Notice at any time by contacting Patient Relations Department; see address on the first page of this Notice. You also may obtain a copy of this notice electronically at our website, http://www.nygsh.org,
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 your protected health information we already have as well as any information we receive in the future. We will post copies of the current Notice in the Hospital. The Notice will contain on the first page, the effective date. In addition, each time you register at or are admitted to the Hospital for treatment, we will make available copies of the current Notice. Any revisions to our Notice will also be posted on our website.
Complaints: If you believe your privacy rights have been violated, you may file a complaint with the Hospital or with the Secretary of the Department of Health and Human Services. To file a complaint with the Hospital, please write to Patient Relations Department, see contact information on the first page of this Notice. You will not be penalized for filing a complaint.
Other Uses and Disclosures of Protected Health Information: not covered by this Notice or the laws that apply to us will be made only with your written authorization, on a Hospital authorization form. If you provide us authorization to use or disclose your protected health information, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose your protected health information for the reasons covered by your written authorization. However, we may continue to use or disclose that information to the extent we have relied on your authorization. You also understand that we are unable to take back any disclosures we have already made with your authorization, and that we are required to retain our records of the treatment that we provided to you.
If you believe your privacy rights have been violated, you may file a complaint with the Hospital or with the Secretary of the Department of Health and Human services. To file a complaint with the Hospital, please write to Patient Relations Department, see address on the first page of this Notice. You will not be penalized for filing a complaint.
Other Uses and Disclosures of Protected Health Information
Other uses and disclosures of protected health information not covered by this Notice or the laws that apply to us will be made only with your written authorization, on a Hospital authorization form. If you provide us authorization to use or disclose your protected health information, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose your protected health information for the reasons covered by your written authorization. However, we may continue to use or disclose that information to the extent we have relied on your authorization. You also understand that we are unable to take back any disclosures we have already made with your authorization, and that we are required to retain our records of the treatment that we provided to you.