Patient Guide 15 Notice of Privacy Practices Effective Date: April 14, 2003 • Revised Date: January 17, 2018 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. MercyOne Siouxland Medical Center is required by the Health Insurance Portability and Accountability Act of 1996, and the Health Information Technology for Economic and Clinical Health Act (found in Title XIII of the American Recovery and Reinvestment Act of 2009) (collectively referred to as “HIPAA”), as amended from time to time, to maintain the privacy of individually identifiable patient health information (this information is “protected health information” and is referred to herein as “PHI”). We are also required to provide patients with a Notice of Privacy Practices regarding PHI. We will only use or disclose your PHI as permitted or required by applicable state law. This Notice applies to your PHI in our possession including the medical records generated by us. MercyOne Siouxland Medical Center understands that your health information is highly personal, and we are committed to safeguarding your privacy. Please read this Notice of Privacy Practices thoroughly. It describes how we will use and disclose your PHI. This Notice applies to the delivery of health care by MercyOne Siouxland Medical Center and its medical staff in the main hospital, outpatient departments and clinics. This Notice also applies to the utilization review and quality assessment activities of MercyOne and MercyOne Siouxland Medical Center as a member of MercyOne a Catholic health care system with facilities throughout Iowa and Nebraska. I. PERMITTED USE OR DISCLOSURE A. Treatment: MercyOne Siouxland Medical Center will use and disclose your PHI to provide, coordinate, or manage your health care and related services to carry out treatment functions. The following are examples of how MercyOne Siouxland Medical Center will use and/or disclose your PHI: i. To your attending physician, consulting physician(s), and other health care providers who have a legitimate need for such information in your care and continued treatment. ii. To coordinate your treatment (e.g., appointment scheduling) with us and other health care providers such as name, address, employment, insurance carrier, etc. iii. To contact you as a reminder that you have an appointment for treatment or medical care at our facilities. iv. To provide you with information about treatment alternatives or other health-related benefits or services. v. If you are an inmate of a correctional institution or under the custody of a law enforcement officer, MercyOne Siouxland Medical Center will disclose your PHI to the correctional institution or law enforcement official. B. Payment: MercyOne Siouxland Medical Center will use and disclose PHI about you for payment purposes. The following are examples of how MercyOne Siouxland Medical Center will use and/or disclose your PHI: i. To an insurance company, third party payer, third party administrator, health plan or other health care provider (or their duly authorized representatives) for payment purposes such as determining coverage, eligibility, pre-approval / authorization for treatment, billing, claims management, reimbursement audits, etc. ii. To collection agencies and other subcontractors engaged in obtaining payment for care. C. Health Care Operations: MercyOne Siouxland Medical Center will use and disclose your PHI for health care operations purposes. The following are examples of how MercyOne Siouxland Medical Center will use and/or disclose your PHI: i. For case management, quality assurance, utilization, accounting, auditing, population based activities relating to improving health or reducing health care costs, education, accreditation, licensing and credentialing activities of MercyOne Siouxland Medical Center. ii. To consultants, accountants, auditors, attorneys, transcription companies, information technology providers, etc. D. Other Uses and Disclosures: As part of treatment, payment and health care operations, MercyOne Siouxland Medical Center may also use your PHI for the following purposes: i. Fundraising Activities: MercyOne Siouxland Medical Center will use and may also disclose some of your PHI to a related foundation for certain fundraising activities. For example, MercyOne Siouxland Medical Center may disclose your demographic information, your treatment dates of service, treating physician information, department of service and outcomes information to the foundation who may ask you for a monetary donation. Any fundraising communication sent to you will let you know how you can exercise your right to opt-out of receiving similar communications in the future. ii. Medical Research: MercyOne Siouxland Medical Center will use and disclose your PHI without your authorization to medical researchers who request it for approved medical research projects. Researchers are required to safeguard all PHI they receive.
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