Patient Guide B. Required by Law: MercyOne Siouxland Medical Center will disclose PHI about you when required by federal, state or local law. Examples include disclosures in response to a court order / subpoena, mandatory state reporting (e.g., gunshot wounds, victims of child abuse or neglect), or information necessary to comply with other laws such as workers’ compensation or similar laws. MercyOne Siouxland Medical Center will report drug diversion and information related to fraudulent prescription activity to law enforcement and regulatory agencies. C. Public Health Oversight or Safety: MercyOne Siouxland Medical Center will use and disclose PHI to avert a serious threat to the health and safety of a person or the public. Examples include disclosures of PHI to state investigators regarding quality of care or to public health agencies regarding immunizations, communicable diseases, etc. MercyOne Siouxland Medical Center will use and disclose PHI for activities related to the quality, safety or effectiveness of FDA regulated products or activities, including collecting and reporting adverse events, tracking and facilitating in product recalls, etc. D. Coroners, Medical Examiners, Funeral Directors: MercyOne Siouxland Medical Center will disclose your PHI to a coroner or medical examiner. For example, this will be necessary to identify a deceased person or to determine a cause of death. MercyOne Siouxland Medical Center may also disclose your medical information to funeral directors as necessary to carry out their duties. E. Organ Procurement: MercyOne Siouxland Medical Center will disclose PHI to an organ procurement organization or entity for organ, eye or tissue donation purposes. F. Specialized Government Functions: MercyOne Siouxland Medical Center will disclose your PHI regarding government functions such as military, national security and intelligence activities. MercyOne Siouxland Medical Center will use or disclose PHI to the Department of Veterans Affairs to determine whether you are eligible for certain benefits. G. Immunizations: MercyOne Siouxland Medical Center will disclose proof of immunization to a school where the state or other similar law requires it prior to admitting a student. V. YOUR HEALTH INFORMATION RIGHTS You have the following individual rights concerning your PHI: A. Right to Inspect and Copy: SSubject to certain limited exceptions, you have the right to access your PHI and to inspect and copy your PHI as long as we maintain the data. If MercyOne Siouxland Medical Center denies your request for access to your PHI, MercyOne Siouxland Medical Center will notify you in writing with the reason for the denial. For example, you do not have the right to psychotherapy notes or to inspect the information which is subject to law prohibiting access. You may have the right to have this decision reviewed. You also have the right to request your PHI in electronic format in cases where MercyOne Siouxland Medical Center utilizes electronic health records. You may also access information via patient portal if made available by MercyOne Siouxland Medical Center. 17 You may be charged a reasonable copying fee in accordance with applicable federal or state law. B. Right to Amend: You have the right to amend your PHI for as long as MercyOne Siouxland Medical Center maintains the data. You must make your request for amendment of your PHI in writing to MercyOne Siouxland Medical Center, including your reason to support the requested amendment. However, MercyOne Siouxland Medical Center will deny your request for amendment if: i. MercyOne Siouxland Medical Center did not create the information; ii. The information is not part of the designated record set; iii. The information would not be available for your inspection (due to its condition or nature); or iv. The information is accurate and complete. If MercyOne Siouxland Medical Center denies your request for changes in your PHI, MercyOne Siouxland Medical Center will notify you in writing with the reason for the denial. MercyOne Siouxland Medical Center will also inform you of your right to submit a written statement disagreeing with the denial. You may ask that MercyOne Siouxland Medical Center include your request for amendment and the denial any time that MercyOne Siouxland Medical Center subsequently discloses the information that you wanted changed. MercyOne Siouxland Medical Center may prepare a rebuttal to your statement of disagreement and will provide you with a copy of that rebuttal. C. Right to an Accounting: You have a right to receive an accounting of the disclosures of your PHI that MercyOne Siouxland Medical Center has made, except for the following disclosures: i. To carry out treatment, payment or health care operations; ii. To you; iii. To persons involved in your care; iv. For national security or intelligence purposes; or v. To correctional institutions or law enforcement officials. You must make your request for an accounting of disclosures of your PHI in writing to MercyOne Siouxland Medical Center. You must include the time period of the accounting, which may not be longer than 6 years. In any given 12-month period, MercyOne Siouxland Medical Center will provide you with an accounting of the disclosures of your PHI at no charge. Any additional requests for an accounting within that time period will be subject to a reasonable fee for preparing the accounting. D. Right to Request Restrictions: You have the right to request restrictions on certain uses and disclosures of your PHI to carry out treatment, payment or health care operations functions or to prohibit such disclosure. However, MercyOne Siouxland Medical Center will consider your request but is not required to agree to the requested restrictions. E. Right to Request Restrictions to a Health Plan: You have the right to request a restriction on disclosure of your PHI to a
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