Privacy Statement

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This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

The employees and staff of Saint Michael's Medical Center follow the privacy practices in this Notice. Saint Michael's Medical Center maintains your personal health information in records that will be maintained in a confidential manner, as required by law.

This health information may include photographs obtained by authorized personnel at Saint Michael's Medical Center for treatment purposes. Saint Michael's Medical Center employees and staff must use and disclose your health information to the extent necessary to provide you with quality health care. To do this, Saint Michael's Medical Center must share your health information as necessary for treatment, payment and health care operations.

1. What Are Treatment, Payment and Health Care Operations?

Treatment includes sharing information among health care providers involved in your care. For example, your physician may share information about your condition with the pharmacist to discuss appropriate medications, or with the radiologist or other consultants in order to make a diagnosis. Saint Michael's Medical Center may use your health information as required by your insurer to obtain payment for your treatment and hospital stay. We also may use and disclose your health information to improve the quality of care, for example, to review charts or for training purposes.

2. How Will the Hospital Use My Health Information?

• Your health information may be used for the purposes listed below, unless you ask for restrictions or specific use or disclosure:
• The hospital directory, which may include your name, general condition, and your location in the hospital
• Religious affiliation may be given to a hospital chaplain or member of the clergy
• Family members or close friends involved in your care or payment for your treatment
• Appointment reminders
• To inform you of treatment alternatives, benefits or services related to your health. (You will have an opportunity to refuse to receive this information)
• As required by law
• Public health activities, including disease prevention, injury or disability; reporting births and deaths; reporting child or elder abuse or neglect; reporting reactions to medications or product problems; notification of recalls; infectious disease control; notifying government authorities of suspected abuse, neglect or domestic violence (if you agree or as required by law)
• Health oversight activities, e.g., audits, inspections, investigations, and licensure
• Lawsuits and disputes (we will attempt to provide you advance notice of a subpoena before disclosing the information)
• Law enforcement (e.g., in response to a court order or other legal process; to identify or locate individuals being sought by authorities; about the victim of a crime under restricted circumstances; about a death that may be the result of criminal conduct; about criminal conduct that occurred in or on the hospital premises; and in emergency circumstances relating to reporting information at the scene of a crime)
• Coroners, medical examiners, and funeral directors
• Organ and tissue donation
• Certain research projects
• To prevent a serious threat to health or safety
• To military command authorities if you are a member of the armed forces or a member of a foreign military authority
• National security, disasters and intelligence activities
• If there is a State of Emergency, we will release patient name, date of birth, city and state to an authority who will be maintaining a database of patients related to the incident
• Protection of the President or other authorized persons for foreign heads of state, or to conduct special investigations
• Inmates (medical information about inmates of correctional institutions may be released to the institution)
• Worker’s Compensation (your health information regarding benefits for work-related illnesses may be released as appropriate)
• We may contact you as part of our fund-raising and marketing efforts as permitted by law

3. Your Authorization is Required for Other Disclosures

Except as described above, we will not use or disclose your health information unless you authorize Saint Michael's Medical Center in writing to disclose your information. If you give authorization to disclose information, you have the right to revoke the authorization, but that can only be effective from the date your revocation is delivered in writing to the Saint Michael's Medical Center Privacy Officer. Call (973) 877-5218 to obtain the address and what needs to be in the notice of revocation.

4. You Have Rights Regarding Your Medical Information

You have the following rights regarding your health information, provided that you make a written request to invoke the right on the form provided by Saint Michael's Medical Center:

• Right to request restrictions. You may request limitations on your health information we use or disclose for health care treatment, payment, or operations (e.g., you may ask us not to disclose that you have had a particular surgery), but 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 with emergency treatment.
• Right to confidential communications. You may request communications in a certain way or at a certain location, but you must specify how or where you wish to be contacted.
• Right to inspect and copy. You have the right to inspect and copy your health information regarding decisions about your care; however, psychotherapy notes may not be inspected or copied. We may charge a fee for copying, mailing and supplies.
• Right to request amendment. If you believe that the health information we have about you is incorrect or incomplete, you may request an amendment of the form provided by the hospital which requires certain specific information. Saint Michael's Medical Center is not required to accept the request for amendment.
• Right to accounting disclosures. You may request a list of the disclosures of your health information that have been made to persons or entities other than for treatment, payment or health care operations in the past six (6) years, but not prior to April 14, 2003. After the first request, there may be a charge.
• Right to a copy of this Notice. You may request a paper copy of this Notice at any time.

5. Requirements Regarding this Notice

Saint Michael's Medical Center is required by law to provide you with this Notice. We will be governed by this Notice for as long as it is in effect. Saint Michael's Medical Center may change this Notice and these changes will be effective for health information we have about you as well as any information we receive in the future. Each time you register at the hospital for health care services as an inpatient or outpatient, you may receive a copy of the Notice in effect at the time. You can always request a copy of our most current privacy notice from the hospital or by contacting our privacy officer at (973) 877-5218.

6. Complaints

If you believe your privacy rights have been violated, you may file a complaint with Saint Michael's Medical Center or with the Secretary of the United States Department of Health and Human Services - 200 Independence Ave. S.W. Room 615F Washington, D.C. 20201. You will not be penalized or retaliated against in any way for making a complaint to the Hospital or the Department of Health and Human Services.

• You may call the Saint Michael's Medical Center Privacy Officer at (973) 877-5218, if
• you have a complaint
• you have any questions about this Notice
• you wish to request restrictions on uses and disclosures for treatment, payment or health care operations; or
• you wish to obtain a form to exercise your individual rights
• you wish to revoke your authorization

This Notice is effective: April 1, 2003