I. THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE
USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE READ IT CAREFULLY. THIS NOTICE OF PRIVACY PRACTICES COVERS
WILLIAMSBURG REGIONAL HOSPITAL AND ITS MEDICAL STAFF IN THE COURSE
OF THEIR PRACTICE AT WILLIAMSBURG REGIONAL HOSPITAL.
II. WE HAVE A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH
INFORMATION (PHI). We are legally required to protect the privacy of your health information.
We call this information "protected health information " or "PHI " for short. PHI includes
information that we have created or received about your past, present or future health care or \
condition, the provision of health care to you, or the payment of health care, and can be used to
identify you personally.
We must provide you with this notice about our privacy practices that explains how, when
and why we use and disclose your PHI. With some exceptions, we may not use or disclose any
more of your PHI than is necessary to accomplish the purpose of the use or disclosure.
We are legally required to follow the privacy practices that are described in this notice.
However, we reserve the right to change the terms of this notice and our privacy policies at any
time. Any changes will apply to the PHI we already have. Before we make important changes
to our policies, we will promptly change this notice and post a new notice in the Admissions
Department of the Hospital. You can also request a copy of this notice from the contact person
listed in Section VI or from our admissions personnel.
III. HOW WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH
INFORMATION. We use and disclose health information for many different reasons. For some
of these uses and disclosures, we need your specific authorization. Below, we have described
the different categories of our uses and disclosures and provide some examples of each.
A. Uses and Disclosures related to treatment, payment or healthcare operations. We may use
and disclose your PHI for the following reasons:
1. For treatment. We may use and disclosure your PHI to physicians, nurses,
medical students and other health care personnel who provide you with health
care services or who are involved in managing your care. We may share your
medical information with other health care providers to coordinate your care. For
example, if you are treated in the Emergency Department, we may share your PHI
with your family physician in order to provide for follow up care for the
emergency condition for which you were treated.
2. To obtain payment for treatment. We may use and disclose your PHI in order to
bill and collect payment for the treatment and services provided to you. For
example, we may provide portions of your PHI to our billing department and
your health plan to get paid for the health services we provided to you. We may
also provide your PHI to our Business Associates, such as billing companies,
claims processing companies and others that process our health care claims.
B. For health care operations. We may disclose your PHI in order to conduct our health
care operations. For example, we may use your PHI in order to evaluate the quality of
healthcare services you received or to evaluate the performance of the health care
professionals who provided health care services to you. We may also provide your PHI
to our accountants, attorneys, consultants or others in order to make sure we are
complying with the laws that affect us.
C. Other Permitted Uses that Do NOT Require Your Authorization. We may use and
disclose your PHI without your authorization for the following reasons:
1. When a disclosure is required by federal, state or local law, judicial or
administrative proceedings or law enforcement. For example, we make disclosures
when a law requires that we report information to government agencies and law
enforcement personnel about victims of abuse, neglect or domestic violence; when
dealing with gunshot wounds or other such wounds; or when ordered in a judicial or
administrative proceeding.
2. For public health activities. For example, we report information about births,
deaths and various diseases to government officials in charge of collecting that
information, and we provide coroners, medical examiners and funeral directors the
necessary information relating to an individual's death.
3. For health oversight activities. For example, we will provide information to assist
the government or other health oversight agencies when it conducts an
investigation or inspection of a health care provider or organization.
4. For purposes of organ donation. We may notify the organ procurement
organizations to assist them in organ, eye, or tissue donation or transplant..
5. To avoid harm. In order to avoid a serious threat to the health or safety of a person
or the public, we may provide your PHI to law enforcement personnel or persons
able to prevent or lessen such harm.
6. For specific government functions. We may disclose PHI of military personnel
and veterans in certain situations and we may disclose PHI for national security
purposes.
7. For worker's compensation purposes. We may provide PHI in order to comply
with Worker's Compensation laws.
8. Appointment reminders and health related benefits and services. We may use PHI
to provide appointment reminders or to notify you of health related benefits or
services that may be of interest to you.
D. Two Uses and Disclosures To Which You Have the Opportunity to Object
1. Patient Directories. We may include your name, location in the facility,
physician name, general condition and religious affiliation in our patient directory
for use by clergy and visitors who ask for you by name, unless you object in
whole or in part. The opportunity to consent may be obtained retroactively in
emergency situations.
2. Disclosures to family, friends or others. We may provide your PHI to a family
member, friend or other person that you indicate is involved in your care or the
payment of your health care, unless you object in whole or in part. The
opportunity to consent may be obtained retroactively in emergency situations.
E. Uses and Disclosures Requiring Your Prior Written Authorization For reasons or
situations not included in Sections III A, B, and C above, we will ask for your written
authorization before using or disclosing your PHI. If you choose to sign an
authorization to disclose your PHI, you can later revoke that authorization in writing to
stop any future uses and disclosures(to the extent that we haven't taken action relying on
the authorization).
IV. YOUR RIGHTS REGARDING YOUR PHI
A. You have the following rights with respect to your PHI:
1. The Right to Request Limits on Uses and Disclosures You have the right to
request in writing that we limit how we use and disclose your PHI. We will
consider your request, but are not legally bound to agree to these limitations.
2. The Right to Choose How We Send PHI to You. You have the right to request
in writing that we send information to you at an alternate address ( for example,
sending information to your work address rather than your home address ) or by
alternate means ( for example, e-mail instead of regular mail ). We must agree
to your request as long as we can easily provide it in the format you have
requested.
3. The Right to See and Get Copies of Your PHI. In most cases, you have the
right to look at or get copies of your PHI that we have, but you must make the
request in writing. In certain situations we may deny your request. If we do, we
will tell you, in writing, our reasons behind the denial and explain your right to
have the denial reviewed. If you request copies of your PHI, we will charge you
a set amount for each page copied, according to our current fee schedule.
Instead of providing the PHI you have requested, we may provide you with a
summary explanation of the PHI as long as you agree in advance to that and to
the cost of providing that information.
4. The Right to Get a List of the Disclosures We Have Made. You have the right to
request in writing a list of instances in which we have disclosed your PHI. This
list will not include uses or disclosures to for treatment, payment or healthcare
operations, disclosures made to you, incidental disclosures otherwise permitted
by law, disclosures which you have previously authorized, those included in the
facility directory, or disclosures to correctional institutions or law enforcement
officials as provided by law. It does not include disclosures made as a part of a
limited data set, which does not contain any individually identifiable protected
health information. It also does not include any disclosures made prior to April
14, 2003. You may request a list of disclosures made within a specific time
frame or all disclosures within the past six years. We will provide the list to you
at no charge; however, if you make more than one request within a 12 month
period, we will charge you a set fee (according to our current fee schedule) for
each additional request.
5. The Right to Correct or Update your PHI. If you believe there is a mistake in
your PHI or that there is missing information, you have the right to request in
writing that we correct the existing information or add the missing information.
You must provide the request in writing and the reason for your request. We
may deny your request if it is determined that the PHI was (a) complete and
accurate, (b) not allowed to be disclosed (c) not created by us or (d) was not part
of the designated record set.
6. The Right to Receive a Paper Copy of this Notice. You have the right to receive
a paper copy of this notice at any time, even if you have agreed to receive the
notice electronically.
V. CONTACT INFORMATION REGARDING THIS PRIVACY NOTICE.
If you have any questions about this notice or any concerns about our privacy
practices, please call 1-843-355-0260 and ask to speak to the Privacy Officer.
VI. HOW TO FILE A COMPLAINT REGARDING OUR PRIVACY PRACTICES
If you think that we may have violated your privacy rights, or disagree with a
decision we have made regarding your rights to your PHI, you may file a written
complaint with the person listed below:
Williamsburg Regional Hospital
ATTN: Privacy Officer
P. O. Drawer 568
500 Nelson Blvd
Kingstree, S. C. 29556
You may also send a written complaint to the Office of Civil Rights, U.S. Department
of Health and Human Services. To file a complaint with the Office of Civil Rights,
send your written complaint to:
Office of Civil Rights
U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington, D.C. 20201