Chilton Notice of Privacy Practices
This notice describes how protected health information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
Our Notice of Privacy Practices describes your rights to access and control your protected health information. Protected health information includes, but is not limited to, personal data, diagnosis, treatment, billing information, etc. It also explains how Chilton Hospital may use and disclose protected health information about you to carry out treatment, payment or healthcare operations and for other purposes that are permitted or required by law. You are encouraged to obtain and review the complete document before signing the consent.
Although the terms of the notice may change at any time, revised copies are available upon request. The new notice will be effective for all protected health information maintained after that time period. If you have any questions about this notice, please contact our Privacy Officer at 973-831-5087.
USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION
Uses and Disclosures of Protected Health Information Based Upon Your Written Consent
You will be asked to sign a consent form. If you consent, your protected health information may be used and disclosed by your physician, Chilton Hospital staff and others outside of Chilton Hospital that are involved in your care and treatment for the purpose of providing healthcare services to you. Your protected health information may also be used and disclosed to pay your healthcare bills and as part of hospital operations.
Following are examples of the types of uses and disclosures of protected healthcare information that Chilton Hospital is permitted to make once you have signed our consent form. These examples are not meant to be all-inclusive, but to describe the types of uses and disclosures that may be made by Chilton Hospital once you have provided consent.
Chilton Hospital may use and disclose your protected health information to provide, coordinate, or manage your healthcare and any related services with a third party that has already obtained your permission to have access to your protected health information. Your protected health information also may be provided to a provider to whom you have been referred to ensure that the provider has the necessary information to diagnose or treat you.
In addition, Chilton Hospital may disclose your protected health information from another provider (e.g., a specialist or laboratory) who, upon request, becomes involved in your care by providing assistance with your healthcare diagnosis or treatment.
Your protected health information also may be used, as needed, to obtain payment for your healthcare services from insurers. This may include explanations about healthcare services recommended for you to determine eligibility or coverage for insurance benefits, reviewing services provided to you for medical necessity, and undertaking utilization review activities.
With your permission, Chilton Hospital may use or disclose your protected health information in order to support our business activities. Examples may include disclosing your protected health information to students that care for patients at Chilton Hospital, calling you by name when your provider is ready to see you, and contacting you to remind you of a medical appointment.
Chilton Hospital will share your protected health information with third party “business associates” that perform various activities such as billing and transcription services. Whenever an arrangement between Chilton Hospital and a business associate involves the use or disclosure of your protected health information, the parties will have a written contract that contains terms that will protect the privacy of your protected health information.
Chilton Hospital may use or disclose your protected health information, as necessary, to provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you. We may also use and disclose your protected health information for other marketing and fundraising activities. For example, your name and address and other demographic information may be used to send you a newsletter about Chilton Hospital programs and services.
Uses and Disclosures of Protected Health Information Based Upon Your Written Authorization Other uses and disclosures of your protected health information will be made only with your written authorization, unless otherwise permitted or required by law as described below. You may revoke this authorization, at any time, in writing, except to the extent that Chilton Hospital has taken an action in reliance on the use or disclosure indicated in the authorization.
Other Permitted and Required Uses and Disclosures That May Be Made with Your Consent, Authorization or Opportunity to Object
You have the opportunity to agree or object to the use or disclosure of all or part of your protected health information. If you are not present or able to agree or object to the use or disclosure of the protected health information, then Chilton Hospital may, using professional judgment, determine whether the disclosure is in your best interest. In this case, only the protected health information that is relevant to your healthcare will be disclosed.
Others Involved in Your Healthcare:
Unless you object, we may disclose to a member of your family, a relative, a close friend or any other person you identify, your protected health information that directly relates to that person’s involvement in your healthcare. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that it is in your best interest based on our professional judgment. We may use or disclose protected health information to notify or assist in notifying a family member, personal representative or any other person that is responsible for your care of your location, general condition or death. Finally, we may use or disclose your protected health information to an authorized public or private entity to assist in disaster relief efforts and to coordinate uses and disclosures to family or other individuals involved in your healthcare.
We may use or disclose your protected health information in an emergency treatment situation. If this happens, we shall try to obtain your consent as soon as reasonably practicable after the delivery of treatment. If we are required by law to treat you and have attempted to obtain your consent but are unable to obtain your consent, we may still use or disclose your protected health information to treat you.
We may use and disclose your protected health information if we attempt to obtain consent from you but are unable to do so due to substantial communication barriers and we determine, using professional judgment, that you intend to consent to use or disclosure under the circumstances.
Other Permitted and Required Uses and Disclosures That May Be Made Without Your Consent, Authorization or Opportunity to Object
We may use or disclose your protected health information in the following situations without your consent or authorization. These situations include:
Required By Law:
We may use or disclose your protected health information to the extent that the use or disclosure is required by law. The use or disclosure will be made in compliance with the law and will be limited to the relevant requirements of the law. You will be notified, as required by law, of any such uses or disclosures.
We may disclose your protected health information for public health activities and purposes to a public health authority that is permitted by law to collect or receive the information. The disclosure will be made for the purpose of controlling disease, injury or disability. We may also disclose your protected health information, if directed by the public health authority, to a foreign government agency that is collaborating with the public health authority.
We may disclose your protected health information, if authorized by law, to a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading the disease or condition.
We may disclose protected health information to a health oversight agency for activities authorized by law, such as audits, investigations, and inspections. Oversight agencies seeking this information include government agencies that oversee the healthcare system, government benefit programs, other government regulatory programs and civil rights laws.
Abuse or Neglect:
We may disclose your protected health information to a public health authority that is authorized by law to receive reports of child abuse or neglect. In addition, we may disclose your protected health information if we believe that you have been a victim of abuse, neglect or domestic violence to the governmental entity or agency authorized to receive such information. In this case, the disclosure will be made consistent with the requirements of applicable federal and state laws.
Food and Drug Administration:
We may disclose your protected health information to a person or company required by the Food and Drug Administration to report adverse events, product defects or problems, biologic product deviations, track products; to enable product recalls; to make repairs or replacements, or to conduct post marketing surveillance, as required.
We may disclose protected health information in the course of any judicial or administrative proceeding, in response to an order of a court or administrative tribunal (to the extent such disclosure is expressly authorized), in certain conditions in response to a subpoena, discovery request or other lawful process.
We may also disclose protected health information, so long as applicable legal requirements are met, for law enforcement purposes.These law enforcement purposes include:
(1) Legal processes otherwise required by law;
(2) Limited information requests for identification and location purposes;
(3) Pertaining to victims of a crime;
(4) Suspicion that death has occurred as a result of criminal conduct;
(5) In the event that a crime occurs on hospital premise; and
(6) Medical emergency (not on the hospital premises) and it is likely that a crime has occurred.
Coroners, Funeral Directors, and Organ Donation:
We may disclose protected health information to a coroner or medical examiner for identification purposes, determining cause of death or for the coroner or medical examiner to perform other duties authorized by law. We may also disclose protected health information to a funeral director, as authorized by law, in order to permit the funeral director to carry out their duties. We may disclose such information in reasonable anticipation of death. Protected health information may be used and disclosed for cadaveric organ, eye or tissue donation purposes.
We may disclose your protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.
Consistent with applicable federal and state laws, we may disclose your protected health information, if we believe that the use or disclosure is necessary to prevent or lessen a serious and imminent threat to the health or safety of a person or the public. We may also disclose protected health information if it is necessary for law enforcement authorities to identify or apprehend an individual.
Military Activity and National Security:
When the appropriate conditions apply, we may use or disclose protected health information of individuals who are Armed Forces personnel (1) for activities deemed necessary by appropriate military command authorities; (2) for the purpose of a determination by the Department of Veterans Affairs of your eligibility for benefits, or (3) to foreign military authority if you are a member of that foreign military services. We may also disclose your protected health information to authorized federal officials for conducting national security and intelligence activities, including for the provision of protective services to the President or others legally authorized.
Your protected health information may be disclosed by us as authorized to comply with workers’ compensation laws and other similar legally established programs.
We may use or disclose your protected health information if you are an inmate of a correctional facility and we created or received your protected health information in the course of providing care to you.
Required Uses and Disclosures:
Under the law, we must make disclosures to you, and when required by the Secretary of the Department of Health and Human Services, to investigate or determine our compliance with the requirements of Section 164.500 et. seq.
Following is a statement of your rights with respect to your protected health information and a brief description of how you may exercise these rights.
You have the right to inspect and copy your protected health information. This means you may inspect and obtain a copy of protected health information about you that is contained in a designated record set for as long as we maintain the protected health information. A “designated record set” contains medical and billing records and any other records that Chilton Hospital uses for making decisions about you.
Under federal law, however, you may not inspect or copy the following records: psychotherapy notes, information compiled in reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information. Depending on the circumstances, a decision to deny access may be reviewable. In some circumstances, you may have a right to have this decision reviewed. Please contact our Privacy Officer at 973-831-5087 if you have questions about access to your medical record.
You have the right to request a restriction of your protected health information. This means you may ask us not to use or disclose any part of your protected health information for the purposes of treatment, payment or healthcare operations. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.
Chilton Hospital is not required to agree to a restriction that you may request. If we believe it is in your best interest to permit use and disclosure of your protected health information, your protected health information will not be restricted. If Chilton Hospital does agree to the requested restriction, we may not use or disclose your protected health information in violation of that restriction unless it is needed to provide emergency treatment. With this in mind, please discuss any restriction you wish to request with your provider. You may request a restriction by requesting an Authorization form from Medical Record Services.
You have the right to request to receive confidential communications from us by alternative means or at an alternative location. We will accommodate reasonable requests. We may also condition this accommodation by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. We will not request an explanation from you as to the basis for the request. Please make this request in writing to our Privacy Officer at 97 West Parkway, Pompton Plains, NJ 07444.
You have the right to request an amendment to your protected health information. This means you may request an amendment of protected health information about you in a designated record set for as long as we maintain this information. In certain cases, we may deny your request for an amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal. Please contact our Privacy Officer to determine if you have questions about amending your medical record.
You have the right to receive an accounting of certain disclosures we have made, if any, of your protected health information. This right applies to disclosures for purposes other than treatment, payment or healthcare operations as described in this Notice of Privacy Practices. It excludes disclosures we may have made to you, to family members or friends involved in your care, or for notification purposes. You have the right to receive specific information regarding these disclosures that occurred after April 14, 2003. The right to receive this information is subject to certain exceptions, restrictions and limitations.
You have the right to obtain a paper copy of this notice from us, upon request, even if you have agreed to accept this notice electronically.
You may contact the hospital’s Privacy Officer at 973-831-5087 or the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. We will not retaliate against you for filing a complaint.