THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW
If you have any questions about this notice, please contact our Privacy Officer at (406)488-2100.
Who Will Follow This Notice
Sidney Health Center (SHC) includes the following affiliated care
settings: SHC Hospital, SHC Extended Care Facility, SHC Home Health,
SHC Hospice, The Lodge at Lone Tree Creek, Community Clinic Pharmacy,
MonDak Clinic & Pharmacy, DuraMed, and SHC-owned clinic offices.
All of these care settings follow the terms of this notice. In
addition, these care settings may share medical information with each
other for treatment, payment or health care operational purposes
described in this notice. We reserve the right to revise or amend this
In addition, this notice applies to:
- Any health care personnel authorized to enter information into your
medical record, including members of our medical staff, employees,
volunteers, trainees, students, or other SHC personnel providing
services in the Hospital or other affiliated care setting listed above.
- All departments and units Sidney Health Center, including our outpatient clinics.
Our Pledge Regarding Medical Information
At SHC, we understand that medical information about you and your health
is personal, and we are committed to protecting the privacy of that
information, wherever generated or used. We create a record of the
care and services you receive at one of our care settings described
above. We need this record to provide you with quality care and to
comply with certain legal requirements. This notice applies to all of
the records of your care generated by SHC, whether made by SHC personnel
or your personal doctor. Your personal doctor, including physician
offices not owned by SHC, may have different policies or notices
regarding the doctor's use and disclosure of your medical information
created in the doctor's office or clinic.
This notice will tell you about the ways in which we may use and
disclose medical information about you. We also describe your rights
and certain obligations we have regarding the use and disclosure of
We are required by law to:
- make sure that medical information that identifies you is kept private;
- give you this notice of our legal duties and privacy practices with respect to medical information about you; and
- follow the terms of the notice that is currently in effect.
How We May Use & Disclose Medical Information About You
The following categories describe different ways that we use and
disclose medical information. For each category of uses or disclosures
we will explain what we mean and try to give some examples. Not every
use or disclosure in a category will be listed. However, all of the
ways we are permitted to use and disclose information will fall within
one of the categories.
We may use medical information about you to provide you with medical
treatment or services. We may disclose medical information about you to
doctors, nurses, technicians, medical students, pharmacists and their
assistants, or other personnel who are involved in taking care of you at
the hospital or other SHC care setting. For example, a doctor treating
you for a broken leg may need to know if you have diabetes because
diabetes may slow the healing process. In addition, the doctor may need
to tell the dietitian if you have diabetes so that we can arrange for
appropriate meals. Different departments of SHC also may share medical
information about you in order to coordinate the different things you
need, such as prescriptions, lab work and x-rays. We also may disclose
medical information about you to people outside SHC who may be involved
in your medical care after you leave SHC, such as family members, clergy
or others we use to provide services that are part of your care.
Certain incidental disclosures of your medical information may occur
as a by-product of permitted uses and disclosures. For example, a
visitor may inadvertently overhear a discussion about your care
occurring at the nurses’ station.
We may use and disclose medical information about you so that the
treatment and services you receive at SHC may be billed to and payment
may be collected from you, an insurance company or a third party. For
example, we may need to give your health plan information about surgery
you received at the hospital so your health plan will pay us or
reimburse you for the surgery. We may also tell your health plan about a
treatment you are going to receive to obtain prior approval or to
determine whether your plan will cover the treatment.
For Health Care Operations
We may use and disclose medical information about you for SHC’s
operations. These uses and disclosures are necessary to run SHC and to
make sure that all of our patients and residents receive quality care.
For example, we may use medical information to review our treatment and
services and to evaluate the performance of our staff in caring for you.
We may also combine medical information about many patients to decide
what additional services SHC should offer, what services are not needed,
and whether certain new treatments are effective. We may also disclose
information to doctors, nurses, technicians, medical students, and
other SHC personnel for review and learning purposes. We may also
combine the medical information we have with medical information from
other health care providers to compare how we are doing and see where we
can make improvements in the care and services we offer. We may remove
information that identifies you from this set of medical information so
others may use it to study health care and health care delivery without
learning who the specific patients are.
We may use and disclose medical information to contact you as a
reminder that you have an appointment for treatment or medical care at a
SHC care setting.
We may use and disclose medical information to tell you about or
recommend possible treatment options or alternatives that may be of
interest to you.
Health Related Benefits & Services
We may use and disclose medical information to tell you about
health-related benefits or services that may be of interest to you.
We may use or disclose a limited amount of information about you to
contact you in an effort to raise money for SHC or for other charitable
endeavors supported by the Foundation for Community Care. We only would
release contact information, such as your name, address and phone
number and the dates you received treatment or services at the hospital.
If you do not want the Foundation to contact you for fundraising
efforts, you must notify the Foundation for Community Care in writing at
221 2nd Street NW, Sidney, MT 59270.
Unless you request that such information not be released, we may
include certain limited information about you in the facility directory
while you are a patient. This information may include your name,
location in the facility, your general condition (e.g., fair, stable,
etc.) and your religious affiliation. The directory information, except
for your religious affiliation, may also be released to people who ask
for you by name. Your religious affiliation may be given to a member of
the clergy, such as a pastor or priest, even if they don’t ask for you
by name. This is so your family, friends and clergy can visit you in
the hospital and generally know how you are doing.
Individuals Involved In Your Care or Payment For Your Care
Unless you object, we may release medical information about you to a
friend or family member who is involved in your medical care. We may
also give information to someone who helps pay for your care. We may
also tell your family or friends your condition and that you are in the
hospital. In addition, we may disclose medical information about you to
an entity assisting in a disaster relief effort so that your family can
be notified about your condition, status and location. We will also
disclose protected health information to an individual if we reasonably
infer from the circumstances, based on the exercise of professional
judgment, that you do not object to the disclosure.
Limited Uses When You Are Not Present or Are Incapacitated
If you are not present or cannot object to disclosure of information
because of incapacity or an emergency circumstance, we will, in the
exercise of professional judgment, disclose protected information in
your best interests. We may use professional judgment and experience to
make reasonable inferences of your best interest in allowing a person to
pick up filled prescriptions, medical supplies, x-rays, or other
similar forms of protected health information on your behalf. In
addition, we may disclose medical information about you to an entity
assisting in a disaster relief effort.
Under certain circumstances, we may use and disclose medical
information about you for research purposes. For example, a research
project may involve comparing the health and recovery of all patients
who received one medication to those who received another, for the same
condition. All research projects, however, are subject to a special
As Required By Law
We will disclose medical information about you when required to do so by federal, state or local law.
To Avert A Serious Threat To Health or Safety
We may use and disclose medical information about you when necessary to
prevent a serious threat to your health and safety or the health and
safety of the public or another person. Any disclosure, however, would
only be to someone able to help prevent the threat.
Organ & Tissue Donation
If you are an organ donor, we may release medical information to
organizations that handle organ procurement or organ, eye or tissue
transplantation or to an organ donation bank, as necessary to facilitate
organ or tissue donation and transplantation.
Military & Veterans
If you are a member of the armed forces, we may release medical
information about you as required by military command authorities. We
may also release medical information about foreign military personnel to
the appropriate foreign military authority.
We may release medical information about you for workers' compensation
or similar programs. These programs provide benefits for work-related
injuries or illness.
Public Health Activities
We may disclose medical information about you for public health activities. These activities generally include the following:
- to prevent or control disease, injury or disability;
- to report births and deaths;
- to report child abuse or neglect;
- to report reactions to medications or problems with products;
- to notify people of recalls of products they may be using;
- to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
- to notify the appropriate government authority if we believe a
patient has been the victim of abuse, neglect or domestic violence. We
will only make this disclosure if you agree or when required or
authorized by law.
- To an employer, when required by federal or state law, to
conduct medical surveillance of the workplace or to evaluate whether an
individual has a work-related illness or injury.
Victims of Abuse, Neglect or Domestic Violence
We may disclose protected health information about an individual we
reasonably believe to be the victim of abuse, neglect or domestic
violence to a person authorized by law to receive such reports. We will
make this disclosure if you agree, or if the disclosure is required or
authorized by law and we believe the disclosure is necessary to prevent
harm to the victim or other potential victims. Also if the patient is
incapacitated, we may disclose information to a person authorized to
receive such reports, if that person represents that the protected
health information is not intended to be used against the patient and
that an immediate enforcement activity depends upon the disclosure.
Health Oversight Activities
We may disclose medical information to a health oversight agency for
activities authorized by law. These oversight activities include, for
example, audits, investigations, inspections, and licensure. These
activities are necessary for the government to monitor the health care
system, government programs, and compliance with civil rights laws.
Lawsuits & Disputes
If you are involved in a lawsuit or a dispute, we may disclose medical
information about you in response to a court or administrative order.
We may also disclose medical information about you in response to a
subpoena, discovery request, or other lawful process by someone else
involved in the dispute.
We may release medical information if asked to do so by a law enforcement official:
- as required by law that mandates reporting of certain types of wounds or injuries.
- In response to a court order, subpoena, warrant, summons or similar process;
- To identify or locate a suspect, fugitive, material witness, or missing person;
- About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement;
- About a death we believe may be the result of criminal conduct;
- About criminal conduct at the hospital; and
- In emergency circumstances to report a crime; the location of the
crime or victims; or the identity, description or location of the person
who committed the crime.
Coroners, Medical Examiners & Funeral Directors
We may release protected health information to a coroner or medical
examiner. This may be necessary, for example, to identify a deceased
person or determine the cause of death. We may also release protected
health information to funeral directors as necessary to carry out their
National Security & Intelligence Activities
We may release medical information about you to authorized federal
officials for intelligence, counterintelligence, and other national
security activities authorized by law. We may disclose medical
information about you to authorized federal officials so they may
provide protection to the President, other authorized persons or foreign
heads of state or conduct special investigations.
If you are an inmate of a correctional institution or under the
custody of a law enforcement official, we may release medical
information about you to the correctional institution or law enforcement
official. This release would be necessary (1) for the institution to
provide you with health care; (2) to protect your health and safety or
the health and safety of others; or (3) for the safety and security of
the correctional institution.
Limited Data Sets
We may disclose limited medical information to third parties for
research, public health, and health care operations. Before disclosing
such information, we will enter into an agreement that limits the
recipient’s use and disclosure of the information and prohibits the
recipient from attempting to re-identify the data or contact you.
Your Rights Regarding Medical Information About You
You have the following rights regarding medical information we maintain about you:
Right to Inspect & Copy
You have the right to inspect and copy medical information that may
be used to make decisions about your care. Usually, this includes
medical and billing records.
To inspect and copy medical information that may be used to make
decisions about you, you must submit your request in writing to the SHC
Privacy Officer. If you request a copy of the information, we may
charge a fee for the costs of copying, mailing or other supplies
associated with your request.
We may deny your request to inspect and copy in certain very limited
circumstances. If you are denied access to medical information, you may
request that the denial be reviewed. Another licensed health care
professional chosen by the hospital will review your request and the
denial. The person conducting the review will not be the person who
denied your request. We will comply with the outcome of the review.
Right to Amend
If you feel that medical information we have about you is incorrect or
incomplete, you may ask us to amend the information. You have the
right to request an amendment for as long as the information is kept by
or for the hospital.
To request an amendment, your request must be made in writing and
submitted to the SHC Privacy Officer. In addition, you must provide a
reason that supports your request.
We may deny your request for an amendment if it is not in writing or
does not include a reason to support the request. In addition, we may
deny your request if you ask us to amend information that:
- Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
- Is not part of the medical information kept by or for the hospital;
- Is not part of the information which you would be permitted to inspect and copy; or
- Is accurate and complete.
Right to an Accounting of Disclosures
You have the right to request an "accounting of disclosures." This is
a list of the disclosures we made of medical information about you for
purposes other than treatment , payment, or health care operations.
To request this list or accounting of disclosures, you must submit your
request in writing to the SHC Privacy Officer. Your request must state a
time period which may not be longer than six years and may not include
dates before April 14, 2003.
Right to Request Restrictions
You have the right to request a restriction or limitation on the
medical information we use or disclose about you for treatment, payment
or health care operations. You also have the right to request a limit
on the medical information we disclose about you to someone who is
involved in your care or the payment for your care, like a family member
or friend. For example, you could ask that we not use or disclose
information about a surgery you had.
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 emergency treatment.
To request restrictions, you must make your request in writing to the
Privacy Officer. In your request, you must tell us (1) what information
you want to limit; (2) whether you want to limit our use, disclosure or
both; and (3) to whom you want the limits to apply, for example,
disclosures to your spouse.
Right to Request Confidential Communications
You have the right to request that we communicate with you about
medical matters in a certain way or at a certain location. For example,
you can ask that we only contact you at work or by mail.
To request confidential communications, you must make your request in
writing to the Privacy Officer. We will not ask you the reason for
your request. We will accommodate all reasonable requests. Your
request must specify how or where you wish to be contacted.
Right to a Paper Copy of this Notice
You have the right to a paper copy of this notice. You may ask us to
give you a copy of this notice at any time. You may also obtain a copy
of this notice at our website, www.sidneyhealth.org.
Changes to this Notice
We reserve the right to change this notice. We reserve the right to
make the revised notice effective for medical information we already
have about you as well as any information we receive in the future. We
will post a copy of the current notice in the Hospital and other
SHC-affiliated care settings.
If you believe your privacy rights have been violated, you may submit a
written complaint to the Privacy Officer at Sidney Health Center. If we
cannot resolve your concern, you also have the right to file a written
complaint with the Secretary of the U.S. Department of Health and Human
Services. The quality of your care will not be jeopardized, nor will
you be penalized for filing a complaint.
Other Uses of Medical Information
Other uses and disclosures of medical information not covered by this
notice or the laws that apply to us will be made only with your written
permission. If you provide us permission to use or disclose medical
information about you, you may revoke that permission, in writing, at
any time. If you revoke your permission, we will no longer use or
disclose medical information about you for the reasons covered by your
written authorization. You understand that we are unable to take back
any disclosures we have already made with your permission, and that we
are required to retain our records of the care that we provided to you.
Effective date: April 7, 2003