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Privacy Policy
Effective April 14, 2004
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.
If you have any questions about this notice, please contact the Privacy Officer designated on the last page of the document.
Who Will Follow This Notice
This notice describes Litzenberg Memorial County Hospital's practices and that of:
Any health care professional authorized to enter information into your hospital medical record; All departments and services of the hospital; Any member of the volunteer group that assists you while you are receiving health care; and any employees, staff and other hospital personnel.
Our Pledge Regarding Medical Information
The hospital understands that medical information about you and your health is personal. The hospital is committed to protecting medical information about you. The hospital creates a record of the care and services you receive at the hospital. The hospital needs this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all the records of your care generated by the hospital, whether made by hospital personnel or your personal doctor. Your personal doctor 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.
The Hospital is Required by Law
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 all medical information about you
Follow the terms of the notice that is currently in effect
Notify you if we are unable to agree to a requested restriction on how your information is used or disclosed
Accommodate reasonable requests you may make to communicate health information by alternative means or at alternative locations.
Obtain your written authorization to use or disclose your health information for reasons other than those listed above and permitted under law.
How the Hospital May Use and Disclose Medical Information About You
For Treatment The hospital may use and disclose your health information to provide you with medical treatment or services. For example, information obtained by a health care provider, such as a physician, nurse, or other person providing health services to you, will document information in your record that is related to your treatment. This information is necessary for health care providers to determine what treatment you should receive. Health care providers will also record actions taken by them in the course of your treatment and note how you respond to the actions.
For Payment The hospital may use and disclose your health information to others for purposes of receiving payment for treatment and services that you receive. For example, a bill may be sent to you or a third-party payer, such as an insurance company or health plan. The information on the bill may contain information that identifies you, your diagnosis, and treatment or supplies used in the course of treatment.
For Health Care Operations The hospital may use and disclose your health information for operational purposes. For example, your health information may be disclosed to members of the hospital's health care staff, risk or quality improvement personnel, and to others to: Evaluate the performance of our staff; Assess the quality of care and outcomes in your cases and in similar cases; Learn how to improve our facilities and services; and Determine how to continually improve the quality and effectiveness of the healthcare we provide.
Appointment Reminders The hospital may use and disclose your health information to contact you as a reminder that you have an appointment for treatment or medical care.
Treatment Alternatives The hospital may use and disclose your health information to recommend possible treatment options or alternatives that may be of interest to you.
Hospital Directory The hospital may include certain limited information about you in the hospital directory while you are a patient at the hospital. This information may include your name, location in the hospital, and your general condition (e.g. fair, stable, etc). Unless there is a specific written request from you to the contrary, this directory information may also be released to people who ask for you by name. This information is released 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 The hospital may use and disclose your information to a friend or family member who is legally involved in your medical care. The hospital may also give information to someone who helps pay for your care, unless there is a specific written request from you to the contrary. In addition, the hospital 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.
Research The hospital may use and disclose your health information for research purposes after your approval and approval by the hospital's Privacy Committee who will review the research proposal and established protocols to ensure the privacy of your health information.
As Required by Law The hospital may use and disclose your health information as required by law. For example, the hospital may disclose information for the following purposes:
For judicial and administrative proceedings pursuant to legal authority;
To report information related to victims of abuse, neglect or domestic violence;
To assist law enforcement officials in their law enforcement duties.
Health or Safety The hospital may use and disclose your health information to avert a serious threat to the health and safety of you or any other person pursuant to applicable law.
Organ and Tissue Donation The hospital may disclose health information in cases of death to a transplant donor network for the purposes of organ, eye or tissue donation.
Military and Veterans If you are a member of the armed forces, the hospital may disclose your information as required by military command authorities. The hospital may also disclose health information about foreign military personnel to the appropriate foreign military authority.
Workers' Compensation The hospital may use and disclose your health information in order to comply with laws and regulations related to Workers' Compensation.
Public Health Risks The hospital may use and disclose your health information for public health activities such as assisting public health authorities or other legal authorities to prevent or control disease, injury, or disability.
Disaster or Mass-Casualty Event The hospital may disclose to family members and friends your location, general condition, or death. Also, the State and County Health Department is allowed access to private health information in a disaster if next of kin cannot be located.
Health Oversight Activities The hospital may disclose your health 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.
Coroners, Medical Examiners and Funeral Directors The hospital may disclose your health information to funeral directors, coroners or medical examiners to enable them to carry out their lawful duties.
National Security and Intelligence Activities The hospital may disclose your health information to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Inmates If you are an inmate of a correctional institution or under the custody of a law enforcement official, the District may disclose your health information 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.
Your Health Information You Have the Right to:
Inspect and obtain copies of your health record as provided for in 45 CFR* §164.524;
Amend your health record as provided in 45 CFR §164.526;R
eceive an accounting of disclosures made of your health information as provided by 45 CFR §164.528;R
Request a restriction on certain uses and disclosures of your information by 45 CFR §164.522; however, the histrict is not required to agree to a requested restriction;
Request communications of your health information by alternative means or at alternative locations; however, transmission of PHI using alternative means (such as the use of e-mail) may not be secure;
Revoke your authorization to use or disclose health information except to the extent that action has already been taken; and Obtain a copy of this notice of privacy practices upon request; you may obtain a copy of this notice at our website, bhanrath@lmchospital.org. or contact the
Hospital's Privacy Office.
Changes to This Notice
The Hospital reserves the right to change this notice. The hospital reserves the right to make the revised or changed notice effective for medical information the hospital already has about you as well as any information the hospital receives in the future. The hospital will post a copy of the current notice in the hospital.
Complaints
If you believe your privacy rights have been violated, you may file a complaint with the hospital or with the Secretary of the Department of Health and Human Services (contact information is on the last page of this notice). To file a complaint with the hospital, contact the Privacy Office. All complaints must be submitted in writing.
You will not be penalized for filing a complaint.
Litzenberg Memorial County Hospital
Privacy Officer
1715 26th Street
Central City, NE 68826
Phone:
308-946-3015
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