THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

I. Understanding Your Health Record Information.

Each time you visit a hospital, physician or other healthcare provider, the provider makes a record of it. Typically, this record contains your health history, current symptoms, examination and test results, diagnoses, treatment and a plan for future care or treatment. This information, often referred to as your medical record, serves as a:

A. Basis for planning your care and treatment.

B. Means of communication among the many health professionals who contribute to your care.

C. Legal document describing the care you received.

D. Means by which you or a third-party payer can verify that you actually received the services billed.

E. Tool in medical education.

F. Source of information for public health officials charged with improving the health regions they serve.

G. Tool to assess the appropriateness and quality of care you received.

H. Tool to improve the quality of healthcare and achieve better patient outcomes.

Understanding what is in your health records and how your health information is used helps you to:

I. Ensure its accuracy and completeness.

J. Understand who, what, where, when, why and how others may access your health information.

K. Make informed decisions about authorizing disclosure to others.

L. Better understand the health information rights detailed below. (See Section III)

II. We Have a Legal Duty to Safeguard Your Protected Health Information

We are legally required to protect the privacy of your health information. We call this information "protected health information," or "PHI" for short. It includes information that can be used to identify you, that we’ve created or received about your past, present, or future health or condition, the provision of health care to you, or the payment of health care. We must provide you with this notice about our privacy practices that explains how, when, and why we use and disclose your health information. With some exceptions, we may not use or disclose any more of your health information 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.

Lakeland Regional Health System (LRHS) and all of its subsidiaries will abide by the LRHS Notice of Privacy Practices. All credentialed medical staff of LRHS and its subsidiaries will abide by the LRHS Notice of Privacy Practices while operating at an LRHS entity. The LRHS Notice of Privacy Practices will not cover the credentialed medical staff in their individual office practices. An Organized Health Care Arrangement (OHCA) is a clinically integrated arrangement in which patients are treated by two or more health care providers. All members of the OHCA may use and disclose protected health information across the arrangement, as they would within their individual operations including as necessary to carry out treatment, payment and health care operations.

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 health information we already have. Before we make an important change to our policies, we will promptly change this notice and post a new notice. You can also request a copy of this notice from the contact person listed in Section VI below at any time and can view a copy of the notice on our Web site at www.lakelandhealth.org.

III. Your Rights Under the Federal Privacy Standard

Although your health record is the physical property of the healthcare provider who completed it, you have certain rights with regard to the information contained therein. You have the right to:

A. Request a restriction on uses and disclosures of your health information. You have the right to ask that we limit how we use and disclose your health information. We will consider your request but are not legally required to accept it. If we accept your request, we will put any limits in writing and abide by them except in emergency situations. You may not limit the uses and disclosures that we are legally required or allowed to make. In those cases, you do not have a right to request restriction.

B. The Right to Choose How We Send Health Information to You. You may also ask us to communicate with you by alternative means and, if the method of communication is reasonable, we must grant the alternative communication request. You have the right to ask that we send information to you to 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 so long as we can easily provide it in the format you requested.

C. Obtain a copy of this notice of privacy practices. Although we have posted a copy in prominent locations throughout the facility and on our Web site, you have a right to a hard copy upon request. You have a right to get a copy of this notice by e-mail. Even if you have agreed to receive notice via e-mail, you also have the right to request a paper copy of this notice.

D. Inspect and copy your health information upon request. In most cases, you have the right to look at or get copies of your health information that we have, but you must make the request in writing. If we do not have your health information, but we know who does, we will tell you how to get it. We will respond to you within 30 days after receiving your written request. In certain situations, such as if access would cause harm, we can deny access. If we do deny the request, we will tell you, in writing, our reasons for the denial and explain your rights to have the denial reviewed. You do not have a right of access to the following:

1. Information compiled in reasonable anticipation of or for use in civil, criminal, or administrative actions or proceedings.

2. Protected health information (PHI) that is subject to the Clinical Laboratory Improvement Amendments of 1988 (CLIA), 42 USC 263a, to the extent that the provision of access to the individual would be prohibited by law.

Information was obtained from someone other than a healthcare provider under a promise of confidentiality and the access requested would be reasonably likely to reveal the source of the information.

In other situations, we may deny you access but, if we do, we must provide you with a review of the decision denying access. These "reviewable" grounds for denial include:

1. Licensed healthcare professional has determined, in the exercise of professional judgment, that the access is reasonably likely to endanger the life or physical safety of yourself or another person.

2. Health information makes reference to another person (other than a healthcare provider) and a licensed healthcare provider has determined, in the exercise of professional judgment, that the access is reasonably likely to cause substantial harm to such other person.

3. The request is made by your personal representative and a licensed healthcare professional has determined, in the exercise of professional judgment, that providing access to such personal representative is reasonably likely to cause substantial harm to you or another person.

4. For these reviewable grounds, another licensed professional must review the decision of the provider denying access within 60 days. If we deny you access, we will explain why and what your rights are, including how to seek review.

If we grant access, we will tell you what, if anything, you have to do to get access. We reserve the right to charge a reasonable, cost-based fee for making copies.

E. Request amendment/correction of your health information. If you believe that there is a mistake in your health information or that a piece of important information is missing, you have a right to request that we correct the existing information or add the missing information. You must provide the request and your reason for the request in writing. We will respond within 60 days of receiving your request. We do not have to grant the request if:

1. We did not create the record. If, as in the case of a consultation report from another provider, we did not create the record, we cannot know whether it is accurate or not. Thus, in such cases, you must seek amendment/correction from the party creating the record. If they amend or correct the record, we will put the corrected record in our records.

2. The records are not available to you as discussed immediately above.

3. The record is accurate and complete.

If we deny your request for amendment/correction, we will notify you why, how you can attach a statement of disagreement to your records (which we may rebut), and how you can complain. If we grant the request, we will make the correction and distribute the correction to those who need it and those you identify to us that you want to receive the corrected information.

F. Obtain an accounting of "non-routine" uses and disclosures- those other than for treatment, payment and healthcare operations. You have the right to get a list of instances in which we have disclosed your health information.

We do not need to provide an accounting for disclosures of protected health information

to you
to the facility directory or to persons involved in your care or for other notification purposes
for national security or intelligence purposes
to correctional institutions or law enforcement officials.
that occurred before April 14, 2003.

We must provide the accounting within 60 days. The list we will give you will include disclosures made in the last six years unless you request a shorter time. The accounting must include:

date of each disclosure
name and address of the organization or person who received the protected health information
a brief description of the information disclosed
a brief statement of the purpose of the disclosure that reasonably informs you of the basis for the disclosure or, in lieu of such statement, a copy of your written authorization, or a copy of the written request for disclosure.

The first accounting in any 12-month period is free. Thereafter, we reserve the right to charge a reasonable, cost-based fee.

G. Revoke your consent or authorization to use or disclose health information except to the extent that we have already taken action in reliance on the consent or authorization.

IV. Our Responsibilities Under the Federal Privacy Standard

In addition to providing you your rights, as detailed above, the federal privacy standard requires us to:

A. Maintain the privacy for your health information, including implementing reasonable and appropriate physical, administrative, and technical safeguards to protect the information.

B. Provide you with this notice as to our legal duties and privacy practices with respect to individually identifiable health information we collect and maintain about you.

C. Abide by the terms of this notice.

D. Train our personnel concerning privacy and confidentiality.

E. Implement a sanction policy to discipline those who breach privacy/confidentiality or our policies with regard thereto.

F. Mitigate (lessen the harm of) any breach of privacy/confidentiality.

We will not use or disclose your health information without your consent or authorization, except as described in this notice or otherwise required by law.

V. 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 or disclosures, we need your prior consent or specific authorization. Below, we describe the different categories of our uses and disclosures and give you some examples of each category.

A. Uses and disclosures relating to treatment, payment or healthcare operations. We may use and disclose your health information for the following reasons.

1. For Treatment. We may disclose your health information to physicians, nurses, healthcare students, and other healthcare personnel who provide you with healthcare services or are involved in your care. For example, an anesthesiologist, a psychiatrist, psychologist, chaplain, clinical social worker, other therapist or counselor, nurse, or other member of your healthcare team will record information in your record to diagnose your condition and determine the best course of treatment for you. The primary caregiver will give treatment orders and document what he or she expects other members of the healthcare team to do to treat you. Those other members will then document the actions they took and their observations. In that way, the primary caregiver will know how you are responding to treatment. We will also provide your physician, other healthcare professionals, or a subsequent healthcare provider with copies of your records to assist them in treating you once we are no longer treating you.

2. To Obtain Payment for Treatment. We may use and disclose your health information in order to bill and collect payment for treatment and services provided to you. For example, we may provide portions of your health information to our Patient Accounts Department and your health plan/insurer to get paid for the healthcare services we provided to you. The information provided may include information that identifies you, your diagnosis, procedures, treatments received, and supplies used. We may also provide your health information to our business associates, such as billing companies, claims processing companies, and others that process our health care claims. We may disclose your health information to a business associate so that they can perform the functions(s) we have contracted with them to do. To protect your health information, however, we require the business associate to appropriately safeguard your information.

3. For Health Care Operations. We may disclose your health information in order to operate this hospital. For example, we may use your health information in order to evaluate the quality of healthcare services that you received or to evaluate the performance of the healthcare professionals who provided healthcare services to you. We will use this information in an effort to continually improve the quality and effectiveness of the healthcare and services we provide. We may also provide your health information to our accountants, attorneys, consultants, and others in order to make sure we are complying with the laws that affect us.

B. Certain Uses and Disclosures Do Not Require Your Consent. We may use and disclose your health information without your consent or 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 or law enforcement personnel about victims of abuse, neglect, or domestic violence; when dealing with gunshot or other wounds; or when ordered in a judicial or administrative proceeding. We may disclose health information for purposes as required by law or in response to a valid subpoena.

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 and medical examiners necessary information relating to an individual’s death. As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability. We may disclose health information to funeral directors consistent with applicable law to enable them to carry out their duties.

3. For health oversight activities. For example, we will provide information to assist the government when it conducts an investigation or inspection of a healthcare provider or organization.

4. For purposes of organ donation. We may notify organ procurement organizations to assist them in organ, eye, or tissue donation and transplants.

5. For research purposes. We may disclose 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 health information.

6. To avoid harm. In order to avoid a serious threat to the health or safety of a person or the public, we may provide health information to law enforcement personnel or persons able to prevent or lessen such harm.

7. For specific government functions. We may disclose health information of military personnel and veterans in certain situations. And we may disclose health information for national security purposes, such as protecting the president of the United States or conducting intelligence operations.

8. For workers’ compensation purposes. We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers’ compensation or other similar programs established by law.

9. Appointment reminders and health-related benefits or services. We may use health information to provide appointment reminders or give you information about treatment alternatives, or other healthcare services or benefits we offer. We may use your health information to provide instructions prior to procedure/treatment /services.

10. Fund-raising activities. We may use health information to raise funds for our organization. The money raised through these activities is used to expand and support the healthcare services and educational programs we provide to the community. If you do not wish to be contacted as part of our fund-raising efforts, please contact the person listed in Section VI below.

11. Food and Drug Administration (FDA). We may disclose to the FDA health information relative to adverse effects/events with respect to food, drugs, supplements, product or product defects, or post marketing surveillance information to enable product recalls, repairs, or replacements.

12. Correctional institution. Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.

13. The Federal Department of Health and Human Services (HHS). Under the privacy standards, we must disclose your health information to HHS as necessary for them to determine our compliance with those standards.

C. Two Uses and Disclosures Require You to Have the Opportunity to Object.

1. Patient Directories. We may include your name, location in facility, 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 health information to a family member, friend, or other person that is involved in your care or the payment for your health care, unless you object in whole or in part. Health professionals using their best judgment may disclose to a family member, other relative, close personal friend health information relevant to that person’s involvement in your care or payment related to your care.

VI. How to Get More Information

If you have questions and/or would like additional information, you may contact the Privacy Officer at 269-983-8195.

VII. How to Complain About Our Privacy Practices

If you think that we may have violated your privacy rights, or you disagree with a decision we made about access to your health information, you may contact the Lakeland privacy officer at 269-983-8195. The privacy officer will follow up on all complaints and respond in writing within 60 days of the complaint.

You also may send a written complaint to the secretary of the Department of Health and Human Services.

The U.S. Department of Health and Human Services
200 Independence Avenue, S.W.
Washington D.C., 20201
Toll-free phone: 1-877-696-6775

We will take no retaliatory action against you if you file a complaint about our privacy practices.

VIII. Effective Date of This Notice

This notice went into effect on April 1, 2003

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