Notice of privacy practices

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. 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," and 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 this health care. We must provide you with this Notice about our privacy practices that explains how, when, and why we use and disclose your PHI. We are legally required to follow the privacy practices that are described in this notice.

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. As we make changes 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 V. below and can view a copy of the Notice on our Web site at www.skiffmed.com.

II. Who Will Follow This Notice:

This notice describes the practices regarding the use of your medical information by the Medical Center and by:

• Any health-care professional authorized to enter information into your medical record at the Medical Center including, without limitation, the members of the Medical Center's medical staff, who are participants in an organized health-care arrangement with the Medical Center for privacy purposes.
• All departments and units of the Medical Center and/or Medical Center clinics you may visit.
• Any member of a volunteer group we allow to help you while you are in the Medical Center or in a Medical Center clinic.
• All employees, staff and other personnel who may need access to your information.
• All entities, sites and locations of the Medical Center, including Home Care, Occupational Health, Assisted Living, Monroe Health Services, Colfax Health Services and Baxter Health Services. In addition, these entities, sites and locations may share medical information with each other for treatment, payment or health-care purposes described in this Notice.

III. How We May Use and Disclose Your Protected Health Information.

We use and disclose health information for many different reasons. Listed below are descriptions of purposes for which the hospital is permitted or required to use or disclose PHI about you without your written authorization. The examples below do not list every possible use or disclosure in a category.

A. Uses and Disclosures Relating to Treatment, Payment, or Health-Care Operations.

For Treatment. We will use and disclose your PHI to provide, coordinate or manage your health care at Skiff Medical Center. We may consult with other health-care providers regarding your treatment, and we may disclose your PHI to another provider to whom you are being referred. For example, if you're being treated for a knee injury, we may disclose your PHI to the Physical Therapy Department in order to coordinate your care. We will also provide your physician or subsequent health-care providers with copies of various reports that would assist them in treating you once you're discharged from this hospital. Departments of Skiff Medical Center may share your medical information to schedule the tests and procedures that you need.

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-care services we provided to you. We may tell your health plan about a treatment you are going to receive in order to obtain prior approval from your plan to cover payment for the treatment you receive. 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.

For Health-Care Operations. We may use and disclose your medical information for Skiff Medical Center operations, such as for peer review, performance improvement, risk management and our compliance with licensure, accreditation or certification requirements. For example, we may disclose your medical information to physicians on our Medical Staff who review treatment of patients. We may disclose information to doctors, nurses, technicians, or other health-care students and Skiff Medical Center personnel for teaching. We may combine medical information about many patients to decide what services Skiff Medical Center should offer and whether new services are cost-effective and how we compare with other health-care providers. Sometimes we will remove identifying information from this medical information so others may use it to study health care and health-care delivery without learning who you are. We may disclose information to other health-care providers involved in your treatment to permit them to carry out the work of their organization or to get paid. For example, we may provide information about your treatment to an ambulance company that brought you to Skiff Medical Center so that the ambulance company can get paid for its services.

We may also contact you directly or through the Medical Center`s Foundation as part of our efforts of raise funds to support the charitable operations of the Medical Center. All fund raising communications will include information about how you may opt out of future communications.

B. Other Permitted and Required Disclosures of and Uses of PHI That May Be Made if You Agree or Do Not Object:

Emergency Treatment. Your authorization isn't required if you need emergency treatment, as long as we try to get your consent after treatment or we try to get your consent but you are unable to communicate with us (for example, if you are unconscious or in severe pain).

Notification. We may use or disclose PHI to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition.

Directory. We may maintain a directory of patients so that your family, friends and clergy may visit you in the Medical Center. Unless you notify us that you object, we will include your name, location in the facility and religious affiliation in the directory. This information, except religious affiliation, will be disclosed to people that ask for you by name. Only members of the clergy will receive religious affiliation information. Your religious affiliation may be given to members of the clergy even if they don`t ask for you by name.

C. Other Permitted and Required Disclosures and Uses of PHI That May Be Made Without Your Authorization or Opportunity to Object.

Law Enforcement. We may release PHI if asked to do so by a law enforcement official in response to a court order; 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 authorization; 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.

Public Health Activities/Required By Law. We will disclose PHI about you when required or allowed by federal, state or local law. We may disclose PHI about you for the following activities: 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; or in compliance with legal proceedings.

Health Oversight Activities. We may disclose your medical information to a federal or state agency for health oversight activities such as audits, investigations, inspections, and licensure of Skiff Medical Center and of the providers who treated you at Skiff Medical Center. These activities are necessary for the government to monitor the health-care system, government programs, and compliance with laws.

Worker's Compensation. We may disclose PHI to the extent authorized by and to the extent necessary to comply with laws relating to worker`s compensation or other similar programs established by law. These programs provide benefits for work-related injuries or illnesses.

Minors. If you are a minor (under 18 years of age) Skiff Medical Center will comply with Iowa law regarding release of PHI of minors.

Individuals Involved in Your Care. We may release your medical information to the person you named in your Durable Power of Attorney for Health Care or to a friend or family member who is your personal representative. We may disclose information to an entity assisting in disaster relief efforts so that your family can be notified about your condition.

Business Associates. There are some services provided in our organization through contacts with business associates. Examples include physician services in the Emergency Room and Radiology, certain lab testing, transcription services and data collection services. When services are contracted, we may disclose your PHI so the Business Associate can perform the job we`ve asked them to do and bill you or your third party payer for services rendered. So that your PHI is protected we require business associates to appropriately safeguard your information.

Coroners, Medical Examiners and Funeral Directors. We may release PHI 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 PHI about patients of the hospital to funeral directors as necessary to carry out their duties.

Organ and Tissue Donation. Consistent with applicable law, we may disclose PHI to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

Research. We may provide PHI in order to conduct medical research that has been evaluated and approved and meets detailed privacy requirements.

Military and Veterans. If you are a member of the U.S. or foreign armed forces, we may release your medical information as required by military command authorities.

Inmates. 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 of PHI would be necessary for the institution to provide you with health care, to protect your health and safety or the health and safety of others, and/or for the safety and security of the correctional institution.

Appointments/Follow-up Calls; Treatment Alternatives and Health Benefits and Services. We may use and disclose PHI to contact you to inform you of an appointment you have for treatment at the hospital; to tell you about or recommend possible treatment options or alternatives that may be of interest.

D. Other Releases of Information. Other uses and disclosures of your PHI not covered by this notice or the laws and regulations that apply to Skiff Medical Center will be made only with your written authorization. If you choose to sign an authorization to discloses information about you, you can later revoke that authorization, in writing, to stop any future uses and disclosures of your PHI.

IV. Your Rights Regarding Your PHI

The Right to Request Limits on Uses and Disclosures of Your PHI. You have the right to ask that we limit how we use and disclose your PHI. We will consider your request but are not legally required to accept it. You may not limit the uses and disclosures that we are legally required or allowed to make.

Please make your request in writing to our Privacy Officer.

The Right to See and Get Copies of Your PHI. 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, but does not include psychotherapy notes. To inspect and copy your PHI you must submit your request in writing. This may be done by contacting our 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. We will comply with the outcome of the review.

The Right to Receive an Accounting of Certain Disclosures We Have Made of Your PHI. You have the right to request a list of certain disclosures of your protected health information made by us during a specified period of up to six years prior to the request, except disclosures: for treatment, payment or health-care operations; made to you; for our facility directory; to persons involved in your care or for the purpose of notifying your family or friends of your whereabouts; for national security or intelligence purposes; made pursuant to your written authorization; incidental to another permissible use or disclosure; for certain notification purposes (including national security, intelligence, correctional, and law enforcement purposes); or made before April 14, 2003. If you wish to make such a request, please contact our Privacy Officer. The first accounting that you request in a 12-month period will be free, but we may charge you for our reasonable costs of providing additional lists in the same 12-month period. We will tell you about these costs, and you may choose to cancel your request at any time before costs are incurred.

The Right to Amend Your PHI. If you believe there is a mistake in your PHI or that a piece of important information is missing, you have the 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 may deny your request in writing if the PHI is correct and complete, not created by us, or not allowed to be disclosed. Please contact our Privacy Officer for this request.

The Right to Request Confidential Communications. We may contact you by telephone or mail to provide appointment reminders or test results. You have the right to request to receive communications from us by alternative means or at alternative locations. For instance, if you wish for us to contact you at a specific address or telephone number, or if you wish for appointment reminders not to be left on voice mail, you should make this request known to us. We will accommodate reasonable requests. You must inform the hospital admitting staff at the time of your admission to the hospital or make your request in writing to our Privacy Officer.

The Right to Obtain a Paper Copy of This Notice. 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.

V. Complaints

If you believe your privacy rights have been violated, you can file a complaint with our Privacy Officer or you may make a written complaint to the Secretary of Health and Human Services. We will take no retaliatory action against you if you file a complaint about our privacy practices.

VI. Who To Contact With Privacy Notice Questions

If you have any questions or would like additional information regarding this Notice of Privacy, you may contact:

Privacy Officer
Skiff Medical Center
204 N. 4th Ave. E.
Newton, IA 50208
Phone: (641) 791-4375

VII. Effective Date of This Notice

This Notice was published and became effective on April 14, 2003.