Notice of Privacy Practices

Effective Date: April 1st, 2003

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

OUR COMMITMENT TO YOUR PRIVACY
Saint Clare's understands that medical (health) information about you is personal. We are committed to protecting health information about you. We create a record of the care and services you receive at Saint Clare's which we need to provide you with quality care and to comply with certain legal requirements. This notice applies to all records of your care generated by Saint Clare's, whether made by Saint Clare's personnel or your personal doctor. If you are being treated by a doctor with a private practice outside of Saint Clare's, your doctor may have different policies or notices regarding the doctor's use and disclosure of your medical information created in the doctor's practice.

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 healthcare information.

Saint Clare's is required by law to:

  • make sure that healthcare information that identifies you is kept private;
  • give you this notice of our legal duties and privacy practices with respect to healthcare information about you; and
  • follow the terms of the notice that is currently in effect.

WHO WILL FOLLOW THIS NOTICE

This notice describes Saint Clare's practices and that of:

  • Any healthcare professional authorized to enter information into your healthcare record.
  • Any member of a volunteer group we allow to help you while you are in the Saint Clare's System.
  • All employees, staff and other Saint Clare's personnel.
  • All of Saint Clare's entities, sites and locations which are required by the "Health Insurance Portability & Accountability Act" will follow the terms of this notice. In addition, these entities, sites and locations may share healthcare information with each other for treatment, payment or healthcare operations purposes described in this notice.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following categories describe different ways that we use and disclose healthcare 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. HIV, genetic, alcohol, substance abuse and mental health records may have special confidentiality protections under the law. You may be asked to sign a special authorization before we can release such information.

  • For Treatment. Saint Clare's may use healthcare information about you to provide you with medical treatment or services. We may disclose health information about you to doctors, nurses, technicians, or other hospital personnel who are involved in taking care of you at Saint Clare's. 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. We also may disclose medical information about you to people outside the hospital who may be involved in your medical care after you leave the hospital, such as family members, Visiting Nurse Association, or others we use to provide services that are part of your care. However, your advance authorization would be required if you were expecting your mental health or substance abuse records from Saint Clare's be sent to a treatment facility outside Saint Clare's.
  • For Payment. Saint Clare's may use and disclose healthcare information about you so that the treatment and services you receive may be billed to you, an insurance company or a third party. For example, we may need to give your insurance company 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 Healthcare Operations. Saint Clare's may use and disclose healthcare information about you for healthcare operations. These uses and disclosures are necessary to run our programs and make sure that all of our patients receive quality care. For example, we may use health information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine information about many patients to decide what additional services Saint Clare's should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, and other Saint Clare's personnel for review and learning purposes. We may also combine the information we have with health information from other hospitals 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 health information so others may use it to study healthcare and healthcare delivery without learning who the specific patients are. Additionally, in certain areas in our System, we may ask you to sign-in so that we know that you have arrived and are waiting for your appointment or test. Our personnel may call your name in a waiting room area to let you know that our staff is ready to see you.
  • Appointment Reminders. We may use and disclose health information to contact you as a reminder that you have an appointment for treatment or healthcare at Saint Clare's.
  • Treatment Alternatives. We may use and disclose health information to tell you about or recommend possible treatment options or alternatives that may be of interest to you.
  • Health-Related Benefits and Services. We may use and disclose health information to tell you about health-related benefits or services that may be of interest to you.
  • Fundraising Activities. We may use health information about you to contact you in an effort to raise money for Saint Clare's and its operations. We may disclose health information to a foundation related to Saint Clare's so that the foundation may contact you in raising money for the hospital. We only would release contact information, such as your name, address and phone number and the dates you received treatment or services at Saint Clare's. If you do not want us to contact you for fundraising efforts, you must notify Saint Clare's Foundation, Inc., 75 Bloomfield Avenue, Denville, NJ 07834 in writing.
  • Hospital Directory. We 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, your general condition (e.g., fair, good, 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 priest or rabbi, 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. You may request that your information not be listed in the directory by calling 973-625-6524.
  • Individuals Involved in Your Care or Payment for Your Care. We may release health 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 health 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. Under certain circumstances, we may use and disclose health 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 approval process. This process evaluates a proposed research project and its use of health information, trying to balance the research needs with patients' need for privacy of their health information. Before we use or disclose medical information for research, the project will have been approved through this research approval process, but we may, however, disclose health information about you to people preparing to conduct a research project, for example, to help them look for patients with specific medical needs, so long as the health information they review does not leave Saint Clare's. We will almost always ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at Saint Clare's.
  • As Required By Law. We will disclose health 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 health 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.

SPECIAL SITUATIONS

  • Organ and Tissue Donation. If you are an organ donor, we may release health 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 and Veterans. If you are a member of the armed forces, we may release health information about you as required by military command authorities. We may also release health information about foreign military personnel to the appropriate foreign military authority.
  • Workers' Compensation. We may release health information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.
  • Public Health Risks. We may disclose health information about you for public health activities. These activities generally include the following:
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    • 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.
  • Health Oversight Activities. We may disclose 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 healthcare system, government programs, and compliance with civil rights laws.
  • Lawsuits and Disputes. If you are involved in a lawsuit or a dispute, we may disclose health information about you in response to a court or administrative order. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
  • Law Enforcement. We may release health information if asked to do so by a law enforcement official:
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    • 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 possible criminal conduct at our System; 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 and Funeral Directors. We may release 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 health information about patients of Saint Clare's to funeral directors as necessary to carry out their duties.
  • National Security and Intelligence Activities. We may release health information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
  • Protective Services for the President and Others. We may disclose health 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.
  • Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide you with healthcare; (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 RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You have the following rights regarding medical information we maintain about you:

  • Right to Inspect and Copy. You have the right to inspect and receive a copy of healthcare 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/or obtain a copy of healthcare information that may be used to make decisions about you, you must submit your request in writing to Saint Clare's Health Information Center, 400 W. Blackwell Street, Dover, NJ 07801. 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 receive a copy in certain limited circumstances. If you are denied access to healthcare information, you may request that the denial be reviewed. Another licensed healthcare professional chosen by Saint Clare's 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 health 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 Saint Clare's.

    To request an amendment, your request must be made in writing and submitted to Saint Clare's Health Information Center, 400 W. Blackwell Street, Dover, NJ 07801. 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 Saint Clare's;
    • 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 we have made, if any, of your protected health information. This is a list of the disclosures we made of health information about you to individuals or entities when we were not required to obtain an authorization from you to release your protected health information. For example, in a situation where we were served with a subpoena requiring us to release the information.

    To request this list or accounting of disclosures, you must submit your request in writing to Saint Clare's Health Information Center, 400 W. Blackwell Street, Dover, NJ 07801. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
  • 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 healthcare operations. You also have the right to request a limit on the health 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.

    By law, 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 Saint Clare's Health Information Center, 400 W. Blackwell Street, Dover, NJ 07801. 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 healthcare matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or only by mail.

    To request confidential communications, you must make your request in writing to Saint Clare's Health Information Center, 400 W. Blackwell Street, Dover, NJ 07801. 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. Even if you have agreed to receive this notice electronically, you are still entitled to a paper copy of this notice. You may obtain a current copy of this notice at our web site: http://www.saintclares.org/

    To obtain a current paper copy of this notice, or to ask any questions regarding this notice, please contact the Saint Clare's Health System Privacy Officer at 400 W Blackwell Street, Dover, NJ 07801.

CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the revised or changed 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 our facilities. The notice will contain, on the first page, the effective date. If we change this notice, we will offer you a copy of the current notice in effect when you register for healthcare services.

COMPLAINTS
If you think we may have violated your privacy rights, or you disagree with a decision we made about access to your protected health information, you may file a complaint with the Saint Clare's Health System Patient Representative: Denville & Boonton Township Area -- 973-625-6035. Dover & Sussex Area -- 973-989-3012. You may also file a written complaint with the Secretary of the U.S. Department of Health and Human Services.

You will not be penalized for filing a complaint.

OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of health 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 health information about you, you may revoke that permission, in writing, at any time. If you revoke your permission in writing, we will no longer use or disclose health 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.

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Franciscan Oaks 19 Pocono Road Denville, NJ 07834
Local Number 973-586-6000
Toll-free Number
1-800-237-3330
© 2012 Franciscan Oaks, a part of Saint Clare's Health System and Catholic Health Initiatives.
All Rights Reserved.