KESSLER MEMORIAL HOSPITAL

Notice of Privacy
Practices

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

 This notice applies to Kessler Memorial Hospital (KMH) and affiliate outpatient and inpatient services provided by medical staff, employees, contractors, and volunteers.  Among Hospital affiliates are: Kessler Memorial Renal Dialysis Service, Cooperative Home Health Care of Atlantic County (Kessler AtlantiCare Home Health), Wound Healing Service at Kessler Memorial Hospital, Egg Harbor Family Medical Center, Kessler Rehabilitation Service, Atlantic Orthopedic & Sports Physical Therapy, and Pain Care Center of Southern New Jersey.  Hospital and affiliate medical staff, employees, contractors, and volunteers will abide by these privacy practices.

Understanding Your Health Record

 Each time you visit the Hospital or affiliate facility, a record of your visit is made.  Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment.  This information, which we refer to as your health or medical record, is an essential part of the health care we provide for you.  It serves as a:

·        Basis for planning your care and treatment,

·        Means of communication among the many health care providers who contribute to your care,

·        Legal document describing the care you received,

·        Means by which you or a third-party payer can verify that the services billed were provided,

·        Tool in educating health professionals,

·        Source of data for medical research,

·        Source of information for public health officials charged with improving the public's health,

·        Source of data for facility planning and marketing, and

·        Tool with which we can assess and continually improve the care we render.

 Your health record contains personal health information, the confidentiality of which is protected under both State and Federal law.  Understanding how we may use and disclose your health information will help you to:

·        Ensure its accuracy,

·        Better understand who, what, when, where and why your health care providers and others may access your health information, and

·        Make more informed decisions when authorizing disclosures to others.

 This notice applies to all of the records of your care at the Hospital or affiliate facility.  Your physician may have different policies regarding the use and disclosure of your medical information created when you visit his or her office.

Your Health Information Rights

 Although your health record is the physical property of the Hospital or affiliate, the information belongs to you.  Under the Federal Privacy Rule, 45 CFR Part 164, you have the right to:

·        Receive a paper copy of this notice and/or an electronic e-mail upon request;

·        Request restrictions on uses or disclosures of your health information which will be considered;

·        Request that we send you confidential communications by alternative means or to an alternative address;

·        Inspect and obtain a copy of your health record;

·        Request that your health record be amended; and

·        Receive an accounting of disclosures of your health information made after April 14, 2003, for purposes other than treatment, payment, or healthcare operations.

Please direct requests to:  Medical Records Department, Kessler Memorial Hospital, 600 South White Horse Pike, Hammonton, N.J. 08037-2099, 609-561-6700, Ext 5280.

Our Responsibilities

 We are required by the Federal Privacy Rules to:

·        Maintain the privacy of your health information,

·        Provide you with notice as to our legal duties and privacy practices with respect to health information we collect and maintain about you, and

·        Abide by the terms of this notice, subject to the following reservation of rights.

We reserve the right to change our health information practices and the terms of this notice for all protected health information we maintain, including health information created or received prior to the effective date of revised practices.  Should our health information practices change, we will post or provide a revised notice.  We will not use or disclose your health information without your authorization or consent, except as described in this notice.

 Uses and Disclosures of Your
Medical Information

 Treatment:  We may use medical information about you to provide you with medical services.  Medical information about you will be available to the physicians, nurses, and other healthcare staff involved in your care.  We may provide your primary care or family physician with copies of various reports for follow-up care.  We may also send relevant portions of your medical record to specialists to whom you have been referred for care.  We may disclose information about you to others who may be involved in your medical care such as family members.

 Payment:  For services you receive, a bill will be sent to you or your insurance company or health plan.  The information accompanying the bill will include information that identifies you, as well as your diagnosis, procedures, and supplies used.  We may also inform your insurance company or health plan about a treatment which has been ordered for you to obtain prior approval or to determine whether your plan will cover the treatment.

 Healthcare Operations:  We may use medical information about you to evaluate the performance of our staff and to review our services.  In so doing, information may be disclosed to physicians, nurses, technicians, medical students, and other healthcare staff.  We may also combine information with information from other healthcare providers for study purposes. When information is combined, patient identifiers are typically deleted.

 Business Associates: We provide some services through business associates, who are independent professionals or organizations that use health information provided by us in order to perform services on our behalf.  Examples include anesthesiology and radiology services, certain laboratory services, a service used for making copies of your health record, or a billing service.  When these services are contracted, we may disclose your health information so that our business associates can do what we have asked them to do.  Other business associates include accreditation agencies and the New Jersey Hospital Association, to whom we disclose comparative information.  To protect your health information, we contractually require each business associate to safeguard your information.

 Facility Directory:  Unless you object, we may use your name, location in the facility, and general condition (e.g. good, stable) and your religious affiliation for directory purposes.  This information may be provided to members of the clergy and, except for religious affiliation, members of your family, friends and others who ask for you by name.  Our directory does not include specific medical information about you.

 Family or friends involved in care:  Unless you object, health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person’s involvement in your care or payment related to your care.

Marketing and Fundraising:  We may use certain information, limited to contact information such as your name, address and phone number, and the dates you received treatment or services, to contact you in an effort to raise funds for the Hospital.  Any such communication addressed to you will contain instructions describing how you may “opt out” of receiving further such communications.

 Appointment Reminders:  We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at the Hospital. 

 Treatment Alternatives:  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. 

 Coroners, Medical Examiners, or Funeral Directors:  We may use and disclose medical information to coroners, medical examiners, or funeral directors for the purposes of identifying a deceased person or carrying out their duties as required by law.

 Organ Procurement:  We may use and disclose medical information to organ procurement organizations for the purposes of organ or tissue donation and transplantation, consistent with applicable law.

 Research:  We may use and disclose medical information for research approved by an Institutional Review Board (IRB) or Privacy Board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.

 Workers Compensation:  We may use and disclose medical information as authorized by law in connection with workers compensation programs. 

 Required Disclosures

 The Federal Privacy Rules require us to disclose your personal health information in two instances: to you at your request, and to the Secretary of Health and Human Services when requested as part of an investigation or compliance review.

 Disclosures Permitted Without Consent
for National Priority Purposes

In addition, the Privacy Rules permit uses and disclosure of your health information without your consent or authorization for certain “national priority” purposes, including:

·        When required by State of Federal law;

·        To State and Federal public health authorities, including State medical officers, the Food and Drug Administration (FDA), and other agencies charged with preventing or controlling disease;

·        To government authorities, including protective service agencies, authorized to receive reports of abuse, neglect or domestic violence;

·        To government health oversight agencies, such as the State and Federal departments of health and human services, Medicare/Medicaid, peer review organizations, State Boards of Medical Examiners, Nursing and Pharmacy, and other licensing authorities;

·        When required or court ordered in a judicial or administrative proceeding;

·        To law enforcement officials for certain law enforcement purposes, including the reporting of certain types of wounds or injuries, or pursuant to a warrant, subpoena, or other legal process, or for the purpose of identifying or locating a subject, fugitive, material witness, missing person, or victim, provided the conditions in the Privacy Rules are met;

·        When required to avert a serious threat to health or safety; and

·        When requested for certain specialized government functions authorized by law, including military and similar situations.

 Uses and Disclosures Specifically
Authorized By You

 We expect to make other uses and disclosures of your protected health information but only with specific written authorization by you or your authorized representative.  You have the right to revoke any such authorization at any time, except to the extent that we have already relied on it making an authorized use or disclosure.

 For More Information or to Report a Problem

 If you have questions about this notice, concerns about our privacy practices, or believe your privacy rights have been violated, please contact: Privacy Compliance Office at Kessler Memorial Hospital, 600 South White Horse Pike, Hammonton, New Jersey 08037-2099, Attention: Robert J. Pelikoski, Privacy Officer, 609-561-6700, Ext 5306.

 If you believe your privacy rights have been violated, you may also file a complaint with the Secretary of the U.S. Department of Health and Human Services at: 200 Independence Ave, S.W., Washington, D.C. 20201.  There will be no retaliation for filing a complaint.

 Effective Date:  This Notice of Privacy Practices is effective April 14, 2003.