Northern Inyo Healthcare District
150 Pioneer Lane
Bishop, CA 93514
(760) 873-5811
Hearing Impaired: Dial 711
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NORTHERN INYO HOSPITAL-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.

If you have any questions about this notice, please contact Northern Inyo Hospital, Privacy
Officer, at (760) 873-2109.

WHO WILL FOLLOW THIS NOTICE
This notice describes our hospital's practices and that of:

All these entities, sites and locations follow the terms of this notice. In addition, these entities,
sites and locations may share medical information with each other for treatment, payment or
health care operations purposes described in this notice.

OUR PLEDGE REGARDING MEDICAL INFORMATION
We understand that medical information about you and your health is personal. We are committed
to protecting medical information about you. We create a record of the care and services you receive
at the hospital. We need this record to provide you with quality care and to comply with certain legal
requirements. This notice applies to all of 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 doctors use and disclosure of your medical information
created in the doctors office or clinic.

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 medical information.

We are required by law to:

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following categories describe different ways that we use and disclose medical 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.

DISCLOSURE AT YOUR REQUEST
We may disclose information when requested by you. This disclosure at your request may require a
written authorization by you.

FOR TREATMENT
We may use medical information about you to provide you with medical treatment or services. We may
disclose medical information about you to doctors, nurses, technicians, health care students, or other
hospital personnel who are involved in taking care of you at the hospital. 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. Different departments of the hospital also may share medical information about
you in order to coordinate the different things you need, such as prescriptions, lab work and X-rays. 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 skilled nursing facilities, home health agencies,
and physicians or other practitioners. For example, we may give your physician access to your health
information to assist your physician in treating you.
FOR PAYMENT

We may use and disclose medical information about you so that the treatment and services you receive
at the hospital may be billed to and payment may be collected from you, an insurance company or a third
party. For example, we may need to give information about surgery you received at the hospital to your
health plan so it 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. We may also provide basic information about you and your health plan, insurance company or
other source of payment to practitioners outside the hospital who are involved in your care, to assist them
in obtaining payment for services they provide to you.

FOR HEALTH CARE OPERATIONS
We may use and disclose medical information about you for health care operations. These uses and
disclosures are necessary to run the hospital and make sure that all of our patients receive quality care.
For example, we may use medical information to review our treatment and services and to evaluate the
performance of our staff in caring for you. We may also combine medical information about many hospital
patients to decide what additional services the hospital should offer, what services are not needed, and
whether certain new treatments are effective. We may also disclose information to doctors, nurses,
technicians, medical students, and other hospital personnel for review and learning purposes. We may
also combine the medical information we have with medical 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 medical information so others may use it to study
health care and health care delivery without learning who the specific patients are.

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.

Health-Related Products and Services
We may use and disclose medical information to tell you about our health-related products or services
that may be of interest to you.

Fundraising Activities
We may use information about you, or disclose such information to a foundation related to the hospital, to
contact you in an effort to raise money for the hospital and its operations. You have the right to opt out of
receiving fundraising communications. If you receive a fundraising communication, it will tell you how to
opt out.

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.,
good, fair, etc.) and your religious affiliation. Unless there is a specific written request from you to the
contrary, this 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 dont 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.

Marketing and Sales
Most uses and disclosures of medical information for marketing purposes, and disclosures that constitute
a sale of medical information, require your authorization.

Individuals Involved in Your Care or Payment for Your Care
We may release medical 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. Unless there is a specific
written request from you to the contrary, we may also tell your family or friends your condition and that you
are in the hospital.

In addition, we may disclose medical information about you to an organization assisting in a disaster relief
effort so that your family can be notified about your condition, status and location. If you arrive at the
emergency department either unconscious or otherwise unable to communicate, we are required to
attempt to contact someone we believe can make health care decisions for you (e.g., a family member
or agent under a health care power of attorney).

<H>Research
Under certain circumstances, we may use and disclose medical 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 medical information, trying to balance the research needs with patients need for privacy of
their medical 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 medical information
about you to people preparing to conduct a research project, for example, to help them look for patients with
specific medical needs, as long as the medical information they review does not leave the hospital.

As Required By Law
We will disclose medical 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 medical 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
We may release medical 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 medical information about you as required by
military command authorities. We may also release medical information about foreign military personnel
to the appropriate foreign military authority.

Workers' Compensation
We may release medical information about you for workers compensation or similar programs. These
programs provide benefits for work-related injuries or illness.

Public Health Activities
We may disclose medical information about you for public health activities. These activities generally
include the following:

  • To prevent or control disease, injury or disability;
  • To report births and deaths;
  • To report regarding the abuse or neglect of children, elders and dependent adults;
  • 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;
  • To notify emergency response employees regarding possible exposure to HIV / AIDS, to the extent
    necessary to comply with state and federal laws.

Health Oversight Activities
We may disclose medical 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.

Lawsuits and Disputes
If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response
to a court or administrative order. We may also disclose medical 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 (which may include written notice to you) or
to obtain an order protecting the information requested.

Law Enforcement
We may release medical information if asked to do so by a law enforcement official:

  • 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 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.

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

National Security and Intelligence Activities
We may release medical 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 medical 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 disclose medical information about you to the correctional institution or law enforcement official.
This disclosure 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.(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.

Multidisciplinary Personnel Teams
We may disclose health information to a multidisciplinary personnel team relevant to the prevention,
identification, management or treatment of an abused child and the childs parents, or elder abuse and
neglect.

Special Categories of Information
In some circumstances, your health information may be subject to restrictions that may limit or preclude
some uses or disclosures described in this notice. For example, there are special restrictions on the use
or disclosure of certain categories of information - e.g., tests for HIV or treatment for mental health conditions
or alcohol and drug abuse. Government health benefit programs, such as Medi-Cal, may also limit the
disclosure of beneficiary information for purposes unrelated to the program.

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 obtain a copy of medical information that may be used to make decisions
about your care. Usually, this includes medical and billing records, but may not include some mental health
information.

To inspect and obtain a copy of medical information that may be used to make decisions about you, you
must submit your request in writing to the Medical Records Department of the hospital. 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 obtain a copy in certain very limited circumstances. If you are
denied access to medical information, you may request that the denial be reviewed. Another licensed
health care professional chosen by the hospital 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 medical 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 the
hospital.

To request an amendment, your request must be made in writing and submitted to the Medical Records
Department of the hospital. 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 the hospital;
  • Is not part of the information which you would be permitted to inspect and copy; or
  • Is accurate and complete.

Even if we deny your request for amendment, you have the right to submit a written addendum, not to exceed 250
words, with respect to any item or statement in your record you believe is incomplete or incorrect. If you clearly
indicate in writing that you want the addendum to be made part of your medical record we will attach it to your records
and include it whenever we make a disclosure of the item or statement you believe to be incomplete or incorrect.

Right to an Accounting of Disclosures
You have the right to request an accounting of disclosures. This is a list of the disclosures we made of medical
information about you other than our own uses for treatment, payment and health care operations (as those
functions are described above), and with other exceptions pursuant to the law.

To request this list or accounting of disclosures, you must submit your request in writing to the Medical Records
Department of the hospital. Your request must state a time period which may not be longer than six years and
may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example,
on paper or electronically). 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.

In addition, we will notify you as required by law following a breach of your unsecured protected health information.

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 health care operations. You also have the right to request a limit on the medical 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.

We are not required to agree to your request, except to the extent that you request us to restrict disclosure to a health
plan or insurer for payment or health care operations purposes if you, or someone else on your behalf (other than the
health plan or insurer), has paid for the item or service out of pocket in full. Even if you request this special restriction,
we can disclose the information to a health plan or insurer for purposes of treating you.

If we agree to another special restriction, 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 the Admission Services Department of the hospital.
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 medical matters in a certain way or at a certain
location. For example, you can ask that we only contact you at work or by mail.

To request confidential communications, you must make your request in writing to the Admission Services Department
of the hospital. 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 copy of this notice at our website: www.nih.org

To obtain a paper copy of this notice: contact the Admission Services Department of the hospital.

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 the hospital. The notice will contain the effective date on the first page, in the top
right-hand corner. In addition, each time you register at or are admitted to the hospital for treatment or health care
services as an inpatient or outpatient, we will offer you a copy of the current notice in effect.

COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with the hospital or with the Secretary
of the U.S. Department of Health and Human Services. All complaints must be submitted in writing.

You will not be penalized for filing a complaint.

To file a complaint with the hospital, contact:
Privacy Officer
Northern Inyo Hospital
150 Pioneer Lane
Bishop, CA 93514

To file a complaint with the Department of Health and Human Services, contact:
Office of Civil Right
US Department of Health and Human Services
50 United Nations Plaza, Room 322
San Francisco, CA 94102
(415) 437-8310

OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be
made only with you written permission. If you provide us permission to use or disclose medical information about
you, you may revoke that permission, in writing, at any time. If you revoke your permission, this will stop any further
use or disclosure of your medical information for the purposes covered by your written authorization, except if we
have already acted in reliance on your permission. 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.

Effective Date: September 23, 2013