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Notice of Privacy

NOTICE OF PRIVACY PRACTICES Effective Date: March 1, 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.

If you have any questions about this Notice, please contact Bellevue Woman's Care Center Compliance Officer, or designee, by dialing (518) 347-3312 (Corporate Compliance Hotline) or (518) 347-3318.

Each time you visit a hospital, physician, or other healthcare provider, a record of your visit is made. Typically this record contains your symptoms, examination and test results, diagnoses, treatment, a plan for future care or treatment, and billing-related information ("protected health information"). This Notice applies to all of the records of your care generated by the center, whether made by centerl personnel, agents of the center, or your doctor. Your doctor may have different policies or notices regarding the doctor's use and disclosure of medical information created in the doctor's office or clinic.

OUR RESPONSIBILITIES
Protected Health Information ('PHI") is any health information that identifies you and is created or received by Bellevue in relation to your past, present, or future health or condition. PHI includes your medical record, billing records maintained on our computer system and any information about you that is discussed verbally.

We are required by law to maintain the privacy of your protected health information and to provide you with a description of our privacy practices and legal duties with respect to your protected health information.

This Notice covers the privacy practices of all health care professionals, employees, contract staff, students and volunteers for Bellevue Woman's Care Center, including all of its' specialty units located on or off campus, such as The Pelvic Health Center, etc.

Within this Notice, a reference to the center may also include the independent and group physician practices with which the center contracts directly for services.

When we provide joint health care to you, we share your protected health information with one another as necessary to perform treatment, to obtain payment or to carry out operational activities. Within this Notice, a reference to the center may also include the above entities.

Whenever we use or disclose your protected health information, we will abide by the terms of our Notice of Privacy Practices. Please sign and return at your earliest convenience the "Acknowledgment of Receipt" form which will acknowledge your receipt of this Notice.

A. Generally, Bellevue may use and disclose your PHI for three basic purposes:

  • Treatment: For example, Bellevue may permit your physician and our nursing staff to access your medical records to provide you with medical care and treatment. Bellevue may also use your PHI to contact you to remind you of scheduled appointments; or to notify you about treatment alternatives or health-related services that may be of interest to you.
  • Payment: For example, Bellevue may permit our business office employees to use your PHI to contact your insurance carrier to verify enrollment or coverage and submit a claim for payment. Bellevue may also disclose your PHI to your insurance carrier or other third party payers to verify that services were provided so that they can pay your bill.
  • Health care operations: For example, Bellevue may use your PHI to evaluate the performance of our employees, assess the quality of care provided and ensure that we are meeting federal and state legal requirements.

B. Bellevue may use and disclose your PHI in the following ways only after you have had an opportunity to agree or object:

  • To maintain a facility directory: As long as you have been notified in advance and had the opportunity to object or restrict the use and disclosure, Bellevue may include your name in its directory and use and disclose your name, location in the facility, your general condition and your religious affiliation. Your religious affiliation may only be disclosed to members of the clergy; other information may be disclosed only to individuals who ask about you by name.
  • For patient care and notification: For example, as long as you agree or do not object or restrict the use and disclosure, Bellevue may disclose certain PHI to your family, friend(s) or other individual(s) to the extent that the individual is involved with your care or arranging for payment for your care.
  • Emergency: In an emergency where the opportunity to object is not practical due to emergency circumstances or your incapacity, Bellevue may disclose certain PHI as long as Bellevue has determined that it is in your best interest to do so.
  • Disaster Relief: Bellevue may disclose your PHI to an entity authorized to assist in disaster relief efforts. Although you have the opportunity to agree or object to these disclosures, your objections may not interfere with the ability to respond to such emergencies.

C. Bellevue may also use and disclose your PHI without your authorization for the following purposes:

  • Public health activities: For example, Bellevue may disclose your PHI to a public health authority for the purpose of preventing or controlling disease; reporting child abuse or neglect; or tracking the quality, safety or effectiveness of FDA-regulated products.
  • Disclosures about victims of abuse, neglect or domestic violence: For example, Bellevue may disclose PHI about you if it believes that you are a victim of abuse, neglect or domestic violence and the disclosure is required or authorized by law, or you agree to the disclosure. If Bellevue makes such a disclosure, you will be notified of the report unless Bellevue believes that by informing you Bellevue would place you at risk of serious harm.
  • Health oversight activities: For example, Bellevue may disclose PHI as required by law to permit civil audits, administrative investigations, licensure or disciplinary actions and review of the health care system in general.
  • Legal proceedings: For example, Bellevue may disclose PHI in response to a court order or subpoena or other lawful request.
  • Law enforcement: Under certain circumstances, Bellevue may disclose PHI to a law enforcement officer.
  • Decedents: For example, Bellevue may disclose PHI to a coroner or medical examiner to identify a deceased person or determine the cause of death.
  • Organ and tissue donation: For example, Bellevue may use or disclose PHI to organizations involved in the procurement, banking or transplantation of organs or tissues so that they may fulfill their responsibilities.
  • Research: Bellevue may disclose PHI to researchers as long as certain criteria have been met to protect the privacy of that information.
  • To avert serious threat to health or safety: For example, Bellevue may disclose PHI if it believes that it will prevent or lessen a serious and imminent threat to the health or safety of a person or the public. Bellevue may also disclose PHI to law enforcement authorities to identify and/or apprehend an individual.
  • Special government functions: For example, Bellevue may use and disclose PHI to assure proper execution of a military mission, conduct national security activities or provide health care to inmates.
  • Workers' compensation: Bellevue may use and disclose PHI to comply with workers' compensation laws and any other work-related programs established by law.
  • Fundraising: For example, Bellevue may use general information from our patient lists to send you materials in connection with our efforts to raise funds for the Center. If we do, we will instruct you how to "opt out" of receiving such fundraising materials.

D. Use of Disclosure Pursuant to an Authorization
Use or disclosure of your PHI for any other purposes requires your written authorization. You have the right to revoke your authorization at any time, except to the extent that Bellevue has already used or disclosed your PHI in reliance on the authorization. For example, Bellevue may not use your PHI to conduct marketing activities or disclose information to a prospective employer without your written authorization. In addition, Bellevue many not disclose psychotherapy notes without your written authorization.

E. Bellevue is committed to protecting your individual rights as they relate to your health information:
Your Individual Rights:

  • You have the right to consent and/or authorize uses and disclosures and to and to request restrictions on future uses and disclosures of your protected health information. We reserve the right to refuse to grant specific restrictions. However, if we agree, we will be bound by such restriction. If you wish to request a restriction, please contact our admissions or medical records department. Your request must state that you wish to restrict the use/disclosure of your PHI, what PHI you wish to restrict, and to whom you wish the restrictions to apply.
  • You have the right to request to receive communications in an alternative manner or at an alternative location. For example, you may request that correspondence be sent to an alternative address or you may request that information be communicated to you electronically. Please contact our admissions staff to make any such request. Bellevue will use its best efforts to accommodate reasonable requests.
  • Generally, you have the right to access, inspect and obtain copies of your own protected health information so long as we maintain that record. You do not, however, have the right to access psychotherapy notes or information compiled in anticipation of, or for used in legal proceedings. In respect to laboratory results that are subject to the clinical Laboratory Improvement Amendments of 1988 (CLIA), we must have authorization from your physician before they may be released directly to you.
  • You have the right to request that your protected health information be amended. Bellevue does not have to grant your request. If you request that your PHI be amended, please submit your request in writing to our medical records department and include the reason for your request.
  • Subject to certain restrictions and limitations, you have the right to receive an accounting of disclosures made for purposes other than treatment, payment of health care operations. Any accounting would also exclude disclosures made to you, for a facility directory and to family or friends involved in your care.
  • You have the right, upon your request, to receive a paper copy of this Notice of Privacy Practices.
  • You have the right to file a complaint with Bellevue and/or the Department of Health and Human Services (DHHS) for violations of your privacy. Bellevue will not retaliate against any individual who files such a complaint.

Should you desire more information about this Notice, or believe that your privacy rights have been violated, you may contact us at the following address:

Bellevue Woman's Care Center
c/o Compliance Officer
2210 Troy Road
Niskayuna, New York 12309

(518) 347-3318
(518) 347-3312 (Corporate Compliance Hotline)


F. Changes to this privacy policy.
This Notice is effective on March 1, 2003. Bellevue is required to abide by the terms of this Notice as it is currently in effect. We, however, reserve the right to update and change this Notice from time to time. We will provide you with any revised Notice by positing it on our website, www.bellevuewoman.org. You may also obtain one by calling and requesting one or asking for one at your next visit.