Grand View Hospital
Grand View Clinics: Ironwood, Hurley and Surgical Center
Caring Home Health
Caring Caregivers, Inc.

This notice describes how your medical information may be used and disclosed and how you can get access to this information. Please take the time to review this material carefully.

I. Who we are
This notice describes the privacy practices of Grand View Health System. It applies to services furnished to you by Grand View Hospital, Grand View Clinics, Caring Home Health and Caring Caregivers, Inc. Federal law requires us to provide this notice to you.

II. Our privacy obligations
Grand View has long been committed to protecting patient privacy. As part of this commitment, we follow federal and state laws that require us to maintain the privacy of your health information and to provide you with this notice of our privacy practices. When we use or disclose your health information, we are required to follow the privacy practices described in this notice (or other notice in effect at the time of the use or disclosure).

We must follow either federal or state law, whichever is more protective of your privacy rights. For example, if federal law allows certain disclosures of your health information without your written authorization, while state law does require your written authorization for such disclosures, we are required to follow the state law.

We reserve the right to change the privacy practices described in this notice at any time. Changes to our privacy practices would apply to all health information we maintain. If we change our privacy practices, we will republish this notice and make it available to you.

III. We may use and disclose your health information with your written authorization
For any purpose other than the ones described below, we may only use or disclose your health information when you give us your written authorization to do so. For example, you will need to sign an authorization form before we can send your health information to your attorney or life insurance company.

Marketing. We must obtain your written authorization before using your health information (name, address, etc.) to send you any marketing materials. The only exceptions to this requirement are that: (1) we can provide you with marketing materials in a face-to-face encounter or a promotional gift of very small value, if we so choose; (2) we may communicate with you about products or services relating to your treatment, to coordinate or manage your care, or to provide you with information about different treatments, providers, or care settings.

Uses and disclosures of your highly confidential information. Federal and state laws require special privacy protection for certain highly confidential information about you, including the part of your health information that: (1) is maintained in psychotherapy notes; (2) is about treatment of mental illness or developmental disability; (3) is about the identity, diagnosis, prognosis, or treatment for alcohol or drug dependency; (4) is about HIV test results; or (5) is about child abuse or neglect. Except for certain treatment purposes described in Section IV below, we will generally obtain your written authorization for use or disclosure of highly confidential information for the purposes described in Section IV. However, we are allowed by law to disclose your highly confidential information for certain purposes without your written authorization. For example, we are allowed to disclose information about treatment of mental illness or developmental disability for program monitoring and evaluation or when requested by a physician for a medical emergency.

IV. When we may use and disclose your health information without your written authorization
Treatment. We may use and disclose your health information to provide treatment and other services to you. For example, a doctor may use the information in your medical record to diagnose your injury or illness and to determine which treatment option, such as medication or surgery, best addresses your health needs. In addition, we may use your health information for appointment reminders or to send you information about treatment alternatives or other health-related benefits and services that may be of interest to you. We may disclose your health information to other health care providers involved in your treatment.

Payment. We may use and disclose your health information to obtain payment for services that we provide to you. For example, in order for an insurance company to pay for your care, we must submit billing information that identifies you, your diagnosis, and the treatment provided to you. We may also need to disclose your health information to another health care provider or health plan for its payment activities—for example, for the health plan to determine your eligibility or coverage.

Health care operations. We may use and disclose medical information about you for health care operations. This is necessary to 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.

Disclosures to business associates. In order for us to carry out treatment, payment, or health care operations, we may disclose your health information to people or organizations who perform services on our behalf that requires the use or disclosure of individually identifiable health information. Such people or organizations are our business associates. For example, we may disclose your health information to an agency that accredits health care organizations or to a collection agency to collect payment of medical bills.

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, stable, 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 minister, even if they don’t ask for you by name, if you have requested a pastoral visit.

Fund-raising communications. We may contact you to request a tax-deductible contribution to support our activities. If we do fund raising, we may share demographic (non-medical) information about you (such as your name, address, and phone number) and dates on which we provided health care to you with our fund-raising staff without your written 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. 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 entity assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.

Public health activities. If required or allowed by law, we may disclose your health information for the following public health activities: (1) to report health information to public health authorities for the purpose of preventing or controlling disease, injury, or disability; (2) to report information about products and services under the jurisdiction of the U.S. Food and Drug Administration; (3) to alert a person who may have been exposed to a communicable disease or may otherwise be at risk of contracting or spreading a disease or condition; and (4) to report information to your employer as required by laws addressing work-related illnesses or workplace safety.

Victim of abuse, neglect, or domestic violence. If we reasonably believe you are a victim of abuse, neglect, or domestic violence and the reporting of such information is required or allowed by law, we may disclose your health information to a government authority, including social services or a protective services agency.

Lawsuits and disputes. We may disclose medical information about you in response to a subpoena, discovery request, or other lawful order from a court.

Health oversight activities. As required or allowed by law, we may disclose your health information to a government agency that is legally responsible for overseeing the health care system and is responsible for ensuring compliance with the rules of government health programs such as Medicare or Medicaid.

Law enforcement officials. We may disclose your health information to the police or other law enforcement officials, as required or allowed by law.

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 when it is relevant to the nature of their duties.

Organ and tissue donation. We may disclose your health information to organizations that facilitate organ, eye, or tissue donation, banking or transplantation.

Health or safety. We may disclose your health information to prevent or lessen a serious and imminent threat to the health or safety of a person or the general public.

Specialized government functions. We may use and disclose your health information for authorized national security activities or to units of the government with special functions, such as the U.S. military or the U.S. Department of State, under certain circumstances.

Research. There are situations when researchers and research staff may use or disclose your health information for research purposes without your authorization. Researchers may conduct research that simply involves reviewing your health information and the health information of others with similar conditions or diseases. In such situations, researchers will not contact you for your authorization but must obtain permission from a board (called the Institutional Review Board) that is set up to ensure that the welfare and privacy of research participants is protected by law. Researchers may also review your health information to determine if there are enough patients with a specific disease or condition to conduct a study or to determine whether you would be a good candidate for a study that will involve interaction with you. In this situation, they may contact you to ask if you would like to participate in a study.

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 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.

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.

To comply with the law. We may use and disclose your health information when required to do so by any other law not already referred to in this section.

V. Your rights regarding your health information
Right to request restrictions on certain uses and disclosures of your health information. You may ask for restrictions on how your health information is used or to whom your health information is disclosed: (1) for treatment, payment, and health care operations; (2) to family or friends involved in your care or payment of medical bills; or (3) to authorities involved in disaster relief efforts. While we will consider all requests for restrictions, we are not required to agree to your request. To request restrictions on how we use and disclose your health information for the purposes described above, you must make your request in writing and submit it to our health information management staff. We will send you a written response.

Right to receive confidential communications of your health information. We will accommodate any reasonable request that we communicate your health information in different ways or places. For example, you may wish to receive your billing statement at an address other than your home. We ask that you put your request in writing.

Right to cancel authorization to use or disclose your health information. You may cancel an authorization you have provided to us except if we have already relied on it. To cancel an authorization, you must make your request in writing and submit it to the health information management staff.

Right to inspect and copy your health information. You may request access to your health information in order to review or request copies of such information. In certain situations we may deny you access to a portion of your health information (for example, mental health records or information gathered for judicial proceedings), as allowed by law. To review or obtain copies of your health information, you must sign an authorization for release of information and submit it to the health information management staff. We will charge you a reasonable fee for copies of your health information, which may include the cost of copying (including the cost of supplies and labor), postage, and preparing an explanation or summary of your health information.

Right to request to correct your health information. You may ask us to correct your health information. While we will consider all requests for corrections, we may deny your request for legitimate reasons (for example, if your health information is accurate and complete or if we did not create the health information you believe is incorrect). To request a correction to your health information, you must make the request in writing and submit it to our health information management staff. The written request must include the reason you are requesting the correction.

Right to receive a record of disclosures of your health information. You may ask for a list of certain disclosures to your health information made by us, on or after April 14, 2003. This list must include the date of each disclosure, who received the health information disclosed, a brief description of the health information disclosed, and the reason why the disclosure was made. This list will not include disclosures made to you or for the purposes of treatment, payment, health care operations, or for certain other purposes. To request a list of such disclosures, you must make your request in writing to our health information management staff. If you request a list of such disclosures more than once during a 12-month period, we may charge you a reasonable fee.

Right to receive paper copy of this notice. You may request a paper copy of this notice at any time, even if you earlier agreed to receive this notice electronically.

Right to your own billing account. Routinely, adult patients will have their own billing account. If you choose to request a multiple adult account (for example, husband and wife), you will need to sign an authorization to release information to allow the disclosure of your health information on the bill to other adults in your account. If you want a combined account, you may contact patient financial services. Separate adult accounts means that you will receive multiple bills.

VI. Complaints
If you believe your privacy rights have been violated, you may file a complaint with the federal Department of Health and Human Services and us. We will not retaliate against you for filing such a complaint. To file a complaint, please contact:

Health Information Management
Hospital Privacy Officer—Grand View Hospital
10561 Grand View Lane
Ironwood, MI 49938

Clinic Privacy Officer—Grand View Clinics
10565 Grand View Lane
Ironwood, MI 49938

Privacy Officer—Home Health/Caring Caregivers, Inc.
10567 Grand View Lane
Ironwood, MI 49938

VII. Questions
If you have any questions about your privacy rights or the information in this notice, you may contact:

Grand View Hospital
(906) 932-2525, ext. 6018

Grand View Clinics
(906) 932-1500, ext. 6420

Caring Home Health/Caring Caregivers
(906) 932-2440, ext. 6117

This notice is effective on April 14, 2003.

THE PRIVACY OF YOUR PHI (PROTECTED HEALTH INFORMATION) IS IMPORTANT TO US.