This notice describes how health information about you may be used and
disclosed and how you can get access to this information. Please review
The employees and staff of Saint Michael's Medical Center follow the
privacy practices in this Notice. Saint Michael's Medical Center maintains
your personal health information in records that will be maintained in
a confidential manner, as required by law.
This health information may include photographs obtained by authorized
personnel at Saint Michael's Medical Center for treatment purposes.
Saint Michael's Medical Center employees and staff must use and disclose
your health information to the extent necessary to provide you with quality
health care. To do this, the hospital may share your health information
as necessary for treatment, payment and health care operations.
What Are Treatment, Payment and Health Care Operations?
Treatment includes sharing information among health care providers involved
in your care. For example, your physician may share information about
your condition with the pharmacist to discuss appropriate medications,
or with the radiologist or other consultants in order to make a diagnosis.
The hospital may use your health information as required by your insurer
to obtain payment for your treatment and hospital stay. We also may use
and disclose your health information to improve the quality of care, for
example, to review charts or for training purposes.
How Will the Hospital Use My Health Information?
Your health information may be used for the purposes listed below, unless
you ask for restrictions or specific use or disclosure:
- The hospital directory, which may include your name, general condition,
and your location in the hospital
- Religious affiliation may be given to a hospital chaplain or member of
- Family members or close friends involved in your care or payment for your treatment
- Appointment reminders
- To inform you of treatment alternatives, benefits or services related to
your health. (You will have an opportunity to refuse to receive this information)
- As required by law
- Public health activities, including disease prevention, injury or disability;
reporting births and deaths; reporting child or elder abuse or neglect;
reporting reactions to medications or product problems; notification of
recalls; infectious disease control; notifying government authorities
of suspected abuse, neglect or domestic violence (if you agree or as required by law)
- Health oversight activities, e.g., audits, inspections, investigations,
- Lawsuits and disputes (we will attempt to provide you advance notice of
a subpoena before disclosing the information)
- Law enforcement (e.g., in response to a court order or other legal process;
to identify or locate individuals being sought by authorities; about the
victim of a crime under restricted circumstances; about a death that may
be the result of criminal conduct; about criminal conduct that occurred
in or on the hospital premises; and in emergency circumstances relating
to reporting information at the scene of a crime)
- Coroners, medical examiners, and funeral directors
- Organ and tissue donation
- Certain research projects
- To prevent a serious threat to health or safety
- To military command authorities if you are a member of the armed forces
or a member of a foreign military authority
- National security, disasters and intelligence activities
- If there is a State of Emergency, we will release patient name, date of
birth, city and state to an authority who will be maintaining a database
of patients related to the incident • Protection of the President
or other authorized persons for foreign heads of state, or to conduct
- Inmates (medical information about inmates of correctional institutions
may be released to the institution)
- Worker’s Compensation (your health information regarding benefits
for work-related illnesses may be released as appropriate)
- We may contact you as part of our fund-raising and marketing efforts as
permitted by law
Your Authorization is Required for Other Disclosures
Except as described above, we will not use or disclose your health information
unless you authorize Saint Michael's Medical Center in writing to
disclose your information. If you give authorization to disclose information,
you have the right to revoke the authorization, but that can only be effective
from the date your revocation is delivered in writing to the Saint Michael's
Medical Center Privacy Officer. Call (973) 877-5470 to obtain the address
and what needs to be in the notice of revocation.
You Have Rights Regarding Your Medical Information
You have the following rights regarding your health information, provided
that you make a written request to invoke the right on the form provided
by Saint Michael's Medical Center:
- Right to request restrictions. You may request limitations on your health
information we use or disclose for health care treatment, payment, or
operations (e.g., you may ask us not to disclose that you have had a particular
surgery), but 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 with emergency treatment.
- Right to confidential communications. You may request communications in
a certain way or at a certain location, but you must specify how or where
you wish to be contacted.
- Right to inspect and copy. You have the right to inspect and copy your
health information regarding decisions about your care; however, psychotherapy
notes may not be inspected or copied. We may charge a fee for copying,
mailing and supplies.
- Right to request amendment. If you believe that the health information
we have about you is incorrect or incomplete, you may request an amendment
of the form provided by the hospital which requires certain specific information.
Saint Michael's Medical Center is not required to accept the request
- Right to accounting disclosures. You may request a list of the disclosures
of your health information that have been made to persons or entities
other than for treatment, payment or health care operations in the past
six (6) years, but not prior to April 14, 2003. After the first request,
there may be a charge.
- Right to a copy of this Notice. You may request a paper copy of this Notice
at any time.
Requirements Regarding this Notice
Saint Michael's Medical Center is required by law to provide you with
this Notice. We will be governed by this Notice for as long as it is in
effect. Saint Michael's Medical Center may change this Notice and
these changes will be effective for health information we have about you
as well as any information we receive in the future. Each time you register
at the hospital for health care services as an inpatient or outpatient,
you may receive a copy of the Notice in effect at the time. You can always
request a copy of our most current privacy notice from the hospital or
by contacting our privacy officer at (973) 877-5470.
If you believe your privacy rights have been violated, you may file a
complaint with Saint Michael's Medical Center or with the Secretary
of the United States Department of Health and Human Services - 200 Independence
Ave. S.W. Room 615F Washington, D.C. 20201. You will not be penalized
or retaliated against in any way for making a complaint to the Hospital
or the Department of Health and Human Services.
You may call the Saint Michael's Medical Center Privacy Officer at
- If you have any questions about this Notice;
- If you have a complaint;
- If you wish to request restrictions on uses and disclosures for treatment,
payment or health care operations;
- If you wish to obtain a form to exercise your individual rights; or
- If you wish to revoke your authorization
Corporate Integrity Hotline
This Notice is effective: April 1, 2003