Effective Date: November 22, 2022
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.
This Notice describes the privacy practices of Community Medical Center and the physicians who provide services to patients at this Facility.
Under federal law, your patient health information is protected and confidential. Patient health information includes information about your symptoms, test results, diagnosis, Treatment, and related medical information. Your Health Information also includes Payment, billing, and insurance information.
We use Health Information about you for Treatment, to obtain Payment, and for Health Care Operations, including administrative purposes and evaluation of the quality of care that you receive. Under some circumstances, we may be required to use or disclose the information even without your permission.
Treatment: We will use and disclose your Health Information to provide you with medical treatment or services. For example, nurses, physicians, and other members of your treatment team will record information in your record and use it to determine the most appropriate course of care. We may also disclose the information to other Health Care Providers who are participating in your Treatment, to pharmacists who are filling your prescriptions, and to family members who are helping with your care.
Payment: We will use and disclose your Health Information for Payment purposes. For example, we may need to obtain authorization from your insurance company before providing certain types of Treatment. We will submit bills and maintain records of Payments from your Health Plan. If you have a legal claim against a third party for causing your injuries, we may file a Facility lien in court to collect Payment from them.
Health Care Operations: We will use and disclose your Health Information to conduct our standard internal operations, including proper administration of records, evaluation of the quality of Treatment, and to assess the care and outcomes of your case and others like it.
We may use your information to contact you with appointment reminders. We may also contact you to provide information about Treatment alternatives or other health-related benefits and services that may be of interest to you.
We may use or disclose identifiable Health Information about you for other reasons, even without your consent. Subject to certain requirements, we are permitted to give out Health Information without your permission for the following purposes:
We may also ask if we can disclose limited information about you to clergy or include it in the Facility directory. Under limited circumstances, we may disclose information to notify or locate your relatives or to assist disaster relief agencies.
In any other situation, we will ask for your written authorization before using or disclosing any identifiable Health Information about you. If you choose to sign an authorization to disclose information, you can later revoke that authorization to stop any future uses and Disclosures.
You have the following rights with regard to your Health Information. Please contact the person listed below to obtain the appropriate form for exercising these rights.
Request Restrictions: The Facility is not required to grant a request for restrictions in all circumstances. However, the Facility must agree to a request for a restriction on the Disclosure of Protected Health Information to a Health Plan, or a Business Associate if a Health Plan, if the Disclosure is for the purposes or carrying out Payment or Health Care operation and is not otherwise Required by Law; and the Facility is paid out of pocket in full. In regards to other requests, restrictions will be granted only as follows: (a) It is the facility’s policy not to agree to any restrictions on uses or Disclosures for Treatment or Health Care Operations, except as stated above. The Privacy Officer must approve any exceptions in writing; (b) The facility is not allowed to grant requests to restrict Disclosures required for public health, law enforcement, or to comply with any other laws or regulations.
Confidential Communications: You may ask us to communicate with you confidentially by, for example, sending notices to a special address or not using postcards to remind you of appointments.
Inspect and Obtain Copies: In most cases, you have the right to look at or get a copy of your Health Information. There may be a charge for the copies based on state established rates.
Amend Information: If you believe that information in your record is incorrect, or if important information is missing, you have the right to request that we correct the existing information or add the missing information.
Accounting of Disclosures: You may request a list of instances where we have disclosed Health Information about you.
We are Required by Law to protect and maintain the privacy of your Health Information, to provide this Notice about our legal duties and privacy practices regarding Protected Health Information, and to abide by the terms of the Notice currently in effect.
We may change our policies at any time. Before we make a significant change in our policies, we will change our Notice and post the new Notice in the admissions area. You can also request a copy of our Notice at any time. For more information about our privacy practices, contact the person listed below.
If you are concerned that we have violated your privacy rights, or if you disagree with a decision we made about your records, you may contact the person listed below. You also may send a written complaint to the U.S. Department of Health and Human Services. The person listed below will provide you with the appropriate address upon request. You will not be penalized in any way for filing a complaint.
If you have any questions, requests, or complaints, please contact the Facility Privacy Officer at:
Director of Health Information Management
Community Medical Center
2827 Fort Missoula Rd.
Missoula, MT 59804