Notice of Privacy Practices
This notice describes how medical information about you may be used and how you can get access to this information. Please review it carefully.
The terms of the Notice of Privacy Practices apply to Lake Health, operating as a clinically integrated health care arrangement composed of TriPoint Medical Center; West Medical Center; all walk-in and diagnostic centers; Mentor, Madison, Chardon and Willowick campuses, Home Health, Skilled Nursing Rehabilitation Unit, Physical Therapy sites, Lake Health Physician Group, the physicians and other licensed professionals seeing and treating patients at each location, and the Lake Health medical staff. All of the entities and persons listed will share your personal health information as necessary to carry out treatment, payment and health care operations as permitted by law.
Lake Health is required by law to maintain the privacy of your personal health information and to provide you with notice of Lake Health legal duties and privacy practices with respect to your personal health information. We are required to abide by the terms of this Notice so long as it remains in effect. We reserve the right to change the terms of this Notice as necessary and make the new Notice effective for all personal health information maintained by Lake Health. You may receive a copy of any revised notices at any of the above listed locations or by mailing a request to Privacy Office, Lake Health, 7590 Auburn Road, Concord Township, OH 44077.
Uses and disclosures of your personal health information
Your Authorization. Except as outlined below, Lake Health will not use or disclose your personal health information for any purpose unless you have signed a form authorizing the use or disclosure. You have the right to revoke that authorization in writing unless Lake Health has acted in reliance on the authorization.
Use and Disclosures for Treatment. Lake Health will make uses and disclosures of your personal health information as necessary for your treatment. For instance, doctors, nurses and other professionals involved in your care will use information in your medical record and information that you provide about your symptoms and reactions to plan a course of treatment for you that may include procedures, medications, tests, etc. Lake Health may also release your personal health information to another health care facility or professional who is not affiliated with this organization but who is or will be providing treatment to you. For instance, if after you leave the hospital you are going to receive home health care, Lake Health may release your personal health information to that home health agency so that a plan of care can be prepared for you.
Uses and Disclosures for Payment. Lake Health will make uses and disclosures of your personal health information as necessary for the payment purposes of those health professionals and facilities that have treated you or provided services to you. For instance, we may forward information regarding your medical procedures and treatment to your insurance company to arrange payment for the services provided to you, or we may use your information to prepare a bill to send to you or the person responsible for your payment.
Facility Directory. Lake Health maintains a facility directory listing the name, room number, general condition and, if you wish, your religious affiliation. Unless you choose to have your information excluded from this directory, the information (excluding your religious affiliation) will be disclosed to anyone who requests it by asking for you by name. This information, including your religious affiliation may also be provided to members of the clergy. You have the right during registration to have your information excluded from this directory and to restrict what information is provided and/or to whom.
Family and Friends Involved in Your Care. With your approval, Lake Health may from time to time disclose your personal health information to designated family, friends and others who are involved in your care or in payment of your care in order to facilitate that person’s involvement in caring for you or paying for you care. If you are unavailable, incapacitated or facing an emergency medical situation and it is determined that a limited disclosure may be in your best interest, limited personal health information may be shared with such individuals without your approval. Lake Health may also disclose limited health information to a public or private entity that is authorized to assist in disaster relief efforts in order for that entity to locate a family member or other persons that may be involved in some aspect of caring for you.
Business Associates. Certain aspects and components of Lake Health services are performed through contracts with outside persons or organizations, such as auditing, accreditation, legal services, etc. At times, it may be necessary to provide certain of your personal health information to one or more of these outside persons or organizations who assist with Lake Health health care operations. In all cases, these business associates are required to appropriately safeguard the privacy of your information.
Fundraising. Lake Health may contact you to donate to a fundraising effort for or on Lake Health’s behalf. You have the right to opt out of receiving fundraising materials/communications and may do so by sending your name and address to Lake Health Foundation together with a statement that you do not wish to receive fundraising materials or communications from Lake Health or the Foundation.
Appointments and Services. Lake Health may contact you to provide appointment reminders or test results. You have the right to request to receive communications regarding your personal health information from us by alternative means or at alternative locations. We will accommodate reasonable requests by you. For instance, you may wish appointment reminders not to be left on voice mail or sent to a particular address. You may request such confidential communication in writing. Request forms may be obtained from registration at any facility and at PrimeHealth offices.
Research. In limited circumstances, Lake Health may use and disclose your personal health information for research purposes. For example, a research organization may wish to compare outcomes of all patients who received a particular drug and will need to review a series of medical records. In all cases where your specific authorization has not been obtained, your privacy will be protected by strict confidentiality requirements applied by 1) the Institutional Review Committee which oversees the research or 2) by representations of the researchers that limit their use and disclosure of patient information.
Confidentiality of Alcohol and Drug Abuse Patient Records. The confidentiality of alcohol and drug abuse patient records maintained by Lake Health is protected by federal law and regulations. Generally, Lake Health may not disclose any information identifying you as an alcohol or drug abuser unless: 1) you consent in writing; 2) the disclosure is allowed by a court order; or 3) the disclosure is made to medical personnel in a medical emergency or to qualified personnel for research, audit or program evaluation.
Other Uses and Disclosures. Federal law and regulations do not protect any information about a crime committed by you either at Lake Health, or against any person who works for Lake Health, or about any threat to commit such a crime. Federal laws and regulations do not protect any information about suspected child or elder abuse or neglect from being reported under state law to appropriate state or local authorities. Lake Health is permitted or required by law to make certain other uses and disclosures of your personal health information without your consent or authorization:
- For any purpose required by law.
- For public health activities, such as required reporting of disease, injury, and birth and death, and for required public health investigations.
- For suspected child abuse or neglect; or if there is suspicion that you may be a victim of abuse, neglect or domestic violence.
- To the Food and Drug Administration if necessary to report adverse events, product defects, or to participate in product recalls.
- To your employer when Lake Health has provided health care to you at the request of your employer to determine workplace-related illness or injury; in most cases you will receive notice that information is disclosed to your employer.
- To a government oversight agency conducting audits, investigations, or civil or criminal proceedings.
- If required to do so by a court or administrative ordered subpoena or discovery requests; in some cases you will have notice of such release.
- To law enforcement officials as required by law to report wounds and injuries and crimes.
- To coroners and/or funeral directors consistent with the law.
- If necessary to arrange an organ or tissue donation from you or a transplant for you.
- In limited circumstances if a serious threat to health or safety is suspected.
- If you are a member of the military as required by armed forces services; or if necessary for national security or intelligence activities.
- To workers’ compensation agencies if necessary for your workers’ compensation benefit determination.
Lake Health may release your personal health information in accordance with any state laws that are more restrictive or limiting than federal privacy regulations. Ohio law requires that we obtain a consent from you before disclosing your personal health information to the Long Term Health Ombudsman regarding your stay in our short-term rehabilitation facility or disclosing the performance or results of an HIV test or diagnosis of AIDS or an AIDS-related condition.
Rights that you have
Access to Your Personal Health Information. You have the right to a copy and/or inspect much of the personal health information that Lake Health retains on your behalf. All requests for access must be made in writing and signed by you or your representative. You may obtain a form from the Health Information Management Department and PrimeHealth offices.
Amendments to Your Personal Health Information. You have the right to request in writing that personal health information that Lake Health maintains be amended or corrected. Lake Health is not obligated to make all requested amendments but will give each request careful consideration. All amendment requests, in order to be considered by Lake Health and/or PrimeHealth must be in writing, signed by you or your representative, and must state the reasons for the amendment/correction request. If a requested amendment or correction is made by Lake Health and/or PrimeHealth, notification may be made to others who work with us and have copies of the uncorrected record if such notification is necessary. You may obtain an amendment request form from the Health Information Management Department and PrimeHealth offices.
Accounting for Disclosures of Your Personal Health Information. You have the right to receive an accounting of certain disclosures made by Lake Health of your personal health information after April 14, 2003. Requests must be made in writing and signed by you or your representative. Accounting forms are available from the Lake Health Health Information Management Department and PrimeHealth offices. The first accounting in any 12-month period is free; you will be charged a fee of $25 for each subsequent accounting in the 12-month period.
Restrictions on Use and Disclosure of Your Personal Health Information. You have the right to request restrictions on certain of Lake Health uses and disclosures of your personal health information for treatment, payment or health care operations. A restriction request form can be obtained from Lake Health Registration, Health Information Management Department or PrimeHealth offices. Lake Health is not required to agree to your restriction request but will attempt to accommodate reasonable requests when appropriate. Lake Health retains the right to terminate an agreed-to restriction if it is believed such termination is appropriate. In case of the termination by Lake Health and/or PrimeHealth, you will be notified of such termination. You also have the right to eliminate, in writing or orally, any agreed-to restriction.
Complaints. If you believe your privacy rights have been violated, you can file a complaint with any team member, supervisor or Lake Health Privacy Officer by mail or by telephone. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services in Washington D.C. in writing within 180 days of a violation of your rights. There will be no retaliation for filing a complaint.
Acknowledgment of Receipt of Notice. You will be asked to sign an acknowledgment form that you received the Notice of Privacy Practices.
For further information
If you have questions or need further assistance regarding this Notice, you may contact the Lake Health Privacy Officer by telephone at 440-354-1999 or by mail at Lake Health, 7590 Auburn Road, Concord Township, OH 44077.
As a patient, you retain the right to obtain a paper copy of this Notice of Privacy Practices, even if you have requested a copy by e-mail or other electronic means.
This notice of Privacy Practices is effective April 14, 2003.