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.



Notice of Privacy Policy

When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.

Get an electronic or paper copy of your medical record:

• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this.
• We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.

Ask us to correct health and claims records:

• You can ask us to correct your health and claims records if you think they are incorrect or incomplete. Ask us how to do this.
• We may say “no” to your request, but we’ll tell you why in writing within 60 days.

Request confidential communications:

• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address.
• We will consider all reasonable requests, and must say “yes” if you tell us you would be in danger if we do not.

Ask us to limit what we use or share:

• You can ask us not to use or share certain health information for treatment, payment, or our operations.
• We are not required to agree to your request, and we may say “no” if it would affect your care.

Get a list of those with whom we’ve shared information: 

• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why.
• We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.

Get a copy of this privacy notice:

• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.

Choose someone to act for you:

• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
• We will make sure the person has this authority and can act for you before we take any action.

File a complaint if  you feel your rights are violated:        

• You can complain if you feel we have violated your rights by contacting us using the information on page 1.
• You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/.
• We will not retaliate against you for filing a complaint.
  

Your Choices

For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.

In these cases, you have both the right and choice to tell us to:

• Share information with your family, close friends, or others involved in your care
• Share information in a disaster relief situation
• Include your information in a hospital directory

If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.

In these cases we never share your information unless you give us written permission:

• Marketing purposes
• Sale of your information
• Most sharing of psychotherapy notes

In the case of fundraising:

• We may contact you for fundraising efforts, but you can tell us not to contact you again.
  
  

Our Uses and Disclosures

How do we typically use or share your health information? We typically use or share your health information in the following ways.

Treat You:

•  We can use your health information and share it with other professionals who are treating you. 
• Example:  A doctor treating you for an injury asks another doctor about your overall health condition.

Run our organization:

•  We can use and share your health information to run our practice, improve your care, and contact you when necessary.
• Example: We use health information about you to manage your treatment and services. 

Bill for your services:

•  We can use and share your health information to bill and get payment from health plans or other entities. 
• Example: We give information about you to your health insurance plan so it will pay for your services.

How else can we use or share your health information? We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html. 

Help with public health and safety issues:

• We can share health information about you for certain situations such as:
• Preventing disease
• Helping with product recalls
• Reporting adverse reactions to medications
• Reporting suspected abuse, neglect, or domestic violence
• Preventing or reducing a serious threat to anyone’s health or safety

Do research:

• We can use or share your information for health research.

Comply with the law:

• We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.

Respond to organ and tissue donation requests:

• We can share health information about you with organ procurement organizations. 

Work with a medical examiner or funeral director:

•  We can share health information with a coroner, medical examiner, or funeral director when an individual dies.

Address workers’ compensation, law enforcement, and other government requests:

• We can use or share health information about you:
• For workers’ compensation claims
• For law enforcement purposes or with a law enforcement official
• With health oversight agencies for activities authorized by law
• For special government functions such as military, national security, and presidential protective services

Respond to lawsuits and legal actions:

• We can share health information about you in response to a court or administrative order, or in response to a subpoena.

Our Responsibilities

• We are required by law to maintain the privacy and security of your protected health information.
• We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
• We must follow the duties and privacy practices described in this notice and give you a copy of it.
• We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. 

For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.

Changes to the Terms of This Notice

We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.

Contact Us

If you have any questions, concerns, or want further information regarding the issues covered in this Notice or for additional information regarding our privacy policies, please contact the Hospital’s Privacy Officer at 220 Essie Davison Drive, Clarinda, Iowa 51632 or via phone at (712)542-2176.

This Notice of Privacy Practices applies to the following organizations:

1. Villisca Family Health Center
2. Bedford Family Health Center
3. Clarinda Mental Health Center
4. Rehabilitation and Sports Medicine Center

Patient Rights & Responsibilities

Patient Rights

All hospital staff, medical staff and contracted agency staff performing patient care shall observe these patient rights.

The patient’s rights shall include, but are not limited to, the following:

• Become informed of his/her rights as a patient in advance of, or when discontinuing, the provision of care. The patient may appoint a representative to receive this information should he/she so desire.

• Receive Beneficiary Notice of Non-Coverage and right to appeal premature discharge.

• Access to treatment or accommodations regardless of race, creed, ethnicity, religion, culture, language, sex, color, age, national origin or ancestry, disability, sexual orientation, gender identity or expression, diagnosis, or source of payment for care, including Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP).

• The right to considerate, dignified and respectful treatment, provided in a safe environment, free from all forms of abuse, neglect, harassment and/or exploitation.

• The right to have his/her cultural, psychosocial, spiritual and personal values, beliefs and preferences respected. To ensure those preferences are identified and communicated to staff, a discussion of these issues shall be included during the initial nursing admission assessment.

• Access protective and advocacy services or have these services accessed on the patient’s behalf.

• Appropriate assessment and management of pain.

• The right to give or withhold informed consent.

• The right to give or withhold informed consent to produce or use film/recordings of the patient for purposed other his/her care.

• The right to participate in the development and implementation of their plan of care. The patient or his/her representative has the right to make informed decisions regarding his or her care, including being informed of their health status, being involved in care planning and treatment, and being able to request or refuse treatment and services, in accordance with law and regulation.

• The right to formulate advance directives and to have hospital staff and practitioner who provide care in the hospital comply with these directives.

• The right to have a family member or representative of his/her choice and physician notified promptly of the patient’s admission to the hospital.

• Have a family member, friend or other designated individual be present for emotional support throughout the course of stay.

• The right to full consideration of privacy concerning his/her medical care program, as well as personal privacy. Case discussion, consultation, examination and treatment are confidential and shall be conducted discreetly. The patient has the right to be advised as to the reason for the presence of any individual involved in his/her healthcare.

• Confidential treatment of all communications and records pertaining to his/her care and his/her stay in the hospital. His/her written permission shall be obtained before his/her medical records can be made available to anyone not directly concerned with his/her care.

• The right to be free from restraints or seclusion of any form that are not medically necessary or are used as a means of coercion, discipline, convenience, or retaliation by staff.

• The right to access information contained in their medical record within a reasonable time frame. The hospital will actively seek to meet these requests as quickly as the record keeping system permits.

• Reasonable responses to any reasonable request he/she may make for service.

• Reasonable continuity of care.

• The right to be advised of the hospital grievance process, should he/she wish to communicate a concern regarding the quality of the care he/she receives or if he/she feels the determined discharge date is premature. To file an internal grievance at CRHC, contact Administration at 712-542-2176. The patient will be provided a written notice of the grievance determination, the steps taken on his/her behalf to investigate the grievance, the results of the grievance, and the grievance completion date. The patient also has the right to appeal to an external agency by contacting:

State Ombudsman

Department of Elder Affairs

1200 10^th Street

Des Moines, Iowa 50309

Phone: 1-800-532-3213 or 515-242-3327

• The patient has the right to expect reasonable safety insofar as the practice and environment are concerned.

• The patient has the right to know the name of the physician who has primary responsibility for coordinating his/her care and the names and professional relationships of other physicians and healthcare providers who will see him/her.

• The patient, at his/her own request and expense has the right to consult with a specialist.

• Regardless of the source of payment of his/her care, the patient has the right to request and receive an explanation of his/her total bill for services rendered in the hospital.

• Be informed about his/her visitation rights. Visitation rights shall include the right to receive visitors chosen by the patient, including, but not limited to, the patient’s spouse, domestic partner (including a same-sex domestic partner), another family member or a friend. The patient may withdraw or deny such consent at any time. The patient must also be informed of any clinical restriction or limitation on such rights.

• Have access and accommodation for religious and spiritual services attendance.

• Obtain information on disclosure of protected health information, in accordance with federal, state and local law.

• Receive information in a manner that he/she understands. Communications with the patient shall be effective and provided in a manner that facilitates understanding by the patient. Written information provided shall be appropriate to the age, understanding and, as appropriate, the language of the patient. As appropriate, communications specific to the vision, speech, hearing cognitive and language-impaired patient shall be appropriate to the impairment.

• Leave the hospital even against the advice of his/her physician.

• Be advised if hospital/personal physician proposes to engage in or perform human experimentation affecting his/her care or treatment. The patient has the right to refuse to participate in such research projects. Refusal to participate or discontinuation of participation shall not compromise the patient’s right to access care, treatment or services.

• Full support and respect of all patient rights should the patient choose to participate in research, investigation and/or clinical trials. This includes the patient’s right to a full informed consent process as it relates to the research, investigation and/or clinical trial. All information provided to subjects shall be contained in the medical record or research file, along with the consent form(s).

• Patients’ rights will apply to the person who may have legal responsibility to make decisions regarding medical care on behalf of the patient.

• The patient has a right to refuse the use of a scribe during the visit.

• Be informed by his/her physician or a delegate of his/her physician of the continuing healthcare requirements following his/her discharge from the hospital.

Patient Responsibilities

The care a patient receives depends partially on the patient himself. Therefore, in addition to these rights, a patient has certain responsibilities as well. These responsibilities shall be presented to the patient in the spirit of mutual trust and respect:

• The patient shall have the responsibility to provide accurate and complete information concerning his/her present complaints, past illnesses, hospitalizations, medications and other matters relating to his/her health.

• The patient shall be responsible for reporting perceived risks in his/her care and unexpected changes in his/her condition to the responsible practitioner.

• The patient shall be responsible for following the treatment plan established by the patient and his/her physician, including the instructions of nurses and other health professionals as they carry out the physician's orders.

• The responsibility for consequences if treatment is refused or if the practitioner’s instructions are not followed.

• The patient and family shall be responsible for asking questions when they do not understand what they have been told about the patient’s care or what they are expected to do.

• The responsibility for being considerate of the rights of other patients and facility personnel.

• The responsibility for being respectful of the property of other people and of the facility.

• The responsibility to inform the hospital and physician of advanced directives formulated and provide a copy of the same.

• The responsibility for assuring the financial obligations for the care provided is fulfilled as promptly as possible.

• The responsibility for abiding by hospital rules and regulations affecting patient care and conduct.

• The patient and family shall be responsible for immediately reporting any concerns or errors they may observe.

• The patient shall be responsible for keeping appointments and for notifying the hospital or physician when he/she is unable to do so.

• The patient and family shall be responsible for asking questions about the patient’s condition, treatments, procedures, Clinical Laboratory and other diagnostic tests.

• The patient shall be responsible for his/her actions should he/she refuse treatment or not follow his/her physician’s orders.

File A Grievance

In the event a patient or the patient’s family or representative have a comment, complaint, or grievance he/she is encouraged to do one or more of the following:

a. Inform or ask any staff member

b. Speak directly to the nursing supervisor or management

c. Request to speak with someone in Administration

d. File a grievance in writing or by calling any of the executives/agencies below:

Clarinda Regional Health Center

Chief Executive Officer (CEO)

220 Essie Davison Drive

Clarinda, Iowa 51632

712- 542-8214

Quality Improvement Organization

Beneficiary and Family Centered Care: Livanta

livantaqio.cms.gov/en/states/iowa

1-888-755-5580

1-888-985-9295

Iowa Department of Inspections, Appeals, & Licensing

6200 Park Ave, Suite 100

Des Moines, Iowa 50321-1270

1-877-686-0027

1-515-281-7102

Health & Human Services

Iowa Long Term Care Ombudsman

510 E 12th St., Suite 2

Des Moines, Iowa 53019

1-866-236-1430

1-515-725-3333