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JOINT NOTICE OF PRIVACY PRACTICES - Effective April 14, 2003
Verdugo Hills Hospital is committed to protecting the privacy of your health information. This Notice covers the privacy practices for Verdugo Hills Hospital and for the following entities for services provided in conjunction with Verdugo Hills Hospital: Foothill Emergency Medical Group, Verdugo Radiology Medical Group, Verdugo Hills Anesthesia, Chandnish K. Ahluawalia M.D. Inc., and the physicians who interpret Electrocardiograms (EKG), Electroencephalograms (EEG), Echocardiograms (Echo) and vascular studies. This notice describes how health information about you may be used and disclosed and how you can get access to this information. Please review this notice carefully. This notice is effective as of April 14, 2003.
If you have any questions about this notice, please contact the Verdugo Hills Hospital’s Privacy Officer at (818) 952-2298.
Uses and Disclosures of Your Health Information
This section of the notice explains how Verdugo Hills Hospital shares your health information between our employees, our business associates and with other organizations when required. We require our business associates to protect the privacy of your health information through written agreements. As explained below, in some instances we will request your written permission to use or disclose your health information.
Uses and disclosures related to treatment, payment and operations. Your health information may be shared between our employees or with our business associates for activities related to treatment, payment and operations. In these instances, Verdugo Hills Hospital will not request your authorization to share your health information. As described in the next section, you have the right to request a restriction on the use and disclosure of your health information for payment or operations purposes.
Examples of activities related to treatment include: tests and treatments received by you at the hospital or in your home and procedures you under go at the hospital. Examples of activities related to payment include: preparing and sending bills for services provided, determinations of insurance coverage, collection of reimbursement from individuals and insurance carriers. Examples of activities related to operations include: quality improvement, fraud and abuse prevention and detection, medical review, and complaint resolution.
Required disclosures that do not require your written permission. Your health information may be disclosed to other organizations without your written consent or authorization in the following circumstances: when required by law; for public health activities; about victims of abuse, neglect, or domestic violence; for health oversight activities (including audits, investigations, and inspections); for judicial and administrative proceedings; for law enforcement purposes; about deceased persons to coroners, health examiners, and funeral directors; for organ and tissue donation; to avert a serious threat to health or safety; for specialized government functions (such as military personnel, and inmates in correctional facilities); for worker's compensation.
Uses and disclosures that require your written permission. In all other circumstances, uses and disclosures of your health information will only be made with your written authorization. You may revoke such an authorization at any time.
Other uses and disclosures. We may contact you to provide appointment reminders or information about treatment alternatives or other health benefits and services that may be of interest to you.
We may contact you to raise funds for Verdugo Hills Hospital. If you prefer not to receive such solicitations, please send a written request to Verdugo Hills Hospital Foundation, 1812 Verdugo Blvd, Glendale, Ca, 91208, asking to be removed from their mailing list.
We may disclose your health information to the benefits administrator of your employer. Your employer's health benefits administrators is prohibited from sharing this information to your employer for purposes of employment-related decisions.
In certain circumstances we will contact the policyholder of the health plan without the authorization of the adult-age dependent specifically VHH may contact the guarantor of adult dependents if an insurance carrier is requesting information from the policyholder.
Your Privacy Rights
This section of the notice describes your rights with respect to your health information and a brief description of how you may exercise these rights.
Right to Restrict Uses and Disclosures for Payment and Operations Purposes. You have the right to request that we restrict uses and disclosure of your health information for activities related to payment and operations as described above. Your request for the restriction must be in writing. We will evaluate all requests for restrictions, however, we may not agree to the restriction. If we agree to the restriction, we will abide by it except in emergencies. We will terminate our agreement to a restriction if you agree to or request the termination of the restriction. If we decided to terminate our agreement to the restriction, we will notify you of our decision.
Right to Request Confidential Communications. You may request that we communicate with you by alternative means or at alternative locations. For example, you may wish to receive communications from us at your work location rather than your home. We must accommodate you request if you clearly state that the disclosure of all or part of your health information could endanger you.
Right to Inspect and Copy Your Health Information. You have a right to inspect and copy your health information for as long as we maintain the information. However, you do not have an automatic right to access psychotherapy notes or information in a criminal, civil or administrative action or proceeding. We will act on a request for access within 30 days of receiving your request if the information is maintained and accessible on-site or within 60 days otherwise (with a possible 30-day extension). We may provide you with a summary of the health information requested if you agree in advance to the summary and to the fees imposed.
We may deny your request for access to you health information under certain circumstances such as when access would endanger the life or safety of you or others. If your request is denied, we will send you a written denial that explains our reason for the denial, your review rights if any and how to file a complaint with our Privacy Office or Secretary of the Department Health and Human Services (HHS).
If your request for access is denied, in certain instances we will provide you with an opportunity for review. The review decision must be made in a reasonable period of time, and we will provide you with a written notice of the review decision.
We charge a fee of $15.00 for business records and $10.75 + $0.25 per Page for medical records for copies of your health information. This fee is based on our copying, mailing and summary preparation costs.
Right to Amend Your Health Information. You have the right to request that we amend your health information if you believe the information is incorrect or inaccurate. We may deny your request to amend your health information if we did not create the health information, if the information is not part of our records, if the information was not available for inspection or the information is accurate and complete.
We will respond to your written request to amend you health information within 60 days of the request (with a possible 30-day extension).
If your request for amendment is granted, we will notify you that amendment was accepted and obtain your identification of and agreement to inform relevant persons. We will make reasonable efforts to inform and provide the amendment within a reasonable time to persons identified by you and by us, including our business associates.
If your request for the amendment is denied, we will provide you with a timely, written notice which explains the reason for the denial, your right to submit a written statement of disagreement or to have the request for amendment included with future disclosures, and your right to complain to the us or the Secretary of HHS. We may prepare a rebuttal statement to your statement of disagreement. We will provide you with a copy of the rebuttal statement.
Any future disclosures of your health information will include the statement of disagreement or request for amendment, the denial notice, and the rebuttal or summary of this information.
Right to An Accounting of Disclosures. You have the right to receive a list or accounting of the disclosures of your health information made us during the six years prior to the request. We will act on your request for an accounting of disclosures within 60 days (with a possible 30-day extension).
This accounting of disclosures will not include the following disclosures:
- disclosures for treatment, payment and operations
- disclosures to you
- disclosures for national security or intelligence purposes
- disclosures to correctional institutions or law enforcement officials
- disclosures made prior to April 14, 2003.
We will provide you with one free accounting each year. For subsequent requests, we will charge a $15.00 fee.
The written accounting of disclosures will include the following information for each disclosures: the date of the disclosure, the person to whom the information was disclosed, a brief description of the information disclosed or in lieu of the summary, a copy of the authorization or request for disclosure.
Right to A Copy of Privacy Notice. This notice is posted on our web site (www.vhhospital.org) and may be printed from there. You have the right to receive a paper copy of this notice upon request. To request a written copy, please send a written request to: Privacy Officer, Verdugo Hills Hospital, 1812 Verdugo Blvd., Glendale, CA 91208.
Complaints. You may complain to us or the Secretary of HHS if you believe you privacy rights have been violated. To file a complaint with Verdugo Hills Hospital contact the Privacy Officer at (818) 952-2298. We will not intimidate, discriminate against, or retaliate against you if you exercise any right or process described in this notice, including the filing of a complaint or testifying, assisting, or participates in an investigation, compliance review, or hearing.
Our Responsibilities
Verdugo Hills Hospital is required by a federal law, the Health Insurance Portability and Accountability Act (HIPAA) and California state laws to maintain the privacy of your health information and to provide you with this notice of privacy practices.
Verdugo Hills Hospital will abide by the terms of this notice of privacy practices.
Changes to Our Privacy Practices
We will provide you with a revised privacy notice upon your first visit after we make a significant change to our policies for use and disclosure, individual privacy rights, our responsibilities or any other practices described in this notice. While Verdugo Hills Hospital reserves the right to implement changes its privacy practices without prior notice, we will provide you with a revised notice upon your first visit after we make a significant change.
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