Notice of Privacy Practices

HOW WE MAY USE AND DISCLOSE YOUR PHI

FOR TREATMENT.  We will use PHI to provide, coordinate or manage health care and any related services. This includes communication with other physicians, nurses, technicians, office staff, or providers of services (specialists, laboratories, orthotists, prosthetists, facilities, pharmacies, etc.) who provide care or services requested by your physician. For example, your doctor or nurse or social worker may provide medical information to your other doctors or health care providers to coordinate your care.

FOR PAYMENT. We will use PHI to obtain payment for services you receive from ICHA, or another provider who has treated you, from an insurance company or a third party. This may include pre-treatment reviews or authorizations, determinations of eligibility and coverage, reviewing services provided to you for medical necessity, and undertaking utilization review activities. For example, we may contact your insurance company before an office or home visit, or surgery, or testing, to determine the need for precertification or to determine whether your plan will cover the services.

BUSINESS OPERATIONS. We may use or disclose PHI in order to support our business activities. These include, but are not limited to, professional peer review, employee review activities, clinical improvement, training or education of students or residents, continuation of medical education, accrediting, insurance and licensing activities, and conducting or arranging for other business activities. For example, we may use your PHI to train medical residents or students who see our patients. We may also disclose your PHI to another health care facility, professional or plan for such purposes as quality assurance if that entity has a healthcare relationship with you.

APPOINTMENTS AND SERVICES. We may contact you as a reminder that you have an appointment for treatment or medical care at the office. We may also contact you with test results. You have the right to request and we will attempt to accommodate reasonable requests by you to receive communications regarding your PHI from us by alternative means or at alternative locations (see "Your Rights").

BUSINESS ASSOCIATES. We will share your PHI with third party 'business associates' who perform various activities (e.g., billing, transcription) for us. Whenever an arrangement with a business associate involves the use or disclosure of PHI, we will have a written contract that contains terms that will protect the privacy of this PHI.

OTHERS INVOLVED IN YOUR HEALTHCARE.Unless you request otherwise, we may disclose, to a member of your or the patient's family, relative, or close friend or any other person you identify, PHI that directly relates to that person's involvement in the patient's health care. If you are unable to agree or object to such a disclosure, we may disclose such information as necessary if we determine that is in the patient's best interest based on our professional judgement. We may use or disclose PHI to notify or assist in notifying a family member, personal representative, or any other person that is responsible for the patient of the patient's location, and general condition.

COMMUNICATION BARRIERS:We may use and disclose your PHI if we or your physician or another physician attempts to obtain consent from you but is unable to do so due to substantial communication barriers and the physician determines, using professional judgement, that you intend to consent to use or disclose under the circumstances.

EMERGENCIES. Your consent is not required before using or disclosing PHI in an emergency treatment situation. We will attempt to obtain consent, but will proceed with treatment and use and disclosure of PHI as needed. If this happens, we or your physician will try to obtain your consent as soon as reasonably possible.

GOODS AND SERVICES: Unless you object, we may use and disclose your PHI to provide you with information about treatment alternatives or other health related benefits and services we offer. For example, your name and address may be used to send you a newsletter about a product or service that may be beneficial to you.

REVOKING CONSENT: You may revoke your Consent at any time by giving us written notice. Your revocation will be effective when we receive it, but it will not apply to any uses and disclosures that occurred before that time. If you do revoke your Consent, we will not be permitted to use or disclose information for purposes of treatment, payment or healthcare operations, and we may therefore choose to discontinue providing you with healthcare treatment and services.

Other uses and disclosures of PHI will be made only with your written Authorization, unless otherwise permitted or required by law as described below. You may revoke an Authorization at any time, in writing.

FACILITY DIRECTORY AND FUNDRAISING: If you receive care from a Children's Hospital entity, and unless you object, we may disclose the patient's name in our inpatient facility directory (name, room, general condition and religious affiliation). Also, unless you object, we may contact you to contribute to a fundraising effort for or on our behalf, and you may be contacted by someone in the future either during or after your care to inquire about your interest in:

• having your story used for fundraising, newsletter articles, fundraising videos, direct mail, and other marketing related efforts;
• visiting with a celebrity or athlete during the patient's stay;
• participating in events, such as press conferences, symphony concerts, and other events both inside and outside our facilities.

You and the patient will always have the option not to participate in the activities above, and may formally opt out at inpatient admission or by writing to Children's Hospital Foundation, 700 Children's Drive, Columbus, OH 43205 with a statement that you do not wish to participate.

The following is a statement of your rights with respect to your PHI. All forms are available online in an Adobe PDF document. If you need to download the latest version - click here.

You have the right to inspect and copy your PHI. You may inspect and obtain a copy of PHI about you or your child. All requests must be in writing to the entity or location providing your care and signed by the patient or his parent or legal guardian if a minor. We will charge for all copies and postage, if mailed. However, under federal law, you may not have a right to inspect or copy certain types of your PHI. In some cases you may have a right to a review of our decision to deny you access to such PHI. Click here to print.

You have the right to request limits on the use and disclosure of PHI.You may ask us not to use or disclose any part of PHI for the purposes of treatment, payment or healthcare operations. You may also ask that PHI not be disclosed to family members or friends who may be involved in your care or the payment for it. Your request must state the specific restriction requested and to whom you want the restriction to apply. Click here to print.

Your physician is not required to agree to a restriction that you may request. If the physician believes it is in you or your child's best interest to permit use of PHI, the PHI use will not be restricted. If your physician agrees to the requested restriction, we may not use PHI in violation of that restriction unless it is needed to provide emergency treatment.

You have the right to request to receive confidential communications from us by alternative means or at an alternative location.You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. We will accommodate reasonable requests. We will not request an explanation from you as to the basis for the request. This request must be made in writing. Click here to print.

You may have the right to amend your PHI. If you believe PHI we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment as long as the information is kept by this office. You must complete and submit a Medical Record Amendment/ Correction Form. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend information that we did not create, or is not part of the health information that we keep, or you would not be permitted to inspect and copy, or is accurate and complete. Click here to print.

You have the right to receive an accounting of certain disclosures we have made. This right applies to disclosures for purposes other than treatment, payment and healthcare operations. You have the right to receive specific information regarding many disclosures that occurred after April 14, 2003. You must submit this request in writing. We may charge you for the costs of providing the list. Click here to print.

You have the right to obtain a paper copy of this notice from us, upon request, at any time. You will be asked to sign an acknowledgement that you received this notice.

CHANGES TO THIS NOTICE. ICHA, or any of its voluntary participants, reserves the right to withdraw from or modify or change this Notice at any time, and to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. Revision to the Notice will be available on request by contacting the office. An updated ICHA Privacy Notice, or a separate corporate Notice in the event of a withdraw from this notice, will be posted by all affected participants within 60 days of the revision.

COMPLAINTS. If you believe your privacy rights have been violated, you can file a written complaint by requesting a complaint form from the location or entity providing your care. You may also file a complaint with the Secretary of Health and Human Services in Washington DC in writing within 180 days of the violation. There will be no retaliation for filing a complaint. Click here to print.

You may be asked to sign an acknowledgment that you received this Notice of Privacy Practices. This Notice was published and becomes effective April 14, 2003.

PUBLIC HEALTH. We may disclose health information about you for public health reasons in order to prevent or control disease, injury or disability; or report births, deaths, non-accidental physical injuries, reactions to medications (for example, in cooperation with the FDA), or problems with products, or if we suspect a serious risk to public safety.

HEALTH OVERSIGHT. We may disclose PHI to a health oversight agency for audits, investigations, inspections, or licensing purposes. These disclosures may be necessary for certain state and federal agencies to monitor the healthcare system, government programs, and compliance with civil rights laws.

LEGAL PROCEEDINGS. We may disclose PHI in the course of any judicial or administrative proceeding, in response to an order of a court, subpoena, discovery request or other lawful process, subject to all applicable legal requirements.

LAW ENFORCEMENT. We may release PHI if asked to do so by a law enforcement official in response to a subpoena, warrant, summons or similar process, subject to all applicable legal requirements. We may also provide limited information for identification, location, or apprehension purposes, information pertaining to victims of crime, suspicion that death has occurred as a result of criminal conduct, in the event that a crime occurs on our premises, or regarding a medical emergency (not on our premises) where it is likely that a crime has occurred.

CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS. We may disclose PHI for identification purposes, determining cause of death or for these persons to perform their duties as authorized by law.

HEALTH AND SAFETY. We may disclose PHI, if permitted by federal and state laws, if we believe that this information is necessary to prevent or lessen a serious and imminent threat to the health and safety of a person or the public.

MILITARY, VETERANS, NATIONAL SECURITY, AND INTELLIGENCE. We may disclose PHI of individuals who are or were Armed Forces, national security or intelligence personnel if requested by military command or other government authorities for the purposes of determination of eligibility for benefits, for activities deemed necessary by appropriate military command, or for conducting national security and intelligence activities (protection of the President or others legally authorized to receive protection). We may also disclose PHI to foreign military authorities if you are a member of that foreign military service.

WORKER'S COMPENSATION. We may disclose PHI as authorized to comply with worker's compensation laws and other similar legally established programs.

INMATES. We may disclose PHI if you are an inmate of a correctional facility and your physician created or received your PHI in the course of providing care to you.

RESEARCH. We may use or disclose your PHI to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of this PHI.

OHIO LAW: Ohio law requires we obtain a consent from you before disclosing the performance or results of an HIV test or diagnoses of AIDS or related conditions.

TOP