Notice of Privacy Practices
This notice describes how your health information may be used and shared with others (disclosed) and how you can get access to this information. Please review this notice carefully.
I. Who must follow this Notice?
Nationwide Children’s Hospital provides health care to patients in partnership with other professionals and health care organizations. Collectively, the following organizations will be referred to as “we” or “us.” While each of these facilities and affiliates operates independently, we will share your health information among ourselves to carry out our treatment, payment, and health care operations.
The information privacy practices in this Notice will be followed by:
Nationwide Children’s Hospital, Inc.
Nationwide Children’s Hospital
The Center for Family Safety and Healing
Nationwide Children’s Hospital’s ChildLabs
Children’s Radiological Institute, Inc.
Children’s Anesthesia Associates, Inc.
Children’s Surgical Associates Corp.
Nationwide Children’s Hospital Foundation
Nationwide Children’s Hospital Homecare
Pediatric Pathology Associates of Columbus, Inc.
Pediatric Academic Association, Inc.
Research Institute at Nationwide Children’s Hospital
Any healthcare professional that treats you at any of our locations.
All employees, medical staff, trainees, students, or volunteers of the entities listed above.
We reserve the right to change this Notice of Privacy Practices and to make any new practices effective for information we already have and for information that we receive in the future. Any changes made to the Notice of Privacy Practices will be posted throughout Nationwide Children’s Hospital and affiliated facilities, in the Patient Registration area, posted on our Web site (www.nationwidechildrens.org) and made available to you at your next appointment.
II. To what information does this Notice apply?
Protected Health Information (PHI) is information that you provide us or that we create or receive about your health care. PHI contains a patient’s age, race, sex, and other personal health information that may identify the patient. The information relates to the patient’s physical or mental health in the past, present, or future, and to the care, treatment, services, and payment for care needed by a patient because of his or her health.
III. Ways We Can Use and Share Your PHI Without Your Written Permission (Authorization)
In many situations, we can use and share your PHI for activities that are common in hospitals. In certain other situations, which we will describe below, we must have your written permission (authorization) to use and/or share your PHI. We do not need any type of permission from you for the following uses and disclosures:
We must use and disclose your health information to provide that information:
a. To you or someone who has the legal right to act for you (your personal
representative) in order to administer your rights as described in this Notice; and
b. To the Secretary of the Department of Health and Human Services, if
necessary, to make sure your privacy is protected.
Uses and Disclosures for Treatment, Payment and Health Care Operations. We may use and share your PHI to provide “Treatment,” obtain “Payment” for your Treatment, and perform our“Health Care Operations.” These terms mean the following:
a. Treatment. We use and share your PHI to provide care and other services to you; for example, to diagnose and treat your injury or illness. In addition, we may contact you to provide appointment reminders or information about treatment options. We may tell you about other health-related benefits and services that might interest you. We may also access and/or disclose PHI with doctors, nurses, and others involved in your care.
b. Payment. We may use and share your PHI to receive payment for services that we provide to you. For example, we may share your PHI to request payment and receive payment from Medicare, Medicaid, your health insurer, HMO, or other company or program that arranges or pays the cost of some or all of your health care (“Your Payor”) and to confirm that Your Payor will pay for health care. As another example, we may share your PHI with the person who you told us is primarily responsible for paying for your Treatment, such as your spouse or parent.
c. Health Care Operations. We may use and share your PHI for our health care operations, which include management, care coordination, planning, and activities that improve the quality and lower the cost of the care that we deliver. For example, we may use PHI to review the quality and skill of our physicians, nurses, and other health care providers. We may use your PHI to conduct quality assessment and improvement activities, including outcomes evaluation and the development of clinical guidelines. We may also use your PHI to participate in population-based activities related to improving health or reducing health care costs. Finally, we might use your PHI to provide you information on health related programs or products such as alternative medical treatments and programs or about health-related products and services, subject to limits imposed by law.
Disclosures to Your Other Health Care Providers. We may also share PHI with your doctor and other health care providers when they need it to provide Treatment to you, to obtain Payment for the care they give to you, to perform certain Health Care Operations, such as reviewing the quality and skill of health care professionals, or to review their actions in following the law.
Use or Disclosure for the Facility Directory of Patients at Nationwide Children’s Hospital. We may include your name, location in the hospital, general health condition and religious affiliation in a patient directory without receiving your permission; however, you reserve the right to tell us you do not want your information in the directory. Information in the directory may be shared with anyone who asks for you by name or with members of the clergy; however, religious affiliation will only be shared with members of the clergy.
Use or Disclosure for track boards, white boards, bed boards, and patient room placards. We may write your first name, the first three letters of your last name, and your medical record number on various tracking boards, at nurse’s
stations, and/or outside of your room unless you tell your caregiver that you do not want your information placed there.
Disclosure to Relatives, Close Friends and Your Other Caregivers. We may share your PHI with your family member/relative, a close personal friend, or another person who you identify if we (1) first provide you with the chance to
object to the disclosure and you do not object; (2) infer that you do not object to the disclosure; or (3) obtain your agreement to share your PHI with these individuals. If you are not present at the time we share your PHI, or you are not
able to agree or disagree to our sharing your PHI because you are not capable or there is an emergency circumstance, we may use our professional judgment to decide that sharing the PHI is in your best interest. We may also use or share your PHI to notify (or assist in notifying) these individuals about your location and general condition.
To Business Associates that perform functions on our behalf or provide us with services if the information is necessary for such functions or services. Our business associates are required, under contract with us, to protect the privacy of your information and are not allowed to use or disclose any information other than as specified in our contract.
For Data Breach Notification Purposes. We may use your contact information to provide legally-required notices of unauthorized acquisition, access, or disclosure of your health information.
Fundraising Communications. We may contact you with information about the importance of contributions to Nationwide Children’s Hospital and invite you to participate. We may share with our fundraising staff limited information about you (e.g., your name, address, gender, insurance status, and phone number) including the dates on which we provided health care to you, without your written authorization. If you do not want to receive any fundraising information in the future, you may opt out in writing to Nationwide Children’s Hospital Foundation, 700 Children’s Drive, Columbus, OH 43205 or opt out electronically on any email communications.
Public Health Activities. We are required or are permitted by law to report PHI to certain government agencies and others. For example, we may share your PHI for the following reasons:
a. to report health information to public health authorities for the purpose of preventing or controlling disease, injury, or disability;
b. to report known or suspected abuse or neglect to the appropriate public child protective services agency, as we are required to do by law;
c. to report information about products and services to the U.S. Food and Drug Administration;
d. to alert a person who may have been exposed to a communicable disease or may otherwise be at risk of developing or spreading a disease or condition;
e. to report information to your employer as required under laws addressing work-related illnesses and injuries or workplace medical surveillance; and
f. to prevent or lessen a serious and imminent threat to a person for the public’s health or safety or to certain government agencies with special functions such as the State Department.
Health Oversight Activities. We may share your PHI with a health oversight agency that oversees the health care system and ensures the rules of government health programs, such as Medicaid, are being followed.
Judicial and Administrative Proceedings. We may share your PHI in the course of a judicial or administrative proceeding in response to a court order or other lawful process.
Law Enforcement Purposes. We may share your PHI with the police or other law enforcement officials as required or permitted by law or in compliance with a court order or warrant.
Correctional Facilities. We may share your PHI if you are an inmate of a cor rectional institution or under the custody of a law enforcement official, but only if necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
Decedents. We may share PHI with a coroner, funeral director, or medical examiner as authorized by law.
Organ and Tissue Procurement. We may share your PHI with organizations that facilitate organ, eye, or tissue procurement, banking, or transplantation.
Research. We may use or share your PHI if the group that oversees our research, the Institutional Review Board, approves a waiver of permission (authorization) for disclosure or for a researcher to begin the research process.
Workers’ Compensation. We may share your PHI as permitted by or required by state law relating to workers’ compensation or other similar programs.
As required by law. We may use and share your PHI when required to do so by any other law not already referred to above.
IV. Uses and Disclosures Requiring Your Written Permission (Authorization)
For any purpose other than the ones described above, we may only use or share your PHI when you grant us your written permission (authorization). For example, you will need to give us your permission before we send your PHI to your life insurance company.
Marketing. We must also obtain your written permission (authorization) prior to using your PHI to send you any marketing materials. However, we may communicate with you about products or services related to your Treatment, case management, or care coordination, or alternative treatments, therapies, health care providers, or care settings without your permission. For example, we may not sell your PHI without your written authorization.
Uses and Disclosures of Your Highly Confidential Information. Federal and state law requires special privacy protections for certain highly confidential information about you (“Highly Confidential Information”), including any portion of your PHI that is: (1) kept in psychotherapy notes; (2) about mental health and developmental disabilities services; (3) about alcohol and drug abuse prevention, Treatment and referral; (4) about HIV/AIDS testing, diagnosis or Treatment; (5) about sexually transmitted disease(s); (6) about genetic testing; (7) about child abuse and neglect; (8) about sexual assault; or (9) Invitro Fertilization (IVF). Before we share your Highly Confidential Information for a purpose other than those permitted by law, we must obtain your written permission.
V. Patient Rights
You have the right to be informed of our privacy practices.
a. Our practices related to protecting the privacy of your health information are described in our Notice of Privacy Practices (NOPP). The NOPP describes how we use your information to provide treatment to you, to obtain payment for that treatment and for our internal business operations. You will be given the opportunity to obtain a paper copy of the NOPP anytime you visit. When you first become our patient, we will ask you to sign an acknowledgement indicating that you have been given the opportunity to review and/or obtain a paper copy of our NOPP. A current version of our NOPP can also be viewed on our website at www.nationwidechildrens.org.
You have the right to request access to your health information.
a. You have the right to see and obtain a copy of health information that may be used to make decisions about you, such as nurse’s notes, lab tests, reports, and treatment plans. You also may, in some cases, receive a summary of this health information. You must make a written request to inspect and/or obtain a copy of your health information. The request form is available by mail at the addr ess below, can be downloaded from our website, or you may call 614-355-0777 to request a copy. We may charge a reasonable fee for any copies.
b. In certain limited circumstances, we may deny your request to inspect and copy your health information. For example, you may not read or be given a copy of psychotherapy notes; information collected for use in a civil, criminal, or administrative action, or court case; and certain PHI that is protected by law. In some situations, you may have the right to have this decision reviewed. Please contact the Health Information Management Department at 614-355-0777 if you have questions about access to your medical record.
You have the right to request that we disclose your health information to others.
a. If you would like some of your health information sent to someone else, for example to an attorney or to your employer, you will need to complete our authorization form indicating that you agree to our disclosing (providing) the information to the others you select. The authorization form is available by mail at the address below, can be downloaded from our website, or you may call 614-355-0777 to request a copy. Once you authorize us to release your health information, we cannot guarantee that the person to whom the information is provided will not disclose the information. You may take back or “revoke” your written authorization at any time, in writing, by mailing your revocation request to the address below, except if we have already acted based on your authorization.
b. If we maintain an electronic health record containing your health information, when and if we are required by law, you will have the right to request that we send a copy of your health information in an electronic format to you or to
a third party that you identify. We may charge a reasonable fee for preparing the electronic copy of your health information.
You have the right to request that we amend your health information.
a. You have the right to ask us to amend health information we maintain about you if you believe the health information is wrong or incomplete. Your request must be in writing and provide the reasons for the requested amendment. The amendment form is available by mail at the address below, can be downloaded from our website, or you may call 614-355-0777 to request an amendment form. Mail your completed amendment form to the address listed below. We
will review the information as requested and either make the correction or let you know why we think our information is correct. If we deny your request, you may give us a written statement disagreeing with our decision that we will keep with your health information.
You have the right to request to receive communications related to your health in another way or at other locations.
a. We normally send your health information to the address and phonenumbers you have provided. However, if you would like to have the information sent elsewhere to protect your privacy, you may request this. We will not ask you to explain why you are making the request. We will agree to reasonable requests. To carry out the request, we will ask you for another address or another way to contact you, for example, mailing to a post office box. The confidential communication request form is available by mail at the address below, can be downloaded from our website, or you may call 614-355-0777 to request a form. Mail your completed form to the address listed below or turn it in at any Patient Registration location.
You have the right to request restrictions on the use and disclosure of your health information.
a. You have the right to ask to restrict uses or disclosures of your health information for treatment, payment, or health care operations. You also have the right to ask to restrict disclosures to family members or to others who are involved in your health care or payment for your health care. While we will try to honor your request and will permit requests consistent with our policies, we are not required to agree to any restriction.
b. We may also have policies on minors that permit your minor child to request certain limits on your access to their health information.
c. The restriction request form is available by mail at the address below, can be downloaded from our website, or you may call 614-355-0777 to request a form. Mail your completed request to the address listed below.
You have the right to request an accounting of people to whom we have disclosed your health information.
a. You have the right to receive an accounting of certain disclosures of your health information made by us during the six years prior to your request. The request must be made in writing. This accounting will not include disclosures of information made: (i) prior to April 14, 2003; (ii) for treatment, payment, and health care operations purposes; (iii) to you or pursuant to your authorization; (iv) to correctional institutions or law enforcement officials; and (v) other disclosures for which federal law does not require us to provide an accounting. The accounting request form is available by mail at the address below, can be downloaded from our website, or you may call 614-355-0777 to request a form. Mail your completed request to the address listed below.
You have the right to express concerns or to ask questions.
a. If you have any concerns about the privacy of your health information or if you have questions about our procedures, you may contact our Privacy Officer at:
By Mail: Nationwide Children’s Hospital
Attention: Privacy Officer
700 Children’s Drive
Columbus OH 43205
By Phone: 614-355-0777
By Email: email@example.com
Via the Web: www.nationwidechildrens.org
You have the right to file a complaint.
a. If you believe your privacy rights have been violated, you may file a complaint with us at the address listed above. You may also notify the Secretary of the U.S. Department of Health and Human Services at the following address:
Celeste Davis, Acting Regional Manager
Office for Civil Rights
U.S. Department of Health and Human Services
233 North Michigan Avenue Suite 240
Chicago, IL 60601
We will not take any action against you for filing a complaint.