NOTICE OF PRIVACY PRACTICES
of CentraState Healthcare System
and its Member Facilities
Revision Date: Feb. 1, 2006
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU THAT IS MAINTAINED BY THE CENTRASTATE HEALTHCARE SYSTEM ("CentraState") OR ANY OF ITS MEMBER FACILITIES MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
If you have any questions about this notice, please contact the CentraState Privacy Officer for CentraState Medical Center at (732) 294-2760 or the Assistant Privacy Officer for Senior Services (for information at Applewood Estate, Monmouth Crossing or The Manor) at (732) 303-7413.
WHO WILL FOLLOW THIS NOTICE
This notice describes CentraState’s practices, which are followed by:
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Those facilities within CentraState that create and maintain medical information, including, CentraState Medical Center, The Manor, Applewood Estates, Monmouth Crossing, CentraState Family Medicine Center, CentraState Health Awareness Center.
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Any healthcare professional authorized to enter information into your health record including, but not limited to, members of CentraState's Medical/Dental Staff. (Please note that this Notice applies to practices followed within the above listed facilities and does not apply to care provided to you in your physician's office or in the office of any other healthcare provider. Your physician should provide you with a Notice of Privacy Practices as it relates to his/her office practice.)
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All departments and units of any CentraState facility.
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Any member of a volunteer group we allow to help you while you are in a CentraState facility.
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All employees, staff and other CentraState personnel.
In addition, these entities, sites and locations may share medical information with each other for treatment, payment or CentraState operations purposes described in this notice.
OUR PLEDGE REGARDING MEDICAL INFORMATION
We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at a CentraState facility. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by CentraState, whether made by CentraState personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your medical information created in the doctor’s office or clinic.
This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information. In all cases where we may share your medical information with others, it is only the minimum necessary amount of information required to satisfy the need or request.
CentraState Healthcare System is required by law to:
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Ensure that medical information that identifies you is kept private;
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Inform you of our legal duties and privacy practices with respect to medical information about you; and
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Follow the terms of the notice that is currently in effect
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures, we will explain what we mean and try to give some examples. Not every potential use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of these categories.
TREATMENT - We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical support staff, volunteers, and clinical interns/students, as appropriate, or other CentraState personnel who are involved in taking care of you at a CentraState facility. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments of a CentraState facility also may share medical information about you in order to coordinate the different things you need, such as prescriptions, laboratory tests and Xrays. We also may disclose some of your medical information to people outside of CentraState who may be involved in your medical care after you leave a CentraState facility, such as: family members, clergy or others we use to provide services that are part of your care. We may also disclose some of your medical information to outside medical equipment vendors and suppliers whose products are related to your medical care.
PAYMENT - We may use and disclose medical information about you so that the treatment and services you receive at a CentraState facility may be billed to, and payment may be collected from you, an insurance company or another third party. For example, we may need to give your health plan information about surgery you received at CentraState Medical Center so your health plan will pay us or reimburse you for the surgery. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. We may also share insurance information with other medical providers (Emergency Department physicians, pathologists, radiologists, etc.) who provided you care but are independent contractors and are, therefore, not employed by CentraState.
HEALTHCARE OPERATIONS - We may use and disclose medical information about you for CentraState operations. These uses and disclosures are necessary to run a CentraState facility and make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical information about many CentraState patients to decide what additional services CentraState should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, medical, nursing, volunteers, clinical interns/students, and other CentraState personnel for review and learning purposes. We may also combine the medical information that we have with medical information from other healthcare systems to compare how we are doing. This will enable us to identify areas that we can improve upon in the care and services we offer. We will remove information that identifies you from this set of medical information, so others may use it to study healthcare and healthcare delivery. They, they will then not be able to identify you specifically.
APPOINTMENT REMINDERS - We may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at the CentraState.
TREATMENT ALTERNATIVES - We may use and disclose medical information to inform you of recommended possible treatment options or alternatives that may be of interest to you.
HEALTH-RELATED BENEFITS AND SERVICES - We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
FUNDRAISING ACTIVITIES - We may disclose medical information to the CentraState Healthcare Foundation, so that they may contact you in raising money for the CentraState. We only would release contact information, such as your name, address and phone number and the dates you received treatment or services at a CentraState facility. If you do not want CentraState to contact you for fundraising efforts, you must notify the office of CentraState’s Vice President of Development in writing at 916 Highway 33, Fairfield Industrial Park, Building 9, Freehold, NJ 07728.
MARKETING - CentraState does not use or share medical information for marketing purposes. If you receive CentraState marketing materials, it is because we have received your contact information from another source, such as ZIP code listings.
CSHSDIRECTORIES - We may include certain limited information about you in the CentraState Medical Center directory while you are a patient, so that your family, friends and clergy can visit you in the hospital and generally know how you are doing. This information may include your name, location in the Medical Center, your general condition (e.g., fair, stable, etc.) and your religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affilia- tion may be given to a member of the clergy, such as a priest, rabbi, or religious volunteer, even if they do not ask for you by name. You have the right to "opt out" of being listed in the directory by notifying the Patient Access Department at the time of your admission/registration. If you choose to "opt out" of our directory, the result can include, but is not limited to, not directing personal phone calls and/or not receiving visitors or floral deliveries to your room. CentraState will not be able to answer any inquiries made by other parties for services you received.
The names and telephone numbers of all the residents in a Senior Services facility are in a directory unless you choose to "opt out" of the facility specific directory. The directory is distributed to other residents within the facility. If you choose to "opt out," your name will not be included in the directory.
INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE- We may release medical information about you to a family member or friend who is involved in your medical care unless otherwise prohibited by law. We may give information to someone who helps pay for your care. We may also tell your family or friends your condition and that you are in a particular CentraState facility. In addition, we may disclose medical information about you to an entity assisting in a disaster relief effort, so that your family can be notified about your condition, status and location. This would not include releasing psychiatric, alcohol or drug treatment records without your express written consent.
RESEARCH - Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with patients’ need for privacy of their medical information. Before we use or disclose medical information for research, the project will have been approved through this research approval process. We may then disclose information to people preparing to conduct a research project; for example, to help them look for patients with specific medical needs, so long as the medical information they review does not leave CentraState. We will ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at CentraState.
AS REQUIRED BY LAW - We may disclose medical information about you to federal, state, or other regulatory bodies, when required by law.
TO AVERT A SERIOUS THREAT TO HEALTH OR SAFETY - We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent the threat.
SPECIAL SITUATIONS
ORGAN AND TISSUE DONATION - If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
MILITARY AND VETERANS - If you are a member of the Armed Forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
WORKERS' COMPENSATION -We may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.
PUBLIC HEALTH RISKS - We may disclose medical information about you:
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to prevent or control disease, injury or disability;
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to report births and deaths;
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to report suspected child abuse or neglect;
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to report reactions to medications or problems with products/medical devices;
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to notify people of recalls of products/medical devices they may be using;
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to notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
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to notify the appropriate government authority if we believe an adult patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
HEALTH REGULATORY OVERSIGHT ACTIVITIES - We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include; for example, audits, investigations, inspections and licensure. These activities are necessary for the government to monitor the healthcare system, government programs, and compliance with civil rights laws.
LAWSUITS AND DISPUTES -If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you or your counsel about the request, and to allow you or your counsel time to obtain an order protecting the information requested, if appropriate. We may also share information with our insurance carrier and/or attorney regarding legal action or potential legal action taken against us by you.
LAW ENFORCEMENT - We may release medical information if asked to do so by a law enforcement official:
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In response to a court order, subpoena, warrant, summons or similar process;
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To identify or locate a suspect, fugitive, material witness, or missing person;
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About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s consent or if required by law even without consent;
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About a death we believe may be the result of criminal conduct;
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About unlawful conduct if it occurs at a CentraState facility; and
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In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.
CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS - We may release medical information to a coroner or medical examiner as required by law. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients of a CentraState facility to funeral directors as necessary to carry out their duties.
NATIONAL SECRUITY AND INTELLIGENCE ACTIVITIES - We may release medical information about you to authorized federal officials for intelligence, counter-intelligence, and other national security activities authorized by law.
PROTECTIVE SERVICES FOR THE PRESIDENT AND OTHERS -We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
INMATES -If you are an inmate of a correctional institution or in the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary: (1) for the institution to provide you with healthcare; (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.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You have the following rights regarding medical information we maintain about you:
To inspect and receive a copy of medical information that may be used to make decisions about you, you must submit your request in writing to the Health Information Management Department at the Medical Center or the Administrator at any CentraState Senior Services facility. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. CentraState has the right to charge a reasonable cost-based fee for these copies. The law does not require that copies of your medical information be provided to you immediately. CentraState will make every effort to provide you with a copy of your complete chart as soon as possible, but in no event later than thirty (30) days after we have received a written request.
We may deny your request to inspect and copy in certain very limited circumstances. For example, CentraState may withhold certain parts of a psychiatric record if the physician or psychologist believes that such review of the complete record would be deleterious to the patient’s best interests. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed healthcare professional chosen by the CentraState facility will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
To request an amendment, your request must be made in writing and submitted to the CentraState Privacy Officer or the Assistant Privacy Officer for the CentraState facility. In addition, you must provide a reason that supports your request. We will act on an amendment within sixty (60) days of receipt of your request.
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:
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Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
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Is not part of the medical information kept by or for the CentraState facility;
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Is not part of the information that you would be permitted to inspect and copy; or
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Is accurate and complete
We will advise you in writing if we decide to deny the request. If your request is denied, you may submit a written statement disagreeing with the denial (all or part). We may then prepare a written rebuttal to your statement of disagreement. The statement of disagreement and rebuttal will be included in any subsequent disclosure of that portion of the medical information to which the dispute entry relates. You may also attach a brief comment or statement pertaining to medical issues to your medical record after it is completed.
RIGHT TO AN ACCOUNTING OF DISCLOSURES -You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of medical information about you.
To request this list or accounting of disclosures, you must submit your request in writing to the Privacy Officer of the CentraState facility holding your medical information. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved, and you may choose to withdraw or modify your request at that time before any costs are incurred.
RIGHT TO REQUEST RESTRICTIONS - You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or healthcare operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a surgery that you have had.
We are not required to agree to your request. If we do agree, we will comply with your request unless the information is needed to provide you emergency treatment or for other purposes permitted by law.
To request restrictions, you must make your request in writing to the Privacy Officer at the CentraState facility. In your request, you must tell us: (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply (for example, disclosures to your spouse).
RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS -You have the right to request that we communicate with you about medical matters in a reasonably certain way or at a reasonably certain location. For example, you can ask that we only contact you at work or by mail.
To request confidential communications, you must make your request in writing to the Privacy Officer at the CentraState facility. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
RIGHT TO A PAPER COPY OF THIS NOTICE - You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. You may obtain a copy of this notice at http://www.centrastate.com/. To obtain a paper copy of this notice, contact the CentraState Privacy Officer or Assistant Privacy Officer at the telephone numbers at the end of this notice.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right 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. We will post a copy of the current notice at each CentraState facility and on our website. The notice will contain the effective date on the first page in the top right-hand corner. In addition, each time you register at or are admitted to a CentraState facility for treatment or healthcare services as an inpatient or outpatient, we will offer you a copy of the current notice in effect.
COMPLAINTS
If you believe your privacy rights have been violated, you may file a complaint with the CentraState Privacy Officer or Assistant Privacy Officer, or with the Secretary of the Department of Health and Human Services, Office of Civil Rights. To file a complaint with CentraState, contact the Privacy Officer or the Assistant Privacy Officer at CentraState Healthcare System, at the address at the end of this notice. To file a complaint with the Department of Health and Human Services you may write to: Office for Civil Rights, U.S. Department of Health and Human Services, Jacob Javits Federal Building, 26 Federal Plaza, Suite 3313 New York, NY 10278. All complaints must be submitted in writing. You will not be penalized for filing a complaint.
OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your written permission. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.
To write to or contact the Hospital Privacy Officer:
CentraState Medical Center
ATTN: Director Health Information Management
901 West Main Street
Freehold, NJ 07728
(732) 294-2760
To write to or contact the Senior Services Assistant Privacy Officer:
Assistant Privacy Officer for CentraState Senior Services
c/o Applewood Estates
1 Applewood Drive
Freehold, NJ 07728
(732) 303-7413
