Regional West Health Services
Notice of Privacy Practice

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.

WHO WILL FOLLOW THIS NOTICE
This Notice describes the information practices of the following affiliated organizations and their covered programs and departments:

• Regional West Medical Center ("RWMC')
• Regional West Physicians Clinic ("RWPC')
• Prairie Haven Hospice

The organizations listed above are collectively referred to as "we" or "our" in this Notice.

This Notice also describes the privacy practices of members of the Medical Staff of RWMC in connection with their treatment and Medical Staff activities at RWMC. Because RWMC is a clinically-integrated care setting, our patients receive care from Hospital staff and from these independent practitioners on the Medical Staff. RWMC and these practitioners must be able to share your medical information freely for treatment, payment, and health care operations as described in this Notice. Accordingly, RWMC and its physicians have formed an organized health care arrangement under which they will jointly:

• Use this Notice as a joint Notice of Privacy Practices for all inpatient and outpatient visits and follow all information practices described in this Notice regarding those visits;
• Obtain a single signed acknowledgment of receipt for this Notice; and
• Share medical information from these inpatient and outpatient Hospital visits with one another so that they can participate in RWMC's health care operations as described in this Notice.

However, this arrangement between RWMC and members of its Medical Staff does not cover the information of these practitioners in their private offices or other practice locations.

UNDERSTANDING YOUR MEDICAL RECORD INFORMATION
Each time you receive services from one of our health care professionals, a Record of your visit is made. Typically, this record describes your symptoms, examination, test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health record or medical record or designated record set, also includes your insurance and financial information and may be in paper or electronic form and serves as a:

• basis for planning your care and treatment;
• means of communication among the many health care professionals who help with your care;
• means by which you or a third party payer, such as your insurance company, can verify that services billed were actually provided;
• a tool in educating health professionals;
• a source of data for medical research;
• a source of information for public health officials who work to improve the health of the nation;
• a source of data for facility planning and marketing;
• a tool with which we can use to continually work to improve our patient care and the outcomes.

Understanding what is in your record and how it is used will help you to:

• make certain it is accurate;
• better understand who, what, when, where and why others may access your health information;
• make a more informed decision when giving your permission for your health information to be sent or released to others.

YOUR RIGHTS REGARDING YOUR MEDICAL INFORMATION
Regional West Health Services has developed procedures as described in federal law that allows you several rights. You may access your records by coming to either the Health Information Management Department at Regional West Medical Center, Medical Records Departments within Regional West Physicians Clinic, or Prairie Haven Hospice and filling out an authorization form.

Right To See And Get Copies Of Your Medical Information
In most cases, you have the right to look at or get copies of your medical information that we have, but you must make the request in writing. If we don't have your information but we know who does, we will tell you how to get it. We will respond to you within 30 days after receiving your written request. In certain situations, we may deny your request. If we do, we will tell you in writing our reasons for the denial and how you can have the denial reviewed.

If you request copies of your medical information, we may charge a fee for the costs of the copying, mailing, or other supplies associated with your request.

Right To Correct Or Update Your Medical Information
If you believe that there is a mistake in your medical information or that a piece of information is missing, you have the right to request that we correct the existing information or add the missing information. That request must be made in writing and you must provide a reason for the change. We will respond within 60 days of receiving your request. We may deny your request if it is not in writing or does not include a reason to support the request. Also, we may deny your request if the medical information is:

• correct and complete;
• not created by us;
• not allowed to be looked at and copied for you; or
• not part of our records.

Our written denial will tell you the reasons for the denial and will tell you how to file a written statement of disagreement with the denial.

Right To Get A List Of The Disclosures We Have Made
You have the right to get a list of instances in which we have disclosed your medical information. This list will not include certain uses or disclosures such as those made for treatment, payment, or health care operations, directly to you, to your family with your authorization, or in our facility directory. This list also won't include uses and disclosures made for national security purposes, to corrections or law enforcement personnel, or before the effective date of this notice. We will respond within 60 days of receiving your written request and will include disclosures made in the last six years, but not before the effective date of this notice, unless you request a shorter time. We will provide the list to you at no charge, but if you make more than one request in the same year, we will charge you a fee for each additional request. We will notify you of the cost involved and you may choose to withdraw or change your request at that time.

Right To Request Limits On Uses And Disclosures Of Your Medical Information
You have the right to ask that we limit how we use and disclose your medical information. We will consider your written request but are not legally required to accept it. If we accept your request, we will abide by them except in emergency situations. You may not limit the uses and disclosures that we are legally required or allowed to make.

Right To Choose How We Send Medical Information To You
You have the right to ask that we send information to you at an alternate address or by alternate means. We must agree to your written request so long as we can easily provide it in the format you requested.

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 also obtain a copy of this notice at our web site, www.rwhs.org 
 
OUR RESPONSIBILITIES
Regional West Health Services is required by law to:

• maintain the privacy of your medical information;
• provide you with a paper copy of this notice as to our legal duties and privacy practices concerning the medical information we collect and maintain about you;
• abide by the terms of this notice;
• notify you if we are unable to agree to a requested limit or restriction;
• follow reasonable requests you may have to communicate your medical information at an alternate address or by an alternate means;
• not use or disclose your health information without your permission or authorization, except as described in this notice.

We reserve the right to change our privacy practices, which may result in changes in this notice. We further reserve the right to make the revised 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 in the hospital and on our web site, www.rwhs.org.  The notice's effective date will be in the bottom right-hand corner of the last page. In addition, when receiving treatment or health care services, each service delivery site will offer you a copy of the current notice in effect. 

EXAMPLES OF USES AND DISCLOSURES WE MAY MAKE WITHOUT YOUR AUTHORIZATION

Not every use or disclosure in a category is listed. However, all the ways we are permitted to use and disclose your medical information will fall within one of the categories.

Uses and Disclosures for Treatment, Payment and Health Care Operations.

• We will use your medical information for treatment. For example, medical information obtained by a nurse, doctor or other health care workers will be recorded in your record and used to decide the treatment that should work best for you. Members of your healthcare team will then record the actions they took and their observations. We may also disclose that information about you to other doctors, nurses, technicians, hospital personnel, medical students and health care students who are involved in your care.

We may also disclose health information about you to your physician or another health care provider or facility so that they can provide health care services to you in other settings.

• We will use and disclose your medical information for payment. For example, a bill may be sent to you or a third-party payer, such as your insurance company. The information on or sent with the bill may include your identity, diagnoses, procedures performed, and supplies used. We may also provide necessary information to other health care providers for their billing purposes in services they provided you.
  We may tell your health plan about treatment you are receiving while you are in the hospital. This may also be done to obtain prior approval or to determine whether your health plan will cover the treatment and/or hospital stay.
  
• We will use and disclose your health information for regular health care operations. For example, members of the Medical Staff and quality management teams may use your medical information to assess the care and outcomes of your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the health care and services we provide, including if we need to offer additional services. We may also disclose your medical information to medical students and other health care students for review and learning purposes.

Other Uses and Disclosures

• We will allow our business associates to use and disclose your medical information if necessary. For example, there are some services provided in our organization through contracts with other persons or organizations, known as business associates. To protect your medical information, however, we require the business associates to appropriately protect your medical information.
  
• We will provide your information for the hospital directory. For example, unless you object, we will use your name, your location in our hospital, condition in general terms, and religious preferences for directory purposes. This directory information may be released to people who contact the hospital and ask for you by name, including the media. The information provided to members of the clergy will be released by religious affiliation.
  
• We may disclose your location or general condition to a family member or your personal representative. If any of these individuals or others you identify are involved in your care, we may also disclose such information as is directly relevant to their involvement. We will only release this information if you agree, are given the opportunity to object and do not, or if in our professional judgment, it would be in your best interest to allow the person to receive the information or act on your behalf. For example, we may allow a family member to pick up your prescriptions, medical supplies, or x-rays. In addition, we may tell your medical information to an organization helping in a disaster relief effort so that your family can be notified about your condition, status, and location.
  
• We may use or disclose your medical information for research. For example, we may disclose information to researchers when their research has been approved through our research approval process. The research team must have established privacy protocols to make certain that your medical information is kept private. We may disclose medical information about you to people preparing to conduct a research project, but the information will stay on site.
  
• Under certain circumstances, we may use or disclose your medical information to prevent a threat of harm to others. We will only do this if we, in good faith, believe it is necessary to prevent or lessen the threat and is to a person reasonably able to prevent or lessen the threat (including the target) or is necessary for law enforcement authorities to identify or apprehend an individual involved in a crime.
  
• We may provide your health information to coroners, medical examiners and funeral directors. For example, we may release medical information to a coroner or medical examiner to identify a deceased person or to determine the cause of death. We may also release medical information about our patients to funeral directors as necessary to carry out their duties.
  
• We may use or disclose your medical information for organ and tissue donation. For example, according to law, we may disclose medical information to organ donation organizations or other organizations involved in the obtaining of organs or tissue, the banking of the organs, or the transplantation of the same.
  
• We may use or disclose your information for appropriate reminders. For example, we may contact you to remind you of appointments for diagnostic testing or treatment or other health-related benefits and services that may be of interest to you, including educational opportunities.
  
• We may use and disclose your medical information for fundraising activities. For example, we may contact you in an effort to raise money for RWHS and their operations. We would only release your name, address, phone number, and dates you received services to a foundation related to RWHS so that they may contact you in raising money. If you do not want the Foundation to contact you for fundraising purposes, you must notify Regional West Health Services in writing.
  
• We may use and disclose your medical information for public health purposes. For example, we may disclose medical information about you for public health activities or as authorized by law. These activities generally include the following examples:
  ­ --to prevent or control disease, injury, or disability;
  ­ --to report births or deaths;
  ­ --to report reactions to medications or problems with products;
  ­ --to notify people of recalls of products they may be using;
  ­ --to notify a person who may have been exposed to a disease or may be at risk for contacting or spreading a disease or condition;
  ­ --to notify the appropriate government authority if we believe a patient has been the victim of abuse or neglect.
  
• We may use and disclose your medical information for Workers' Compensation. For example, we may release medical information about you for workers' compensation or similar programs. These programs provide benefits for work-related injuries or illness.
  
• We may disclose your medical information to a correctional institution. For example, if you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release your medical information to the correctional institution or law enforcement official. This release would be necessary for the institution to provide you with health care, to protect your health and safety or the health and safety of others, or for the safety and security of the correctional institution.
  
• We may use and disclose your medical information for national security and intelligence activities authorized by law or for protective services of the President. If you are a military member, we may disclose to military authorities under certain circumstances.
  
• We may use and disclose your medical information for law enforcement purposes. For example, we may release medical information if asked to do so by a law enforcement official:
  --in response to a court order, subpoena, warrant, summons or similar process;
  --to identify or locate a suspect, fugitive, material witness or missing person;
  --about the victim of a crime if, under certain circumstances, we are unable to obtain the victim's agreement;
  --about a death we believe may be the result of criminal conduct;
  --about criminal conduct at the hospital;
  --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.
  
• We may use and disclose your medical information for health oversight activities. For example, we may disclose medical information to a health oversight agency for activities authorized by law. This may include audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.
  
• There are certain incidental uses or disclosures of your information that occur while we are providing service to you or conducting our business. For example, after surgery the nurse or doctor may need to use your name to identify family members that may be waiting for you in a waiting area. Other individuals waiting in the same area may hear your name called. We will make reasonable efforts to limit these incidental uses and disclosures.

Right To Withdraw Your Authorization To Use Or Disclose Your Medical Information
Other uses and disclosures of your medical information not covered above will be made only with your written permission. If you authorize us to use and disclose your information, you may revoke that authorization at any time. Such revocation will not affect any action we have taken in reliance on your authorization.

FOR MORE INFORMATION OR TO REPORT A CONCERN
If you have questions about this notice and would like additional information you may contact the Privacy Officer at Regional West Health Services 308.630.1016.

Complaints or questions about your privacy rights must be made in writing to the Privacy Officer at Regional West Health Services, 4021 Avenue B, Scottsbluff, Nebraska, 69361.

If you believe your privacy rights have been violated and not addressed by Regional West Health Services, you have the right to file a complaint with the Secretary of Health and Human Services. You will not be penalized or retaliated against for filing a complaint.

Reference: 45 Code of Federal Register 164.520

Effective date: 04/14/03
Version: #2