UNDERSTANDING YOUR HEALTH RECORD/INFORMATION.

Each time you visit a hospital, physician, or other healthcare provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment and a plan for future care or treatment. This information, often referred to as your health or medical record serves as a:

• Basis for planning your care and treatment
• Means of communication among the many health professionals who contribute to your care
• Legal document describing the care you received
• Means by which you or a third-party payer 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 charged with improving the health of the nation
• A source of data for facility planning and marketing
• A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve

• Ensure its accuracy
• Better understand who, what, when, where, and why others may access your health information
• Make more informed decisions when authorizing disclosure to others

YOUR HEALTH INFORMATION RIGHTS.

Although your health record is the physical property of the healthcare practitioner or facility that compiled it, the information belongs to you. You have the right to:

1. Request a restriction on certain uses and disclosures of your information
2. Obtain a paper copy of the notice of information practices upon request
3. Inspect and obtain a copy of your health record
4. Amend your health record
5. Obtain an accounting of disclosures of your health information
6. Request communications of your health information by alternative means or at alternative locations
7. Revoke your authorization to use or disclose health information except to the extent that action has already been taken
8. The right to receive confidential communications of protected health information

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 the GFHC. 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 GFHC, whether made by GFHC personnel or generated by another outside source. Your family health care provider may have different policies or notices regarding their use and disclosure of your medical information created in their 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.

We are required by law to:

• make sure that medical information that identifies you is kept private
• make every reasonable effort to limit disclosure of medical information to the minimum necessary to accomplish the intended purpose.
• restrict access to your medical information to those employees who need to know that information to provide products and services to you.
• follow the terms of the notice that is currently in effect
• notify you if we are unable to agree to a requested restriction
• accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.

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 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 the categories.

For Treatment. We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to any health center staff, outside accreditors and auditors, medical or physical therapy students or residents, outside consultants such as psychiatrist or dietitian, or people we ask to transport you (i.e., ambulance, Colby security officer) who are involved in taking care of you at the Health Center. For example, a practitioner treating you for a broken arm may have to know if you have diabetes because that may affect the healing process. In addition the practitioner may need to tell the physical therapist about your condition. In order to coordinate the different care you require, we may need to share lab work, x-rays, prescription information. We may also disclose medical information about you to people outside GFHC who may be involved in your medical care after we receive a written authorization form from you. These people may include consultants, practitioners we refer you to, home medical providers, therapists, or others we use to provide services that are part of your care.

For Payment. We may use and disclose medical information about you so that the treatment and services you receive may be billed to and payment may be collected from you, a family member, the Colby College Business Office, an insurance company or a third party. We will obtain written authorization before doing so. For example, we may need to give your health plan information about a procedure you had at GFHC or medication received so your health plan will pay us or reimburse you. 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.

For Health Center Operations. Members of the medical staff, the risk or quality management committee may use information from your health record to assess the care and outcomes in your case and others like it. This information will then be used in an continual effort to improve the quality and effectiveness of the healthcare and service we provide. 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 patients to decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to practitioners, nurses, technicians, and other GFHC personnel for review and learning purposes. We may also combine the medical information we have with medical information from other Health Centers to compare how we are doing and see where we can make improvements 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 health care and health care delivery without learning who the specific patients are.

Appointment Reminders. We may use and disclose medical information to contact you as a reminder for follow-up appointments, for lab work, for immunizations, for bill payment.

Treatment Alternatives. We may use and disclose medical information to tell you about or recommend 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.

Individuals Involved In Your Care Or Payment For Your Care. We may release medical information pertaining to a specific occurrence to a family member or friend. We may also give information to someone who helps pay for your care. An authorization will be obtained from you before we release information. 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.

As Required By Law. We will disclose medical information about you when required to do so by federal, state or local law. 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 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 about the request or to obtain an order protecting the information requested.

Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities 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.

Business Associates. There are some services provided at GFHC through contacts with business associates. Examples include x-rays ordered by us, but obtained at MGMC or laboratory specimens obtained at GFHC but sent to the State Health Lab for testing. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job weÕve asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.

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.

WorkerÕs Compensation. We may release medical information about you for workerÕs compensation or similar programs. These programs provide benefits for work-related injuries.

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, but we may, however, disclose medical information about you 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 GFHC. 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 GFHC.

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.

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.

Public Health Risks. As required by law, we may disclose medical information about you to public health or legal authorities charged with preventing or controlling disease, injury, or disability. These generally include the following:

• To prevent or control disease, injury or disability.
• To report births and deaths.
• To report child abuse or neglect.
• 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 contracting or spreading a disease or condition.
• To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence. We will only make this disclosure if you agree and when required or authorized by law.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU.

You have the following rights regarding medical information we maintain about you:

• Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes.
• To inspect and copy medical information that may be used to make decisions about you, you must submit an authorization. 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.
• We may deny your request in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by the Medical Director will review your request and the denial. The person conducting the review will not be the person who denied your request. We will abide by the outcome of the review.
• Right to Amend. If you feel that medical information we have about you is not correct or incomplete, you may ask to have that information amended. You have the right to request an amendment to medical information for as long as the information is kept by us.

• To request an amendment, you must submit your request in writing to the Medical Director and must include reasons that support your requested amendment.
• 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:

• was not created by us, unless the person or entity that created the information is no longer available to make the amendment
• is not part of the information kept by us
• is not part of the information which you would be permitted to inspect and copy
• is accurate and complete.

Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at home, not at work, or visa versa.

To request confidential communications, you must submit your request in writing to the Medical Director. We will not ask the reason for your request. We will accommodate all reasonable requests. Your request must specify how and where you wish to be contacted.

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 health care 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 of your care, like a family member or friend.

To request restrictions, you must submit your request in writing to the Medical Director. 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.

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 with emergency treatment.

COMPLAINTS.

If you believe your privacy rights have been violated, you may file a complaint with the Medical Director or the Health Care Advisory Committee.
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 by applicable laws 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. Please understand that we are unable to take back any disclosures we have already made with your permission.

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 in the health center.