Notice of Privacy Practices at Christopher House of Worcester
This notice describes how information about you may be used and
disclosed and how you can get access to this information
PLEASE REVIEW IT CAREFULLY
Understanding your health information:
While you are a resident at Christopher House, a medical record is established and maintained to document the care and treatment you receive. This record may contain your current symptoms, medical history, diagnoses, observations, examinations, diagnostic testing results, treatment and plans for ongoing care. This information serves:
  1. as a basis for planning your care and treatment
  2. as a means of communication among the professional members of the health care treatment team
  3. as a legal document describing the care and treatment you received
  4. as the means by which you or a third party payer can verify that the services billed were actually provided
  5. in some instances, as a tool for educating health professionals such as student nurses and physicians
  6. as a source of data for medical research
  7. as a source of information for public health officials who are charged with improving the health of the nation.
  8. as a source of data for facility planning and marketing
  9. as a tool with which we can assess and continually work to improve the care we provide and the outcomes or results we achieve.
Your Health Information Rights:
Although your health record is the physical property of the Christopher House of Worcester who compiles the record, the information belongs to you: You have the right, as provided in 45 CFR164.522-528 to:
  1. request a restriction on certain uses and disclosures of your information
  2. obtain a copy of this notice of information practices upon request.
  3. inspect and receive 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
Our Responsibilities:
Christopher House is required to:
  1. maintain the privacy of your health information
  2. provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
  3. abide by the terms of this notice
  4. notify you if we are unable to agree to a requested restriction
  5. accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations.
For More Information or to Report a Problem:
If you have questions and would like additional information, you may contact the Director of Health Information Management at (508) 754-3800, ext. 112.
If you believe your privacy rights have been violated, you can file a complaint with the Director of Health Information Management or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.

EXAMPLES OF DISCLOSURES FOR TREATMENT, PAYMENT AND HEALTH OPERATIONS
  1. We will use your health information for treatment.
    For example: Information obtained by a nurse, physician or other member of your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectation of the members of your healthcare team. Members of your healthcare team will then record the actions they took, and their observations. In that way, the physician will know how you are responding to treatment. We will also provide your physician or a subsequent healthcare provider with copies of various reports that should assist him or her in treating you once you are discharged from this facility.
  2. We will use your health information for payment.
    For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you as well as your diagnosis, procedures and medical supplies used.
  3. We will use your health information for regular health operations.
    For example: Members of the medical staff, the risk or quality improvement manager or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide.
    1. Business Associates:
      There are some services provided in our organization through contracts with business associates. Examples include pharmacy and laboratory testing. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we've 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.
    2. Directory:
      Unless you notify us that you object, we will use your name, location in the facility, general condition and religious affiliation for directory purposes. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name.
    3. Notification
      We may use or disclose information to notify or assist in notifying a family member, personal representative or another person responsible for your care, your location and general condition.
    4. Communication with Family
      Health professionals, using their best judgement, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that person's involvement in your care. Or payment related to your care.
    5. Research
      We may disclose information 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 your health information
    6. Funeral Directors:
      We may disclose health information to your funeral director consistent with applicable law to carry our their duties.
    7. Organ procurement organizations:
      Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs for the purpose of tissue donation and transplant. (IN ACCORDANCE WITH YOUR STATED PREFERENCE)
    8. Marketing:
      We may contact you to provide appointment reminders or information about treatment alternatives or other health related benefits and services that may be of interest to you.
    9. Fund Raising:
      We may contact you as part of a fund raising effort.
    10. Food and Drug Administration (FDA):
      We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs or replacement.
    11. Workers Compensation:
      We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
    12. Public Health:
      As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury or disability.
    13. Correctional Institution:
      Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.
    14. Law Enforcement:
      We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena or court order.

Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.

EFFECTIVE DATE: 4/13/2003

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