We Strive to make our Hospital Safe and Secure

Memorial Hospital respects the patient's right to privacy and security. There are walled partitions or cubicle curtains in all patient care areas to provide privacy and respect without visual obstruction to the nursing staff or other hospital caregivers. In the emergency department separate exam rooms and/or cubicle curtains assure visual privacy while spacing of exam areas affords auditory privacy. On the Nursing Care Units, bathing, positioning and the use of bedpans and bedside commodes are accomplished assuring patient privacy and comfort. Cubicle curtains are pulled and any visitors are asked to step outside the room during physician visits and/or patient care requiring privacy. At all outpatient sites patients are interviewed out of hearing range of other patients or visitors.

All of the HIPAA Privacy/Security Laws are complied with by this facility.

View our privacy policy below.

Privacy Policy

Notice of Privacy Practice Effective 4/14/2003 Memorial Hospital, Chester, Illinois

This notice describes medical information about you may be used and disclosed and how you can get access to this information.

WHO WILL FOLLOW THIS NOTICE
This notice describes Memorial Hospital's practices and that of: 1) Health care professionals authorized to enter information into your hospital chart. 2) Departments and units of the hospital. 3) Members of a volunteer group. 4) Employee staff and other hospital personnel.

OUR PLEDGE REGARDING MEDICAL INFORMATION
We understand that medical information about you and your health is personal. We are committed to protecting your medical information. We create a record of the care and services you receive at the hospital. 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 the hospital, whether made by hospital personnel or your personal doctor(s). Your doctor(s) may have different policies or notices regarding the doctor's use or disclosure of your medical information created in the doctor's office and/or clinic.
If you have any further questions about this notice you may feel free to Contact Us
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
Give you this notice of our legal duties and privacy practices with respect to medical information about you
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 or disclose medical information. For each category of uses or disclosures we will explain what we mean and give examples. Not every use or disclosure in a category will be listed. All of the ways we are permitted to use or disclose information will fall within one.

FOR TREATMENT
May use medical information about you to provide medical treatment or services. We may disclose medical information about you to doctors/nurses/technicians/other hospital personnel who are involved in taking care of you. Example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow healing process or the doctor may need to tell the dietitian if you have diabetes to arrange for appropriate meals. Various departments of the hospital may share medical information to coordinate different things you need, such as prescriptions/lab data/x-rays. We also may disclose medical information about you to other entities involved in your medical care, such as family members, clergy, or others who provide services that are a part of your care, ie. your family physician, specialists, nursing home, home health agency, Bi-County Health Department, or other hospital associates.

FOR PAYMENT
We may use/disclose medical information about you so that treatment and services you receive at Memorial may be billed to and payment collected from you, insurance companies or a third party. Example, we may need to give your health information about surgery you received 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 provide your Protected Health Information (PHI) to our business associates such as billing companies or claims processing companies.

FOR HEALTH CARE OPERATIONS
Disclosure of health information about you may be necessary for hospital operations in order to run the hospital and make sure that patients receive quality care. Example, may use medical information to review treatment/services and evaluate performance of our staff in your care. May combine medical information we have with many hospital patients to decide what additional services should be offered, what services are not needed, and whether new treatments are effective. May also disclose information to doctors, nurses, technicians and other hospital personnel for review and learning purposes. May combine medical information we have with medical information from other hospitals to compare where to improve. May remove information that identifies you from this PHI so others may use it to study health care delivery without specific identification. May provide your PHI to our accountants/attorneys/consultants/accreditation bodies to assure compliance. If this facility sells/transfers assets to (or consolidates/merges with an entity who is or will be a covered entity at completion of the transaction) or uses/discloses PHI in connection with such transactions, due diligence will be utilized in transferring records containing PHI. Uses/disclosures that are incidental to otherwise permitted uses/disclosures may occur, however, such are not considered a violation of the Rule provided that the covered entity has met reasonable safeguards and minimum necessary requirements. Example: Doctors can talk to patients in semi-private rooms or confer at nurses stations without fear of violating the Rule if over heard by a passerby.

OTHER USES/DISCLOSURES
Appointment reminders
Follow-up phone calls post discharge
Treatment alternatives
Health related benefits and services

FUNDRAISING ACTIVITIES
May use your PHI in an effort to raise money for the hospital. ONLY WITH YOUR CONSENT, we may disclose PHI to a foundation that is raising money for the hospital.

MARKETING
Must obtain an individual’s written authorization to use PHI for marketing purposes. Exception: Doctors/other covered entities communicating with patients about treatment options are not considered marketing.

HOSPITAL DIRECTORY
May include certain limited information about you in the hospital directory while you are a patient. Information may include name, location in the hospital, your general condition (ie. fair, stable) and your religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name. Religious affiliation may be given to a member of the clergy even if they don't ask for you by name.

INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE
May release your PHI to a friend/family member who is involved in your care. May disclose your PHI to your family doctor/power of attorney for healthcare/disaster relief effort so that your family can be notified about your condition, status, and location.

FOR RESEARCH PURPOSES
In certain circumstances, may provide PHI in order to conduct medical research.

AS REQUIRED BY LAW
Will disclose PHI about you required to do so by Law.

TO AVERT A SERIOUS THREAT TO HEALTH OR SAFETY
May use/disclose PHI about you when necessary to prevent a serious threat to health/safety to you or the public. Any disclosure would only be to someone able to help prevent the threat. May disclose PHI to a person subject to jurisdiction of the FDA for public health purposes related to the quality/safety/effectiveness of FDA-regulated products/activities such as collecting/reporting adverse events, dangerous products, or defects/problems with FDA regulated products.

SPECIAL SITUATIONS:
Organ/Tissue Donation
May release PHI required by Law to organizations that handle organ/eye/tissue donation bank/procurement and/or transplantation.

WORKERS'COMPENSATION
May release PHI for workers' compensation or similar programs that provide benefits for work-related injuries or illness.

PUBLIC HEALTH RISKS
May disclose PHI for public health activities. These activities generally include the following: To prevent or control disease/injury/disability; to report births, deaths, child or adult abuse/neglect, medication reactions, problems with products; To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading disease; To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence when required by law.

HEALTH OVERSIGHT ACTVITIES
May disclose PHI to a health oversight agency authorized by law. This may include audits/investigation/inspection/licensure. Such activities are necessary for the government to monitor healthcare systems/government programs/compliance with civil rights laws.

LAWSUITS AND DISPUTES
If you are involved in lawsuit/dispute we may disclose PHI about you in response to a court or administrative order, ie. subpoena, discovery request or other lawful process by someone else involved.

INMATES
If an inmate of a correctional institution or under the custody of a law enforcement official, PHI may be released to them. Release would be 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; (3) for the safety and security of the correctional institution or (4) for payment of bills.

LAW ENFORCEMENT
May release PHI if asked by a law enforcement official: Response to Court Order/subpoena/warrant/summons, or similar process; Identify/locate suspect/fugitive/material witness/missing person; About the victim of a crime if, under certain circumstances, we are unable to obtain the person’s agreement; About a death we believe that may be the result of criminal conduct; About criminal conduct at the hospital, and in emergency circumstances to report a crime/location or identity/description/location of a person who committed the crime.

MILITARY AND VETERANS
If you are a member of the armed forces, we may release PHI as required by military command authorities. May release medical information about foreign military personnel to foreign military authority.

CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS
May release PHI to a coroner/medical examiner. This may be necessary to identify a deceased person or determine the cause of death. May release PHI about patients in the hospital to funeral directors as necessary to carry out their duties.

NATIONAL SECURITY/INTELLIGENCE ACTIVITIES
May release PHI to authorized Federal officials for intelligence, counterintelligence, and other National security activities authorized by law.

PROTECTIVE SERVICES FOR THE PRESIDENT & OTHERS
May disclose PHI to authorized Federal officials so they may provide protection to the President/other authorized persons/foreign heads of state or to conduct special investigations.

YOUR RIGHTS REGARDING MEDICAL INFORMATION WE MAINTAIN FOR YOU. RIGHT TO INSPECT/COPY
You have the right to inspect and copy PHI that may be used to make decisions about your care. This includes medical and billing records, but does not include psychotherapy notes. Instead of providing the PHI, we may provide you with a summary or an explanation of the PHI as long as you agree.

To inspect and copy PHI that may be used to make decisions, you must submit your request in writing to the Health Information Management Department. If you request a copy of the information, we may charge a fee for costs. We will respond within 30 days of receiving your request. We may deny your request to inspect/copy in certain limited circumstances. If denied access to PHI, you may request that the denial be reviewed. We will respond to the denial request within 30 days after receiving your written request for review and again may deny that request. If we do, we will tell you, in writing, our reasons for the denial.

RIGHT TO AMEND
If you feel the PHI we have about you is incorrect/incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the hospital.

To request an amendment, your request must be made in writing on a specific form for such purposes and you must provide a reason that supports your request. The request must be made to the Administrator, Eric Freeburg. (618-826-4581, ext. 298.)

We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. We must act upon your written request within 60 days unless a one-time extension of 30 days is agreed upon and give reason for delay.

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 PHI kept by or for the hospital; Is not part of the information (Designated Record Set) which you would be permitted to inspect and copy; Is accurate and complete.

We will give you a written denial that includes the reason for denial. This denial must include information as to how to complain to this organization or the Secretary of Health and Human Services. You may file a “Statement of Disagreement” of the denial giving the basis for the disagreement. A written statement must be made on a standard form provided by the hospital and must be limited to one page. This facility may give the patient a written rebuttal to the "Statement of Disagreement".

The facility must link or append certain amendment request information to the patient’s record, ie. request for amendment, hospital denial, patient statement of disagreement, and hospital’s rebuttal (if any). If the patient does not submit a written statement of disagreement, the hospital, upon request of the patient, must include certain amendment request information with any future disclosures of PHI of issue. If a standard transaction does not allow you to include the required additional information when disclosing PHI, the hospital may transmit the additional information to the recipient separately.

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 work or by mail.

To make this specific request you must submit a written request to the Hospital Administrator. Reason for your request will not be asked.

RIGHT TO GET A LIST OF THE DISCLOSURES WE HAVE MADE
List will not include uses/disclosures made for treatment, payment or health care operations listed in this Privacy Notice. The list we will give you will include disclosures made in the last six years after the effective date of the HIPAA Compliance Requirement, unless you request a shorter time after the effective date of April 14, 2003. The list will include date of the disclosure, to which PHI was disclosed (including their address, if known), description of the information disclosed and reason for the disclosure. Within 30 days of request, one list will be provided at no charge, for more requests in same year, a $5.00 charge will be made for each request. Example: Immunization records sent to schools.

RIGHT TO REQUEST RESTRICTIONS
You have the right to request a restriction/limitation of the PHI we use/disclose about you for treatment/payment/health care operations. You have the right to request a limit on the PHI we disclose about you to someone who is involved in your care or the payment of your care. Example: You could ask that we not disclose information about a surgery you had performed.

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.

To request restrictions, request must be in writing to the hospital administrator. In your request, you must tell: (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 t your spouse.

RIGHT TO A PAPER COPY OF THIS NOTICE
You have the right to a paper copy of this notice. May also obtain a copy of this notice at our web site, www.mhchester.com. A paper copy of this notice may be obtained at the Registration Desk.

CHANGES TO THIS NOTICE
We reserve the right to change this notice at any time and may make the revised notice effective for PHI we already have about you as well as any PHI we receive in the future. A copy of the current notice is posted with the effective date. Also, each time you register for treatment, you will be given a copy of the current notice in effect.

GRIEVANCES
If you believe your privacy rights have been violated, you may file a written grievance with the hospital administrator, 618-826-4581, Ext. 298 or with the Secretary of the Department of Health/Human Services 877-696-6775 or 202-619-0257. There will be no retaliation against a person who exercises the privacy rights or files a grievance against this hospital.

EXCLUSIONS FOR EMPLOYMENT RECORDS
Employment records maintained by this hospital in its capacity as an employer are excluded from the definition of PHI. However, individually identifiable health information created, received, or maintained by this facility in its healthcare capacity is protected health information.

OTHER USES OF MEDICAL INFORMATION
Other uses/disclosures of PHI 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/disclose PHI about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use/disclose PHI 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.

In special cases, in which the minor controls his/her own PHI under Illinois State Law, and that Law does not define the parent’s ability to access the child’s PHI, a licensed healthcare provider continues to be able to exercise discretion to deny or grant such access.

LIMITED DATA SET
A limited data set may be created and disseminated (that does not include directly identifiable information) for research, public health, and healthcare operations. The recipient must agree to limit the use of the data set for the purposes for which it was given and to ensure the security of the data as well as not to identify the information or use it to contact any individual.

1/18/02; Revised: 1/28/02, 1/30/02, 4/5/02, 5/21/02, 8/13/02, 8/30/02, 9/2/02; 12/10/02.