Bozeman Deaconess Hospital Privacy Policy-

> Notice of Privacy Practices

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.

The terms of this Notice of Privacy Practices apply to Bozeman Deaconess Health Services (BDHS) operating as a clinically integrated health care arrangement composed of Bozeman Deaconess Hospital and Bozeman Deaconess Health Group and the physicians and other licensed professionals seeing and treating patients at each of these facilities. All of the entities and persons listed will share personal health information of our patients as necessary to carry out treatment, payment and health care operations as permitted by law.

We are required by law to maintain the privacy of our patients' personal health information and to provide patients with notice of our legal duties and privacy practices with respect to your personal health information. We are required to abide by the terms of this Notice so long as it remains in effect. We reserve the right to change the terms of this Notice of Privacy Practices as necessary and to make the new Notice effective for all personal health information maintained by us. You may receive a copy of any revised notices at BDHS Patient Registration or a copy may be obtained by mailing a request to BDHS Patient Financial Services, 1600 Ellis Drive, Bozeman, MT 59715-6999.

Examples of disclosure for treatment, payment and health operations BDHS will use your personal health information for your treatment. For instance, doctors and nurses and other professionals involved in your care will use information in your medical record and information that you provide about your symptoms and reactions to plan a course of treatment for you that may include procedures, medications, tests, etc. We may also release your personal health information to another health care facility or professional who is not affiliated with our organization but who is or will be providing treatment to you.

We will use your health information for payment. For instance, we may forward information regarding your medical procedures and treatment to your insurance company to arrange payment for the services provided to you or we may use your information to prepare a bill to send to you or to the person responsible for your payment.

We will use and disclose your personal health information for our health care operations. For instance, clinical improvement, professional peer review, business management, accreditation and licensing, etc.

Permitted uses and disclosures:

Your Authorization

Except as outlined below, we will not use or disclose your personal health information for any purpose unless you have signed a form authorizing the use or disclosure. You have the right to revoke that authorization in writing unless we have taken any action in reliance on the authorization.

Facility Directory

We maintain a facility directory listing the name, room number, general condition and, if you wish, your religious affiliation. Unless you choose to have your information excluded from this directory, the information, excluding your religious affiliation, will be disclosed to anyone who requests it by asking for you by name. This information, including your religious affiliation, may also be provided to members of the community clergy. You have the right during registration to have your information excluded from this directory.

Family and Friends Involved In Your Care

With your approval, we may from time to time disclose your personal health information to designated family, friends, and others who are involved in your care or in payment of your care in order to facilitate that person's involvement in caring for you or paying for your care. If you are unavailable, incapacitated, or facing an emergency medical situation and we determine that a limited disclosure may be in your best interest, we may share limited personal health information with such individuals without your approval. We may also disclose limited personal health information to a public or private entity that is authorized to assist in disaster relief efforts in order for that entity to locate a family member or other persons that may be involved in some aspect of caring for you.

Business Associates

Certain aspects and components of our services are performed through contracts with outside persons or organizations, such as auditing, accreditation, legal services, etc. At times it may be necessary for us to provide certain aspects of your personal health information to one or more of these outside persons or organizations who assist us with our health care operations. In all cases, we require these business associates to appropriately safeguard the privacy of your information.

Development Activities

We may release demographic information about you to Bozeman Deaconess Foundation. Allowable information that may be released to Bozeman Deaconess Foundation includes: name, address, phone number, age, gender, insurance status, and dates of service. Information regarding illnesses and/or treatments will not be released. If you do not want to receive direct solicitations regarding current fundraising efforts please send written notification to: Bozeman Deaconess Hospital, 915 Highland Blvd., Bozeman, Montana, 59715, c/o Marketing Communications Department.

Appointments and Services

We may contact you to provide appointment reminders, test results or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Health Products and Services

We may from time to time use your personal health information to communicate with you about health products and services necessary for your treatment, to advise you of new products and services we offer, and to provide general health and wellness information.

Research

In limited circumstances, we may use and disclose your personal health information for research purposes. For example, a research organization may wish to compare outcomes of all patients that received a particular drug and will need to review a series of medical records. In all cases where your specific authorization has not been obtained, your privacy will be protected by strict confidentiality requirements applied by an Institutional Review Board or privacy board which oversees the research or by representations of the researchers that limit their use and disclosure of patient information.

Required uses and disclosures:

We are permitted or required by law to make certain other uses and disclosures of your personal health information without your consent or authorization, including but not limited to the following:
We may release your personal health information for any purpose required by law.
We may release your personal health information for public health activities, such as required reporting of disease, injury, and birth and death, and for required public health investigations.
We may release your personal health information as required by law if we suspect child abuse or neglect; we may also release your personal health information as required by law if we believe you to be a victim of abuse, neglect or domestic violence.
We may release your personal health information to the Food and Drug Administration if necessary to report adverse events, product defects or to participate in product recalls.
We may release your personal health information to your employer when we have provided health care to you at the request of your employer to determine workplace-related illness or injury; in most cases you will receive notice that information is disclosed to your employer.
We may release your personal health information if required by law to a government oversight agency conducting audits, investigations or civil or criminal proceedings.
We may release your personal health information if required to do so by subpoena or discovery request; in some cases you will have notice of such release.
We may release your personal health information to law enforcement officials as required by law to report wounds and injuries and crimes.
We may release your personal health information to coroners and/or funeral directors consistent with law.
We may release your personal health information if necessary to arrange an organ or tissue donation from you or a transplant for you.
We may release your personal health information if, in limited instances, we suspect a serious threat to health or safety.
We may release your personal health information if you are a member of the military as required by armed forces services; we may also release your personal health information if necessary for national security or intelligence activities.
We may release your personal health information to workers' compensation agencies if necessary for your workers' compensation benefit determination.
Your health information rights
Although your health record is the physical property of BDHS, the information belongs to you. You have the right:
To copy and/or inspect much of the personal health information that we retain on your behalf. All requests for access must be made in writing and signed by you or your representative. You may obtain an access request form from BDHS Medical Records, 915 Highland Blvd., Bozeman, MT 59715.
To request in writing that personal health information that we maintain about you be amended or corrected. We are not obligated to make all requested amendments but will give each request careful consideration. All amendment requests, in order to be considered by us, must be in writing, signed by you or your representative, and must state the reasons for the amendment/correction request. If an amendment or correction you request is made by us, we may also notify others who work with us and have copies of the uncorrected record if we believe that such notification is necessary. You may obtain an amendment request form from BDHS Medical Records, 915 Highland Blvd., Bozeman, MT 59715.
To receive an accounting of certain disclosures made by us of your personal health information after April 14, 2003. Requests must be made in writing and signed by you or your representative. Accounting request forms are available from BDHS Medical Records, 915 Highland Blvd., Bozeman, MT 59715. The first accounting in any 12-month period is free; you will be charged a fee for each subsequent accounting you request within the same 12-month period.
To request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522. BDHS will honor your request for restrictions to the extent possible.
To request restrictions on certain of our uses and disclosures of your personal health information for treatment, payment or health care operations. A restriction request form can be obtained from BDHS Medical Records, 915 Highland Blvd., Bozeman, MT 59715. We are not required to agree to your restriction request but will attempt to accommodate reasonable requests when appropriate and we retain the right to terminate an agreed-to restriction if we believe such termination is appropriate. In the event of a termination by us, we will notify you of such termination. You also have the right to terminate, in writing or orally, any agreed-to restriction.
To obtain additional copies of the Notice of Privacy Practices upon request.

You will be asked to sign an acknowledgment form that you received this Notice of Practice Practices.

For more information or to report a problem:

If you believe your privacy rights have been violated, you can file a complaint with the BDHS Privacy Officer or with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint. If you have questions and/or would like additional information, please contact the BDHS Privacy Officer at (406) 556-5584.

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