HIPAA Privacy Notice
THE FOLLOWING NOTICE DESCRIBES FAIRFIELD MEMORIAL HOSPITAL’S HIPAA PRIVACY PRACTICES, HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THE INFORMATION CAREFULLY.
At Fairfield Memorial Hospital, we recognize that the basis of each patient relationship is trust. The basis of trust comes not only from the ability of Fairfield Memorial Hospital to provide the quality care and services that are expected, but also from the ability to maintain the personal privacy of the patients/residents we serve.
Embedded in our culture is a tradition of protecting your health information, personal privacy, and confidential information. It has always been and will always be a top priority to maintain standards and procedures that are designed to prevent misuse of your confidential information.
• Your confidential healthcare information may be released to other healthcare professionals within the organization for the purpose of
providing you with quality healthcare.
• Your confidential healthcare information may be released to your insurance provider for the purpose of the hospital receiving payment for providing you with needed healthcare services.
• Your confidential healthcare information may be released to public or law enforcement officials in the event of an investigation in which you are a victim of abuse, a crime, or domestic violence.
• Your confidential healthcare information may be released to other healthcare providers in the event you need emergency care.
• Your confidential healthcare information may be released to other healthcare providers or facilities for concurrent care or referral or transfer of care from our hospital or providers.
• Your confidential healthcare information may be released to a public health organization or federal organization in the event of a
communicable disease or to report a defective device or untoward event to a biological product (food or medication).
• Your confidential healthcare information may not be released for any other purpose than that which is identified in this notice.
• Disclosures of the following protected health information (PHI) requires your written authorization: use of psychotherapy notes, mental health and substance abuse treatment records, disclosure of PHI for marketing, and disclosures that constitutes a sale of PHI. You may revoke your permission to release confidential healthcare information at any time.
• You may be contacted by the organization to remind you of any appointments, healthcare treatment options or other health services that may be of interest to you.
• You may be contacted by the organization for the purposes of raising funds to support the hospital’s operations. You may opt out of receiving such communications by calling the following number: 618-847-8260 or by following the directions provided in the fundraising materials.
• You have the right to restrict the use of your confidential healthcare information. However, the organization may choose to refuse your
restriction if it is in conflict of providing you with quality healthcare or in the event of an emergency situation.
• You have the right to receive confidential communication about your health status.
• You have the right to review in the format you prefer or an acceptable alternative.
• You have the right to make an amendment to your healthcare information.
• You have the right to know who has accessed your confidential healthcare information and for what purpose.
• You have the right and choice to include your information in a hospital directory.
• You have the right to access your health information stored electronically without cost and undue delay.
• You have the right to restrict disclosures to your health plan of any PHI created from a service that you have paid for out of pocket.
• You have the right to possess a copy of this Privacy Notice upon request. This copy can be in the form of an electronic transmission or on paper.
• You have the right to choose someone (healthcare power of attorney) or legal guardian to exercise your rights and make choices about your health information. Verification is required before any action can or will be taken.
• You have the right and choice to tell us to share information with your family, close friends, or others involved in your care.
• Your confidential healthcare information may be released to demonstrate compliance with the Privacy law to the Department of Health and Human Services.
• Your confidential healthcare information may be released to respond to organ and tissue donation requirements.
• Your confidential healthcare information may be used or shared for health research.
• Your confidential healthcare information may be shared with a coroner, medical examiner, or funeral director when an individual dies.
• Your confidential healthcare information can be used or shared for workers compensation claims, with health oversight agencies for activities authorized by law and for special government functions such as military, national security, and presidential protective services.
• Your confidential healthcare information can be shared in response to a court or administrative order, or in response to a subpoena.
• The organization will notify patient(s) when a reportable breach is discovered. Notification will be made to the patient(s) as soon as possible and no later than 60 days from when the breach is discovered. Notification will include a brief description of how the breach occurred, a description of the PHI involved, and steps patient(s) should take to protect themselves from harm. The notification will also include contact information for the individual to ask questions.
• FMH is required by law to protect the privacy of its patients. It will keep confidential any and all patient healthcare information and will
provide patients with a list of duties or practices that protect confidential healthcare information.
• FMH will abide by the terms of this notice. The organization reserves the right to make changes to this notice and continue to maintain the confidentiality of all healthcare information.
• Health plans are prohibited from using or disclosing genetic information of an individual for underwriting purposes.
• You have the right to complain to FMH or to the US Department of Health and Human Services Office of Civil Rights. You may file a complaint with FMH by notifying our Privacy Officer. All complaints must be in writing. We will not retaliate against you for filing a complaint. If you have any questions about this Notice or if you want to object to or complain about any use or disclosure or exercise any right explained above, please contact:
ATTN.: Dana Shantel Taylor LCSW ACSW, HIPAA Privacy Officer
Fairfield Memorial Hospital
303 NW 11th Street
Fairfield, IL 62837
This notice is effective as of April 14, 2003. Revised on June 15, 2011. Revised October 24, 2011. Revised on September 23, 2013.
Revised February 21, 2023