III. Uses and Disclosures Requiring Your Written Authorization

For uses and disclosures of your information beyond treatment, payment and operations purposes, we are required to have your written authorization, except as permitted by law. You have the right to revoke an authorization at any time to stop future uses or disclosures of your information except to the extent that we have already undertaken an action in reliance upon your authorization. Your revocation request must be to us in writing. The name, address, telephone number of the person to contact is located on the last page of this document. You may use our Authorization for Use or Disclosure of Protected Health Information form and/or our Revocation of an Authorization form to submit your request to us. Copies of these forms are available in the medical records office.

Examples of uses or disclosures that would require your written authorization include, but are not limited to, the following:

A request to provide your PHI to an attorney for use in a civil litigation claim.
A request to provide certain information to an insurance or pharmaceutical facility for the purposes of providing you with information relative to insurance benefits or new medications that may be of interest to you.
A request to provide certain information to another individual or facility.

IV. Uses or Disclosures of Information Based Upon Your Verbal Agreement

In the following situations, we may disclose a limited amount of your PHI if we provide you with an advance oral or written notice and you do not object to such release or such release is not otherwise prohibited by law. However, if there is an emergency situation and you are unable to object (because you were not present or you were incapacitated, etc.), disclosure may be made if it is consistent with any prior expressed wishes and disclosures is determined to be in your best interest. When a disclosure is made based on these or emergency situations, we will only disclose health information relevant to the person’s involvement in your care. For example, if you are sent to the emergency room, we may only inform the person that you suffered an apparent heart attack, stroke, etc., and/or we may provide information on your prognosis or progress. You will be informed and given an opportunity to object to further disclosures of such information as soon as you are able to do so.

Information Used or Disclosed in the Facility Directory:

We may use or disclose your name, unit or room number, and religious affiliation in our facility directory. We may also disclose your religious affiliation to a member of the clergy. Information concerning your general condition or room location may be provided to callers or visitors when they ask for you by name. You may object to the release of this information. You may use our Request to Restrict the Use or Disclosure of Protected Health Information form to notify us of your objection or your objection may be made orally. The name, address, and telephone number of the person to whom you may make your objection to is listed on the last page of this document. (See also Section VI, paragraph 1.)

Information Disclosed to Family Members, Friends, or Others Involved in Your Care:

We may disclose your PHI to your family members and friends who are involved in your care or who help pay for your care. We may also disclose your PHI to a disaster relief organization for the purposes of notifying your family and/or friends about your general condition, location, and/or status (i.e., alive or dead). You may object to the release of this information. You may use our Request to Restrict the Use or Disclosure Of Protected Health Information form to notify us of your objection or your objection may be made orally. The name, address, and telephone number of the person to whom you may a make your objection is listed on the last page of this document. (See also Section VI, paragraph 1.)

V. Uses and Disclosures of Information That Do Not Require Your Consent or Authorization

State and federal laws and regulations either require or permit us to use or disclose your PHI without your consent or authorization. The uses or disclosures that we may make without your consent or authorization include the following:

When Required by Law:

We may disclose your PHI when a federal, state or local law requires we report information about suspected abuse, neglect, or domestic violence, reporting adverse reactions to medications or injury from a health care product, or in response to a court order or subpoena.

For Public Health Activities for the Purpose of Preventing or Controlling Disease, Injury or Disability:

We may disclose your PHI when we are required to collect information about disease or injuries (e.g., your exposure to a disease or your risk for spreading or contracting a communicable disease or condition, product recalls, or to report vital statistics (e.g., births/deaths to the public health authority).

For Health Oversight Activities:

We may disclose your PHI to a health oversight agency such as a protection and advocacy agency, the state agency responsible for inspecting our facility or to other agencies responsible for monitoring the health care system for such purposes as reporting or investigation of unusual incidents or to ensure that we are in compliance with applicable state and federal laws and regulations and civil rights issues.

To Coroners, Medical Examiners, Funeral Directors, Organ Procurement Organizations or Tissue Banks:

We may disclose your PHI to a coroner or medical examiner for the purpose of identifying a deceased individual or to determine the cause of death. We may also disclose your health information to a funeral director for the purpose of carrying out you wishes and/or for the funeral director to perform his/her necessary duties.

If you are an organ donor, we may disclose your PHI to the organization that will handle your organ, eye or tissue donation for the purpose of facilitating your organ or tissue donation or transplantation.

For Research Purposes:

We may disclose your PHI for research purposes only when a privacy board has approved the research project. However, we may disclose your PHI to individuals preparing to conduct an approved research project in order to assist such individuals in identifying persons to be included in the research project. Researchers identifying persons to be included in the research project will be required to conduct all activities onsite. If it becomes necessary to use or disclose information about you that could be used to identify you name, we will obtain your written authorization before permitting the researcher to use your information. Researchers will be required to sign a Confidentiality and Non-Disclosure Agreement form before being permitted access to health information for research purposes. A sample copy of this agreement may be obtained from the medical records office.

To Avert a Serious Threat to Health or Safety:

We may disclose your PHI to avoid a serious threat to your health or to the health or safety of others. When such disclosure is necessary, information will only be released to those law enforcement agencies or individuals who have the ability or authority to prevent or lessen the threat of harm.

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