Notice of Privacy Practices
ATTACHMENT TO AHA REGULATORY ADVISORY Effective Date: March 1, 2017
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW
If you have any questions about this notice, please contact the Privacy
Officer at (559) 788-6066 or email
OUR PLEDGE REGARDING MEDICAL INFORMATION
Your medical and mental health treatment information and records are personal
and private. Sierra View Medical Center is committed to protecting your
health information. The medical and mental health information we create
and maintain is known as Protected Health Information/electronic Protected
Health Information or PHI/ePHI. We are required by Federal and State laws
to protect the privacy of your medical and mental health information and
obtain a signed authorization by you for certain disclosures.
We are required by law to provide you with this Notice of our legal duties
and privacy practices with respect to your medical and mental health information.
This Notice explains how we may legally use and disclose your protected
health information and your rights regarding the privacy of your protected
health information. We are required to follow all the terms of this notice.
We reserve the right to change the provisions of this Notice and make
it effective for all protected health information we maintain.
If you have any questions and/or would like additional information, you
may contact the Chief Privacy Officer at (559)788-6066 or the Privacy
Coordinator at (559)791-4706 or the Compliance Hot Line at (559) 791-4777.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following categories describe different ways that we use and disclose
your protected health information. For each category, we will explain
what we mean and try to give some examples. Not every use or disclosure
in a category will be listed. However, all of the ways we are permitted to use
and disclose your protected health information will fall within one of
the categories. We will separately describe the ways we use and disclose
HIV/AIDS and substance and/or alcohol abuse information later in this Notice.
For Treatment - We may use and disclose your protected health information to provide,
coordinate, or manage your healthcare and any related services. We may
also disclose your health information to other providers who may be treating
you or involved in your care.
For Payment - We may use or disclose your protected health information to obtain payment
for the health care services provided to you. For example, we may include
information with a bill to Medi-Cal or Medicare that identifies you, your
diagnosis, and services provided in order to receive payment.
For Health Care Operations - We may use and disclose your protected health information to support
the business activities of Sierra View Medical Center. For example, we
may use your protected health information to review and evaluate our treatment
and services or to improve the care and services we offer. In addition,
we may disclose your health information with other staff or business associates,
who perform billing, consulting, auditing, investigatory, and other services
for Sierra View Medical Center.
Hospital Directory - We may include certain limited information about you in the hospital
directory while you are a patient at the hospital. This information may
include your name, location in the hospital, your general condition (e.g.,
good, fair, etc.) and your religious affiliation. Unless there is a specific
written request from you to the contrary, this directory information,
except for your religious affiliation, may also be released to people
who ask for you by name. Your religious affiliation may be given to a
member of the clergy, such as a priest or rabbi, even if they don’t
ask for you by name. This information is released so your family, friends
and clergy can visit you in the hospital and generally know how you are doing.
Fundraising Activities - We may use information about you, or disclose such information to a
foundation related to the hospital, to contact you in an effort to raise
money for the hospital and its operations. You have the right to opt out
of receiving fundraising communications. If you receive a fundraising
communication, it will tell you how to opt out.
Marketing And Sales- Most uses and disclosures of medical information for marketing purposes,
and disclosures that constitute a sale of medical information, require
Required by Law - We will use and disclose your protected health information when required
by Federal, State, or local law.
Health Oversight Activities - We may disclose your protected health information to Federal or State
agencies that audit, investigate, and inspect government health benefit programs.
Public Health Activities - We may use and disclose your protected health information to public
health authorities or government agencies for reporting certain diseases,
injuries, illnesses, and events as required by law. For example, we may
disclose your medical information to a local government agency in order
to assist the agency during the investigation of an outbreak of disease
in the area.
Victims of Abuse, Neglect, or Domestic Violence - We may disclose your protected health information to other government
agencies to report
suspected abuse, neglect, or domestic violence. We will only disclose
this information if you agree, if the law requires us to, or when it is
necessary to protect someone from serious harm.
Lawsuits and Legal Actions - We may disclose your protected health information in response to a court
order, subpoena, or other lawful process, as allowed by law, for legal
Law Enforcement - We may disclose your protected health information to law enforcement
officials, such as the police, sheriff, or FBI, in response to a search
warrant or court order, to locate or identify a missing person, a suspect,
or a fugitive. In addition, we may disclose your information to report
a crime that happens at our clinics or offices, or to report certain types
of wounds, injuries, or deaths that may result from a crime.
Coroners, Medical Examiners, and Funeral Directors - We may disclose your protected health information to funeral directors,
coroners, and medical examiners to identify a dead person, determine what
caused the death, or for other official duties.
Organ and Tissue Donation - We may disclose your protected health information to organizations that
take care of organ, eye, or tissue donations and transplants.
Research - We may use and disclose your protected health information for research,
if approved by an Institutional Review Board (IRB). An IRB is a committee
responsible for reviewing the research proposal and establishing protocols
to ensure the privacy of your protected health information.
To Stop a Serious Threat to Health or Safety - We may use or disclose your protected health information if it is necessary
to lessen the imminent threat of a serious threat to health or safety.
Inmates - If you are an inmate of a correctional institution, we may disclose
your protected health information to the correctional institution to protect
your health and safety, or to protect the health and safety of others
at the institution.
Military Activity and National Security - If you are or were a member of the armed forces, we may disclose your
protected health information to military authorities. We may also share
your protected health information with authorized Federal officials when
necessary for national security, intelligence activities, or the protection
of the President or other government officials.
Government Programs for Public Benefits - We may use or disclose your protected health information to help you
qualify for government benefit programs, such as Medicare, Medi-Cal, Supplemental
Security Income, or other benefits or services available. We may also
contact you to tell you about possible treatment options or health-related
benefits or services, upon written authorization.
Workers’ Compensation - We will use and disclose your protected health information for workers’
compensation or similar programs that provide benefits for work-related
injuries or illness.
Family and Friends Involved in or Paying for Your Care - We may disclose your protected health information to a friend, family
member, or any other person you identify as being involved with your medical
care or payment for care. For example, you may bring a friend or family
member to your appointment and have that person in the exam room while
talking with a health care provider. You may inform us verbally or in
writing if you object to disclosures to your family and friends.
Disaster Relief - We may disclose your protected health information to public or private
entities in a disaster to provide needed medical care or to help you find
members of your family.
Appointment Reminders - We may use the contact information that you provided us to remind you
of your upcoming medical appointments with Sierra View Medical Center.
Immunization Records - We may disclose your child’s proof of immunization to their school,
if State or other law requires the school to have such information prior
to admitting your child as a student. We will obtain the parent’s
or guardian’s authorization prior to doing so, though this may be
Uses And Disclosures Of Your Protected Health Information Requiring Your
Permission - We will obtain your written permission through an authorization for
other uses and disclosures of your protected health information not covered
by this Notice. You may revoke the authorization in writing at any time
and we will stop disclosing protected health information about you for
the reasons stated in your written authorization. Any disclosures made
prior to the revocation are not affected by the revocation. We are also
required to retain our records of the care you receive from Sierra View
Uses And Disclosures Of HIV/AIDS Information - We may disclose any public health records relating to HIV/AIDS we develop
or acquire that contain your protected health information as provided
by law for public health purposes or to other public health agencies or
corroborating medical researchers when the information is necessary to
carry out their duties in investigation, control, or surveillance of disease.
Your physician who orders an HIV test on your behalf may disclose the
result of your HIV test to yourhealth care providers for purposes related
to your diagnosis, care, or treatment.
Uses And Disclosures Of Your Substance And Alcohol Abuse Information - The confidentiality of your alcohol and drug abuse records we maintain
is protected by Federal law and regulations. Generally, we are not allowed
to disclose to an outside person your participation in the program or
identify you as an alcohol or drug abuser unless:
(1) You consent in writing;
(2) The disclosure is allowed by a court order; or
(3) The disclosure is made to medical personnel in a medical emergency
or to qualified personnel
for research, audit, or program evaluation.
Federal law and regulations do not protect any information about a crime
committed by you either at our program or against any person who works
for the program or about any threat to commit such a crime.
Federal laws and regulations do not protect any information about suspected
child abuse or neglect from being reported under State law to appropriate
State or local authorities.
Your Rights Regarding Protected Health Information About You
1. Right to Inspect and Copy
You have the right to inspect and copy your protected health information
in our designated record set, which includes medical and billing records,
as long as we maintain that information. You have the right to access
your records in any format that the Sierra View Medical Center maintains them in
and you may direct them to be sent to a third party. A request must be
submitted in writing and a fee may be charged for the costs of copying,
mailing, and for any other supplies used in fulfilling your request. We
may deny your request to inspect and copy your records. If this occurs,
we will send you a written statement as to why and we will explain your
right, if any, to have the denial reviewed.
2. Right to Request an Amendment
You have the right to request that we amend your protected health information
if you feel that it is incomplete or inaccurate. The request must be in
writing and provide reasons that support your request including what information
is incomplete or inaccurate.
We may deny your request if it is not in writing or does not include a
reason to support the request. We may also deny your request if:
• The information is correct and accurate.
• The information was not created by us.
• The information is not part of the records you are permitted to
inspect and copy.
• The person who created it is no longer available to make the amendment.
If we deny your request for amendment, you have the right to file a written
addendum, not to exceed five (5) pages. You may request in writing that
the written addendum be added to your medical records, along with your
original request to change your medical information and the written denial
to make the change.
3. Right to an Accounting of Disclosures
You have the right to request an “accounting of disclosures”
which is a list of disclosures we made of your protected health information.
The request must be made in writing and can only include disclosures that
occurred between the date of your request and up to six years before this
date, but not before April 14, 2003. The list will not include disclosures:
• Based on your written authorization;
• To treat you or to receive payment for your treatment;
• For certain business reasons;
• To family members or friends involved in your medical treatment or care;
• To jails, prisons, or law enforcement; or
• For reasons related to legal actions.
For Electronic Health Records (EHR), the accounting of disclosures would
also include disclosures of your protected health information made to
carry out treatment, payment, and health care operations. This requirement
is limited to disclosures within the three (3) year period prior to your
request and after January 1, 2014.
You can request one free accounting of disclosures in a 12 month period,
but may be charged for additional lists.
4. Right to Request Restrictions
You have the right to request a restriction or limitation on how we use
or disclose your protected health information for treatment, payment,
or health care operations. For example, you could ask us to limit the
information we share with someone who is involved in your care or the
payment for your care. For example, you might ask that we limit disclosures
to your spouse. We may ask that you give us your request in writing. If
we agree to your request, we will not use or disclose the protected health
information in violation of such restriction except if we believe this
information is required to provide you with necessary medical treatment or care.
We are not required to agree to your request except that you have the right
to restrict disclosures to a Health Plan or its business associate if
you or someone on your behalf pays out of pocket in full for the health
care item or service unless we are required by law to disclose the protected
health information. We require the payment be made in full at the time
of the request for restriction. If payment is not made, the restriction
will be void and disclosure of protected health information will be made
to your Health Plan for payment. In some cases where a restriction of
disclosure cannot be made or involves another party, we will discuss with
you in detail.
5. Right to Request Confidential Communications
You have the right to request how we communicate with you to preserve your
privacy. For example, you may request that we call you only at your work
number, or send mail to a special address. Your request must be made in
writing and must specify how or where we are to contact you. We will accommodate
all reasonable requests.
Right to Revoke an Authorization - You have the right to take back or revoke your written authorization to
use and disclose your protected health information at any time. You must
let us know in writing. If you take back your written authorization, we
will stop sharing your protected health information. However, we cannot
take back any information already used or shared while the authorization
was valid. Sierra View Medical Center is required by law to keep a record
of the medical treatment you receive from the facility, whether or not
you give us written permission to use or share it. You do not have the
right to have information removed from your record.
Right to a Paper Copy of this Notice - You have the right to receive a paper copy of this notice any time you
request it, unless you are an inmate at the jail.
Breach Notification - In the event of a breach of your unsecured protected health information,
Sierra View Medical Center will notify you of the circumstances of the breach.
Right to File a Complaint - If you believe your privacy rights have been violated, you may file a complaint
with the hospital or with the Secretary of State of the U.S. Department
of Health and Human Services. To file a complaint with the hospital, contact
the Chief Privacy Officer at (559)788-6066, the Privacy Coordinator at
(559)791-4706, the Compliance Hot Line at (559)791-4777, or in writing
to Sierra View Medical Center, c/o The Chief Privacy Officer, 465 W. Putnam,
Porterville, California 93257.
You will not be retaliated against for filing a complaint.
Our Responsibilities - We must follow the terms of this Notice while it is in effect. We reserve
the right to change this Notice and our privacy practices at any time.
Changes in our privacy practices will apply to any protected health information
we already have and to protected health information we create or receive
in the future. We will also post and make the new Notice available at
Sierra View Medical Center locations in the waiting areas or at the reception
desk. The Notice will also be available on Sierra View Medical Center's