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Providence Medical Center Privacy Policy

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.

Providence Medical Center is committed to providing our regional community the highest quality health care available. This commitment extends to offering the best technological medical advances through services we provide, equipment used in the rendering of those services and ongoing education for our employees to maintain skills which are reflective of current standards of care throughout the country. Patients in our facility experience small town caring and warmth as they are surrounded by the familiar faces of our staff while receiving the best medical care anywhere.

We regard the confidentiality of care we provide to you as a sacred trust. Our patients have the right to expect that any information collected about them during the course of illness, injury, hospitalization and/or rehabilitation ("private health information") is maintained in a secure manner. This notice is to let you know how we safeguard that information, to whom information may be disclosed and how you may access the information we currently have regarding your confidential medical care.

Types of Information Which May Be Disclosed
To provide you with proper medical treatment, it is sometimes necessary for our facility to share your medical information with other physicians and/or health care providers. This would be the case, for example, if you were to be transferred to another facility for care that we are unable to provide, or if your family physician requests a specialty physician to provide consultation regarding your condition.

To protect the public health of our nation, the government requires that certain disease states be reported to the State Department of Health. If you contract one of these "communicable" diseases, pertinent information required by the state will be reported.

The government also allows certain research entities to obtain information about disease states thus enabling potential cures and treatments to be studied. For instance, the National Cancer Institute gathers data from cancer patients across the country in hopes of finding common factors among patients which may lead to the cure and/or treatment of cancer.

Medicare/Medicaid and/or your insurance company requires certain aspects of your personal health information in order to provide payment of your claim. Upon admission to this facility for inpatient or outpatient services, you will be asked to sign a consent to release this information to enable payment.

Members of our staff will have access to your private health information on ‘a need to know’ basis. Only those aspects of your record necessary for a staff member to provide optimal treatment to you will be available to that health care professional. In other words, a staff member who is not involved in your care or treatment will not have access to your medical record.

If you are involved in a commission of a crime, we are required by law to provide law enforcement with information pertinent to the case. Government agencies authorized by the Department of Health and Human Services to inspect this facility to ensure compliance with federally funded programs (i.e., Medicare) are also granted access to the medical record of any patient treated by this facility.

If you are being treated by this facility for a work-related injury or illness, information required for medical surveillance of your condition will be provided to your employer.

Statements of Use and Disclosure
Because we feel it is in your best interest, we may provide you with appointment reminders or information about treatment alternatives or other health related benefits and services.

Individual Rights Regarding Your Personal Health Information
You may request restrictions on certain uses and disclosures of protected health information as it pertains to treatment, payment or health care operations. For example, you may limit who is notified as to your hospitalization/condition. We will not disclose any information to family, friends or clergy without your approval.

If you are unable to communicate such restrictions or are in an emergency situation, this facility reserves the right to disclose only that information, and to only those individuals, which in our staff’s professional judgment would serve as a benefit to you. By law, this facility is not required to agree to your requested restrictions.

  • You have the right to inspect and obtain a copy of your protected health information. There are a few exceptions to this:


  • Psychotherapy notes;


  • Information compiled in reasonable anticipation of, or for use in, a civil, criminal, or administrative action or


  • Any information subject to the Clinical Laboratory Improvements Amendments of 1988 to the extent the provision of access to the individual would be prohibited by law.


  • Any records that are subject to the Privacy Act.


  • Any protected health information which was obtained from someone other than a health care provider under a promise of confidentiality and the access requested would be reasonably likely to reveal the source of the information.


Subject to review by the patient, the facility may deny access to any information which a licensed health care professional has determined, in the exercise of professional judgment, such access is reasonably likely to endanger your life or physical safety or another person.

For any requests regarding inspection which have been denied, a written explanation will be provided to you.

A reasonable, cost based fee will be charged for any copies made of the medical record. You have the right to request and receive communications of protected health information by alternative means or at alternative locations. In other words, you have the right to request that any communications to you about your health may be made to your place of employment, for example, or to a designated phone number rather than to your home if you don’t want family members to know about a certain treatment. This facility will accommodate all reasonable requests in this regard.

You have the right to amend your protected health information. Your request to amend your record must be submitted to this facility in writing. Your request may be denied by this facility if the private health information which is the subject of the request:

  • Was not created at this facility;


  • Is not a part of the designated record set;


  • Would not be a part of the record which could be inspected by the patient (outlined above);


  • Is determined to be accurate and complete. For any requests regarding amendment which have been denied, written explanation will be provided to you.

You have the right to request and receive an accounting of any disclosures made for purposes other than treatment, payment and health care operations for up to six years prior to the request for an accounting.

Information which would be exempt from this accounting includes:

  • Facility directories or other types of notification made without your objection.


  • Persons involved in your care.


  • National security or intelligence.


  • Disclosures to law enforcement or correctional institutions.


Any disclosures made prior to April 14, 2003.

If you are receiving this notice electronically, you have the right to request a paper notice. Call or write the Business Office at Providence Medical Center to request a copy of the notice.

Any use and disclosure of your private health information will be made only with your express, written authorization. Furthermore, you have the right to revoke such authorization.

What’s Being Done to Safeguard Your Personal Health Information?

Providence Medical Center has implemented several processes to ensure the security of your personal health information. We will continue to improve our security systems through new processes and technology as it becomes available. Our current strategy includes, but is not limited to:

  • Private patient and exam rooms;


  • Staff education regarding the importance of confidentiality;


  • Staff discipline when patient confidentiality is breached;


  • Software and hardware security measures which limits access to patient information;


  • Secured and verified transmission of electronic billing;


Policies and procedures to effect security of medical records, access to medical records, and use of currently available technology systems used for communication (i.e., telemedicine, facsimile machines, etc.)

What To Do If You Feel Your Privacy Rights Have Been Violated Or If You Would Like To Submit A Request For Your Personal Health Information
If you feel that your privacy rights have been violated in any way, Providence Medical Center encourages you to file a complaint. You will not be retaliated against in any way for filing such a complaint. Complaints can be lodged verbally or in writing by contacting:

Dennis Spangler, Privacy Officer
1200 Providence Road
Wayne, NE 68787
(402) 375-7997

You may also make a complaint with the Secretary of the Department of Health and Human Services.

A request for private health information may be submitted to the Medical Records Department of Providence

Medical center or to the privacy officer identified above.

Legal Requirements
Providence Medical Center is required by law to maintain the privacy of protected health information and to provide you with notice of our legal duties and privacy practices with respect to protected health information. We are required to abide by the terms of this notice which goes into effect October 1, 2001. Providence Medical Center reserves the right to change and revise at any time our privacy practices as stated in this notice, to private health information that was created or received prior to the effective date of the notice revision. Furthermore, if there is a change in law that necessitates a change to our policies and procedures, we will promptly document and implement the revised policy or procedure. If these changes affect the contents of this notice, a revision of the notice will be available. The revised notice will be:

  • mailed with the next billing to the patient,


  • available at points throughout the hospital,


  • posted on the facility’s web site, and


  • marked or highlighted to show the revisions.


Providence Medical Center
1200 Providence Road
Wayne, NE 68787
(402) 375-3800

Implemented 10/01/01

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