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York Hospital Privacy Notice

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. EFFECTIVE DATE: August 2018. Revised February 2023

AUTHORIZED USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION:

York may use and disclose your PHI, without your authorization, for purposes of treatment, payment, and health care operations. For example:

  • TREATMENT: York may use or disclose your PHI to other health care providers for treatment and continuity of care purposes and to arrange for the provision, coordination, and management of health care services for you. For example, 约克可能会向您的初级保健医生披露您的住院信息,以便在您出院后为您安排适当的院后护理. York may also disclose PHI about you to a pharmacist to process your prescription, or to a medical equipment supplier for supplies and equipment necessary for your care.
  • PAYMENT: 约克可向您的健康保险公司或其他第三方付款人健康计划(如Medicare或MaineCare (Medicaid))使用或披露您的PHI信息,以获取向您提供的医疗保健服务的付款或报销, or to determine your eligibility for coverage and benefits, unless you pay in full out of pocket for services provided to you and request in writing that your PHI not be disclosed to third-party payors.
  • HEALTH CARE OPERATIONS: York may use or disclose your PHI for certain health care operations purposes, such as quality review and improvement activities, risk management activities, and to conduct and process patient satisfaction surveys.
  • ORGANIZED HEALTH CARE ARRANGEMENT PURPOSES: 参与约克有组织医疗保健安排(如下所述)的约克实体可在必要时相互分享您的PHI,以开展治疗, payment or health care operations relating to the organized health care arrangement.
  • PATIENT PORTAL York offers a Patient Portal for patients to view their health information online. York currently utilizes RelayHealth and eClinical Works (eCW) for confidentially storing your personal and medical information. RelayHealth and eCW use a secure, encrypted connection that meets the highest industry standards. All health data is stored on a secure server and managed with the protection of your information in mind. Only you – and those you authorize – are able to see or gain access to the information in your Portal. RelayHealth’s complete privacy policy may be viewed by visiting their website at http://www.relayhealth.com/privacy and eCW’s complete privacy policy may be viewed by visiting their website at http://www.eclinicalworks. com/privacy-policy/.
  • HEALTH INFORMATION EXCHANGE York participates in a statewide health information exchange (HIE). The HIE helps the hospital provide higher quality, more efficient care by sharing health information across a secure system with other participating providers. This means that if you are admitted to a Maine health care facility not affiliated with York Hospital, health care providers

there will be able to see important health information held in our electronic medical record systems. You do not have to participate in the HIE to receive care. For more information about HealthInfoNet and your choices regarding participation, visit www.hinfonet.org or call toll-free 1-866-592-4352.

YORK MAY ALSO USE AND DISCLOSE YOUR PHI WITHOUT YOUR AUTHORIZATION IN THE FOLLOWING ADDITIONAL CIRCUMSTANCES:

  • AS REQUIRED BY LAW: York may use and disclose your PHI when required or authorized by state and federal law.
  • PUBLIC HEALTH ACTIVITIES: York may use and disclose your PHI to public health authorities for public health activities, such as to comply with mandatory communicable disease and vital statistics reporting laws.
  • ABUSE, NEGLECT, AND EXPLOITATION REPORTING: York may disclose your PHI to government authorities, such as Child Protective Services or Adult Protective Services, that are authorized by law to receive reports of actual or suspected cases of abuse, neglect, or exploitation of children and incapacitated or dependent adults.
  • HEALTH OVERSIGHT ACTIVITIES: York may use and disclose your PHI to a health oversight agency for activities authorized by law such as compliance with health oversight audits, investigations, licensure surveys and inspections, and compliant investigations. Oversight agencies authorized to receive your PHI include government agencies that oversee the health care system, government benefit programs, and other government regulatory programs, including the Maine Department of Health and Human Services, the federal Medicare program, and Maine health care professional licensing boards.
  • JUDICIAL AND ADMINISTRATIVE PROCEEDINGS: York may disclose your PHI in judicial or administrative proceedings when required or authorized by law, for example, in response to an order of a court or pursuant to a subpoena served by a governmental entity authorized by law to have access to your PHI.
  • LAW ENFORCEMENT PURPOSES: York may disclose your PHI, so long as applicable legal requirements are met, for certain law enforcement purposes such as to report gunshot wounds, crimes committed on York’s premises, or crimes committed against York personnel.
  • CORONERS AND MEDICAL EXAMINERS: York may use and disclose PHI to coroners and medical examiners regarding a deceased patient for identification purposes, or for a coroner or medical examiner to determine a cause of death or to perform other duties authorized by law.
  • FUNERAL DIRECTORS: 如有必要,约克可根据适用法律向殡仪主管使用和披露PHI,以履行其为已故患者安排葬礼的职责. If necessary to carry out such duties, York may disclose such information prior to and in reasonable anticipation of a patient’s death.
  • BODY, ORGAN, EYE OR TISSUE DONATION PURPOSES: York may use and disclose PHI to organ procurement organizations or other entities for cadaveric (body), organ, eye, or tissue donation purposes.
  • RESEARCH: 约克可出于研究目的使用和披露您的个人信息,前提是该研究以及与该研究相关的任何使用和披露均得到机构审查委员会(IRB)或隐私委员会的批准,且该研究产生的或与该研究相关的任何报告中未披露您的身份信息.
  • USES AND DISCLOSURES TO AVERT THREATS OF HARM OR SAFETY: York may use and disclose your PHI when necessary to prevent or lessen a direct threat of serious, imminent harm to health or safety.
  • SPECIALIZED GOVERNMENT FUNCTIONS: York may disclose your PHI for the following specialized government functions when such disclosures are authorized or required by applicable law:
  1. Armed Forces and Foreign Military Personnel: 约克可披露武装部队成员和外国军事人员的PHI,以进行适当军事指挥当局认为必要的活动,以确保适当执行军事任务.
  2. National Security and Intelligence Activities: York may disclose your PHI to authorized federal officials for the conduct of lawful intelligence, counter-intelligence, and other national security activities authorized by the National Security Act and related Executive Orders.
  3. Protective Services for the President and Others: York may disclose your PHI to authorized federal officials for the provision of protective services to the President or other persons, or for the conduct of investigations, authorized under applicable federal law.
  4. Correctional Institutions and Law Enforcement Custodians: York may disclose to a correctional institution or a law enforcement official having lawful custody of an inmate or other individual, PHI about the inmate or other person when necessary (i) to provide health care to the inmate or person in custody, (ii) for the health and safety of the inmate or person in custody, (iii) for the health and safety of correctional personnel, (iv) for the health and safety of persons responsible for transporting the inmate or person in custody,
    1. for law enforcement on correctional facility premises, and
    2. for administering and maintaining the safety, security and good order of the correctional institution.
  • WORKERS’COMPENSATION: 约克可在获得授权并遵守与工人赔偿或其他提供工伤或疾病福利而不考虑过失的类似计划相关的法律时披露您的PHI.
  • BUSINESS ASSOCIATES: 约克可将您的PHI披露给为或代表约克提供服务的商业合作承包商,前提是该等承包商已书面同意适当保护您的PHI.
  • PERSONAL REPRESENTATIVES: York may disclose your PHI to a personal representative, such as your guardian, health care power of attorney agent, or health care surrogate, who is authorized to make health care decisions on your behalf when you lack the capacity to make your own health care decisions.
  • USES AND DISCLOSURES FOR FACILITY DIRECTORY PURPOSES: Unless you or your personal representative notify York that you object to and wish to prohibit or restrict any such uses and disclosures, York may use and disclose the following limited PHI about you for the following facility directory purposes:
  1. York may use limited PHI about you to maintain a facility directory—namely, your presence and room location in a York facility, a brief general description of your health status and condition that does not communicate specific medical information about you, and your religious affiliation.
  2. York may disclose such facility directory information about you (except for your religious affiliation) to persons who ask for you by name, including members of the public and law enforcement officials.
  3. York may also disclose such facility directly information about you, including your religious affiliation, to members of the clergy.
  4. 约克还可能向通过姓名询问您的媒体人员披露您的健康状况的简要概述,但不会传达有关您的具体医疗信息(但不包括您的房间号码).
  • PERSONS INVOLVED IN YOUR CARE AND USES AND DISCLOSURES FOR NOTIFICATION PURPOSES: York may disclose your PHI to family members, relatives, or close personal friends involved in your care, involved in securing payment for your care, 或用于通知目的,除非您或您的个人代表通知冰球突破您反对并希望禁止或限制此类披露.
  • DISASTER RELIEF: 约克可向法律授权的公共或私人实体使用并披露您的个人信息,以协助救灾工作以达到某些通知目的, provided you have been given the opportunity to agree or to object to such uses and disclosures.
  • FUNDRAISING ACTIVITIES: York Hospital may use your information for fundraising to support the hospital’s mission of excellence, but you can tell us not to contact you again. To opt out of future fundraising communications, contact York Hospital’s Director of Corporate Compliance & Privacy at York Hospital, 15 Hospital Drive in York, ME 03909 or call (207)351-2443. Information we may use is limited to demographic or other information allowed by law (such as name, address, telephone number or e-mail information, age, date of birth, gender, health insurance status, dates of service, department of service information, treating physician information, or outcome information). 冰球突破还可以向机构相关的基金会披露此类有限信息,以便为冰球突破开展筹款活动.

USES AND DISCLOSURES OF PROTECTED HEALTH INFORMATION REQUIRING YOUR AUTHORIZATION:

  • WRITTEN AUTHORIZATION: For other types of uses and disclosures not described in this Notice of Privacy Practices, York will obtain your written authorization before using or disclosing your PHI. For example, the following uses and disclosures require work to obtain your written authorization:
    • Psychotherapy Notes: In the event that York maintains psychotherapy notes about you that are kept separate from the rest of your York medical record, 约克将获得您的书面授权,以使用或披露该等心理治疗记录,除非适用法律规定的授权要求有例外情况.
    • Marketing: York will obtain your written authorization for any use or disclosure of your PHI to sell or market products or services, except in limited circumstances (for example, in face-to-face marketing communications with you).
    • Sale of PHI: York will obtain your written authorization for any disclosure of your PHI that involves a sale of your PHI, unless an exception applies under applicable law.
    • Photographs and Video recordings: York will not photograph or video record you, or use or disclose any photographs and video recordings of you, for non-treatment related purposes, for marketing or public relations purposes, without your written authorization, unless the creation, use, or disclosure of such photographs or video recordings are authorized by law (e.g., for York facility security surveillance purposes).
  • RIGHT TO REVOKE AUTHORIZATION: You may revoke an authorization to disclose your PHI at any time, to the extent that York or others have not already relied upon your authorization, by giving written notice of your revocation to York’s Privacy Officer.

SPECIAL PROTECTIONS FOR CERTAIN TYPES OF PROTECTED HEALTH INFORMATION:

  • CONFIDENTIALITY OF MENTAL HEALTH INFORMATION: If York maintains information about you derived from mental health services provided to you by a York psychiatrist, psychologist, clinical nurse specialist, social worker or counseling professional, York will not disclose such mental health information to another health practitioner or facility outside of York or its organizational affiliates for a diagnostic, treatment or continuity of care purpose, without your written authorization, unless such disclosure is necessary in an emergency or is otherwise authorized or required by law. If a York licensed mental health facility, program or agency maintains mental health information about you, 除非得到适用的精神健康保密法律法规的授权或要求,York将不会使用或披露有关您的该等精神健康设施PHI.
  • CONFIDENTIALITY OF HIV INFORMATION: If York maintains any information regarding your HIV status (such as HIV test results or medical records containing HIV information), such information is afforded heightened protection under Maine law and York will maintain the confidentiality and privacy of such information, and will not use or disclose such information, except as specifically authorized or required by Maine’s HIV confidentiality laws.
  • CONFIDENTIALITY OF SUBSTANCE ABUSE PROGRAM INFORMATION: If a York substance abuse program maintains, or if York acquires from another provider or facility, 任何与您有关的药物滥用PHI信息都将受到根据42°C规定的某些药物滥用项目记录所提供的联邦保密保护.F.R. Part 2, York will maintain the confidentiality and privacy of such information, and will not use or disclose such information, except as specifically authorized or required by 42 C.F.R. Part 2. If York creates, acquires or maintains any substance abuse information about you that is not from a Part 2 substance abuse program, York will protect the confidentiality of such information and use and disclose such information in the same way York protects, uses and discloses your other PHI.

YOUR RIGHTS WITH RESPECT TO PROTECTED

HEALTH INFORMATION: The following is a statement of your rights with respect to your PHI and a brief description of how you may exercise these rights.

  • YOU HAVE THE RIGHT TO ACCESS, INSPECT AND COPY YOUR PHI. This means you may inspect at reasonable times and obtain a copy of your clinical records and billing records within 30 days of receipt of your written request. If we need extra time, we may extend the time once for an additional 30 days and we will provide you written notice of the extension. You have the right to receive your health information in the form and format of your choosing, if such information can be readily produced in such form and format, or in a readable hardcopy form, or in another format agreed to between you and York. If York maintains your PHI in an electronic health record, 您有权以电子格式获取您的健康信息副本,并指示约克将您的PHI电子副本直接传输给您选择的另一个明确指定的实体或个人. You may be charged reasonable costs (including labor and supplies) associated with providing copies of your records, or of preparing any summaries that you request. In certain limited circumstances, you may be denied access to your health information and records. However, you may request that a decision denying you access to your PHI and records be reviewed. Please contactYork’s Privacy Officer if you have questions about your right to access your PHI.
  • YOU HAVE THE RIGHT TO REQUEST A RESTRICTION ON CERTAIN USES AND DISCLOSURES OF YOUR PHI. For example, you may request that any part of your PHI not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice. If you request that York not disclose your PHI to a third-party payor health plan for purposes of carrying out payment or health care operations, and you have paid York in full out of pocket for services provided to you, York is required to honor your requested restriction. Otherwise,

York无需同意所要求的限制,并可根据具体情况自行决定是否履行所要求的限制. If York agrees to a requested restriction, York will not use or disclose your PHI in violation of the agreed upon restriction, unless the use or disclosure is needed to provide emergency treatment. Your request for a restriction must state the

specific restriction requested and to whom you want the restriction to apply. 如本通知所述,经您授权或法律允许或要求的PHI披露可能包括York从其他医疗保健提供者和机构收到的PHI披露,除非您要求且York同意对此类信息披露的要求限制.

    • YOU HAVE THE RIGHT TO REQUEST TO RECEIVE CONFIDENTIAL COMMUNICATIONS OF PHI FROM US BY ALTERNATIVE MEANS OR AT AN ALTERNATIVE LOCATION. York will accommodate reasonable requests. York may place conditions on such accommodations, for example, by asking you for information as to how payment will be handled or specification of an alternative address or other method of contact. York will not request an explanation from you as to the basis for the request. Please make such requests in writing to York’s Privacy Officer.
    • YOU HAVE THE RIGHT TO SUBMIT AMENDMENTS, CORRECTIONS AND CLARIFICATIONS TO YOUR PHI. You may request amendments, corrections and clarifications to PHI contained in your medical records. Your request must be in writing and you must provide a reason supporting your request. If you are requesting a change to the PHI in your treatment record, we will place your requested amendment, correction or clarification in your record. York may add a response to your record, and will provide to you a copy of our response. If you are requesting a change in other records (that are neither medical or billing records), York may deny your request. If your request is denied, we will notify you in writing and provide our reasons for the denial. You have the right to file a statement of disagreement with York’s Privacy Officer and York may prepare a response to your statement. York will provide you with a copy of our response. Please contact York’s Privacy Officer if you have any questions about modifying your PHI.
    • YOU HAVE THE RIGHT TO RECEIVE AN ACCOUNTING OF CERTAIN DISCLOSURES. You have the right to receive an accounting of certain disclosures of your PHI made by York in the six years prior to the date of your request. The accounting will not include disclosures made directly to you, disclosures made to others pursuant to your written authorization, disclosures made to carry out treatment, payment, and health care operations for which your written authorization was not required, incidental uses and disclosures, and uses and disclosures for which an accounting is not required by law. However, you have the right to request an accounting of disclosures made for purposes of treatment, payment, or health care operations through an electronic health record during the three years prior to your request. To request an accounting of disclosures of your PHI, contact York’s Privacy Officer.
    • IMPORTANT NOTICE TO MINORS REGARDING MINOR’S PRIVACY RIGHTS: 如果您是法律授权代表您自己同意接受医疗保健服务的未成年人,并且您实际上代表您自己同意接受此类服务, 就您代表您自己同意的医疗保健服务而言,约克需保护您的PHI隐私,其方式与约克保护成人PHI隐私的方式相同, unless a special exception applies under the law. For example, York is authorized by law to notify your parent or guardian if, 根据您的约克郡医疗服务提供者的判断,未通知您的父母或监护人将严重危及您的健康,或将严重限制您的约克郡医疗服务提供者为您提供治疗的能力. Additionally, if you want York to bill your parent’s insurance for services provided to you, your parents will receive from their insurance company an Explanation of Benefits regarding the services provided to you by York and, as a result, the fact that you received services from York will not be confidential from your parents. However, if you do not want your parents to know that you are receiving services from York, 您必须在向您提供服务时通知约克,以便安排私人或自费支付该等服务, or to determine your eligibility for free or discounted care.
    • YOU HAVE THE RIGHT TO OBTAIN A PAPER COPY OF THIS NOTICE FROM US, UPON REQUEST, even if you have agreed to accept this Notice electronically.
    • YOU HAVE THE RIGHT TO FILE A COMPLAINT. You have the right to file a complaint with York or the Secretary of the U.S. Department of Health and Human Services if you believe your privacy rights have been violated by York. You may file a complaint with York by notifying York’s Privacy Officer using the contact information provided below. York will not retaliate against you in any way for filing a complaint.

York Hospital

Loving Kindness Way, York, ME 03909 207.363.4321 toll free 877.363.4321 csbgyv.gracemccauley.com

LIST OF YORK ENTITIES AND SERVICE DELIVERY SITE LOCATION/ADDRESS OF PRIVACY PRACTICES

THE BERWICKS:

      • York Hospital in Berwick: 4 Dana Dr, Berwick, ME 03901 [Berwick Walk-In Care, Lab, X-ray, Berwick Pharmacy] Temporarily closed
      • York Hospital in South Berwick: 57 Portland St, South Berwick, ME 03908 [Great Works Family Practice, Lab, X-ray, Physical Therapy – South Berwick, Pediatric Physical Therapy]

KITTERY:

      • York Hospital in Kittery: 35 Walker St, Kittery, ME 03904 [Kittery Walk-In Care, Lab, X-ray, Kittery Family Practice]
      • Oncology & Physical Therapy: 75 US Route 1 Bypass, Kittery, ME 03904

NEW HAMPSHIRE:

      • Cardiovascular Care of NH & York Hospital: 2064 Woodbury Ave, Newington, NH 03802

SANFORD:

      • York Hospital in Sanford: 1474 Main St, Sanford, ME 04073 [Sanford Walk-in Care, Lab & X-ray, York Hospital Family Medicine in Sanford]

WELLS/MOODY:

      • York Hospital in Wells: 112 & 114 Sanford Rd, Wells, ME 04090 [Cardiovascular Care, Wells Walk-In Care, Wells Emergency Care, Lab, Imaging, Wound Healing, Breast Care – Wells, Physical Therapy – Wells, OBGYN -Wells, Pediatrics – Wells, Oncology – Wells, Wells Family Medicine]
      • Webhannet Internal Medicine: 277 Post Rd, Moody, ME 04054

YORK:

      • York Hospital at Long Sands: 127 Long Sands Rd (Stes 7A, 7B, 9, 11, 12), York, ME 03909 [Cardiovascular Care of York Hospital, Oncology & Infusion – York, Home Care & Hospice, York Family Practice, Physical Therapy – York]
      • York Hospital Prescription Assistance Program & Psychiatry Associates of York Hospital: 32 York St, York, ME 03909
      • Urology Associates of York Hospital: 16 Long Sands Rd, York, Maine 03909
      • York Walk-In Care: 343 US Rt.1, York, Maine 03909 [Walk-In Visits, Pediatric Therapy]