Notice of Privacy Practices
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.
The terms of this Notice of Privacy Practices apply to Dayton Children’s Hospital operating as a clinically integrated health care arrangement composed of Dayton Children’s Hospital (Dayton Children’s),the physicians and other licensed professionals seeing and treating patients at Dayton Children’s, Care House, Children’s Care Group, Children’s Emergency Services, Inc., Children’s Health Clinic, Children’s Home Care of Dayton, Dayton Newborn Care Specialists, Inc., Dayton Pediatric Imaging, Inc., Orthopaedic Center for Spinal ,Pediatric Care and Children’s Anesthesia Group, Inc., and Wright State Physicians. The members of this clinically integrated health care arrangement work and practice in hospitals, clinics, homes and physician offices. All of the entities and persons listed will share protected health information of our patients as necessary to carry out treatment, payment, and health care operations as permitted by law.
We are required by law to maintain the privacy of our patients' protected health information and to provide patients with notice of our legal duties and privacy practices with respect to your protected health information. We are required to abide by the terms of this Notice so long as it remains in effect. We reserve the right to change the terms of this Notice of Privacy Practices as necessary and to make the new Notice effective for all protected health information maintained by us. You may receive a copy of our revised notice at any registration area, on Dayton Children’s web site, www.childrensdayton.orgor a copy may be obtained by mailing a request to: Privacy Officer, One Children’s Plaza, Dayton, OH 45404-1815.
USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION
Your Authorization. Except as outlined below, we will not use or disclose your protected health information for any purpose unless you have signed a form authorizing the use or disclosure. You have the right to revoke that authorization in writing unless we have taken any action in reliance on the authorization. There will be certain uses and disclosures of your protected health information for which we will always obtain a prior authorization. These include:
Marketing Communicationsunless the communication is made directly to you in person, is simply a promotional gift of nominal value, is a prescription refill reminder, general health or wellness information, or a communication about health related products or services that we offer or that are directly related to your treatment.
Most Salesof your personal health information unless for treatment or payment purposes or as required by law.
Psychotherapy Notesunless otherwise permitted or required by law.
Uses and Disclosures for Treatment. We will make uses and disclosures of your protected health information as necessary for your treatment. For instance, doctors and nurses and other professionals involved in your care will use information in your medical record and information that you provide about your symptoms and reactions to plan a course of treatment for you that may include procedures, medications, tests, etc. We may also release your protected health information to another health care facility or professional who is not affiliated with our organization but who is or will be providing treatment to you. For instance, if, after you leave the hospital, you are going to receive home health care, we may release your protected health information to that home health care agency so that a plan of care can be prepared for you.
Uses and Disclosures for Payment. We will make uses and disclosures of your protected health information as necessary for the payment purposes of those health professionals and facilities that have treated you or provided services to you. For instance, we may forward information regarding your medical procedures and treatment to your insurance company to arrange payment for the services provided to you or we may use your information to prepare a bill to send to you or to the person responsible for your payment.
Uses and Disclosures for Health Care Operations. We will use and disclose your protected health information as necessary, and as permitted by law, for our health care operations, which include clinical improvement, professional peer review, business management, accreditation and licensing, etc. For instance, we may use and disclose your protected health information for purposes of improving the clinical treatment and care of our patients. We may also disclose your protected health information to another health care facility, health care professional, or health plan for such things as quality assurance and case management, but only if that facility, professional, or plan also has or has had a patient relationship with you.
Our Patient Directory. We maintain a patient directory listing the name and room number of our patients. Unless you choose to have your information excluded from this directory, the information will be disclosed to those who request it by asking for you by name. You have the right during registration to have your information excluded from this directory and also to request restrictions on what information is provided and/or to whom. If you choose to be excluded from the directory, no information will be disclosed to anyone who inquires about you; this includes delivery agencies.
Family and Friends Involved In Your Care. With your approval, we may from time to time disclose your protected health information to designated family, friends, and others who are involved in the patient's care or in payment of that care in order to facilitate that person’s involvement in caring or paying for care. If patient/legal guardian/approved representative is unavailable, incapacitated, or facing an emergency medical situation and we determine that a limited disclosure may be in the patient's best interest; we may share limited protected health information with such individuals without your approval. We may also disclose limited protected health information to a public or private entity that is authorized to assist in disaster relief efforts in order for that entity to locate a family member or other persons that may be involved in some aspect of caring for the patient.
Business Associates. Certain aspects and components of our services are performed through contracts with outside persons or organizations, such as auditing, accreditation, legal services, etc. At times it may be necessary for us to provide certain of your protected health information to one or more of these outside persons or organizations who assist us with our health care operations. In all cases, we require these business associates to appropriately safeguard the privacy of your information.
Fundraising. We may contact you to donate to a fundraising effort for or on our behalf. You have the right to "opt-out" of receiving fundraising materials/communications and may do so by sending your name and address to Dayton Children’s Hospital, Development Department, One Children’s Plaza, Dayton, Ohio, 45404-1815 together with a statement that you do not wish to receive fundraising materials/communications from us. Your opt-out request will be treated as a revocation of your authorization for us to contact you regarding fundraising.
Appointments and Services. We may contact you to provide appointment reminders or test results. You have the right to request to receive communications regarding your protected health information from us by alternative means or at alternative locations. We will consider all reasonable requests by you. For instance, if you wish appointment reminders to not be left on voice mail or sent to a particular address, we will consider reasonable requests. Request for confidential communication must be made at each visit.
Health Products and Services. We may from time to time use your protected health information to communicate with you about health products and services necessary for your treatment, to advise you of new products and services we offer, and to provide general health and wellness information.
Research. In limited circumstances, we may use and disclose your protected health information for research purposes. For example, a researcher organization may wish to compare outcomes of all patients who received a particular drug and will need to review a series of medical records. In all cases where your specific authorization is not obtained, your privacy will be protected by strict confidentiality requirements applied by an Institutional Review Board or privacy board which oversees the research or by representations of the researchers that limit their use and disclosure of patient information.
Other Uses and Disclosures. We are permitted or required by law to make certain other uses and disclosures of your protected health information without your consent or authorization.
- We may release your protected health information for any purpose required by law;
- We may release your protected health information for public health activities, such as required reporting of disease, injury, and birth and death, and for required public health investigations;
- We may release your protected health information as required by law if we suspect child abuse or neglect; we may also release your protected health information as required by law if we believe you to be a victim of abuse, neglect, or domestic violence;
- We may release your protected health information to the Food and Drug Administration if necessary to report adverse events, product defects, or to participate in product recalls;
- We may release your protected health information to your employer when we have provided health care to you at the request of your employer; in most cases you will receive notice when that information is disclosed to your employer;
- We may release your protected health information if required by law to a government oversight agency conducting audits, investigations, or civil or criminal proceedings;
- We may release your protected health information if required to do so by a court or administrative ordered subpoena or discovery request; in most cases you will have notice of such release;
- We may release your protected health information to law enforcement officials as required by law to report wounds and injuries and crimes;
- We may release your protected health information to coroners and/or funeral directors consistent with law;
- We may release your protected health information if necessary to arrange an organ or tissue donation from you or a transplant for you;
- We may release your protected health information if you are a member of the military as required by armed forces services; we may also release your protected health information if necessary for national security or intelligence activities; and
- We may release your protected health information to workers' compensation agencies if necessary for your workers' compensation benefit determination.
RIGHTS THAT YOU HAVE
Access to Your/Your Child’s Protected Health Information. You have the right to obtain a copy and/or inspect much of the protected health information that we retain on your behalf. All requests for access must be made in writing and signed by you or your representative. We will charge you per page as regulated by the Ohio Department of Health. We may also charge for postage if you request a mailed copy. You may obtain an access request form from the Health Information Management department. You have the right to obtain an electronic copy of your health information that exists in an electronic format and you may direct that the copy be transmitted directly to an entity or person designated by you, provided that any such designation is clear, conspicuous, and specific with complete name and mailing address or other identifying information.
Amendments to Your Protected Health Information. You have the right to request in writing that protected health information that we maintain about you be amended or corrected. We are not obligated to make requested amendments but will give each request careful consideration. All amendment requests, in order to be considered by us, must be in writing, signed by you or your representative, and must state the reasons for the amendment/correction request. If an amendment or correction you request is made by us, we may also notify others who work with us and have copies of the uncorrected record if we believe that such notification is necessary. You may obtain an amendment request form from the Health Information Management department.
Accounting for Disclosures of Your Protected Health Information. You have the right to receive an accounting of certain disclosures made by us of your protected health information. Requests must be made in writing and signed by you or your representative. Accounting request forms are available from the Health Information Management department. The first accounting in any 12-month period is free; you will be charged a fee of $15.00 for each subsequent accounting you request within the same 12-month period.
Restrictions on Use and Disclosure of Your Protected Health Information. You have the right to request restrictions on certain of our uses and disclosures of your protected health information for treatment, payment, or health care operations. A restriction request form can be obtained from the Health Information Management department. With exception of restriction requests for disclosures to health plans for purposes of carrying out payment or health care operations when the information pertains solely to a health care service for which we have been paid in full by you, we are not required to agree to your restriction request. However we will attempt to accommodate reasonable requests when appropriate and we retain the right to terminate an agreed-to restriction if we believe such termination is appropriate. In the event of a termination by us, we will notify you of such termination. You also have the right to terminate any agreed-to restriction by contacting the Health Information Management department.
In the unlikely event that there is a breach of your personal health information, you will receive notice and information on steps you may take to protect yourself from harm.
Complaints. If you believe your child’s or family’s privacy rights have been violated, you can file a complaint with the Department of Patient Relations. The complaint can be filed by calling the Department of Patient Relations at (937) 641-3306 or filling out one of Dayton Children’s Hospital’s complaint forms that are located at the Department of Patient Relations, the information desk, and the inpatient units. Upon completion of the forms, you can turn them in at the information desk or in the Department of Patient Relations. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services in Washington D.C. in writing within 180 days of a violation of your rights. There will be no retaliation for filing a complaint.
FOR FURTHER INFORMATION
If you have questions or need further assistance regarding this notice, you may contact the Privacy Officer at One Children's Plaza, Dayton, OH 45404-1815 or by calling (937) 641-3450. As a patient you retain the right to obtain a paper copy of this Notice of Privacy Practices, even if you have requested such copy by e-mail or other electronic means.
This Notice of Privacy Practices was effective April 14, 2003.
It was most recently revised, September 3, 2013.