This notice describes how medical information about you may be used and disclosed and how you can get access to this information.
Please review this carefully.
Effective April 14, 2003

Your health information rights

Although your health record is the physical property of Marias Medical Center, the information belongs to you. You have the right to:

 •   Request a restriction on certain uses and disclosures of your information as provided by 45 CFR 164.522. Marias Medical Center will honor your request for restrictions to the extent possible.
•   Obtain a paper copy of the notice of information practices upon request.
•   Inspect and obtain a copy of your health record upon written request as provided for in 45 CFR 164.524.
•   Amend your health record upon written  request as provided for in CFR 164.528 and Montana Uniform Health Care Information  Act (MCA 50-16-541).
•   Obtain an  accounting of disclosures of your health information upon written request as provided for in 45 CFR 164.528.
•   Request communications of your health information by alternative means or at alternative locations.
•   Revoke your authorization to use or disclose health information except to the extent that action has already been taken.

 Understanding your health information

Understanding what is in your record and how your health information is used helps you to ensure its accuracy and better understand who, what, when, where, and why others may access your health information. Each time you visit a hospital, physician, or other health care provider, a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care of treatment. This information, often referred to as your health or medical  record, serves as a :
•   Basis for planning your care and treatment.
•   Means of communication among the many health professionals who contribute to your care.
•   Legal document describing the care you received.
•   Means by which you or your insurance company can verify that services billed were actually provided.
•   A tool in educating health professionals.
•   A source of data for medical research.
•   A source of information for public health officials charged with improving the health of the nation.
•   A source of data for facility planning and marketing.
•   A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve.

Required uses and disclosures

Food and Drug Administration (FDA): We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable produce recalls, repairs, or replacement.

Public health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

Workers compensation: We may disclose health information to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.

Law enforcement and correctional institutions: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena. Should you be an inmate of a correctional institution, we may disclose to the institution or their agents health information necessary for  your health and the health and safety of other individuals.

In addition, Federal law makes provision for your health information to be released to an appropriate health oversight agency, public health authority or attorney, provided that a work force member or business associate believes in good faith Marias Medical Center may have engaged in unlawful  conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, workers or the public.

Organ procurement organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

Funeral directors and coroners: We may disclose health information to funeral directors consistent with applicable law to carry out their duties.

Examples of disclosures for treatment, payment and health operations

Marias Medical Center will use your health information for treatment. For example, information obtained by a nurse, physician, or other member of your health care team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your health care team. Members of your health care team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment. Marias Medical Center will also provide your physician or a subsequent health care provider with copies of various reports that will assist him or her in treating you once you’re discharged.

We will use your health information for payment. For example, Marias Medical Center will send a bill to you and/or your insurance company. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.

We will use your health information for regular health operations. For example, members of the medical staff or the departments that provided your care may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually  improve the quality and effectiveness of the health care and service we provide.

We will use your health information for treatment, payment and health operations of other covered entities. For example, Marias Medical Center may release information to your physician so that he or she may send a bill to you and/or your insurance company. In addition, Marias Medical Center may provide your physician or referring hospital with information required to perform quality improvement, peer review, compliance review and medical education.

Marias Medical Center responsibilities
 

Marias Medical Center is required to:
• Maintain the privacy of your health information.
• Provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you.
• Obtain your  written acknowledgment of receipt of our notice of privacy practices at our first date of service.    If your acknowledgment cannot be obtained, we must document our efforts to obtain your acknowledgment and the reasons why it was not obtained.
• Post our notice of privacy practices in a clear and prominent location where it is reasonable to expect individuals seeking service will be able to read the notice.
• Abide by the terms of our notice of privacy practices.
• Notify you if we are unable to agree to a requested restriction.
• Accommodate reasonable requests you may have to communicate health information by alternative means or at alternative locations. Marias Medical Center reserves the right to change this notice. We reserve the right to make the  revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the hospital. The notice will contain the effective date. In addition, each time you register at or are admitted to the hospital for treatment or health care services, we will offer you a copy of the current notice in effect.

For more information or to report a problem

If you believe your privacy rights have been violated, you can file a complaint with the Marias Medical Center Privacy Officer or with the Secretary of Health and Human Services. There will be not retaliation for filing a complaint. If you have questions and/or would like additional information, please contact HIPAA Hotline at 406-434-3293.

Other permitted uses and disclosures

Directory: Unless you notify us that you object, we will use your name and location in the facility for directory purposes. This information may be provided to members of the clergy and, except for religious affiliation, to other people who ask for you by name.

Notification of family: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for  your care.

Communication with family: Health professionals, using their best judgment, may disclose to a family member, other relative, close personal friend or any other person you identify, health information relevant to that persons involvement to your care or payment related to your care.

Communicating appointment reminders and health care alternatives: We may contact you to provide appointment reminders or provide you with information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Research: We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.

Business associates: There are some services provided in our organization through contacts with business associates. Examples include physician services in the emergency department and radiology, certain laboratory tests. When these services are contracted, we may disclose your health information to the business associate so that they can perform the job we’ve asked them to do and bill you or your insurance company for services rendered. To protect your  health information, we require the business associate to appropriately safeguard your information.  

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Marias Medical Center
640 Park Avenue
Box 915
Shelby, MT 59474
406-434-3200

Questions or problems regarding this web site should be directed to [jbrusven@mmcmt.org].
Copyright © 2002 [Marias Medical Center]. All rights reserved.
Last modified: 10/10/09.