Los Alamos Medical Center 3917 W. Road Los Alamos, NM 87544 NOTICE OF PRIVACY PRACTICES REQUIRED BY THE HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 (HIPAA) WHO WILL FOLLOW THIS NOTICE- This notice describes our hospital�s practices and that of 1) any healthcare professional authorized to enter information into our hospital chart; 2)all departments and units of the hospital; 3) any member of a volunteer group we allow to assist you while you are in the hospital; and 4) all employees, staff and hospital personnel. MEDICAL INFORMATION- Each time you visit a hospital, physician, or other provider of health care, a record is made of your visit. We need this information to provide you with quality care and to comply with the law. We are required by law to maintain the privacy of your health information and we are committed to doing so. We will abide by the terms of this notice as required by federal law. HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU Treatment. We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technician, medical students, or other personnel who are involved in taking care of you. For example, a doctor treating you for a broken hip mat need to know if you have diabetes because diabetes may slow down the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. We also may disclose medical information about you to people outside the hospital who may be involved in your medical care after you have received care with us, such as family members, clergy, or others who provide services that are part of your care, such as doctors, nurses, therapists, home health agencies, nursing homes and medical equipment providers. Payment. We may use and disclose medical information about you so that the treatment and services you receive from us may be billed to and payment collected from you, an insurance company, or a third party. For example, we may need to give your health plan information about treatment you received at one of our hospitals so your plan will pay us or reimburse you for the treatment. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. For healthcare Operations. We may use and disclose medical information about you for our operations. These uses and disclosures are necessary to run the organization and make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. Individuals Involved in Your Care or Payment for your Care. We may release medical information about you to a friend or family member who is involved in your medical care. As Required By Law. We will disclose medical information about you when required to do so by federal, state, or local law. To Avert a Serious Threat to health or Safety. We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of another person or public. Any disclosure, however, would only be to someone able to help prevent the threat. Military and Veterans. If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may use and disclose to components of the Department of Veterans Affairs medical information about you to determine whether you are eligible for certain benefits. Public Health Activities. We may disclose medical information about you for public health activities. These activities generally include the following: to prevent or control disease, injury, or disability; to report deaths; to report reactions to medications or problems with products; to notify people of recalls of products they may be using; to notify the appropriate government authorities if we believe a patient has been a victim of abuse, neglect, or domestic violence. Health Oversight Activities. We may disclose medical information to a health oversight agency for activities authorized by law. These activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the healthcare system, government programs, and compliance with civil rights laws. Law Enforcement. We may release medical information if asked to do so by law enforcement officials: in response to a valid court order, subpoena, warrant, summons, similar process or with your consent; about the victim of a crime if, under certain circumstances, we are unable to obtain the person�s agreement; about a death we believe may be the result of criminal conduct; about criminal conduct within Valley Health System; or in emergency circumstances to report a crime, the location of the crime or victims, or the identity, description, or location of the crime or victims, or the identity, description, or location of the person who committed the crime. Coroners, Medical Examiners, and Funeral Directors. We may release medical information to a coroner or medical examiner. We may also release medical information about deceased patients of the hospital to funeral directors as necessary to carry out their duties upon the request of the patient�s family. National security and Intelligence Activities. We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law. YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care. Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. Right to an Accounting of Disclosures. You have the right to request an accounting of disclosures. This is a list of the disclosures we made of the medical information about you other than disclosures made to you, disclosures which you authorized, disclosures for treatment, payment, or operations, or certain disclosures required by law. Right to Request Restrictions. You have the right to request a restriction or limitation on the medical information we use or disclose about you for your treatment, payment, or health care operations. Right to Confidential Communications. You have the right to request to receive communications from us on a confidential basis by using alternative means for receipt of information or by receiving the information at alternative locations. Changes to this Notice We reserve the right to change this Notice. We reserve the right to make the revised Notice effective for medical information we already have about you as well as any information we receive in the future.. OTHER USES OF MEDICAL INFORMATION We may request your written permission for other uses and disclosures of medical information. If you provide us permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission and that we are required to retain our records of the care that we provided to you. COMPLAINTS If you believe your privacy rights have been violated, you may file a complaint with the Secretary of the Department of Health and Human Services or our Privacy Officer. All complaints must be submitted in writing. You will not be retaliated against for filing a complaint. Effective Date: April 14, 2003 Privacy Officer If you have questions, requests, or complaints please contact: Sharon Bennett 3917 W. Road Los Alamos, NM 87544 505-661-9520