NOTICE OF ST. JOHN?S HEALTH SYSTEM NOTICE OF PRIVACY PRACTICES EFFECTIVE DATE: DECEMBER 1, 2006 THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN ACCESS THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. This notice explains how we may use and disclose your medical information, our obligations related to the use and disclosure of your medical information and your rights related to any medical information that we have about you. Thin notice applies to the medical information that is generated in or by St. John?s entities and facilities. This notice also describes the practices of St. John?s and that of any physician with staff privileged with respect to your Protected Health Information (PHI) created while you are a patient of St. John?s. Physicians with staff privileges and personnel authorized to have access to your medical chart are subject to this notice. In addition, physicians with staff privileges may share medical information with each other for treatment, payment or healthcare operations described in this notice. Generally, we are required by law to ensure that medical information that identifies you is kept private. Further, we must give you this notice related to our legal duties and privacy practices with respect to any medical information we create or receive about you. We are required by law to follow the terms of the notice that is currently in effect. I understand that the physicians participating in my care at St. John?s may not be employees or agents of St. John?s and may not be acting for or on behalf of St. John?s but are independent physicians who have been granted privileges to use facilities for the care of their patients. I understand that medical decisions regarding my care and treatment at St. John?s may be made by such physicians and not by St. John?s. With a few exceptions, we are required to obtain your authorization for the use or disclosure of the information. We have listed some of the reasons why we might use or disclose your medical information and some examples of the types of uses and disclosures below. Not every use or disclosure is covered but all of the ways that we are allowed to use and disclose information will fall into one of the categories. If you have any questions about the content of this notice, or if you need to contact someone at At this site about any of the information contained in this notice, please contact: St. John?s Corporate Privacy Officer 1235 E. Cherokee, Springfield, MO 65804 Toll free for areas outside of Springfield (1-888-664-4722) In addition to hospital department, clinic departments, employees, staff, and other St. John?s personnel, the following persons will also follow the practices described in this notice: * Any healthcare professional who is authorized to enter information in your medical record; * Any member of a volunteer group that we allow to help you while you are at this site; any student, resident or intern. All sites within St. John?s will follow the terms of this Notice of Privacy practices. In addition, they may share medical information for treatment, payment, healthcare operations as they are describes in this Notice of Privacy Practices. USE AND DISCLOSURE OF MEDICAL INFORMATION We can use or disclose medical information about you regarding your treatment, payment for services or for healthcare operations. We may also disclose your protected health information (PHI) for the treatment activities of another provider, the payment activities of another provider or covered entity, and certain limited healthcare operations of another covered entity. For treatment: to provide you with medical treatment or services, we may need to use or disclose information about you to doctors, nurses, technicians, medical students, or other hospital personnel who are involved in your treatment. For example, a doctor may need to know what drugs you are allergic to before prescribing medications. Departments within the hospital may share medical information about you to coordinate your care. For instance, the laboratory may request the information to complete lab work. Also for coordination of care, we will disclose information to other healthcare providers from whom you seek treatment in order that the combined treatment provided by all is in your best interest. For example, we will seek and/or inform other healthcare providers of pharmaceutical prescriptions that we have or they have written on your behalf to ensure that there are no harmful drug interactions and to ensure that prescribed dosages are appropriate. We may disclose medical information about you to people who may be involved in you medical care after you leave the hospital, such as home health agencies, nursing homes, your family, and clergy members. For payment: we may use and disclose your medical information for the hospital to bill and receive payment for the treatment that you received here. For example, we may use or disclose your medical information to your insurance company about a service you received at the hospital so that your insurance company can pay us or reimburse you for the service. We may also ask your insurance company for prior authorization for a service to determine whether or not the insurance will cover it. For health care operations: we can use and disclose medical information about you for hospital operations. These include uses and disclosures that are necessary to run the hospital and make sure that our patients receive quality care. For example, we may use or disclose medical information about you to evaluate our staff?s performance in caring for you. Medical information about you and other St. John?s patients may also be combines to allow us to evaluate whether St. John?s should offer additional services or discontinue other services and whether certain treatments are effective. We may also compare this information with other hospitals to evaluate whether we can make improvements in the care and services that we offer, to best protect your privacy when we are combining medical information, we will make best efforts to remove information that identifies you. For Research: We may disclose information to researched when their research has been approved by institutional review board (IRB) that has reviewed the research proposal and established protocols to ensure the privacy of your health information. USES AND DISCLOSURES OF MEDICAL INFORMATION THAT DO NOT REQUIRE YOUR AUTHORIZATION We can use or disclose health information about you without your authorization when there is an emergency or when we are required by law to treat you; when we are required by law to use or disclose certain information, or when substantial communication barriers to obtaining authorization from you. Further, we may use or disclose your health information without your authorization in any of the following circumstances. When necessary to contact you to provide: * Appointment reminders * Information about treatment alternatives or other health related benefits or services that may be of interest to you or, * Participation in a clinical trial or research protocol; * When it is required by law; * When it involves use and disclosure for public health activities, such as mandated disease reporting; * When reporting information about victims of abuse or neglect; * When disclosing information for the purpose of medical device tracking and health oversight activities, such as audits, investigations, inspections, licensure or disciplinary actions, or legal proceedings or actions; * When disclosing information for judicial and administrative proceedings in accordance with state and /or federal laws, for instance, in response to a court order such as a court ordered subpoena; * When disclosing information for law enforcement purposes, for instance, to locate or identify a suspect, fugitive, witness, or missing persons or regarding a victim of a crime who cannot give consent or authorization because of incapacity; * When disclosing information about deceased persons to medical examiners, coroners, and funeral directors; * When disclosing or using information for organ and tissue donation purposes; * When disclosing information related to a research project when a waiver of authorization has been approved by the institutional review board and/or the Privacy Committee; * When we believe in good faith that the disclosure is necessary to avert a serious health or safety threat to you or to the public?s safety; * When disclosure is necessary for specialized government functions, such as military service, for the protection of the president, or for national security and intelligence activities; * When required by military command authorities, if you are a member of the armed forces (or foreign military personnel, to appropriate authorities); * In the case of a prison inmate, information can be released to the correctional facility in which he or she resides for the following purposes: (1) for the institution to provide the inmate with healthcare, (2) to protect the health and safety of the inmate or the health and safety of others; or (3) for the safety and security of the correctional facility; and * When disclosure is necessary to comply with worker?s compensation laws or purposes. PLANNED USES OR DISCLOSURES TO WHICH YOU MAY OBJECT * We will use or disclose your health information for any of the purposes described in the above section unless you affirmatively object to or otherwise restrict a particular release. You must direct your written objections or restrictions to a Privacy Site Coordinator or the St. John?s Corporate Privacy Officer, 1235 E. Cherokee, Springfield, MO 65804. * We may use or disclose your health information in order to include you in the hospital patient directory. Directory information includes your name, location in the hospital, your room number, and condition. We may disclose this information to people who ask for you by name. In addition, a member of clergy may obtain your religious affiliation. * We may use health information about you to contact you in an effort to raise money for the hospital. A Foundation related to the hospitals or clinics may receive contact information, which includes your name, address and phone number and the dates that you received services from the hospital, clinics, Mercy Villa or Home Care but will not receive medical information from your medical records. * We may release health information about you to your personal representative, a friend and/or family member who is involved in your care, if applicable to state and federal regulations. We can tell you personal representative, family and/or friend of your condition and that you are in the hospital for treatment or services. We can also give this information to someone who will help or is helping pay for your care. * We can disclose health information about you to a public or privacy entity that is authorized by law or its charter to assist in disaster relief, i.e. American Red Cross, for the purpose of notification of family and/or friends of your whereabouts and condition. OTHER USES AND DISCLOSURES We will not use or disclose your health information without your written authorization except a describes in this Notice of Privacy Practices. If you provide us written authorization to use or disclose information, you can change your mind and revoke your authorization at any time, as long as it is in writing. If you revoke your authorization, we will no longer use or disclose the information. However, we will not be able to take back any disclosures that we have made pursuant to your previous authorization. YOUR HEALTH INFORMATION RIGHTS Although your health record is the property of St. John?s you have the right to: * Request Restrictions: you have the right to request that we restrict any use or disclosure of your health information. We are not required to agree to any restriction that you request. If we do agree to adhere to your restrictions, we will comply with your request unless the information is needed to provide you emergency treatment. Any request to restrict uses or disclosures must be made in writing to St. John?s Privacy Officer. Your request must indicate (1) what information you want limited; (2) whether you want to limit use, disclosure, or both; and (3) to whom you want the limits to apply. * Receive Information In Certain Form And Location: you have the right to receive information about your health in a certain form and location. For instance, you can request that we not contact you at work. To request confidential communications, make a written request to a Privacy Site Coordinator or St. John?s Corporate Privacy Officer. The request must tell us how and where you want to receive information. We will accommodate reasonable requests. If your request is approved, the confidential communication will remain in effect until revoked in writing by you. * Inspect And Copy Personal Health Information: you have the right to inspect and copy your health information that may be used to make decisions about your care, with the exception of psychotherapy notes. If you want to see or copy your medical information you must submit your request in writing to the Privacy Site Coordinator or to St. John?s Corporate Privacy Officer. If you request copies of information, we may charge you a fee for any costs associated with your request, including the cost of copies, mailing, and other supplies. In limited circumstances, we can deny access to your health information. If access is denied, you can request that the denial be reviewed. Another licensed healthcare professional chosen by the hospital will review your request and the denial. We will adhere to the decision of the reviewer. * Request Amendment to Personal Health Information: you have a right to request that your health information be amended if you believe that it is incorrect or incomplete. You have the right to request amendments as long as the information is kept by St. John?s. To request an amendment of your information, you must submit it in writing to St. John?s Privacy Officer. In addition, you must give the reason that want the information amended, including why you think the information is incorrect or incomplete and specify whom you want notified of the change such as your personal physician. We may extend the time for an additional 30 days provided we notify you of our reason for delay and the date we expect to complete our action on your request. We can deny your request it is not in writing and if it does not include a reason why the information should be amended. We can also deny the request for the following reasons: (1) the information was not created by the hospital, unless the person or entity that created the information is no longer available; (2) the information is not part of the medical record kept by or for the hospital; (3) the information is not part of the information that you would be permitted to inspect and copy; or (4) we believe the information is accurate and complete. * Accounting of Disclosures: you have the right to receive an accounting of disclosures of medical information that we have made, with some exceptions. You must submit your request in writing to a Privacy Site Coordinator or St. John?s Privacy Officer. Your request must state the time period that may not be longer than six years and may not include dates before April 14, 2003. You should include how you want the information reported to you. You have the right to receive a free accounting every 12 months. If you request more than one accounting in a 12 month period, we may charge you a reasonable fee for the costs of providing that list. We will notify you of the charge for such a request and you can then choose to withdraw or change your request before any costs are incurred. Exception: disclosures made pursuant to an authorization signed by you or your representatives are exempted from the accounting of disclosures requirement. * Receive A Paper Copy Of This Notice: even if you agreed to receive this notice in another form, you can still have a paper copy of this notice. To obtain a paper copy, contact the Privacy Site Coordinator or St. John?s privacy Officer. You can also obtain a copy of this notice at our website, www.stjohns.com COMPLAINTS If you believe that we have violated any of your privacy rights or have hot adhered to the information contained in this notice, you can file a complaint by putting it in writing and sending it to a Privacy Site Coordinator or the St. John?s Corporate Privacy Officer, 1235 E. Cherokee, Springfield, MO 65804. You may also file a complaint with the Secretary of the US Department of Health and Human Services, 200 Independence Avenue, S.W., Washington, D.C. 20201. To acquire a copy of the St. John?s Complaint form contact the Privacy and Data Security Department 417-820-8471 or you may contact the Office for Civil Rights at 1-800-368-1019. According to the law, you will not be retaliated against not intimidated for filing a complaint with either St. John?s or the Department of Health and Human Services. CHANGES TO THIS NOTICE OF PRIVACY PRACTICES We reserve the right to change or modify the information contained in this notice. Any changes that we make will be effective for any health information that we may have about you and information that we might obtain. Each time you receive services from St. John?s, we will make available to you the most current copy of our notice. The most recent version of the notice will be posted in our building or can be obtained from a Privacy site Coordinator or St. John?s Corporate Privacy Officer whose information is included on the first page of this Notice of Privacy Practices.
Welcome to Mercy Pharmacy-Licking. As your local Good Neighbor Pharmacy, we offer quality products at affordable prices, while providing the personalized attention and customer service you expect from a local business. As your neighbors, we live, work and play in the same community as you and your family. We’re the local business owners you see in the neighborhood, at the school play, and volunteering at the local charity. We believe it is our responsibility to take care of our community and our neighbors, and it’s one we take very seriously. We thrive on the opportunity to serve you and your family to the best of our abilities because your business and your health are very important to us. Get to know your neighbor – we’re here to help.