Notice of Privacy Practices - UC Davis Health System

ucdmc.ucdavis.edu

Notice of Privacy Practices - UC Davis Health System

How we may use and disclosemedical information about you (continued)a new cancer therapy may ask whether any of the patientsundergoing that therapy might be willing to be interviewed.Hospital directory. If you are hospitalized, we may includecertain limited information about you in the hospital directory.This is so your family, friends and clergy can visit you in thehospital and generally know how you are doing. This informationmay include your name, location in the hospital, yourgeneral condition (e.g., fair, serious, etc.) and your religiousaffiliation. The directory information, except for your religiousaffiliation, may also be released to people who ask for you byname. Your religious affiliation may be given to members of theclergy, such as ministers or rabbis, even if they don’t ask for youby name. You may restrict or prohibit the use or disclosure ofthis information by notifying Health Information ManagementDepartment, UC Davis Health System, 2315 Stockton Blvd.,Building 12, Sacramento, California 95817.Individuals involved in your care or payment for your care.We may release medical information to anyone involved in yourmedical care, e.g., a friend, family member, personal representativeor any individual you identify. We may also give informationto someone who helps pay for your care. We may also tellyour family or friends about your general condition and thatyou are in the hospital.Disaster-relief efforts. We may disclose medical informationabout you to an entity assisting in a disaster-relief effort so thatyour family can be notified about your condition, status andlocation.Research. The University of California is a research institution.All research projects conducted by the University of Californiamust be approved through a special review process to protectpatient safety, welfare and confidentiality. Your medical informationmay be important to further research efforts and the developmentof new knowledge. We may use and disclose medicalinformation about our patients for research purposes, subjectto the confidentiality provisions of federal and state law.On occasion, researchers contact patients regarding their interestin participating in certain research studies. Enrollment inthose studies can only occur after you have been informedabout the study, had an opportunity to ask questions and indicatedyour willingness to participate by signing a consent form.When approved through a special review process, other studiesmay be performed using your medical information withoutrequiring your consent. These studies will not affect yourtreatment or welfare, and your medical information willcontinue to be protected. For example, a research study mayinvolve a chart review to compare the outcomes of patientswho received different types of treatment.As required by law. We will disclose medical informationabout you when required to do so by federal or state law.To avert a serious threat to health or safety. We may use anddisclose medical information about you when necessary toprevent or lessen a serious and imminent threat to your healthand safety or the health and safety of the public or anotherperson. Any disclosure would be to someone able to help stopor reduce the threat.Organ and tissue donation. If you are an organ donor, we mayrelease medical information to organizations that handle organ5 UC DAVIS HEALTH SYSTEMNOTICE OF PRIVACY PRACTICES 6


How we may use and disclosemedical information about you (continued)procurement or organ, eye or tissue transplantation or to anorgan-donation bank, as necessary to facilitate organ or tissuedonation and transplantation.Military and veterans. If you are or were a member of thearmed forces, we may release medical information about you tomilitary command authorities as authorized or required by law.We may also release medical information about foreign militarypersonnel to the appropriate military authority as authorized orrequired by law.Workers’ compensation. We may use or disclose medicalinformation about you for workers’ compensation or similarprograms as authorized or required by law. These programsprovide benefits for work-related injuries or illness.Public-health disclosures. We may disclose medical informationabout you for public-health purposes. These purposesgenerally include the following:❖ preventing or controlling disease (such as cancer and tuberculosis),injury or disability;❖ reporting vital events such as births and deaths;❖ reporting child abuse or neglect;❖ reporting adverse events or surveillance related to food,medications or defects or problems with products;❖ notifying persons of recalls, repairs or replacements ofproducts they may be using;❖ notifying a person who may have been exposed to a diseaseor may be at risk of contracting or spreading a disease orcondition;❖ reporting to the employer findings concerning a work-relatedillness or injury or workplace-related medical surveillance;❖ notifying the appropriate government authority if we believea patient has been the victim of abuse, neglect or domesticviolence and make this disclosure as authorized or requiredby law.Health-oversight activities. We may disclose medical informationto governmental, licensing, auditing and accreditingagencies as authorized or required by law.Legal proceedings. We may disclose medical information tocourts, attorneys and court employees in the course of conservatorshipand certain other judicial or administrative proceedings.Lawsuits and other legal actions. In connection with lawsuitsor other legal proceedings, we may disclose medical informationabout you in response to a court or administrative order,or in response to a subpoena, discovery request, warrant,summons or other lawful process.Law enforcement. If asked to do so by law enforcement, andas authorized or required by law, we may release medicalinformation:❖ to identify or locate a suspect, fugitive, material witness ormissing person;❖ about a suspected victim of a crime if, under certain limitedcircumstances, we are unable to obtain the person’s agreement;❖ about a death suspected to be the result of criminal conduct;❖ about criminal conduct at UC Davis Health System; and❖ in case of a medical emergency, to report a crime; the locationof the crime or victims; or the identity, description orlocation of the person who committed the crime.7 UC DAVIS HEALTH SYSTEMNOTICE OF PRIVACY PRACTICES 8


Coroners, medical examiners and funeral directors. In mostcircumstances, we may disclose medical information to a coroneror medical examiner. This may be necessary, for example, toidentify a deceased person or determine cause of death. We mayalso disclose medical information about patients of UC DavisHealth System to funeral directors as necessary to carry outtheir duties.National-security and intelligence activities. As authorized orrequired by law, we may disclose medical information aboutyou to authorized federal officials for intelligence, counterintelligenceand other national-security activities.Protective services for the president and others. As authorizedor required by law, we may disclose medical informationabout you to authorized federal officials so they may conductspecial investigations or provide protection to the president,other authorized persons or foreign heads of state.Inmates. If you are an inmate of a correctional institution orunder the custody of law enforcement officials, we may releasemedical information about you to the correctional institutionas authorized or required by law.Your rights regarding medicalinformation about youYour medical information is the property of UC Davis HealthSystem. You have the following rights, however, regardingmedical information we maintain about you:Right to inspect and copy. With certain exceptions, you havethe right to inspect and/or receive a copy of your medicalinformation.To inspect and/or to receive a copy of your medical information,you must submit your request in writing to Health InformationManagement Department, UC Davis Health System, 2315Stockton Blvd., Building 12, Sacramento, California 95817.If you request a copy of the information, there is a fee for theseservices.We may deny your request to inspect and/or to receive a copyin certain limited circumstances. If you are denied access tomedical information, in most cases, you may have the denialreviewed. Another licensed health-care professional chosenby UC Davis Health System will review your request and thedenial. The person conducting the review will not be the personwho denied your request. We will comply with the outcomeof the review.Right to request an amendment or addendum. If you feel thatmedical information we have about you is incorrect or incomplete,you may ask us to amend the information or add anaddendum (addition to the record). You have the right torequest an amendment or addendum for as long as the informationis kept by or for UC Davis Health System.Amendment. To request an amendment, your request mustbe made in writing and submitted to Health Information ManagementDepartment, UC Davis Health System, 2315 StocktonBlvd., Building 12, Sacramento, California 95817. In addition,you must provide a reason that supports your request.We may deny your request for an amendment if it is not inwriting or does not include a reason to support the request.In addition, we may deny your request if you ask us to amendinformation that:9 UC DAVIS HEALTH SYSTEMNOTICE OF PRIVACY PRACTICES 10


Your rights regarding medicalinformation about you (continued)❖ was not created by UC Davis Health System;❖ is not part of the medical information kept by or for UCDavis Health System;❖ is not part of the information which you would be permittedto inspect and copy; or❖ is accurate and complete in the record.Addendum. To submit an addendum, the addendum must bemade in writing and submitted to Health Information ManagementDepartment, UC Davis Health System, 2315 StocktonBlvd., Building 12, Sacramento, California 95817. An addendummust not be longer than 250 words per alleged incompleteor incorrect item in your record.Right to an accounting of disclosures. You have the right toreceive a list of the disclosures we have made of your medicalinformation.To request this accounting of disclosures, you must submit yourrequest in writing to Health Information Management Department,UC Davis Health System, 2315 Stockton Blvd., Building12, Sacramento, California 95817. Your request must state atime period that may not be longer than the six previous yearsand may not include dates before April 14, 2003. You areentitled to one accounting within any 12-month period at nocost. If you request a second accounting within that 12-monthperiod, there will be a charge for the cost of compiling theaccounting. We will notify you of the cost involved and youmay choose to withdraw or modify your request at that timebefore any costs are incurred.Right to request restrictions. You have the right to requesta restriction or limitation on the medical information weuse or disclose about you for treatment, payment or healthcareoperations. You also have the right to request a limiton the medical information we disclose about you tosomeone who is involved in your care or the payment foryour care, such as a family member or friend. For example,you could ask that we not use or disclose information to afamily member about a surgery you had.To request a restriction, you must make your request inwriting to Health Information Management Department,UC Davis Health System, 2315 Stockton Blvd., Building 12,Sacramento, California 95817. In your request, you musttell us (1) what information you want to limit; (2) whetheryou want to limit our use, disclosure or both; and (3) towhom you want the limits to apply, for example, only toyou and your spouse. We are not required to agree to yourrequest. If we do agree, our agreement must be in writing,and we will comply with your request unless the informationis needed to provide you emergency treatment.Right to request confidential communications. You havethe right to request that we communicate with you aboutmedical matters in a certain way or at a certain location.For example, you may ask that we contact you only athome or only by mail.To request confidential communications, you must makeyour request in writing to Health Information ManagementDepartment, UC Davis Health System, 2315 Stockton Blvd.,Building 12, Sacramento, California 95817. We will accom-11 UC DAVIS HEALTH SYSTEMNOTICE OF PRIVACY PRACTICES 12


Your rights regarding medicalinformation about you (continued)modate all reasonable requests. Your request must specify howor where you wish to be contacted.Right to a paper copy of this Notice. You have the right to apaper copy of this Notice. You may ask us to give you a copy ofthis Notice at any time. Even if you have agreed to receive thisNotice electronically, you are still entitled to a paper copy ofthis Notice.Copies of this Notice shall be available throughout UC DavisHealth System, or you may obtain a copy at our Web site,http://www.ucdmc.ucdavis.edu/compliance/Changes to UC Davis Health System’sprivacy practices and this NoticeWe reserve the right to change UC Davis Health System’s privacypractices and this Notice. We reserve the right to make therevised or changed Notice effective for medical information wealready have about you as well as any information we receive inthe future. We will post a copy of the current Notice at UCDavis Health System. In addition, at any time you may requesta copy of the current Notice in effect.If you believe your privacy rights have been violated, youmay file a complaint with UC Davis Health System or withthe Secretary of the Department of Health and HumanServices. To file a written complaint with UC Davis HealthSystem, contact Guest Assistance and Customer Services,UC Davis Health System, 2315 Stockton Boulevard,Sacramento, California 95817, telephone number(916) 734-5527, or (800) 305-6540.You will not be penalized for filing a complaint.Other uses of medical informationOther uses and disclosures of medical information notcovered by this Notice will be made only with your writtenpermission. If you provide us permission to use or disclosemedical information about you, you may revoke thatpermission, in writing, at any time. If you revoke yourpermission, we will no longer use or disclose medicalinformation about you for the reasons covered by yourwritten permission. We are unable to take back anydisclosures we have already made with your permission,and we will retain our records of the care provided toyou as required by law.Questions or complaintsIf you have any questions about this Notice, please contactHealth Information Management Department, UC DavisHealth System, 2315 Stockton Blvd., Building 12, Sacramento,California 95817, telephone number (916) 734-5205.13 UC DAVIS HEALTH SYSTEMNOTICE OF PRIVACY PRACTICES 14

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