Notice of Privacy Practices Portneuf Medical Center

Effective Date: September 1, 2012Notice of Privacy PracticesPortneuf Medical CenterRight to Request Restrictions: You have the right to request a restriction or limitation on the health informationwe use or disclose about you for treatment, payment or health care operations. You also have the right torequest a limit on the health information we disclose about you to someone who is involved in your care or thepayment for your care, like a family member or friend. For example, you could ask that we not use or discloseinformation about a medical procedure you received. Please realize, we are only required to agree to yourrequest in the following circumstances: (1) the disclosure would be to a health plan for purposes of carrying outhealth care operations or payment activities (and not treatment activities), except as required by law, and (2)your information pertains solely to health care services or items for which you have paid the facility in full, “outof pocket.” For other requests, we are not required to agree; if we do agree, we will comply with your requestunless the information is needed to provide emergency treatment to you.Any request for a restriction must be sent in writing to the Privacy Officer. To request restrictions, you mustmake your request in writing to the Portneuf Medical Center Privacy Officer.Right to Request Confidential Communications. You have the right to request that we communicate with youabout medical treatment and options in a certain way or at a certain location. For example, you can ask that wecontact you at a different phone number or address than that shown in your records.To request confidential communications, you must make your request in writing to the Portneuf Medical CenterPrivacy Officer. We will not ask you the reason for your request. We will accommodate all reasonable requests.Your request must specify how or where you wish to be contacted.Right to a Paper Copy of This Notice. You have the right to a paper copy of this Notice. You will be offered apaper copy of this Notice during the admission or registration process. You may ask us to give you a copy of thisNotice at any time, or you may contact the Portneuf Medical Center Privacy Officer at 777 Hospital Way,Pocatello, ID 83201.Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice.You may obtain a copy this Notice at our website, http://www.portmed.org.State Law Issues. Many states have requirements regarding the mandatory or voluntary reporting of healthinformation for various purposes, such as maintaining records of births and deaths or engaging in activitiesrelating to the improvement of health care or the reduction of health care costs. In addition, some states haveenacted privacy laws or other laws respecting the confidentiality of medical information that have requirementsdifferent from, and in some cases more stringent than, those described herein. To the extent that an applicablestate privacy law imposes requirements that are more restrictive than federal privacy law, the state law willpreempt the federal law.Changes to This NoticeWe reserve the right to change this Notice at any time. We reserve the right to make the revised or changedNotice effective for medical and billing information we already have about you as well as any information we