Notice of Patient Privacy Practices
Effective Date: November 1, 2017
We understand that medical information about you and your health is personal.
We are committed to protecting your medical information. We create a record
of the care and services you receive at all of our facilities. We need
this record to provide you with quality care and to comply with legal
requirements. We are required by law to maintain the privacy of your medical
information and to provide you with notice of our legal duties and privacy
practices with respect to your medical information. This notice applies
to all of the records of your care generated at our facilities, whether
made by our hospital personnel or your personal doctor. Health care professionals
outside of Marshall Medical Center may have different policies.
We have adopted a secure, integrated, electronic health record (EHR) technology
to enhance and improve the efficiency, effectiveness, clinical, and quality
of care provided to our patients. The University of California Davis Health
System (UCDHS) hosts our EHR platform of our patients’ medical records.
Your medical information may be accessed by UCDHS for maintenance and
interoperability purposes in accordance with federal and state privacy laws.
I. WHO WILL FOLLOW THIS NOTICE
This notice describes our privacy practices and those of:
- Any health care professional authorized to enter information into your
- All employees, staff and volunteers of all our departments and units.
- Affiliated entities.
- Other health care professionals who provide you with medical care in our
All entities and health care providers described in this notice may share
your medical information with each other, as necessary to carry out their
treatment, payment and operations.
II. HOW WE MAY USE AND DISCLOSE YOUR HEALTH INFORMATION
The law permits us to use or disclose your medical in- formation for the
1. Disclosure at your request. We may disclose in- formation when requested
by you. This disclosure may require a written authorization by you.
2. Treatment. We use your medical information to provide you with medical
treatment services. We may disclose medical information to doctors, our
staff, healthcare students, or others involved in your care. For example,
a doctor treating you for a broken leg may need to know if you have diabetes
because diabetes may slow the healing process. In addition, the doctor
may need to tell the dietician if you have diabetes so that we can arrange
for appropriate meals. Different departments of Marshall Medical Center
may share your medical information in order to coordinate your care, such
as prescriptions, lab work and x-rays. We may disclose your medical information
to people outside of the organization who are involved in your medical
care after you leave our facilities, such as skilled nursing facilities,
home health agencies, hospice, or durable medical equipment suppliers.
3. Payment. We may use and disclose your medical information so that the
treatment and services you receive at our facilities can be billed to
and payment may be collected from you, an insurance company, or a third
party. 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. We may also provide basic information about
you and your health plan, insurance company or other source of payment
to practitioners outside Marshall Medical Center who are involved in your
care, to assist them in obtaining payment for services they provide to
you. However, we cannot disclose information to your health plan for payment
purposes if you ask us not to, and you pay for the services yourself.
4. Health Care Operations. We may use and disclose your medical information
for health care operations. These uses and disclosures are necessary to
run the organization and make sure that all of our patients receive quality
care. For example: 1) conducting quality assessment and improvement activities,
including outcomes evaluation and development of clinical guidelines;
2) reviewing the competence or qualifications of health care professionals;
3) conducting or arranging for medical review, legal services, and auditing
functions; 4) business planning and development; 5) business management
and general activities; and 6) reporting to health oversight agencies,
including the California Cancer Registry for reporting cancer cases. In
all of the above situations, we may remove information that identifies
you so others may use the data to study health care and health care delivery.
5. Appointment Reminders. We may use and disclose medical information to
contact you as a reminder that you have an appointment for treatment or
medical care at our facilities.
6. Treatment Alternatives and Health Related Products. We may use and disclose
medical information to tell you about or recommend possible treatment
options or alternatives that may be of interest to you.
7. Hospital Directory. We may include certain limited information about
you in the hospital directory while you are a patient at the hospital.
This information may include your name, location in the hospital, your
general condition (e.g., good, fair, etc.) and your religious affiliation.
Unless there is a specific written request from you to the contrary, this
directory information, except for your religious affiliation, may also
be released to people who ask for you by name. Your religious affiliation
may be given to a member of the clergy, even if they don’t ask for
you by name. This information is released so your family, friends and
clergy can visit you in the hospital and generally know how you are doing.
8. Communication with Friends and Family. We may disclose your relevant
medical information to a friend or family member who is involved in your
care or to someone who helps pay for your care. In addition, we may disclose
your medical information to an organization assisting in a disaster relief
effort so that your family can be notified about your condition, status
and location. If you arrive at the Emergency Department either unconscious
or otherwise unable to communicate, we are required to attempt to contact
someone we believe can make health care decisions for you (e.g., a family
member or agent under a health care power of attorney).
9. Fundraising. We may use or disclose your demo- graphic information,
dates of services and departments where services were provided to The
Marshall Foundation for Community Health in an effort to raise money for
the hospital and its operations. You have the right to opt out of receiving
10. As Required By Law, Judicial or Administrative Proceeding or to Law
Enforcement. We may dis- close your medical information as required by
law, in the course of administrative or judicial proceedings or to law
enforcement in response to a court order, subpoena, search warrant or
summons. We may disclose your medical information to a law enforcement
official for the following reasons: (1) in response to a court order,
subpoena, warrant, or summons; (2) to identify or locate a suspect, fugitive,
material witness, or missing person; (3) about a death we believe may
be the result of criminal conduct; and (4) about criminal conduct at the hospital.
11. To Avert Serious Threat to Health or Safety and for Public Health Purposes.
We may disclose your medical information to appropriate agencies such
as Animal Control, DMV, or Poison Control to prevent serious threat to
your health and safety, or the health and safety of the public or another
person. As required by law, we may disclose your medical information to
public health authorities for purposes related to: (1) preventing or controlling
disease, injury or disability; (2) reporting child, elder, or dependent
adult abuse or neglect; (3) reporting domestic violence; (4) reporting
problems with products and reactions to medications; (5) reporting disease
or infection exposure; (6) reporting births and deaths; and (7) notifying
emergency response employees regarding possible exposure to HIV/AIDS,
to the extent necessary to comply with state and federal laws.
12. Health Oversight Activities. We may disclose your medical information
to health oversight agencies during the course of audits, investigations,
in- spections, licensure and other proceedings, as authorized by law.
13. Coroners, Medical Examiners, Funeral Directors. In the event of your
death, we may disclose your medical information to coroners, medical examiners
and funeral directors, as necessary to carry out their duties.
14. Organ and Tissue Donation. We may disclose your medical information
to organizations involved in procuring, banking or transplanting organs
and tissues, as necessary to facilitate organ or tissue donation or transplantation.
15. Research. Under certain circumstances, we may use and disclose your
medical information for research purposes, which may include informing
you of research studies that might be of interest to you. Such research
projects must be approved by an Institutional Review Board that has reviewed
the research proposal and establishes protocols to ensure the privacy
of your health information.
16. National Security and Military Personnel. We may disclose your medical
information to federal officials for intelligence, counterintelligence,
or other national security purposes, as required by law. If you are a
member of the armed forces, we may disclose your medical information,
as required by military command authorities.
17. Inmates. If you are an inmate of a correctional institution or under
the custody of a law enforcement official, we may disclose your medical
information to the correctional institution or law enforcement official.
18. Workers’ Compensation. We may disclose your medical information
as necessary to comply with Workers’ Compensation laws.
19. Special Categories of Information. In some circumstances, your medical
information may be subject to restriction that may limit or preclude some
uses or disclosures described in this notice. For example, there are special
restrictions on the use or disclosure of certain categories of information
(e.g., HIV tests or treatment for mental health conditions or alcohol
and drug abuse). Government health benefit programs, such as Medi-Cal,
may also limit the disclosure of beneficiary information for purposes
unrelated to the program.
III. OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of your medical information not covered by this
notice or the laws that apply to us will be made only with your written
authorization. If you provide us authorization to use or disclose your
medical information, you may revoke that authorization, in writing, at
any time. If you revoke your authorization, this will stop any further
use or disclosure of your medical information for the purposes which you
authorized, except if we have already acted in reliance on your authorization.
IV. YOUR MEDICAL INFORMATION RIGHTS
You have the following rights regarding your medical information:
1. Right to Inspect and Copy. You have the right to inspect and obtain
a copy of medical information that may be used to make decisions about
your care by submitting a request in writing to Health Information Management,
Marshall Medical Center, 1100 Marshall Way, Placerville, CA 95667. If
you request a copy of the information, we may charge for the costs of
copying, mailing, or other supplies associated with your request. We may
deny your request in certain, very limited circumstances, in which case
you may request a review of the denial. Another licensed health care professional,
not involved with the denial, will review your request and the denial.
We will comply with the outcome of the review.
2. Right to Amend. You have the right to ask us to amend your medical information
if you feel we have incorrect or incomplete information by submitting
a request in writing to Health Information Management, Marshall Medical
Center, 1100 Marshall Way, Placerville, CA 95667. You must provide a reason
that supports your request. We may deny your request if you ask us to
amend information that: (1) was not created by us; (2) is not part of
the medical information kept by or for us; (3) is not part of the information
which you can inspect and copy; or (4) is accurate and complete. Even
if we deny your request, you have the right to submit a written addendum,
not to exceed 250 words, with respect to any item or statement in your
record which you believe to be incorrect or incomplete. The addendum will
be attached to your medical record.
3. Right to an Accounting of Disclosures. You have the right to request
an “accounting of disclosures” (a list of disclosures we made
of your medical information except those for treatment, payment, health
care operations and certain other disclosures not required by law to be
accounted) by submitting a request in writing to Health Information Management,
Marshall Medical Center, 1100 Marshall Way, Placerville, CA 95667. Your
request must state a time period which may not be longer than six years
and may not include disclosures dated before April 14, 2003. Your request
should indicate in what form you want the list; for example, on paper
or electronically. The first list you request will be free. We will charge
you the cost of preparation for subsequent lists you request within a
12 month period. In addition, we will notify you as required by law following
a breach of your unsecured protected health information.
4. 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 treatment, payment, health care operations or to someone who is involved
in your care or the payment for your care. You must submit your request
in writing to Health Information Management, Marshall Medical Center,
1100 Marshall Way, Placerville, CA 95667. You may also request a limit
on the medical information we disclose about you to someone who is involved
in your care or the payment for your care. We are not required to agree
to your request, except to the extent that you request us to restrict
disclosure to a health plan or insurer for payment or health care operations
purposes, if you, or someone else on your behalf (other than health plan
or insurer) has paid for the item or service out-of-pocket in full. Even
if you request this special restriction, we can disclose the information
to a health plan or insurer for purposes of treating you. If we do agree,
we will comply with your request unless the information is needed to provide
you emergency treatment.
5. Right to Request Confidential Communications. You have the right to
choose how we communicate with you about medical matters, i.e. only at
work or by mail. To request confidential communications, you must make
your request in writing at the time of service or in writing to Health
Information Management, Marshall Medical Center, 1100 Marshall Way, Placerville,
CA 95667. We will accommodate all reasonable requests.
6. Right to a Paper Copy of This Notice. You have the right to a paper
copy of this notice. You may obtain a paper copy of this notice at the
registration desk at most of our facilities. You may also obtain a copy
of this notice at our website: www.marshallmedical.org.
V. CHANGES TO THIS NOTICE
We reserve the right to change this Notice at any time in the future, and
to make the new provisions effective for all information we maintain,
including information that was created or received prior to the date of
the change. We will offer you a copy of the current Notice in effect each
time you register or are admitted to the hospital.
If you believe your privacy rights have been violated, contact:
Marshall Medical Center
1100 Marshall Way
Placerville, CA 95667
You may also file a complaint with the Secretary of the U.S. Department
of Health and Human Services.You will not be penalized for filing a complaint.