Patient Privacy Practices Information & Forms
Marshall Medical Center Confidentiality
Notice of Privacy Practices
Effective Date: March 23, 2013
Marshall Medical Center creates 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 committed to protecting
your medical information. We understand that medical information about
you and your health is personal. 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
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 Marshall Medical Center departments
- 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 information for the
- Disclosure at your request. We may disclose information when requested
by you. This disclosure may require a written authorization by you.
- Treatment. We use medical information about you to provide you with medical
treatment services. We may disclose medical information to doctors, or
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 dietitian if you have diabetes so that we can arrange
for appropriate meals. Different departments of Marshall Medical Center
may share medical information about you in order to coordinate your care,
such as prescriptions, lab work and x-rays. We may disclose medical information
about you 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.
We may share your information with ACCEL (Access El Dorado). ACCEL is
a health program that allows community health services to work together
for improved care in El Dorado County. Health care providers involved
in your care can share information through ACCEL to help provide better
care and treatment. As a patient, you can request not to share your health
information with ACCEL. Your request must be submitted in writing to Marshall
Medical Center’s Privacy Officer.
- Payment. We may use and disclose 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 to approval or to determine whether your plan will cover
- Health Care Operations. We may use and disclose medical information about
you 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. Health care operations include: 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.
- 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.
- 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.
- 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.
- 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
medical information about you 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).
- Fundraising. We may use or disclose your demographic information, dates
of services and departments where services were provided to The Marshall
Foundation in an effort to raise money for the hospital and its operations.
You have the right to opt out of receiving fundraising communications.
- As Required By Law, Judicial or Administrative Proceeding or to Law Enforcement.
We may disclose 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.
- 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; and (6) reporting births and deaths.
- Health Oversight Activities. We may disclose your medical information to
health agencies during the course of audits, investigations, inspections,
licensure and other proceedings, as authorized by law.
- Deceased Person Information. 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.
- 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.
- Research. We may disclose your medical information to researchers conducting
research that has been approved by Marshall Medical Center’s Institutional
Review Board. We will ask for your written authorization if the researcher
will have access to your name, address, other information that reveals
who you are, or if the researcher will be involved in your care at the facility.
- National Security and Military Personnel. We may disclose your medical
information to federal officials for military, intelligence, counterintelligence,
or other national security purposes. If you are a member of the armed
forces, we may disclose your medical information to military command authorities.
- Inmates. If you are an inmate of a correctional institution or under the
custody of a law enforcement official, we may release medical information
about you to the correctional institution or law enforcement official.
- Worker’s Compensation. We may disclose your medical information as
necessary to comply with Worker’s Compensation laws.
- Special Categories of Information. In some circumstances, your health 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:
- Right to Inspect and Copy. You have the right to inspect and request a
copy of medical information that may be used to make decisions about your
care by submitting a request in writing to Medical Records, 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.
- 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 Medical Records, 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 the hospital; (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.
- 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 Medical Records, 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.
- 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 Medical Records, 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. If we do agree, we
will comply with your request unless the information is needed to provide
you emergency treatment.
- 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 Medical Records, Marshall
Medical Center, 1100 Marshall Way, Placerville, CA 95667. We will accommodate
all reasonable requests.
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 admitting
desk at most of our facilities. You may also obtain a copy of this notice
at our website:
V. CHANGES TO THIS NOTICE OF PRIVACY
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 admitted to the hospital.
If you believe your privacy rights have been violated, contact:
Marshall Medical Center
1100 Marshall Way
Placerville, CA 95667
You will not be penalized for filing a complaint. You may also file a complaint
with the Secretary of the Department of Health and Human Services.