Effective Date: April 1, 2003

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

Our Pledge To Protect Your Privacy

We understand that medical information about you and your health is personal. We are committed to protecting medical information about you. We create a record of the care and services you receive at the hospital. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the records of your care generated by the hospital, whether made by hospital personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor's use and disclosure of your medical information created in the doctor's office or clinic.

We are required by law to:

• make sure that medical information that identifies you is kept private;
• give you this notice of our legal duties and privacy practices with respect to medical information about you; and
• follow the terms of the notice that is currently in effect.

The following individuals and organizations share the Hospital’s commitment to protect your privacy and will comply with this Notice:

• Any health care professional authorized to enter information into your Hospital medical records.
  
• Members of our medical staff, employees, volunteers, trainees, students, and other hospital personnel providing services in the Hospital or Hospital affiliated patient care settings listed below
  
• All departments and units of the hospital, including our outpatient clinics
  
• Patient care settings affiliated with this Hospital, and all medical staff, employees, volunteers, trainees, students or other personnel providing services in these patient care settings; for example, contracted services from Ellis Hospital. For a complete listing of affiliations please contact our Privacy Officer at 518.386.3635.
  

Note: This hospital may provide services to you in an integrated way with our medical staff and the affiliated patient care settings referenced above. However, Sunnyview Hospital accepts no legal responsibility for activities solely attributable to these other providers or care settings.

This hospital and other medical providers are required by law to maintain the privacy of your medical information. We also are required to notify you of our legal duties and privacy practices regarding your medical information, and abide by the practices described in the notice.

How we may use and disclose your medical information

Members of our medical staff, appropriate hospital employees and other participants in our patient care system, such as affiliated clinics or hospitals, may share your medical information as necessary for your treatment, payment for services provided and health care operations, without your express permission. Other uses require your specific authorization. The following describes how we may use and disclose your information without express permission. Other parts of this notice describe uses and disclosures that require your authorization, and the rights you have to restrict our use and disclosure of your medical information.

Uses and disclosures without your express permission

This section discusses the requirements of federal privacy laws. New York law provides additional protections in some circumstances.

• Treatment, We are permitted to use and disclose your medical information within this hospital and within our affiliated clinics and hospitals as necessary to provide you with medical treatment and services. We also are permitted to disclose your medical information to other health care providers outside this hospital and its affiliated clinics and hospitals as necessary for those providers to provide you with medical treatment and services. For example, physicians and other health professionals treating you in this hospital will document information about your treatment in your medical record. This record will be released to other health professionals assisting in your treatment to ensure they are fully informed about your medical condition and treatment needs.
  
• Payment We are permitted to use and disclose your medical information for our payment purposes or the payment purposes of other health care providers or health plans. For example, our billing department may release medical information to your health insurer to allow the insurer to pay us or reimburse you for your treatment. We also may release medical information to emergency responders to allow them to obtain payment or reimbursement for services provided to you.
  
• Health care operations, We are permitted to use and disclose your medical information for purposes of our own hospital operations. We also are permitted to disclose your medical information for the health care operations of another health care provider or health plan so long as they have a relationship with you and need the information for their own quality assurance purposes, for purposes of reviewing the qualifications of their health care professionals or conducting skill improvement programs. For example, our quality assurance department may use your medical information to assess the quality of care in your case and ensure our hospital continues to provide the quality care you and other patients deserve. We may use your medical information to ensure we are complying with all federal and state compliance requirements. We also may disclose your medical information to a community physician to assist the physician in assessing the quality of care provided in your case and for other similar purposes.
  

Uses and disclosures that we may make unless you object

• Providing information from our hospital directory. Hospital directory information includes your name, location in the hospital, religious affiliation and general condition. We may release location and general condition information to individuals who ask for you by name. This may include your family and friends or even the media in some circumstances. We are allowed to release all facility directory information to the clergy even if they do not ask for you by name. If you do not want us to make these disclosures, you must notify our Privacy Officer at 518.386.3635.
  
• Family or friends involved in your care. Health professionals, using their best judgment, will disclose to a family member or close personal friend, or anyone else you identify, medical information relevant to that person's involvement in your care. We may also give information to someone who helps pay for your care. If you do not want us to make these disclosures, you must notify our Privacy Officer at 518.386.3635.
  
• 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 the hospital.
  
• Treatment Alternatives. We may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that we offer that may be of interest to you.
  
• Health-Related Benefits and Services. We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.
  
• Soliciting funds for the hospital. We may use demographic information about you to contact you in an effort to raise money for the hospital and its operations. We may disclose medical information to a foundation related to the hospital so that the foundation may contact you in raising money for the hospital. We only would release contact information, such as your name, address and phone number and when you received treatment. If you do not want your information used in this way, you must notify our Privacy Officer at 518.386.3635.
  
• Solicitations NOT for the hospital. We may use demographic information about you to contact you in an effort to raise money or participation for educational and recreational activities and other specialized programs sponsored by the hospital. If you do not want your information used in this way, you must notify our Privacy Officer at 518.386.3635.
  
• In the Event of a Disaster. We may disclose medical information about you to other health care providers and to an entity assisting in a disaster relief effort to coordinate care and so that your family can be notified about your condition and location. If you do not want us to make these disclosures, you must notify our Privacy Officer at 518.386.3635.
  

Uses and disclosures that do not require your authorization

We may use or disclose your medical information for the following purposes:

• Research when approved by the Institutional Review Board (or Privacy Board). Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process through the Institutional Review Board. Before we use or disclose medical information for research without your authorization, the project will have been approved through this research approval process.
  
• To organ procurement organizations, for purposes of organ and tissue donation. If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.
  
• To the military as required by military command authorities. If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.
  
• As authorized by law in connection with the Workers' Compensation Program. We may release medical information about you for workers' compensation or similar programs, to the extent authorized by law. These programs provide benefits for work-related injuries or illness.
  
• To support public health activities. These activities typically include reports to such agencies as the New York Department of Human Services as required or authorized by state law. These reports may include, but not necessarily be limited to, the following:
  
  • To prevent or control disease, injury or disability.
  • To report births and deaths.
  • To report child abuse or neglect.
  • To notify a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;
  • To notify the appropriate government authority if we believe a patient has been the victim of abuse or neglect. We will only make this disclosure if the patient agrees or when required or authorized by law.
  • To the Food and Drug Administration relative to adverse events concerning food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.
• To health oversight agencies such as state and federal regulatory agencies. We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
  
• Pursuant to lawful subpoena or court order. If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a civil subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell patients about the request or to obtain an order protecting the information requested.
  
• To law enforcement officials for certain law enforcement purposes. We may disclose your medical information to law enforcement officials as required by law or as directed by court order, warrant, criminal subpoena or other lawful process, and in other limited circumstances for purposes of identifying or locating suspects, fugitives, material witnesses, missing persons or crime victims.
  
• To coroners, medical examiners and funeral directors. We may release medical information to a coroner or medical examiner as necessary to identify a deceased person or carrying out their duties as required by law. New York law specifically requires us to report to the medical examiner when an injury apparently resulted from a gunshot wound.
  
• For national security and intelligence activities. We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
  
• When required to avert a serious threat to health or safety. We may use and disclose medical information about you when necessary to prevent a serious threat to your health and safety or the health and safety of the public or another person.
  
• Protective Services for the President and Others. We may disclose medical information about you to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.
  
• 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. This release would be necessary (1) for the institution to provide you with health care; (2) to protect your health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.
  
• As required by federal, state or local law. We will disclose medical information about you when required to do so by federal, state or local law.
  
• Incidental disclosures. Certain incidental disclosures of your medical information occur as a byproduct of lawful and permitted use and disclosure of your medical information. For example, a visitor may inadvertently overhear a discussion about your care occurring at the nurses station. These incidental disclosures are permitted if the hospital applies reasonable safeguards to protect your medical information.
  

Before disclosing this information, we must enter into an agreement with the recipient of the information that limits who may use or receive the data and requires the recipient to agree not to re-identify the data or contact you. The agreement must contain assurances that the recipient of the information will use appropriate safeguards to prevent inappropriate use or disclosure of the information.

Uses and disclosures requiring your authorization

Other uses and disclosures for purposes other than described above require your express authorization. For example, this hospital must obtain your authorization before disclosing your medical information to a life insurer or to an employer, except under special circumstances such as when disclosure to the employer is required by law. You have the right to revoke an authorization at any time, except to the extent we have already relied on it in making an authorized use or disclosure. Your revocation of an authorization must be in writing.

Sunnyview Hospital hopes that if you choose to revoke an authorization, you will help us comply with your wishes by identifying the authorization you are choosing to revoke. Ways of telling us which authorization you are revoking might include indicating who you authorized to receive information or the approximate timeframe in which you signed the authorization.

Disclosures to Business Associates

Sunnyview Hospital contracts with outside companies that perform business services for us, such as billing companies, management consultants, quality assurance reviewers, accountants or attorneys. In certain circumstances, we may need to share your medical information with a business associate so it can perform a service on our behalf. The Hospital will limit the disclosure of your information to a business associate to the amount of information that is the minimum necessary for the company to perform services for the Hospital. In addition, we will have a written contact in place with the business associate requiring it to protect the privacy of your medical information.

Your Rights

You have the right to:

• Request to inspect and copy your medical information used to make decisions about your care. You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. To inspect and copy medical information that may be used to make decisions about patients, you must submit a request in writing. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed.
  
• Request an amendment to your medical record. If you believe that medical information that may be used to make decisions about your care is incorrect or incomplete, you may ask us to amend the information. This request must be in writing. Your request must include a reason for the amendment. We may deny your request if we believe the records are complete and accurate, if the records were not created by us and creator of the record is available, or if the records are otherwise not subject to patient access. We will put any denial in writing and explain our reasons for denial. You have the right to respond in writing to our explanation of denial, and to require that your request, our denial, and your statement of disagreement, if any, be included in future disclosures of the disputed record.
  
• Request that we send you confidential communications by alternative means or at alternative locations. For example, you may ask that we only contact you at work, by mail, or by e-mail. A request for confidential communication must be made in writing. We will honor all reasonable requests.
  
• Request additional restrictions on the use and disclosure of your medical record. You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment or health care operations. You also have the right to request a limit on the medical information we disclose about you to someone who is involved in a your care or the payment for your care, like a family member or friend. For example, you could ask that we not use or disclose information about a particular procedure you underwent. To request a restriction, you must put your request in writing.
  

We are not required to agree to your request for restrictions. If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment. If we do not agree with your request we will notify you in writing.

• Request an accounting of disclosures. You may request, in writing, an accounting of disclosures we made of your medical information in the previous six years, beginning April 14, 2003. You are not entitled to an accounting of disclosures made for purposes of treatment, payment or healthcare operations, disclosures you authorized, disclosures to you, incidental disclosures, disclosures to family or other persons involved in your care, disclosures to correctional institutions and law enforcement in some circumstances, disclosures of limited data set information or disclosures for national security or law enforcement purposes.
  
• Receive a paper copy of this notice if you received the notice electronically. You may obtain a paper copy of this notice at any time by requesting a copy from any member of our staff.
  

Please direct requests discussed above to our Privacy Officer at 518.386.3635.

We reserve the right to change our health information practices and the terms of this Notice, and to make the new provisions effective for all protected health information we maintain, including health information created or received prior the effective date of any such revised notice. Should our health information practices change, we will post the revised Notice at our service delivery sites and make the revised Notice available to you at your request.

If you believe your privacy rights have been violated, you may file a complaint with the hospital or with the Secretary of the Department of Health and Human Services. To file a complaint with the hospital, contact the Vice President of Administrative Services, 1270 Belmont Avenue, Schenectady, NY 12308, 518.386.3658. Or with the Secretary of the Department of Health and Human Services, 200 Independent Avenue S.W., Washington, DC. The DHHS toll-free telephone number is 1-877-696-6775. There will be no retaliation for filing a complaint.