Notice of Information Practices (Spanish Version here.)
This Notice of Information Practices describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
You have the right to:
You have some choices in the way that we use and share information as we:
We may use and share your information as we:
|• Treat you
• Run our organization
• Bill for your services
• Help with public health and safety issues
• Do research
• Comply with the law
• Respond to organ and tissue donation requests
• Work with a medical examiner or funeral director
• Address workers’ compensation, law enforcement, and other government requests
• Respond to lawsuits and legal actions
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Request an electronic or paper copy of your medical record
Request to correct your medical record
Request confidential communications
Ask us to limit what we use or share
Request a list of those with whom we’ve shared your information (Accounting of Disclosures)
Receive a copy of this privacy notice
You can ask for a paper copy of this notice at any time in the Admissions Department or in our clinics, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
File a complaint if you feel your rights are violated
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share information that we believe is in your best interest. In this case, we will tell you about it later, and ask you your preferences when you can let us know. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases, we never share your information unless you give us written permission:
We will never sell your information.
In the case of fundraising:
We typically use or share your health information in the following ways.
We can use your health information and share it with other professionals who are treating you. We provide your physician or subsequent healthcare providers with copies of various reports that assist in treating you once you’re discharged from the hospital or leave our clinics. These reports may be provided through the Quality Health Network.
Example: A doctor treating you for an injury asks another doctor about your overall health condition.
Run our organization
We can use and share your health information to run our practice, improve your care, and contact you when necessary. This may include sharing your information with contracted business associates so that they can perform a job or service we’ve asked them to do.
Example: We use health information about you to manage your treatment and services.
Bill for your services
We can use and share your health information to bill and get payment from health plans or other entities.
Example: We give information about you to your health insurance plan so it will pay for your services.
We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html.
Help with public health and safety issues
We can share health information about you for certain situations such as:
We can use or share your information for health research when the research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information. We may remove information that identifies you from the research data so others may use it to study healthcare without learning who you are.
Comply with the law
We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Respond to organ and tissue donation requests
We can share health information about you with organ procurement organizations.
Work with a medical examiner or funeral director
We can share health information with a coroner, medical examiner, or funeral director when individuals die.
Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you:
Respond to lawsuits and legal actions
We can share health information about you in response to a court or administrative order, or in response to a subpoena.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
We will update this notice promptly if there are any changes required by law to your privacy rights or our responsibilities. While we can change the terms of this notice, and the changes will apply to all information we have about you, no changes to this notice will be put in place, unless required by law, until the revised notice with the new effective date is made available to you (upon request in our offices or Admissions department and on our web site).
If you have any questions about this notice, please contact the Privacy Officer at (970) 252-2670.
This notice describes Montrose Memorial Hospital’s privacy practices and that of any healthcare professional authorized to enter information into your MMH hospital or clinic medical record or view your information for treatment, payment or operations including all hospital departments and units; medical and nursing students; any member of a volunteer group we allow to help you while you are in the hospital; and all MMH employees, staff, and other workforce personnel. All managed and affiliated sites of Montrose Memorial Hospital will follow the terms of this notice. All of these locations may share medical information with each other for the treatment, payment, or hospital operations purposes described in this notice.
Discrimination is Against the Law
Montrose Memorial Hospital complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Montrose Memorial Hospital does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Provides free aids and services to people with disabilities to communicate effectively with us, such as:
Provides free language services to people whose primary language is not English, such as:
If you need these services, contact the Compliance Officer, Clinic Manager or the House Supervisor.
If you believe that Montrose Memorial Hospital has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Compliance Officer, 800 S. 3rd Street, Montrose CO 81401, 970-240-7368, or email@example.com You can file a grievance in person, by mail, fax, or email. If you need help filing a grievance, the Compliance Officer is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at: U.S. Department of Health and Human Services, 200 Independence Avenue, SW, Room 509F, HHH Building, Washington, D.C. 20201; 1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.
ATTENTION: If you do not speak English, language assistance services, free of charge, are available to you. Call 1-970-249-2211.
Español (Spanish) ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1-970-249-2211.
Tiếng Việt (Vietnamese) CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1-970-249-2211.
繁體中文 (Chinese) 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1-970-249-2211。
한국어 (Korean) 주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1-970-249-2211번으로 전화해 주십시오.
Русский (Russian) ВНИМАНИЕ: Если вы говорите на русском языке, то вам доступны бесплатные услуги перевода. Звоните 1-970-249-2211.
አማርኛ (Amharic) ማስታወሻ: የሚናገሩት ቋንቋ ኣማርኛ ከሆነ የትርጉም እርዳታ ድርጅቶች፣ በነጻ ሊያግዝዎት ተዘጋጀተዋል፡ ወደ ሚከተለው ቁጥር ይደውሉ 1-970-249-2211.
ملحوظة: إذا كنت تتحدث اذكر اللغة، فإن خدمات المساعدة اللغوية تتوافر لك بالمجان. اتصل برقم 1-079-942-1122.
Deutsch (German) ACHTUNG: Wenn Sie Deutsch sprechen, stehen Ihnen kostenlos sprachliche Hilfsdienstleistungen zur Verfügung. Rufnummer: 1-970-249-2211.
Français (French) ATTENTION : Si vous parlez français, des services d’aide linguistique vous sont proposés gratuitement. Appelez le 1-970-249-2211.
नेपाली (Nepali) ध्यान दिनुहोस्: तपार्इंले नेपाली बोल्नुहुन्छ भने तपार्इंको निम्ति भाषा सहायता सेवाहरू निःशुल्क रूपमा उपलब्ध छ । फोन गर्नुहोस् 1-970-249-2211।
Tagalog (Filipino) PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1-970-249-2211.
Cushite ◊ Oroomiffa (Oromo) XIYYEEFFANNAA: Afaan dubbattu Oroomiffa, tajaajila gargaarsa afaanii, kanfaltiidhaan ala, ni argama. Bilbilaa 1-970-249-2211.
Persian رسی (Farsi)توجه: اگر به زبان فارسی گفتگو می کنید، تسهیلات زبانی بصورت رایگان برای شما فراهم می باشد. با 1-970-249-2211تماس بگیرید.
Kru Ɓàsɔ́ɔ̀-wùɖù-po-nyɔ̀ (Bassa) Dè ɖɛ nìà kɛ dyéɖé gbo: Ɔ jǔ ké m̀ [Ɓàsɔ́ɔ̀-wùɖù-po-nyɔ̀] jǔ ní, nìí, à wuɖu kà kò ɖò po-poɔ̀ ɓɛ́ìn m̀ gbo kpáa. Ɖá 1-970-249-2211
Igbo asusu (Ibo) Ige nti: O buru na asu Ibo asusu, enyemaka diri gi site na call 1-970-249-2211.
èdè Yorùbá (Yoruba) AKIYESI: Ti o ba nso ede Yoruba ofe ni iranlowo lori ede wa fun yin o. E pe ero ibanisoro yi 1-970-249-2211.
If you have any questions about this notice, please contact our Privacy Officer at 252-2670.
Version 9 7/31/18