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g PRIVACY NOTICE- USES AND DISCLOSURES OF HEALTH INFORMATION "Tf-fIS NOTICE DESCRIBES HOW MEDICAL INFORKATION ABOUT YOU MAY BE USED-AND 9ISCLOSED AND If OW YOU CAN GET ACCESS TO THIS INFORKA.TION. PLEASE REVIEW IT CAREFULLY." GENERAL INFORMATION: When you are admitted, receive treatment or diagnostic services at this Facility a record of visits/services is,made. The record will generally include a history, prhyskal, consultations,assessment by nursing,social services, dietary, diagnostic reports,such as X-ray and laboratory results,the Alinimunz Data Set,medications, treatments, care planiplan of care,authorizations,consents,progress notes,.by the physician, nursing,social servicess and others involved in the treatment services. This information is included in your health record either manual and/or computerized and is issued as a: • Source for documenting assessment, planning care and treatment,recording informed consent,recording progress,ongoing assessment of health status/progress/needs • Meansof communicating among health professionals who evaluate you and/or provide care and treatment, copies are provided for continuity of care to.consultants,hospitals, emergency room or other Health Facility where you might be transferred • Source to support billing for services and to meet the requirements of third party payers • Legal document supporting the care,services and treatment provided • A resource during surveys by the state,federal and other review agencies • A toolwith which we.can assess and continually work to improve care • A source to be used by students and a tool in educating health professionals derstaadingwhat is in your record ands, how your health information is used will assist you to: 'SURF ACCURACY,BETTER UNDERS'T'AND who,what,when,where, and why others may need access to .our health information,rmatzon,MAKE INFORMED DECISIONS when authorizing FOUR RIGHTS: The health record is the physical property the Facility that compelled it. The informatioik belongs to you. YOU HAVE THE RIGHT TO: • Request restriction on certain uses and disclosures of your information provided by 45 CFR 164.522. Restriction may be terminated in writing or orally and then documented in the record. • Inspect and copy yotir health record as provided in 45 CPR 164528. • Request alternate means of communication to obtain your health information 45 CFR 164.522(b}. • Request an accounting of disclosures of Protected Health Informed 45 CFR 164.528. • Request receipt of the notice electronically and/or to obtain a paper copy of the notice 164.52(bXl)(Iv)(f) • Revoke authorization to use or disclose health information except to the extent that action has.already been taken 45.CFR 164.508(b)(5) • Report a problem-or if you have a question or desire additional information,you may contact the Medical Records Department, at(209) 9�S -3444, or if not satisfied,contact the Privacy Officer/Administrator at the same number. • File a complaint if you think your privacy rights have been violated. If you are not satisfied with the response to your concern,you may file a written or oral complaint with the Administrator. If your response is still a concern,you may file a complaint with O'Connor Woods.(209) 956-3400. • You are also notified that you may file a complaint with the Secretary of Health and Human Services,Office for Civil Rights. - - - •_ -.