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Notice of Privacy Practices

THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY ACCESS THIS INFORMATION. PLEASE READ IT CAREFULLY.


The privacy practices outlined in this brochure apply to Fort Madison Community Hospital and its medical staff, including physicians and health care providers attending to patients at the Hospital, Fort Madison Community Hospital Home Health Care, Fort Madison Community Hospital Pharmacy and Fort Madison Physicians & Surgeons, as members of an Organized Health Care Arrangement. Hereafter, these entities will collectively be referred to as "FMCH and its Entities."

FMCH and its Entities are dedicated to protecting your medical information. We are required by law to maintain the privacy of protected health information and to provide you with this Notice of our legal duties and privacy practices with respect to protected health information.

FMCH and its Entities are required by law to abide by the terms of this Notice and we reserve the right to change the terms of this Notice, making any revision applicable to all the protected health information we maintain. If FMCH and its Entities revise the terms of this Notice, they will post a revised notice at the facility and will make paper copies of this Notice of Privacy Practices for Protected Health Information available upon request.

How Your Medical Information will be Used and Disclosed

FMCH and its Entities will use your medical information as part of rendering patient care. For example, your medical information may be used by the health care professional treating you, by the business office to process your payment for the services rendered and by administrative personnel reviewing the quality and appropriateness of the care you receive.

FMCH and its Entities may also use and/or disclose your information in accordance with federal and state laws for the following purposes:
  • FMCH and its Entities may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

  • FMCH and its Entities may contact you for the purpose of customer satisfaction.

  • FMCH and its Entities may disclose information when required by the United States Department of Health and Human Services as part of an investigation or determination of the Hospital’s compliance with relevant law.

  • Unless you object, with the exception of Behavioral Health Patients, FMCH and its Entities will provide general information, including your name, location in the facility and your one word condition. This information will be released to people who ask for you by name.

  • Unless you object, with the exception of Behavioral Health Patients, FMCH and its Entities will provide general information, including your name, location in the facility, your one word condition and religious affiliation to members of the clergy.

  • Unless you object, with the exception of Behavioral Health Patients, FMCH and its Entities may use or disclose your medical information to notify a family member, a personal representative or another person responsible for your care, of your location, general condition or death.

  • Unless you object, with the exception of Behavioral Health Patients, FMCH and its Entities may disclose to family members, other relatives, or close personal friends the medical information directly relevant to such person’s involvement with your care.

  • FMCH and its Entities may disclose your medical information to a public or private entity for the purpose of coordinating with that entity to assist in disaster relief efforts.

  • FMCH and its Entities may use or disclose your medical information for public health activities, including the reporting of disease, injury, vital events and the conduct of public health surveillance, investigation and/or intervention. FMCH and its Entities may disclose your medical information to a health oversight agency for oversight activities authorized by law, including audits, investigations, inspections, licensure or disciplinary actions, administrative and/or legal proceedings.

  • FMCH and its Entities may disclose your medical information in the course of certain judicial or administrative proceedings.

  • FMCH and its Entities may disclose your medical information for law enforcement purposes or other specialized governmental functions.

  • If you are an organ donor, FMCH and its Entities may disclose your medical information to organ donation and procurement organizations.

  • FMCH and its Entities may use your medical information for marketing in a face-to-face communication and/or provide you with a promotional gift of nominal value. In other circumstances, we will obtain an authorization prior to using your medical information for marketing.

  • FMCH and its Entities may use your medical information for fundraising purposes.

  • FMCH and its Entities may use and disclose your medical information to prevent or lessen a serious threat to the health or safety of another person or the public.

  • FMCH and its Entities may disclose your medical information as authorized by laws relating to workers’ compensation or similar programs.

  • 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.

  • FMCH and its Entities may disclose to the FDA health information relative to adverse effects with respect to food, drugs, supplements, product or product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacement.

  • If you are a member of the armed forces, Fort Madison Community Hospital may release medical information about you as required by military command authorities.

  • FMCH and its Entities will not use or disclose your medical information for any other purposes without your written authorization. Once given, you may revoke your authorization in writing at any time.

Your Rights Regarding Your Medical Information

You have the following rights with respect to your medical information:
  • The right to request "restrictions" on certain uses and disclosures of your medical information. FMCH and its Entities are not required to agree to your requested restriction.

  • The right to request communications of your health information by alternative means or at alternative locations.

  • The right to inspect and copy your medical information. You must submit your request in writing. This right is subject to certain specific exceptions and you may be charged a reasonable fee for any copies of your records.

  • The right to request an amendment of your medical information in writing. FMCH and its Entities may deny your request for certain specific reasons, and if denied, FMCH and its Entities will provide you with a written explanation for the denial and information regarding further rights you would have at that point.

  • The right to receive an accounting of the disclosures of your medical information made by FMCH and its Entities except for disclosures for treatment, payment or Hospital operational purposes and for certain other specific disclosure types.

  • The right to request a paper copy of this Notice of Privacy Practices for Protected Health Information.

  • The right to complain to FMCH and its Entities and/or to the United States Department of Health and Human Services if you believe your privacy rights have been violated. To complain, please contact the FMCH Privacy Officer at 1-800-273-8452 or the Secretary of the United States Department of Health and Human Services. If you choose to file a complaint, you will not be retaliated against in any way.

  • If you would like further information regarding your rights or regarding the uses and disclosures of your medical information, you may contact the Director of Information Services.

    THIS NOTICE IS EFFECTIVE AS OF APRIL 14, 2003.




    fmchmail@fmchosp.com