Notice of Information Practices
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:
- Request a copy of your paper or electronic medical record
- Request to correct your paper or electronic medical record
- Request confidential communication
- Ask us to limit the information we share
- Request a list of those with whom we’ve shared your information (Accounting of Disclosures)
- Receive a copy of this privacy notice
- Choose someone to act for you
- File a complaint if you believe your privacy rights have been violated
You have some choices in the way that we use and share information as we:
- Tell family and friends about your condition
- Provide disaster relief
- Include you in a hospital directory
- Provide mental health care
- Market our services
- Raise funds
Our Uses and Disclosures
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
- You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Call the Health Information Management Office at (970) 240-7365.
- In the Health Information Management office, you will be provided a records request form to fill out. You may request medical and billing information not including psychotherapy notes. We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee. If you are a minor considered an adult for purposes of consenting to medical care, certain care records are protected by Colorado law and will not be available to your parents, unless we have your written permission.
- We may deny your request to inspect or copy in certain very limited circumstances. If you are denied access to medical information, you may request that the denial be reviewed. Another licensed health care professional chosen by the hospital will review your request and the denial. The person conducting the review will not be the person who denied your request. We will comply with the outcome of the review.
- You may also view and download your personal health record, results, and other care information (not including Emergency Room reports) from the hospital or clinic portal. Ask us how to do this.
Request to correct your medical record
- You can ask us to correct health information about you that you think is incorrect or incomplete by writing a letter addressed to the Privacy Officer. Include in your letter what information you would like changed and why.
- We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications
- You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. Write a letter addressed to the Privacy Officer with your request.
- We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
- You can ask us not to use or share certain health information for treatment, payment, or our operations. We are not required to agree to your request, and we may say “no” if it would affect your care.
- To make this request, write a letter addressed to the Privacy Officer telling us what information you do not want us to use or share and to whom you want the limits to apply.
- If we agree, we will not be able to limit the information that was already used or shared with your permission prior to our agreeing to your request.
- If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Request a list of those with whom we’ve shared your information (Accounting of Disclosures)
- You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask (not earlier than 4/21/2003), who we shared it with, and why.
- We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make or for disaster notifications). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
- To request this list, write a letter addressed to the Health Information Management department. Let us know if you would like the list on paper or electronically.
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
- If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
- We will make sure the person has this authority and can act for you before we take any action.
- You can ask our Admissions Department for a Medical Power of Attorney form to place in your medical record.
File a complaint if you feel your rights are violated
- You can complain if you feel we have violated your rights by writing a letter to the Privacy Officer.
- You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting hhs.gov/ocr/privacy/hipaa/complaints/.
- We will not retaliate against you for filing a complaint.
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:
- Share information with your family, close friends, or others involved in your care
- Share information in a disaster relief situation
- Include or not include your name and location in a hospital directory so that people who ask for you by name may visit or call. If you do not object, religious affiliation may also be given to a member of the clergy, even if they don’t ask for you by name, to assist with your spiritual needs.
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:
- Marketing purposes
- Most sharing of psychotherapy notes
We will never sell your information.
In the case of fundraising:
- We may contact you for fundraising efforts, but you can tell us not to contact you again. Your decision to opt out of fundraising communications will have no impact on your treatment or payment for services.
Our Uses and Disclosures
How do we typically use or share your health information?
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.
How else can we use or share your health information?
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:
- Preventing disease
- Helping with product recalls
- Reporting adverse reactions to medications
- Reporting suspected abuse, neglect, or domestic violence
- Preventing or reducing a serious threat to anyone’s health or safety
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:
- For workers’ compensation claims
- For law enforcement purposes (for example if you are under custody or an inmate) or with a law enforcement official
- With health oversight agencies for activities authorized by law
- For special government functions such as military, national security, and presidential protective services
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.
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information.
- We must obtain a written agreement with our Business Associates with whom we contract for services that they will appropriately safeguard the privacy of your information.
- We must follow the duties and privacy practices described in this notice and give you a copy of it.
- We must make every effort to obtain your dated written acknowledgement that you (or your personal representative) accepted this notice of information practices. In an emergency situation, the hospital personnel will obtain this written acknowledgment when it is practicable to do so.
- We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html.
Changes to the Terms of this Notice
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 Regional Health’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 Regional Health 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.
Notice of Nondiscrimination
Discrimination is Against the Law
Montrose Regional Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Montrose Regional Health does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.
Montrose Regional Health:
Provides free aids and services to people with disabilities to communicate effectively with us, such as:
- Qualified sign language interpreters
- Written information in other formats (large print, audio, accessible electronic formats, other formats)
Provides free language services to people whose primary language is not English, such as:
- Qualified interpreters
- Information written in other languages
If you need these services, contact the Compliance Officer, Clinic Manager or the House Supervisor.
If you believe that Montrose Regional Health 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 firstname.lastname@example.org 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