THIS NOTICE DESCRIBES HOW PROTECTED HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU MAY GAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
The Health Insurance Portability and Accountability Act of 1996 (HIPAA) directs health care providers, payers, and other health care entities to develop policies and procedures to ensure the security, integrity, privacy and authenticity of health information, and to safeguard access to and disclosure of health information. The federal government has privacy rules, which require that we provide you with information on how we might use or disclose your identifiable health information. The Indiana Poison Center is required by the federal government to give you our Notice of Privacy Practices.
OUR COMMITMENT TO YOUR PRIVACY
As a healthcare provider, The Indiana Poison Center uses your confidential health information and creates records regarding that health information in order to provide you with quality care and to comply with certain legal requirements. We understand that this health information is personal, and we are dedicated to maintaining your privacy rights under Federal and State law. This Notice explains our rights and obligations regarding the use and disclosure of your health information as well as your rights regarding your own health information.
We are required by law to: (1) make sure that your health information is kept private; (2) give you this Notice of our legal duties and privacy practices with respect to your health information; and (3) follow the terms of the Notice that are currently in effect.
WHO WILL FOLLOW THIS NOTICE
The Indiana Poison Center is a division of Indiana University Health, Inc. (IU Health), and is operated by IU Health under contract to the Indiana State of Department of Health, Division of Trauma and Injury Prevention. The medical toxicologists of the Center are all faculty of the Indiana University School of Medicine. All of our staff, whether IU Health employees or IU School of Mediine faculty, will follow the provisions contained in this notice.
HOW WE MAY USE OR DISCLOSE YOUR HEALTH INFORMATION WITHOUT YOUR AUTHORIZATION
The following information describes different ways that we may use or disclose your health information without your authorization. For each category of use or disclosure we will explain what we mean and give examples to help you better understand each category. Although we cannot list every use or disclosure within a category, we are only permitted to use or disclose your health information without your authorization if it falls within one of these categories.
CATEGORIES FOR USES AND DISCLOSURES:
Treatment – We may use health information about you to provide you with medical treatment or services. We may disclose health information about you to doctors, specialists in poison information, nurses, pharmacists, technicians, medical students, residents, student nurses, or other healthcare personnel who are involved in taking care of you at the Indiana Poison Center or at another healthcare provider. For example, a doctor treating you for a liver problem may need to know if the drugs to which you have been exposed may change how the liver problem should be treated.
Public Health – As part of our public health function for the State of Indiana, we share information about your exposure and health status if it falls under the mandate of the State’s Department of Health to protect the public health by watching for illnesses or complications of drugs, plants, or exposures to animals. We share data about all exposures reported to us, except for the name of the caller and the name of the patient, to the National Poison Data System maintained by the American Association of Poison Control Centers, to allow for regional and national surveillance for new health hazards. We may also share information with public health agencies or other governmental authorities to report public health activities or risks, as required or authorized by law, or when you request us to do so. These activities generally include the following: to prevent or control disease, injury or disability; to report births and deaths; to report child abuse or neglect; to report reactions to medications or problems with products; to notify people of recalls of products they may be using; 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 as authorized by law; to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence.
Payment – The cost of most of the services provided by the Indiana Poison Center is covered by the funds we receive from the State and Federal governments and our Member Hospital Program. In the event you or your representative request a service for which a charge is made, we will let you know if there is going to be a charge for the requested services. If you wish to proceed after being informed that there is a charge, we may give your health information to your insurance company in order to receive payment for those services.
Health Care Operations – We may use and disclose health information about you for the Indiana Poison Center’s operations. For example, we may use health information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine health information about our patients to decide what additional services should be offered, what services are not needed, and whether certain new treatments are effective. We may disclose your health information to doctors, nurses, technicians, medical students, residents, nursing staff and other personnel for review and learning purposes. We may combine the health information we have with health information from other healthcare providers to compare how we are doing and see where we can make improvements in the care and services we offer.
Medical Staff Members – We may disclose health information about you to physicians and other health care providers who have been given clinical privileges to provide patient care at the Indiana Poison Center as necessary to carry out their treatment, payment and health care operations relating to the provision of care to patients seen by the Indiana Poison Center.
Follow-up Calls and Treatment Alternatives – We may use or disclose health information to check on you after you have contacted us or after someone else has contacted us on your behalf. If you have an answering machine we may leave a message. We may contact you about possible treatment options or alternatives or other health related benefits or services that may be of interest to you.
Fund-raising Activities – We may use health information to contact you for fund-raising needs. We would only use contact information, such as your name, address and phone number and the dates you received treatment or services. If you do not want the Indiana Poison Center to contact you for fund-raising efforts, you must put the request in writing and send to the Director, Indiana Poison Center, 1701 N Senate Blvd., Room B402, Indianapolis, Indiana 46202.
Individuals Involved in Your Care or Payment for Your Care – Unless you object, we may disclose health information to a friend or family member who is involved in your medical care or who assists in taking care of you or your child. We may tell your family or friends your general condition and where you are (such as, that you are in the hospital). In addition, we may disclose health information about you to an entity assisting in a disaster relief effort so that your family can be notified about your condition, status and location.
Research – We may use or disclose health information under certain circumstances for medical research purposes. We will obtain your written authorization to use or disclose your health information for research purposes except when (a) our use or disclosure was approved by an Institutional Review Board (IRB); (b) we obtain the written agreement of a researcher that (i) the information being sought is necessary to prepare a research protocol; (ii) the use or disclosure of your health information is being used only for preparing to conduct a research project, for example, to help them look for patients with specific medical needs, as long as the health information reviewed does not leave the Indiana Poison Center; or (c) the health information sought by the researcher only relates to patients who are deceased and the researcher agrees in writing that the use or disclosure is necessary for the research. In certain circumstances we may contact you to ask you to participate in a research project if you meet certain requirements of the study.
As indicated, certain research studies will be subject to a special approval process by the IRB. This process evaluates a proposed study and its use of health information, trying to balance the research needs with patients’ need for privacy of their health information. In almost all clinical trial studies where you participate personally in the study we will seek authorization from you for use or disclosure of your health information.
As Required By Law – We may use or disclose health information when required to do so by federal, state or local law.
To Avert a Serious Threat to Health or Safety – We may use or disclose health information when necessary to prevent a serious threat to your health and safety, another person or the public. Any disclosure, however, would only be to someone able to help prevent the threat.
We may also use or disclose your health information without your authorization in the following situations:
Organ and Tissue Donation – 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.
Military and Veterans – To military command authorities as required, if you are a member of the armed forces. We may also disclose health information about foreign military personnel to the appropriate foreign military authority.
Workers’ Compensation – To workers’ compensation or similar programs that provide benefits for work-related injuries or illness.
Health Oversight Activities – 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.
Lawsuits and Disputes – In response to a court or administrative order, if you are involved in a lawsuit or a dispute. We may also disclose health information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell you about the request or to obtain an order protecting the health information requested.
Law Enforcement – In response to a court order, subpoena, warrant, summons or similar process; or upon request by a law enforcement official to identify or locate a suspect, fugitive, material witness, or missing person or to obtain information about the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s authorization. We may report a death we believe may be the result of criminal conduct or report suspected criminal conduct occurring on the premises. We may also report information related to a suspected crime discovered in the course of providing emergency medical services.
Coroners, Medical Examiners and Funeral Directors – To a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release health information about patients of the Indiana Poison Center to funeral directors as necessary to carry out their duties.
National Security and Intelligence Activities – To authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.
Protective Services for the President and Others – To authorized federal officials so they may provide protection to the President of the United States, other authorized persons or foreign heads of state or to conduct special investigations.
Inmates – To the correctional institution or law enforcement official, if you are an inmate of a correctional institution or under the custody of a 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.
USES AND DISCLOSURES WHICH REQUIRE YOUR AUTHORIZATION
Other types of uses and disclosures of your health information not described in this Notice will be made only with your written authorization. You may revoke your authorization by giving written notice to the medical records department where you received your care. Please see the list of addresses at the end of this Notice. If you revoke your authorization we will no longer use or disclose your health information as permitted by your initial authorization. Please understand that we will not be able to take back any disclosures we have already made and that we are still required to retain our records containing your health information that documents the care that we provided to you.
YOUR RIGHTS REGARDING YOUR HEALTH INFORMATION
THESE RIGHTS ARE EFFECTIVE APRIL 14, 2003
Right to Inspect and Copy: You have the right to inspect and obtain a copy of the Indiana Poison Center’s medical record regarding the advice and recommendations we have provided. To inspect and copy your medical or billing record, you must submit your request in writing to the Indiana Poison Center. You need to include in your request your name or if acting as a personal representative include the name of the patient, social security number, date of birth and dates of service if known, and the phone number(s) from which we were called, if known. Please see the list of addresses at the end of this notice. If you request a copy, you may be charged a fee for the costs of copying, mailing or other supplies associated with your request.
We may deny your request to inspect and copy records in certain limited circumstances; however, you may request that the denial be reviewed. A licensed health care professional chosen by The Indiana Poison Center 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.
Right to Request an Amendment: If you feel that health information we have about you is incorrect, you may ask us to amend it. You have the right to request an amendment for as long as the health information is kept by or for the Indiana Poison Center. To request an amendment, your request must be made in writing and submitted to The Director, Indiana Poison Center. Your request may not include dates before April 14, 2003. In addition, you must provide a reason that supports your request. You need to include in your request your name or if acting as a personal representative include the name of the patient, social security number, date of birth and dates of service if known, and the phone number(s) from which we were called, if known. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. In addition, we may deny your request if you ask us to amend health information that:
- Was not created by us, unless the person or entity that created the health information is no longer available to make the amendment.
- Is not part of the health information kept by or for the Indiana Poison Center.
- Is not part of the health information which you would be permitted to inspect and copy.
- Is accurate and complete.
Right to an Accounting of Disclosures: You have the right to request a list of the disclosures we made of your health information except disclosures:
- For treatment, payment or healthcare operations
- To public health authorities
- Pursuant to an authorization
- For incident to a permitted use or disclosure
- For certain other limited disclosures defined by law
To request this list of disclosures, you must submit your request in writing to the Director, Indiana Poison Center, at 1701 N. Senate Blvd., Room B402, Indianapolis, Indiana 46202. Your request must specify a time period for which you are seeking an accounting of disclosures and include your name or if acting as a personal representative include the name of the patient, social security number, date of birth and dates of service if known, and the phone number(s) from which we were called, if known.
You may not request disclosures that are more than six years from the date of your request or that were before April 14, 2003. Your request should indicate in what form you want the list, for example, on paper or electronically. The first list you request within a 12-month period will be free. For additional lists, we may charge you for the costs of providing the list. We will notify you of the cost involved and you may choose to withdraw or modify your request at that time before any costs are incurred.
Right to Request Restrictions: You have the right to request a restriction or limitation on the health 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 health information we disclose about you to someone who is involved in 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 surgery you had.
We are not required to agree to your request: If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment. We have the right to revoke our agreement at any time, and once we notify you of this revocation, we may use or disclose your health information without regard to any restriction or limitation you may have requested.
To request restrictions, you must make your request in writing to The Director, Indiana Poison Center, 1701 N. Senate Blvd., Room B402, Indianapolis, Indiana 46202. In your request, you must tell us (1) what information you want to limit; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply, for example, disclosures to your spouse.
Right to Request Confidential Communications: You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we only contact you at work or by mail.
To request confidential communications, you must make your request in writing to The Director, Indiana Poison Center, 1701 N. Senate Blvd., Room B402, Indianapolis, Indiana 46202. You will need to include your name or if acting as a personal representative include the name of the patient, social security number, date of birth and dates of service if known, and the phone number(s) from which we were contacted, if known.
We will not ask you the reason for your request. We will work to accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.
Right To Receive a Paper Copy of This Notice: Even if you have agreed to receive this Notice electronically, you have the right to receive a paper copy of this Notice, which you may ask for at any time.
You may obtain a copy of this Notice at our website, www.Indianapoisoncenter.org.
To obtain a paper copy of this Notice, write to the Director, Indiana Poison Center, 1701 N. Senate Blvd., Room B402, Indianapolis, Indiana 46202
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for health information we already have about you as well as any information we receive in the future. We will post a copy of the current Notice at the Indiana Poison Center and you may request a copy of the current notice. In addition, the current notice will be posted at www.Indianapoisoncenter.org.
If you want to file a complaint you may call 1-317-962-2335. You may also file a complaint with the Secretary of the Department of Health and Human Services. You will not be penalized for filing a complaint. For further information you may send written inquiries to the Director, Indiana Poison Center, 1701 N. Senate Blvd., Room B402, Indianapolis, Indiana 46202