THIS NOTICE OF PRIVACY 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.

WHO WILL FOLLOW THIS NOTICE

This notice describes the privacy practices of Boys Town National Research Hospital entities including those of:

  • Any health care professional authorized to enter information into your medical record.
  • All members of the hospital Medical Staff
  • All departments and units of the hospital, including outpatient clinics.
  • Any member of a volunteer group we allow to help you while care is being provided.
  • Creighton University Pharmacy
  • All the above-identified entities, sites and locations will follow the terms of this notice. In addition, these entities, sites and locations may share medical information with each other for treatment, payment or hospital operations as described in this notice.

UNDERSTANDING YOUR HEALTH RECORD/INFORMATION

Every time you visit a physician, the hospital or other healthcare provider, a record of your visit is made. This health record includes symptoms, examination and test results, diagnosis, treatment, and plans for future care or treatment. Your provider uses this information to plan your care and treatment. Your health record is also used as a communication tool by the many providers at the hospital. Your health information is also used by insurance companies to verify that services we billed for were actually provided. Although your health record belongs to the hospital, you do have certain rights with regard to your health information.

This privacy practices notice will tell you about the ways in which we may use and disclose medical information about you. It also describes your rights and certain obligations we have regarding the use and disclosure of your medical information.

We are required by law to:

  • Make sure that medical information that identifies you is kept private.
  • Follow the terms of the notice that is currently in effect.
  • Follow the terms of the notice that is currently in effect.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU

The following categories describe different ways we use and disclose medical information. For each category of uses and disclosures, we will explain what we mean and give some examples. Not every use or disclosure in a category will be listed. All of the ways we are permitted to use and disclose information will fall within one of the identified categories.

For Treatment

Information obtained by members of your healthcare team will be recorded in your record and used to determine the course of your treatment. Healthcare team members will communicate with one another personally and through the health record to coordinate your care. We may provide your physician or other healthcare provider with copies of reports that may help determine your future treatment. We may also disclose your information to another healthcare provider for its payment purposes or its healthcare operations.

For Payment

We may use and disclose medical information about you so that the treatment and services you receive may be billed to and payment may be collected from you, an insurance company, or a third party. We may also tell your health plan about a treatment you are going to receive to obtain prior approval (pre-certification) or to determine whether your plan will cover the treatment.

For Health Care Operations

We may use and disclose medical information about you for hospital operations. These uses and disclosures are necessary to operate the entity and promote quality care. We may use medical information to review our treatment and services and to evaluate the performance of our staff. We may also combine medical information about many patients to decide what additional services we should offer, what services are not needed, and whether certain new treatments are effective. We may disclose information to doctors, nurses, technicians, medical students and other personnel for review and learning purposes. We may disclose medical information about you to entities outside of the hospital for certain healthcare operations as long as both entities have treated you. We may also combine the medical information we have with medical information from other hospitals to compare how we are doing and see where we can make improvements in care and services. We may remove information that identifies you from this set of medical information so that others may use it to study health care and health care delivery without learning patient specifics.

We may disclose your health information to an appropriate health oversight agency, public health authority or attorney involved in health oversight activities.

Business Associates

We may disclose medical information to other persons or organizations, known as business associates, who provide services on our behalf under contract. To protect your medical information, we require our business associates to appropriately safeguard the information we disclose to them.

Health Related Benefits & Services

We may contact you to regarding appointments, information about treatment alternatives, test results, or other health related benefits and services.

We may use your information to provide you with information regarding health-related products, benefits or services (not limited to marketing and fundraising).

Fundraising Activities

We may disclose information about you to our hospital related foundation so the foundation may contact you in raising money for hospital operations. We will only release demographic information, such as your name, address and phone number, and the dates you received treatment or services. If you do not want to be contacted for fundraising efforts, you must notify the Hospital Privacy Officer in writing.

Notification/Communication

We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location, and general condition.

Unless state or federal law otherwise restricts us, or unless you instruct us not to, we may release your location within the hospital to people who ask for you by name. In addition, we may release your name, location, and religious affiliation to members of the clergy.

We may disclose information to specified authorities if we believe in good faith that a disclosure of your protected health information is necessary to prevent or minimize a serious threat to you or the public's health or safety

Research

We may disclose information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to protect the privacy of your health information. In addition, we may disclose information to researchers in preparation for research.

As Required By Law

We will disclose medical information about you when required to do so by federal, state or local law.

Organ procurement organizations

Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

Workers' Compensation

We may release medical information about you for workers' compensation or similar programs that provide benefits for work-related injuries or illness.

State & Governmental Reporting

We may disclose your protected health information to a public health authority that is permitted to collect or receive the information. We may be required to report information to help prevent or control disease, injury, or disability. We may also disclose information, if directed by the public health authority, to a foreign government agency that collaborates with the public health authority. This includes reporting child abuse, domestic violence or neglect, FDA regulated products or activities, and exposure to communicable diseases.

Consistent with applicable law, we may disclose health information about you for judicial, administrative and law enforcement purposes.

We may disclose your health information for military and veterans' activities, national security and intelligence activities, and similar special governmental functions as required or permitted by law.

We may release medical information about you to a correctional institution or law enforcement official if you are an inmate of a correctional institution or under the custody of a law enforcement official.

Legal Disclosure

If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical 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 information requested.

OTHER USES OF MEDICAL INFORMATION

Other uses and disclosures of medical information not covered by this notice or the laws that apply to us will be made only with your authorization. If you provide us authorization to use or disclose medical information about you, you may revoke that authorization, in writing, at any time. If you revoke your authorization, we will no longer use or disclose medical information for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your authorization and that we are required to retain records of the care provided.

YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU

You have the following rights regarding medical information we maintain about you:

Right to Inspect and Copy

You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records. This does not include psychotherapy records.

You must submit your request to inspect and copy medical information that may be used to make decisions about you in writing to the Medical Records Director. If you request a copy of the information, we may charge a fee for the costs of copying, mailing or other supplies associated with your request. Use this form to request the release of medical information.

We may deny your request to inspect and copy medical information in certain circumstances. If you are denied access to medical information, you may request that the denial be reviewed. A 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.

Right to Amend

If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have the right to request an amendment for as long as the information is kept by or for the Hospital.

To request an amendment, your request must be in writing and submitted to the Medical Records Director. In addition, you must provide a reason that supports your request for amendment. 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 information:

  • Not created by us, unless the person or entity that created the information is no longer available to make the amendment;
  • Not part of the medical information kept by or for a hospital entity;
  • Not part of the information which you would be permitted to inspect and copy under the law; or
  • That is accurate and complete.

Right to an Accounting of Disclosures

You have the right to request an accounting of disclosures, which is a list of medical information disclosures made about you.

To request an accounting of disclosures, you must submit a request in writing to the Medical Records Director. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper, electronically). The first list of disclosures you request within a 12-month period will be free. We may charge for the costs of providing additional lists. We will notify you of the cost involved and you may choose to withdraw or modify your request before any costs are incurred.

Right to Request Restrictions

You have the right to request a restriction or limitation on the medical 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 medical information we disclose about you to someone who is involved in your care or the payment for care, like a family member or friend.

We are not required to agree to your request. If we do agree to a requested restriction, we will comply with your request unless the information is needed to provide emergency treatment.

To request restrictions, you must make your request in writing to the Privacy Officer. 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.

Right to Request Confidential Communications

You have the right to request that we communicate with you about your medical matters in a certain way or at a certain location.

To request confidential communications, you must make your request in writing to the Privacy Officer. We will not ask you the reason for your request. We will accommodate all reasonable requests. Your request must specify how or where you wish to be contacted.

Right to a Paper Copy of This Notice

You have the right to a paper copy of this notice. You may ask us to give you a copy of this notice at any time. Even if you have agreed to receive this notice electronically, you are entitled to a paper copy of this notice.

You may obtain a copy of this notice at our website, http://www.boystownhospital.org/. To obtain a paper copy of this notice, contact the Privacy Officer.

CHANGES TO THIS NOTICE

We reserve the right to or may be required by law to change our privacy practices, which may result in changes to this notice. We further reserve the right to make the revised or changed privacy practices notice effective for medical 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 in each hospital entity and on our website. The notice will contain the version number and effective date. In addition, each time you register you or are admitted to the hospital or otherwise treated by a hospital entity, we will offer you a copy of the current notice in effect.

COMPLAINTS

If you believe your privacy rights have been violated, you may file a complaint with the BTNRH Privacy Officer or with the Secretary of the Department of Health and Human Services. You will not be penalized or otherwise retaliated against for filing a complaint.

Contact:

Privacy Officer
Boys Town National Research Hospital
555 North 30th Street
Omaha, NE 68131
(402) 498-6587

If you have any questions or would like additional information about this notice or our Privacy Practices, please contact the Privacy Officer at (402) 498-6587.