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THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY. THE PRIVACY OF YOUR MEDICAL INFORMATION IS IMPORTANT TO US.

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OUR LEGAL DUTY

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We are legally required to protect the privacy of your medical information. We must provide you with this notice about our privacy practices, our legal duties, and your rights concerning your medical information. We are required to follow the privacy practices that are described in this notice. This notice takes effect April14, 2003 and will remain in effect until we replace it.
We reserve the right to change the terms of this notice and our privacy policies at any time. A change in our privacy practices and the new terms of our notice are effective for all medical information that we maintain, including medical information we created or received before we made the change. Before we make a significant change in our privacy practices, we will change this notice and make the new notice available upon request.
You may request a copy of our notice at any time. For more information about our privacy practices, or for additional copies of this notice, please contact us using the information listed at the end of this notice.

HOW WE MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION

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We use and disclose medical information for many different reasons. For some of these uses or disclosures, we need your prior consent or specific authorization. Below, we describe the different categories of our uses and disclosures.
Uses and Disclosures Relating to Treatment, Payment, or Health Care Operations:
Treatment: We may disclose your medical information to physicians, nurses, medical students, and other health care personnel who provide you with health care services or are involved in your care.
Payment: We may use and disclose your medical information in order to bill and collect payment for the treatment and services provided to you. We may also provide your medical information to our business associates, such as billing companies, claims processing companies, and others that process our health care claims.
Health Care Operations: We may use and disclose your medical information in order to operate this hospital. For example, we may use your medical information in order to evaluate the quality of health care services that you received or to evaluate the performance of the health care professionals who provided health care services to you. We may also provide your medical information to our accountants, attorneys, consultants, and others in order to make sure we are complying with the laws that affect us.
We may disclose your medical information to another entity that has a relationship with you and is subject to the federal privacy rules, for their health care operations relating to quality assessment and improvement activities, reviewing the competence or qualifications of health care professionals, or detecting or preventing health care fraud and abuse.
On Your Authorization: You may give us written authorization to use your medical information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosure permitted by your authorization while it was in effect. Unless you give us a written authorization, we cannot use or disclose your medical information for any reason except those described in this notice.
To Your Family and Friends: We may disclose your medical information to a family member, friend or other person to the extent necessary to help with your health care or with payment for your health care. We may use or disclose your name, location, and general condition or death to notify, or assist in the notification of (including identifying or locating), a person involved in your care.
Before we disclose your medical information to a person involved in your health care or payment for your health care, we will provide you with an opportunity to object to such uses or disclosures. If you are not present, or in the event of your incapacity or an emergency, we will disclose your medical information based on our professional judgment of whether the disclosure would be in your best interest.
We will also use our professional judgment and our experience with common practice to allow a person to pick up filled prescriptions, medical supplies, x-rays or other similar forms of medical information.
When a Disclosure is Required by Federal, State or Local Law, Judicial or Administrative Proceedings, or Law Enforcement: For example we make disclosures when a law requires that we report information to government agencies and law enforcement personnel about victims of abuse, neglect, or domestic violence; when dealing with gunshot and other wounds; or when ordered in a judicial or administrative proceeding.
For Public Health Activities: For example, we report information about births, deaths, and various diseases to government official in charge of collecting that information , and we provide coroners, medical examiners, and funeral directors necessary information relating to an individual's death.
For Health Oversight Activities: For example, we will provide information to assist the government when it conducts an investigation or inspection of a health care provider or organization.
For Purposes of Organ Donation: We may notify organ procurement organizations to assist them in organ, eye, or tissue donation and transplants.
To Avoid Harm: In order to avoid a serious threat to the health or safety of a person or the public, we may provide medical information to law enforcement personnel or persons able to prevent or lessen such harm.
For Specific Government Functions: We may disclose medical information of military personnel and veterans in certain situations. And we may disclose medical information for national security purposes.
For Workers' Compensation Purposes: We may provide medical information in order to comply with workers' compensation laws.
Disaster Relief: We may use or disclose your medical information to a public or private entity authorized by law to assist in disaster relief efforts.

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YOUR RIGHTS

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Access: You have the right to look at or get copies of your medical information, with limited exceptions. You must make the request in writing. If we don't have your medical information but we know who does, we will tell you how to get it. We will respond to you within 30 days after receiving your written request. In certain situations, we may deny your request. If we do, we will tell you, in writing our reasons for the denial and explain your right to have the denial reviewed.
If you request copies of your medical information, we will charge you $.60 for each page. Instead of providing the medical information you requested, we may provide you with a summary or explanation of your medical information as long as you agree to that and to the cost in advance.
Disclosure Accounting: You have the right to receive a list of instances in which we have disclosed your medical information for purposes other than treatment, payment, health care operations, as authorized by you, and for certain other activities, since April 14, 2003. We will provide you with the date on which we made the disclosure, the name of the person or entity to whom we disclosed your medical information, a description of the medical information we disclosed, the reason for the disclosure, and certain other information. If you request this accounting more than once in a 12-month period, we may charge you a reasonable, cost-based fee for responding to these additional requests.
We will respond within 60 days of receiving your request. The list we will give you will include disclosures made in the last six years unless you request a shorter time.
Restriction: You have the right to ask that we limit how we use and disclose your medical information. We will consider your request but are not legally required to accept it. If we accept your request, we will put the agreement in writing and abide by the limitations, except in emergency situations. You may not limit the uses and disclosures that we are legally required or allowed to make.
Confidential Communication: You have the right to ask that we communicate with you about your medical information by alternative means or to alternative locations. You must make your request in writing. We must agree to your request if it is reasonable, specifies the alternative means or location, and provides satisfactory explanation of how payments will be handled under the alternative means or location you request.
Amendment: You have the right to request that we amend your medical information. You must provide the request and your reason for the request in writing. We will respond within 60 days of receiving your request. We may deny your request in writing if the medical information is 1) correct and complete, 2) not created by us, 3) not allowed to be disclosed, or 4) not part of our records. Our written denial will state the reason for the denial and explain your right to file a written statement of disagreement with the denial. If you don't file one, you have the right to request that your request and our denial be attached to all future disclosures of your medical information. If we approve your request, we will make the amendment to your medical information, we will tell you that we have done it, we will tell others that need to know about the amendment to your medical information, and we will include the amendment in any further disclosure of that medical information.
Electronic Notice: You have the right to get a copy of this notice by e-mail. Even if you have agreed to receive notice via e-mail, you also have the right to request a paper copy of this notice.

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QUESTIONS AND COMPLAINTS

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If you want more information about our privacy practices or have questions or concerns, please contact us using the information listed at the end of this notice.
If you are concerned that we may have violated your privacy rights, or you disagree with a decision we made about access to your medical information or in response to a request you made to amend or restrict the use or disclosure of your medical information or to have us communicate with you by alternative means or at alternative locations, you may complain to us by using the contact information listed at the end of this notice. You also may submit a written complaint to the U.S. Department of Health and Human services. We will provide you with the address to file your complaint with the U.S. Department of Health and Human Services upon request.
We support your right to the privacy of your medical information. We will not retaliate in any way if you choose to file a complaint with us or with the U.S. Department of Health and Human Services.

Contact:	Ralayne Hill, Privacy Officer
Telephone:	775-635-2550, ext 118
Fax:	775-635-6056
E-mail:	medrec@battlemtgeneralhospital.org
Address:	Battle Mountain General Hospital 535 So. Humboldt St. Battle Mountain, Nevada 89820