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.
Federal and State Laws Relating to False Statements and False Claims.
“We Take Pride in Caring About Your Privacy”
Here at Raritan Bay Medical Center, we are dedicated to protecting the privacy of your medical information while providing you with the highest quality medical care. This Notice:
- Explains how we use and share your protected health information (PHI)
- Describes your rights regarding your PHI
- Outlines how you can exercise those rights
Who is required to abide by this Notice?
- Employees, staff, students, volunteers, clergy, physicians and clinical staff
- All hospital departments and units
- All individuals authorized to enter information in your medical chart
This Notice applies to Raritan Bay Medical Center at our Old Bridge Division and our Perth Amboy location,and our Old Bridge location, Raritan Management Corporation, Raritan Bay Health Services Corporation, Respond Ambulance Service, Joseph S. Yewaisis Outpatient Center, Primary Care Physicians, Raritan Bay Pediatrics, Addiction Treatment Services & Methadone Clinic, Women’s Center, Sleep Center and the Medical Pavillion at Woodbridge. The individuals and entities listed above, at all listed locations, may share PHI with each other for the purposes outlined in this notice. Your doctor may have different privacy policies and practices relating to PHI created or received by his or her practice.
We are required by law to:
- Maintain the privacy of your PHI
- Provide you with this Notice to describe how we do that
- Advise you of your rights with regard to your PHI
- Abide by the terms described in the version of this Notice currently in effect
WE MAY USE OR SHARE YOUR PHI ONLY FOR THESE PURPOSES:
Treatment – We may use and share your PHI with doctors, nurses and other clinical professionals who are directly or indirectly involved in providing for your care. For example, we may share your PHI with a reference laboratory to help us reach a diagnosis. We will provide additional protections to your PHI related to treatment for mental health, alcohol and substance abuse and HIV/AIDS.
Payment - We may use and share your PHI for the purposes of obtaining payment for the health care products and services you receive from us. For example, we may contact your health insurance company to verify that you are entitled to benefits, or we may share details regarding your treatment with a third party payer in order to bill for and collect the fees associated with your treatment.
Health Care Operations – We may use and share your PHI as necessary to run our facilities and to ensure that all patients receive the highest quality of care. For example, we may use your PHI to evaluate the quality of care you receive from us, to create a learning experience for a clinical professional, or to conduct a cost management analysis. When we share your PHI with an outside party to perform these services, we will do so subject to a written contract that requires that the information be kept confidential.
Value-Added Patient Outreach – We may use your PHI to contact you about an appointment reminder, an alternative treatment for your condition, or other health related services that may be of interest to you.
Directory – We may use the following information to maintain our hospital directory: your name, your location, your general condition expressed as one word (e.g., good, fair),and your religious affiliation. Unless you object, we may provide this information to members of the clergy and we may provide your location and general condition to any individual who asks for you by name. You may object to this use of your PHI in writing through our registrar.
To Family and Individuals Involved in Your Care – Unless you object, we may share with your family member, other relative or your close personal friend, the PHI directly related to that person’s involvement with your care, or payment for your healthcare. We may also use your PHI to notify family of your location, condition or death. If you are present, you may object orally to a disclosure to a family member or friend. For example, you may ask a doctor to refrain from sharing certain information while family members or friends are at your bedside.
For Disaster Relief – Unless you object, we may share your PHI with an entity assisting in disaster relief efforts, in order for your family to be able to locate you or learn of your condition. Even if you object, we may not be able to honor your request if we believe that it interferes with our ability to respond appropriately to the emergency or disaster condition.
Fundraising – We may share your contact information with Raritan Bay Healthcare Foundation to reach out to you for the purpose of raising funds for our hospitals.
As Required By Law – We may share your PHI as the law requires with regard to abuse, neglect or domestic violence, in response to a court order, valid subpoena or as otherwise required by state, federal or local law.
Public Health Activities – We may share your PHI for public health activities. Examples include disease reporting, birth and death recording, reporting adverse reactions or product defects to the FDA, to enable product recall or replacement. We may also share PHI if we believe you have been exposed to a contagious disease, or if you may be at risk of spreading one. We may share PHI with your employer if we are treating you at your employer’s request and it is in relation to a work related illness or injury.
Health Oversight Activities – We may share your PHI with an oversight agency, as required by law. Examples include audits, civil investigations, inspections and licensure activities. These activities are intended to oversee our health care system and government benefit programs and to protect your civil rights.
Law Enforcement Purposes – We may share your PHI as the law requires with regard to the reporting of certain types of injuries, in response to a court order or grand jury subpoena. We may release limited information to assist law enforcement in locating a fugitive, suspect or missing person. We may share your PHI with law enforcement officials if we believe you are the victim of a crime, and you do not object. We may share PHI if we suspect that a crime has been committed on our premises.
Coroners, Funeral Directors and Organ, Tissue and Eye Donation Entities – We may share your PHI in order to confirm identity, determine cause of death, or for the purposes of facilitating organ, tissue and eye donations and transplants.
Research – We may share your PHI with researchers when authorized by law, for example, if the research proposal was reviewed and approved by our Institutional Review Board and safeguards are established to ensure the privacy of your PHI. In most cases, however, we will obtain your written authorization before your PHI is shared for research purposes.
To Avert a Serious Threat to Health and Safety – We may use and share your PHI if we believe that doing so is necessary to avoid a serious threat to your personal health or safety, or to the health or safety of another individual.
Specialized Government Functions – If you are a member of domestic or foreign armed forces, we may share your PHI with authorized military command authorities. We may also share your PHI for national security activities, to provide protective services for the President of the United States or to a correctional institution if you are an inmate of that institution.
Workers’ Compensation – We may share your PHI, as required by law, with programs that provide benefits for work-related illnesses and injuries.
With Your Expressed Authorization – You may permit the sharing of your PHI with any outside party by signing an authorization form. You may revoke your authorization at any time, in writing.
YOU HAVE RIGHTS WITH REGARD TO YOUR PROTECTED HEALTH INFORMATION. SPECIFICALLY, YOU HAVE THE RIGHT TO:
Receive a Copy of this Notice – You have the right to receive a paper copy of this notice upon request, even if you have chosen to receive the notice electronically. Any of our registrars will be happy to provide you with this paper notice. It is also available on our website. www.rbmc.org
Access Your PHI – You have the right to review and obtain a copy of your PHI we keep for the purpose of making decisions about your care. Your written request should be directed to our medical records department on a request form provided for your convenience. In rare cases, we may deny your request to access your record. In such a case, you have the right to appeal our decision to a reviewing official. We will abide by the decision made by the reviewing official. If you request a copy of your PHI, we may charge a fee to cover the costs of copying, postage or preparation of explanation or summary of the PHI.
Receive Confidential Communications From Us – You may request that we communicate with you in a confidential way by providing an alternative address or telephone number. You may do so orally during the registration process, or in writing at any time. Your request should be directed to the attention of our admissions registrar. You do not have to give us a reason. We will honor all reasonable requests.
Amend Your PHI – You have the right to an accurate and complete medical record. You may request that we amend any PHI we keep for the purpose of making decisions about your care, for as long as we keep that PHI. We ask that you make your request in writing to our director of medical records, and that you provide a reason for your request. We will give our serious consideration to all requests. We are not required to agree to all requested amendments, however, we will communicate with you in writing if we deny your request, and will explain the reason for our denial and your right of appeal.
Request Restrictions on Certain Uses and Disclosures of Your PHI – You have the right to request that we restrict the use and disclosure of your PHI for treatment, payment or healthcare operations. We are not required to agree to your requested restrictions. Even if we agree to your request, in certain situations your restrictions may not be followed. These situations include emergency treatment and disclosures to the Secretary of the Department of Health and Human Services. You may address your written request for a restriction to our privacy officer.
Receive an Accounting of Disclosures – You have the right to see a list of the entities with which we shared your PHI, going back six years from the date of your request. The list will not include routine disclosures for treatment, payment or operations purposes, disclosures that you authorized or disclosures made before April 14, 2003, but it will include most of the other disclosures outlined in this Notice. Your request for this list should be made in writing to the attention of our medical records director. In most cases, we will provide you with the list within 30 days.
If you have questions about the content of this Notice, or believe your privacy rights have been violated, please contact us at the address below. We pledge to use your comments for performance and process improvement only; you will not be retaliated against for filing a complaint. You also have the right to complain to the Secretary of the Department of Health and Human Services.
Privacy Officer
Raritan Bay Medical Center
530 New Brunswick Avenue
Perth Amboy, NJ 08861
Phone: 732.324.6062
Fax: 732.324.4979
privacyofficer@rbmc.org
www.rbmc.org
The effective date of this Notice is April 14, 2003. We reserve the right to make changes to this Notice, and to make the new Notice provisions effective for all PHI we maintain. We will post the new Notice prominently in our offices and electronically on our web site. Paper copies of the revised Notice will be available through our registrars and our Privacy Office.