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Ø Law
Enforcement. We may
release without your consent medical information to a law enforcement
official: · in
response to a court order, grand jury demand, or search warrant; · to
report a death or injury we believe may be the result of criminal conduct; or · to
report criminal conduct committed at Mayview. Ø Coroners,
Medical Examiners, and Funeral Directors. We may release, without your consent,
medical information 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 medical information about the identity of patients to
funeral directors as necessary to carry out their duties. Ø Behavioral
Health Care. Regardless
of the other parts of this Notice, any information related to behavioral
health care treatment, including psychotherapy notes, will not be disclosed
outside Mayview except as authorized by you in writing, pursuant to a court
order, or as required by law. Psychotherapy notes are not included in medical
records maintained by Mayview. YOUR
RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU You
have the following rights regarding medical information we maintain about
you: Ø Right
to Inspect and Copy. If you are a current patient, you or your
legal representative have the right to inspect your records within 24 hours
of your request, excluding weekends and holidays. If you are a current
patient, you or your legal representative have a right to purchase copies of
your records or any portions of your records on two working days’ advance
notice to Mayview. If you are no longer a current patient at the time of your
request to inspect or copy your records, Mayview has up to 60 days from the
date of your request. To
inspect or receive a copy of your records, you must submit your request in
writing to the Business Office. If you request a copy of the information, we
may charge a fee not to exceed the community standard rate for the costs of
copying, mailing, or other supplies associated with your request and may
collect the fee before providing the copy to you. Ø 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 Mayview. To
request an amendment, your request must be made in writing and submitted to
the Social Worker. In addition, you must provide a reason that supports your
request. · 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 that: · was
created by a provider other than Mayview, unless the provider who created the
information is no longer available to consider or make the amendment; · is
not part of the medical information kept by or for Mayview; · is
not part of the information that you would be permitted to inspect and copy;
or · has
been determined to be accurate and complete. Ø Right
to an Accounting of Disclosures. You have the right to request a list of
certain disclosures we have made of medical information about you. To
request this list or accounting of disclosures, you must submit your request
in writing to the Business Office. Your request must state a time period that
may not be longer than six years prior to the request and may not include
dates before April 14, 2003. Your request should indicate in what form you
want the list. 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. We may
collect the fee before providing the list to you. Ø Right
to Request Restrictions.
Except where we are required to disclose the information by law, you
have the right to request a restriction or limitation on the medical
information we use or disclose about you. For example, you could ask that we
not use or disclose information about a treatment you had to a family member
or friend. We
are not required to agree to your request to restrict use or disclosure of
your information within Mayview or among the health care professionals
currently involved in your care at Mayview except with regard to
psychotherapy notes. If we do agree, we will comply with your requested
restriction unless the information is needed to provide you emergency
treatment. Except as permitted or required by law, we will only disclose your
confidential medical information to persons outside Mayview, who are not currently
involved in your care at Mayview, in accordance with your written
authorization. To
request restrictions, you must make your request in writing to the Social
Worker. 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. Ø Right
to Request Alternative Communications. You or your legal representative 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 by speaking with you in a certain location or contacting your
representative at work or at a certain mailing address. To
request communications by certain means, you must make your request in
writing to the Social Worker and specify how or where you wish to be
contacted. We will not ask you the reason for your request. We will
accommodate reasonable requests. Ø Right
to a Paper Copy of This Notice.
You have the right to a paper copy of this notice or any revised
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 still entitled
to a paper copy of this notice. To
obtain a paper copy of this notice, contact the Admissions Director at (919)
828-2348. OTHER
USES OF MEDICAL INFORMATION Other
uses and disclosures of medical information not covered by this notice will
be made only with your written permission or as required by law. If you
provide us permission to use or disclose medical information about you, you
may revoke that permission, in writing, at any time. If you revoke your
permission, we will no longer use or disclose medical information about you
for the purposes that you had authorized in writing. You understand that we
are unable to take back any disclosures we have already made with your
permission, and that we are required to retain our records of the care that
we provided to you. 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 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 at Mayview. The notice will remain in effect for
each subsequent visit unless changed. If the notice changes, a copy will be
made available to you upon request. COMPLAINTS
If
you believe your privacy rights have been violated, you may file a complaint
with Mayview or with the Secretary of the United States Department of Health
and Human Services. To file a complaint with Mayview, contact us by using the
Feedback procedure in the About Mayview booklet. The final authority for
review of complaints to the facility will be the Administrator or the Privacy
Officer, at (919) 828-2348. All complaints must be submitted in writing. You
will not be penalized for filing a complaint. If
you have any questions about this notice, please contact the Admissions
Director at (919)-828-2348. |