Patient Privacy

Your Privacy is Important to Us

Effective Date: April 14, 2003

This notice describes how health information about your child may be used and disclosed and how you can get access to this information. Please review it carefully. When we refer to your child, we also mean you. If you have any questions about this notice, please contact the Children's Hospital Central California Privacy Officer at 559-353-5660.

Who does this notice cover?

This notice describes our hospital's practices and that of:

• All employees, staff, volunteers and other personnel whose work is under direct control of Children’s Hospital Central California.
• All affiliated physicians who provide care to our patients.
• Any health care professional authorized to enter information into your child’s medical chart.
• Any off-campus sites operated by Children’s Hospital Central California.
• Any clinics operated by Specialty Medical Group Central California, Inc.

Our pledge regarding medical information

In the course of receiving services from Children’s Hospital Central California, you will provide us with personal information about your child’s health with the understanding that this information will be kept confidential. We create a record of the care and services your child receives at the hospital. We need this record to provide your child with quality care and to comply with certain legal requirements. This notice applies to all of the records of your child’s care generated by the hospital, whether made by hospital personnel or your child’s personal doctor. Your child’s personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your child’s medical information created in the doctor’s office or clinic.

This notice will tell you about the ways in which we may use and disclose information about your child. We will also describe your rights and certain obligations we have regarding the use and disclosure of such information.

Children’s Hospital Responsibilities

• We are required to protect the privacy of your child’s personal health information.
• We must give this notice of our privacy practices and legal duties regarding health information to anyone who asks for it.
• We must follow the terms of the notice that are currently in effect.

Our right to change this notice

We reserve the right to change our Policies and Procedures, as described in this Notice, at any time. We reserve the right to apply these changes to any health information which we already have, as well as to any health information we receive in the future. We will post a copy of the current notice in prominent locations throughout the hospital. The new notice will include an effective date.

How we may use or disclose your health information

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

For Treatment. We will use information about your child to provide him/her with medical treatment or services. This means we will disclose health information about your child to doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of your child at the hospital. For example, your child may be treated by a physician at the Charlie Mitchell Clinic who may refer your child to the Pulmonology Clinic for care of your child’s asthma. The Charlie Mitchell Clinic physician may need to share health information with the pulmonologist. Different departments of the hospital also may share health information about your child in order to coordinate the different services that your child needs, such as prescriptions, lab work and x-rays. We may share information about your child to individuals outside the hospital who may need it in order to provide you with medical treatment or services after you leave the hospital. This may include, but is not limited to primary care physicians and referring physicians.

For Payment. We will use your child’s health information, and disclose it to others, as necessary to obtain payment for the services we provide to you. For example, we may need to provide health information about surgery that your child received at the hospital so your health plan will pay us or reimburse you for the surgery. We may also tell your health plan about a treatment your child is going to receive to obtain prior approval or to determine whether your plan will cover the treatment.

For Health Care Operations. We will use your child’s health information for activities that are necessary to run the hospital and make sure that all of our patients receive quality care. For example, 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 hospital patients to decide what additional services the hospital should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, medical students, and other hospital personnel for review and learning purposes. 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 the care and services we offer.

Appointment Reminders. We will use and disclose health information to contact you as a reminder that your child has an appointment for treatment or medical care at the hospital.

Treatment Alternatives. We may use health information to inform you about possible treatment options or alternatives that may be of interest to you.

Health-Related Benefits and Services. We may use health information to inform you of health-related benefits or services that may be of interest to you.

Fundraising. We may use your child’s health information to contact you to ask for donations to the hospital and its operations. We may disclose medical information to a foundation related to the hospital for the same purpose. If you do not want the hospital to contact you for fundrasising efforts, contact the Children’s Hospital Central California Privacy Officer in writing at 9300 Valley Children's Place, Mailstop FE06, Madera, CA 93636-8762, Mailstop FE06.

Hospital Directory. We may list your child in our hospital directory if your child is a patient at the hospital. The listing includes your child’s name, location in the hospital, his/her general condition (e.g., fair, stable, etc.). We will also list your child’s religion in the directory, but will disclose that information only to members of the clergy. Except for members of the clergy, we will only disclose the information in the directory to individuals who ask for your child by name. If you ask, we will not list you in the directory, or we will omit any information you ask us to omit.We may also participate in activities with your child where volunteers may be involved with the care of your child. These volunteers may know that your child is at the hospital. This may include volunteers through our hospital guilds.

Individuals Involved in Your Child's Care or Payment for Your Child's Care. We may release information about your child to his/her personal representative unless you tell us in advance not to do so. Unless there is a specific written request form you stating otherwise, we may also tell your family or friends your child’s condition and that your child is in the hospital. In addition, we may disclose medical information about your child to an entity assisting in a disaster relief effort so that your family can be notified about your child’s condition, status and location.

Research. Under certain circumstances, we may disclose your child’s information in connection with research projects. Federal rules govern disclosure of your health information for research purposes without your authorization; however, federal rules also require a patient’s informed consent prior to the receipt of health care services as part of a research project and adequate safeguards to protect the privacy of your child’s health information.

Legal Requirement to Disclose Information. We will disclose your child’s health information when we are required by law to do so. This includes reporting information to government agencies that have the legal responsibility to monitor the health care system. For instance, we may be required to disclose your child’s health information, and the information of others, if we are audited by Medicare or Medicaid. We will also disclose your child’s health information when we are required to do so by a court order or other judicial or administrative process.

To Avert a Serious Threat. We may use and disclose health information if we decide that the disclosure is necessary to prevent serious harm to the public or to an individual. The disclosure will only be made to someone who is able to prevent or reduce the threat.

Organ and Tissue Donation. If your child is an organ donor, we may release information 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.

Public Health Activities. We may disclose medical information about your child for public health activities. We will only make this disclosure if you agree or when required or authorized by law. These activities generally include the following:

• to prevent or control disease, injury or disability including but not limited to the reporting of sexually transmitted diseases, tuberculosis, positive HIV results, etc.
• to report births and deaths;
• to report the abuse or neglect of children, elders and dependent adults;
• 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;
• to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence.

Health Oversight Activities. We may disclose health information 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.

Law Enforcement. We may release your child’s health information for law enforcement purposes, such as:

• to identify or locate a suspect, fugitive, material witness, victim or missing person, or in connection with suspected criminal activity;
• to a federal agency investigating our compliance with federal privacy regulations; or
• to report a crime in emergency circumstances.

Coroners, Medical Examiners and Funeral Directors. We may release your child’s health 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 patients of the hospital to funeral directors as necessary to carry out their duties.

National Security and Intelligence Activities. We may release medical information about your child to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Protective Services for the President and Others. We may disclose medical information about your child to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.

Inmates. If your child is an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about your child to the correctional institution or law enforcement official. This release would be necessary (1) for the institution to provide your child with health care; (2) to protect your child’s health and safety or the health and safety of others; or (3) for the safety and security of the correctional institution.

Your rights

Authorization. Although your child’s health record is the physical property of Children’s Hospital Central California, the information belongs to you and your child. We may use or disclose your child’s health information for any purpose that is listed in this notice without your written authorization. We will not use your health information for any other reason without your written authorization. If you authorize us to use or disclose your child’s health information, you can revoke the authorization at any time.

Right to Inspect and Copy. You have the right to inspect and copy information that may be used to make decisions about your child’s care for a fee. Usually, this includes medical and billing records, but may not include some mental health information. If you want to review or receive a copy of these records, you must make a request in writing. We may charge a fee for the cost of copying and mailing the records. We may also deny you access to certain information. If we do, we will give you the reason, in writing. We will also explain how you may appeal the decision.

Right to Amend. If you feel that information we have about your child 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. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. Please note that even if we accept your request, we are not required to delete any information from your health record.

Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures of health information about your child. This accounting will list the times we have given your health information to others. The list will include the dates of the disclosures, the names of the people or organizations to whom the information was disclosed, a description of the information, and the reason. Disclosures for the following reasons will not be included on the list: disclosures for treatment, payment or healthcare operations; disclosures of information in our Hospital directory; disclosures for national security purposes; disclosures you have authorized and disclosures made directly to you.

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 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 your child 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 child’s care or the payment for your child’s care, like a family member or friend. 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 emergency treatment.

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.

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 still entitled to a paper copy of this notice.

Complaints

If you believe you/your child’s privacy rights have been violated, you may file a complaint with the hospital. To file a complaint with the hospital,
contact the Children’s Hospital Central California Privacy Officer, 9300 Valley Children’s Place, Mailstop FE06, Madera, California, 93636-8762, telephone (559)-353-5660, Email Privacy Officer.  All complaints must be in writing.

You may also file a complaint directly with the Secretary of the U.S. Department of Health and Human Services, at the Office for Civil Rights. All complaints must be in writing. We will not take any retaliation against you if you file a complaint.

For More Information

To act on any of the information provided in the Privacy Notice or for more information about our privacy practices, you may contact the Children’s Hospital Central California Privacy Officer, 9300 Valley Children’s Place, Mailstop FE06, Madera, CA 93636-8762, telephone (559) 353-5660, Email Privacy Officer.

9300 Valley Children’s Place
Madera, California 93636-8762
T: 559.353.3000

Your Privacy is Important to Us - Campus Pharmacy

Effective Date:  April 14, 2003

This notice describes how information about you may be used and disclosed and how you can get access to this information. Please review it carefully. When we refer to you, we also mean your child. If you have  any questions about this notice, please contact the Children's Hospital Central California  Privacy Officer at 559-353-5660.

Who does this notice cover?

This notice describes the privacy practices of the employees and staff of the Children's Hospital Central California Campus Pharmacy.

Our pledge regarding health information

This notice will tell you about the ways in which we may use and disclose health information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of health information.

Campus Pharmacy, Children’s Hospital Central California responsibilities

In the course of receiving services from Campus Pharmacy, Children's Hospital Central California, you will provide us with personal information about your health with the understanding that this information will be kept confidential. We create a record of the pharmaceutical  services you receive. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all of the prescription records of your services generated by the Campus Pharmacy. Your personal doctor may have different policies or notices regarding the doctor's use and disclosure of your health information created in the doctor's office or clinic.

• We are required to protect the privacy of your personal health information.
• We must give this notice of our privacy practices and legal duties regarding health information to anyone who asks for it.
• We must follow the terms of the notice that are currently in effect.

Our right to change this notice

We reserve the right to change our Policies and Procedures, as described in this Notice, at any time. We reserve the right to apply these changes to any health information which we already have, as well as to any health information we receive in the future. We will post a copy of the current notice in a prominent location in the Campus Pharmacy. The new notice will include an effective date.

How we may use and disclose your health information

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

For Treatment. We will use health information about you to provide prescription services. For example, information obtained by the pharmacist will be used to dispense prescription  medications to you. We will document in your prescription record information related to the medication dispensed to you and services provided to you. Pharmacists may need to obtain health information about you from family members, primary care physician, or your Children's Hospital records in order to evaluate potential drug reactions.   We may share prescription  information with another pharmacy when you choose to transfer a  prescription so that prescription refills may be completed. We may share information about you to  individuals outside the Campus Pharmacy who may be need it in order to provide you with medical treatment or services after you leave the Campus Pharmacy. This may include, but is not limited to  primary care physicians and referring physicians.

For Payment. We will use your health information, and disclose it to others, as  necessary to obtain payment for the services we provide to you. For example, we will contact your insurer or pharmacy benefit manager to determine whether it will pay for your prescription and the amount  of your co-payment. We will bill you or a third-party payer for the cost of prescription medications dispensed to you. The information on or accompanying the bill may include information that identifies you, as well as the prescriptions you
are taking.

For Health Care Operations. We will use your health information for activities that are necessary to run the Campus Pharmacy and make sure that all of our patients receive quality care. For example, the Campus Pharmacy may use information in you health record to monitor the performance of the pharmacists providing treatment to you. This information will be used in an effort to continually improve the quality and effectiveness of the health care and service we provide.

Health-Related Benefits, Services and Communications. We may contact you to provide refill reminders or inform you of health-related benefits or services that may be of interest to you.

Food and Drug Administration (FDA). We may disclose to the FDA, or persons under the jurisdiction of the FDA, health information relative to adverse events with respect to drugs, food, supplements, products and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

Fundraising. Campus Pharmacy is a part of Children's Hospital and we may use your health information to contact you to ask for donations to the  hospital and its operations. We may disclose information to a foundation related to the hospital for the same purpose. If you do not want the hospital to contact you for fundraising efforts, contact the Children's Hospital Central California Privacy Officer in writing at 9300 Valley Children's Place, Mailstop FE06, Madera, CA 93736, Mail Stop FE06.

Individuals Involved in You Care or Payment for Your Care. Pharmacists, using their  professional judgment, may disclose to a family member, other relative, close personal friend or any person you identify, health information  relevant to that person's  involvement in your care or payment related to your care.

Research. Under certain circumstances, we may disclose your information in connection with research projects.  Federal rules govern disclosure of your health information for research purposes without your authorization; however, federal rules also require a patient's informed consent prior to the receipt of health care services as part of a research project and adequate safeguards to protect the privacy of your health information.

Legal Requirement to Disclose Information. We will disclose your health  information when we are required by law to do so. This includes reporting information to government agencies that have the legal responsibility to monitor the health care system. For instance, we may be required to disclose your health information, and the information of others, if we are audited by Medicare or Medicaid, Medical Board of Pharmacy or the Drug Enforcement Agency. We will also disclose your health information when we are required to do so by a court order or other judicial or administrative process.

To Avert a Serious Threat to Health or Safety. We may disclose health information if we decide that the disclosure is necessary to prevent serious harm to the public or to an individual. The disclosure will only be made to someone who is able to prevent or reduce the threat.

Organ and Tissue Donation. If you are an organ donor, we may release information 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.

Worker's Compensation. If you are an employee of Children's Hospital, we may disclose your health information as authorized or as necessary to comply with laws relating to worker's compensation or similar programs established by law.

Public Health Risks. We may disclose your medical information for public health activities.  We will only make this disclosure if you agree or when required or authorized by law. These activities generally include the following:

• to prevent or control disease, injury or disability including but not limited to the reporting of sexually transmitted diseases, tuberculosis, positive HIV results, etc. to report births and deaths;
• to report the abuse or  neglect of children, elders and dependent adults;
• 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;
• to notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence.

Health Oversight Activities. We may disclose information 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.

Law Enforcement.

We may release your health information for law enforcement purposes, such as:

• to identify or locate a suspect, fugitive, material witness, victim or missing person, or in connection with suspected criminal activity;
• to a federal agency investigating our compliance with federal privacy regulations; or
• to report a crime in emergency circumstances.

Coroners, Medical Examiners and Funeral Directors. We may release your health 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 patients of the hospital to funeral directors as necessary to carry out their duties.

Military and Veterans. If you are a member of the armed forces, we may release health information about you as required by military command authorities.  We may also release health information about foreign military personnel to the appropriate military authority.

National Security and Intelligence Activities. We may release your health information to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Protective Services for the President and Others. We may disclose your health information to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or conduct special investigations.

Inmates. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release health information about you to the correctional institution or 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.

Your Rights

Authorization. Although your prescription record is the physical property of the Campus Pharmacy, Children's Hospital Central California, the information belongs to you. We may use or disclose your health information for any purpose that is listed in this notice without your written authorization. We will not use your health information for any other reason without your written authorization. If you authorize us to use or disclose your health information, you can revoke the authorization at any time.

Right to Inspect and Copy. You have the right to inspect and copy your prescription and billing records for a fee.   If you want to review or receive a copy of these records, you must make a request in writing. We may charge a fee for the cost of copying and mailing the records. We may also deny you access to certain information. If we do, we will give you the reason, in writing. We will also explain how you may appeal the decision.

Right to Amend. If you feel that 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 as long as the information is kept by or for the Campus Pharmacy. We may deny your request for an amendment if it is not in writing or does not include a reason to support the request.  Please note that even if we accept your request, we are not required to delete any information from your prescription record.

Right to an Accounting of Disclosures. You have the right to request a list of certain disclosures of your prescription and billing records. This accounting will list the times we have given your health information to others. The list will include the dates of the disclosures, the names of the people or organizations to whom the information was disclosed, a description of the information, and the reason. Disclosures for the following reasons will not be included on the list: disclosures for treatment, payment or healthcare operations; disclosures for national security purposes; disclosures you have authorized and disclosures made directly to you.

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 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 your prescription records 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, such as a family member or friend. 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 emergency treatment.

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.

Right to a Paper Copy of Privacy 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 still entitled to a paper copy of this notice.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with the hospital. To file a complaint with the hospital, contact the Children's Hospital Central California Privacy Officer, 9300 Valley Children's Place, Mail Stop FE06, Madera, California, 93738, (559) 353-5660. All complaints must be in writing.

You may also file a complaint directly with the Secretary of the U.S. Department of Health and Human Services, at the Office for Civil Rights. All complaints must be in writing. We will not take any retaliation against you if you file a complaint.

For more information

To act on any of the information provided in the Privacy Notice or for more information about our privacy practices, you may contact the Children's Hospital Central California Privacy Officer, 9300 Valley Children's Place, Mailstop FE06, Madera, CA 93638, telephone (559) 353-5660, E-mail Privacy Officer.

9300 Valley Children’s Place
Madera, California 93636
Reviewed by Legal Services January 14, 2003
T: 559.353.3000