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Longmont United Hospital's HIPAA Statement

Longmont United Hospital is committed to respecting the privacy of our patients and maintaining the confidentiality of their protected health information. When you consent to treatment at Longmont United Hospital you consent to the use of your information as outlined in our Notice of Privacy Practices. If we decide to change our Notice, such changes will be posted here on our web site. You may visit our web site and browse without giving us any personal information.

If you have questions or comments regarding our Privacy Policies or the security of your information, please call our main number 303.651.5111 and ask for Carol Smith, Privacy Officer or John Peterson, Security Officer.

Notice of Privacy Practices (Effective April 14, 2003)

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.

If this notice was sent to you by e-mail, you may request a paper copy of this notice.

Our Pledge to You

The health care providers at Longmont United Hospital (LUH) create a detailed record of the care and services you receive at our facilities. By law, we must keep this record private. And we must give you this summary of our legal duties and privacy practices, and follow them. Our policies apply to all of the records of your care that LUH maintains.

Who Will Follow These Privacy Practices

Longmont United Hospital provides health care in partnership with physicians, other health-care providers and agencies. These privacy practices will be followed by:

• any health care provider who treats you at any of our locations;
• all board members, employees, staff and volunteers of our organization;
• all members of our Organized Health Care Arrangement (members of our Medical Staff and Allied Health Practitioners such as Nurse Midwives and Nurse Practitioners);
• any business associate or partner who agrees to maintain your privacy.

Some Ways Your Medical Record May be Used or Shared

We may use or share medical information about you:

• for treatment, such as a referral to a specialist or other health care agency;
• for payment, such as your insurance company, Medicare or Medicaid;
• for health care functions such as to improve our services;
• for regulatory agencies such as during an audit or survey of our facilities;
• with those whom you designate to be involved in your care;
• in an emergency or disaster so that your family or friends can be told where you are and how you are;
• when required for public health reports, abuse or neglect reports, funeral arrangements, and organ donation;
• when required by law such as a request from law enforcement or a legal order;
• when required by military authorities if you are a member of the military or a veteran;
• for national security and intelligence activities, or for the protection of the President or others.

Other Ways That Information About You May be Used

Unless you tell us not to, we may use information that we have about you to:

• list you in our hospital directory and give your room number and your status (good, fair, etc.) to those who ask for you by name;
• tell a clergy member of your religion (even if the clergy does not ask for you by name);
• remind you of an appointment;
• recommend possible treatment options;
• tell you about health-related services;
• raise money for our hospital or any of our other facilities.

If you do not want your information to be used for fundraising or marketing, please notify the LUH Privacy Officer in writing.

Uses and Disclosures That Require Your Authorization

In any other situation not covered by this notice we will get your written authorization before using or sharing your health information, including release of psychotherapy records. You may revoke any authorization in writing.

Your Rights Regarding Medical Information About You

In most cases, you may review and obtain a copy of your medical record. There may be a fee for the cost to copy and mail it. Your request must specify how or where you wish to receive your medical record. We will honor all reasonable requests.

You may ask us to correct your record if you think that it is incorrect or that key information is missing. You must put your request in writing and state the reason for your request. We cannot revise your record if the information was not created by us; or is not part of the medical record we maintain; or is not part of the record that you can review or copy; or if we find out that the record is accurate.

You may get a list of when and to whom we gave your medical information. Such a list would not include the permitted disclosures outlined within this notice. Your written request for such a list must state a time period; it must start after April 14, 2003 and be within six years. The first list in a 12-month period is free; other requests will include a fee for our cost to produce the list. We will inform you of the cost before we process your request.

You may ask that we communicate medical information about you in a confidential way, such as sending mail to an address other than your home. We will honor all reasonable requests. Our waiting areas and some of our treatment areas, such as in our physical therapy department, are shared with other patients. Please tell us if you object to this type of waiting or treatment areas. We will do our best to accommodate your request for privacy.

You may ask that we not use or disclose a certain part of your information as allowed by this notice unless you sign a consent to release the information. By law, we do not have to accept such a request, but we will seriously consider it and inform you of our decision. Your request must tell us what specific information you want to limit and to whom the limits apply.

You may make any of these request in writing to the LUH Medical Records Department.

Authorization to Release Protected Health Information

Autorización Para Liberar la Informción de Salud Protegida

Changes to LUH Privacy Notice

We may change our privacy policies at any time. Changes will apply to prior and new medical information. Before we make major changes in our policies, we will change our Notice of Privacy Practices and post the new notice in our facilities and on our Web site (www.luhcares.org). You can get a copy of the current privacy notice at any time. The effective date is listed just below the title.

Complaints and Appeals

You may contact the LUH Privacy Officer if:

• you think that your privacy rights may have been violated;
• you disagree with our decision about access to your records;
• you disagree with our decision not to correct your record.

We will not punish you in any way for filing a complaint. You may also send a written complaint to the U.S. Department of Health and Human Services' Office of Civil Rights.