Southwest Utah Community Health Center
168 North 100 East, Suite 101
St. George, Utah 84770
(435) 986-2565
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Notice of Privacy Practices
for Protected Health Information
(Effective: April 12, 2003)
HIPAA: Health Insurance Portability and Accountability Act of 1996
This Notice describes how medical information about YOU may be used, disclosed, and/or requested, and how YOU can get access to this information. Please review this Notice carefully.
OUR PRIVACY PROMISE TO YOU
The Southwest Utah Community Health Center ('Community Health Center') understands that your medical and health information is personal. Protecting your health information is important. We follow strict federal and state laws that require us to maintain the confidentiality of your health information.
HOW WE USE YOUR HEALTH INFORMATION
When you receive care from the Community Health Center, we may use your health information for treating, billing, and normal health care business operations. Examples of how we use your information include:
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Treatment – We keep records of health care and related services we provide to you We use these records (such as your history of immunizations) to document that we delivered quality care to you.
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Payment - We keep billing records that include payment information and documentation of the services provided to you. Your information may be used to obtain payment from you, your insurance company, or another third party. We may also contact your insurance company to verify coverage for your care, or to notify them of upcoming services that may need prior notice or approval.
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Health Care Operations – We use health information to improve the quality of care, train staff and students, provide customer service, arrange costs, conduct required business duties, and make plans to better serve our communities.
OTHER SERVICES WE PROVIDE
We may also use your health information to:
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Recommend treatment alternatives.
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Tell you about health services and products that may benefit you.
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Share information with third parties such as our business associates) who assist us with treatment, payment, and health care operations (and who must also safeguard your health information).
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Notify immediate family members and authorized personal representative(s) about certain health information that (in our professional judgment) is in your best interest, is necessary for them to know, and is relevant to their involvement in your care. If you are able to object, we will respond to your request that we do not give such notifications.
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Remind you of an appointment unless you request that we not send reminders to you. You may also request to receive your health information by alternative means or at alternative locations.
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Contact you for fundraising purposes (or at your option, respond to your request that we do not contact you for fundraising purposes).
SHARING YOUR HEALTH INFORMATION
There are limited situations when we are permitted or required to disclose health information about you without your signed authorization. These situations are:
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For public health purposes such as tracking diseases and injuries, reporting births and deaths, and reporting reactions to drugs and problems with medical devices, as required by law.
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To protect victims of abuse, neglect, or domestic violence, as required by law.
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For required state/federal health oversight activities such as investigations, audits, and inspections.
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For lawsuits and similar proceedings, as required by law or court order.
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When requested by law enforcement, as required by law or court order.
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For coroners, medical examiners, and funeral directors, as required by law.
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For organ and tissue donation, as required by law.
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For research approved by our review process and pursuant to strict federal guidelines.
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To reduce or prevent a serious threat to public health and safety, as required by law.
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For state required workers' compensation or other similar programs, if you are injured at work.
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For specialized government functions such as intelligence and national security, as required by law or court order.
[All other uses/disclosures, not described in this Notice, require a signed authorization from you. You may revoke (in writing) such authorization at any time (to the extent it has not been acted upon). If you would like to authorize us to act on a particular health information need that you have, please obtain/complete a copy of our easy-to-use authorization/revocation/request form from the Community Health Center Privacy Officer.]
OUR PRIVACY RESPONSIBILITIES
The Community Health Center is required by law to:
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Maintain the privacy of your health information,
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Provide this Notice that describes the ways we may use, share and request your health information,
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Follow the terms of our Notice currently in effect.
We reserve the right to make changes to this Notice at any time, and make the new privacy practices effective for all information we maintain. Current Notices are available at all Community Health Center facilities. You may obtain a copy of any previous edition of this Notice from the Community Health Center Privacy Officer.
YOUR INDIVIDUAL PRIVACY RIGHTS
You have the right to:
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Request restrictions on how we use, share and/or request your health information. We will consider all requests carefully, but are not required to agree to restrictions.*
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Request that we use alternative means or alternative locations in our confidential communications to you.*
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Inspect and copy your health information, including medical and billing records. Fees may apply. Under limited circumstances, we may deny you access to a portion of your health records and you may request a review of the denial.*
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Request corrections or additions to your health information to ensure accuracy.*
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Request an accounting of certain disclosures of your health information made by us. The accounting does not include disclosures made for treatment, payment, health care operations, and some disclosures required by law. Your request must state the period of time desired for the accounting, which must be within the six years prior to your request, and excludes dates prior to April 14, 2003. The first accounting is free, but a fee will apply if more than one request is made in a 12 month period.*
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Request a paper copy of this Notice, even if you agree to receive it electronically.
*To ensure clarity, all requests must be submitted in writing. Easy to use request forms are available from the Community Health Center Privacy Officer.
OUR ORGANIZATION
This Notice describes the privacy practices of the Southwest Utah Community Health Center ('Community Health Center') and pertains to all Health Center employees and volunteers at such locations. The Community Health Center may have affiliated health care providers and business associates who are not employed by the Community Health Center, but are either authorized to assist or have a contractual relations with the Community Health Center and who may have different privacy practices than those described in this Notice.
CONTACT US ABOUT YOR PRIVACY RIGHTS
Contact the Community Health Center Privacy Officer for more information about your privacy rights and to obtain copies of our request forms. Also, please contact us if you are concerned about a privacy rights problem, wish to file a complaint or concern that your privacy rights have been violated, or disagree with any decision we made regarding your privacy rights or in the handling of your health information. We will promptly and thoroughly investigate all complaints and concerns, and will not retaliate against you for filing a complaint or concern.
Contact: Southwest Utah Community Health Center Privacy Officer – 168 North 100 East – St. George, Utah 84770 – Phone: 435-986-2565 – Fax: 435-986-2577 Additionally, you have the right to file a written complaint with the Office of Civil Rights – U.S. Department of Health and Human Services.
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Patient's Bill of Rights and Responsibilities
The Patient's Bill of Rights and Responsibilities have been adopted to promote quality care with satisfaction for patients, families, providers, and staff, regardless of race, color, religion, sex, age, national origin, physical or mental disability, veteran status and/or the ability to pay.
The providers and staff at Southwest Utah Community Health Center are committed to providing quality health care and maintaining the dignity and integrity of our patients.
As a Patient, You Have the Right:
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To be treated with dignity and respect.
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To be provided assistance in a prompt, courteous and responsible manner.
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To complete privacy and confidentiality.
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To information regarding your diagnosis, evaluation, treatments and prospects for recovery in terms you can understand.
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To understand the medications prescribed for you, what they are, what they are for, how to take them properly and what the possible side effects are.
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To be informed of the costs associated with your treatment upon request.
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To participate in decisions involving your health care, including, but not limited to choosing your health care provider and receiving information about any proposed treatment or procedure in order to give informed consent.
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To know the names, titles and qualifications of all who provide your care.
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To be informed of the procedure for submitting a complaint about Southwest Utah Community Health Center and/or the quality of care you have received and to receive a response to your complaint in a timely manner.
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To initiate the grievance procedure without fear of reprisal, which includes the right to a fair hearing, if you are not satisfied with SWUCHC’s decision regarding any complaint.
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To review and obtain a copy of your medical record, subject to state law and SWUCHC’s policies and procedures.
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To participate in the development of your plan of care in a language you can understand and to have a designated representative involved.
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To reasonable access to care within SWUCHC’s scope of services, it’s stated mission and applicable laws and regulations.
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To refuse treatment to the extent permitted by law.
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To participate in the consideration of ethical issues that arise in your care.
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To be informed of medical consequences and risks of your decision to refuse treatment.
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To formulate an Advanced Directive or Living Will.
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To designate a surrogate decision maker, such as your guardian, next of kin, or legally authorized responsible person.
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To care which takes into consideration your psychosocial, spiritual, and cultural values.
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To appropriate assessment and management of pain.
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To access to emergency health care services.
As a Patient, You Have the Responsibility:
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To know the benefits and exclusions of your health plan coverage.
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To respect the rights, property and environment of all SWUCHC health care providers, employees, and patients.
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To provide SWUCHC with complete and accurate information about all present and past health matters and report all unexpected changes in your condition.
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To clearly understand a prescribed course of treatment and comply with the treatment plan agreed upon by you and your physician.
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To keep your appointments and, if unable to do so, to notify the office as soon as possible so that your appointment time can be given to another patient.
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To pay all applicable co-payments at the time of service.
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To express your opinions, concerns or complaints in a constructive manner to the appropriate people.
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To remember to notify SWUCHC in a timely manner of changes in family size, address, phone number or insurance company status.
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To cooperate with all persons providing your care and treatment.
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To try to understand and follow instructions concerning your treatment and ask questions if you do not understand or need an explanation.
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To be responsible in your payment for treatment and to be cooperative and timely in providing insurance and eligibility information.
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To accept responsibility for consequences following a decision to refuse treatment or instructions.
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To provide proof of identity and/or income when requested to do so.
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Mission Statement: Making lives better in Southwest Utah by providing accessible, quality health care, regardless of financial, language, or cultural barriers.
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