隐私政策

本隐私惯例通知适用于bet356附属的所有实体. 具体来说，实体包括bet356及其场外设施. 实体还包括费尔菲尔德医疗保健专业人员, 费尔菲尔德诊断成像, 河景外科中心, 河谷校区和费尔菲尔德医学睡眠实验室. Entities also include any future deliver sites established by bet356 or its affiliates. 上述所有实体都将共享我们患者的个人健康信息, 必要时, 进行治疗, 法律允许的支付和医疗业务.

We are required by law to maintain the privacy of our patients’ personal health information and to provide patients with notice of our legal duties and privacy practices with respect to your personal health information. 我们必须遵守本通知的条款，只要它仍然有效. We reserve the right to change the terms of this 私隐实务通知 必要时 and to make the new Notice effective for all personal health information maintained by us. 您可以通过向医疗记录部门提交请求获得任何修改通知的副本.

您个人健康信息的使用和披露

你的授权. 除了下面概述的, we will not use or disclose your personal health information for any purpose unless you have signed a form authorizing the use or disclosure. You have the right to revoke that authorization in writing unless we have taken any action in reliance on the authorization. There are certain uses and disclosures of your personal health information for which we will always obtain a prior authorization, 这些包括:

• 营销沟通，除非该沟通是直接向您本人进行的, 仅仅是象征性的促销礼物吗, 是处方补充提醒吗, 一般健康或健康信息, or a communication about health related products or services that we offer or that are directly related to your treatment.
• 除非法律要求用于治疗或付款目的，否则大多数销售您的健康信息.
• 心理治疗笔记，除非法律另有允许或要求.

治疗的使用和披露. 我们将根据您的治疗需要使用和披露您的个人健康信息. 例如, doctors and nurses and other 专业s involved in your care will use information in your medical record and information that you provide about your symptoms and reactions to plan a course of treatment for you that may include procedures, 药物, 测试, 等. We may also release your personal health information to another health care facility or 专业 who is not affiliated with our organization but who is or will be providing treatment to you. 例如, if, 在你出院之后, 你将接受家庭保健, we may release your personal health information to that home health 年龄ncy so that a plan of care can be prepared for you.

付款的使用和披露. We will make uses and disclosures of your personal health information 必要时 for the 付款 purposes of those health 专业s and facilities that have treated you or provided services to you. 例如, we may forward information regarding your medical procedures and treatment to your insurance company to arrange 付款 for the services provided to you or we may use your information to prepare a bill to send to you or to the person responsible for your 付款.

医疗保健操作的使用和披露. 我们将在必要时使用和披露您的个人健康信息, 而且是法律允许的, 为了我们的医疗保健业务, 包括临床改善, 专业同行评议, 企业管理, 认可及发牌, 等. 例如, we may use and disclose your personal health information for purposes of improving the clinical treatment and care of our patients. 我们也可能向其他医疗机构披露您的个人健康信息, 卫生保健专业人员, 或者健康计划，比如质量保证和病例管理, 但前提是那个设施, 专业, 或者计划也和你有过耐心的关系.

我们的设施目录. 我们有一个设施目录，上面有你的名字, 房间号码, 一般情况及, 如果你愿意, 你的宗教信仰. 除非您选择将您的信息排除在此目录之外, 的信息, 排除你的宗教信仰, 会不会向任何通过询问你的名字而提出要求的人披露. 这些信息，包括你的宗教信仰，可能会提供给神职人员. You have the right during registration to have your information excluded from this directory and also to restrict what information is provided and/or to whom.

照顾你的家人和朋友. 如果你同意的话, 我们可能会不时将您的个人健康信息透露给指定的家人, 朋友, and others who are involved in your care or in 付款 of your care in order to facilitate that person’s involvement in caring for you or paying for your care. 如果你不在, 丧失民事行为能力, 或者面对紧急医疗情况, 我们认为有限度的披露可能对你最有利, 我们可能会在未经您同意的情况下与此类个人共享有限的个人健康信息. We may also disclose limited health information to a public or private entity that is authorized to assist in disaster relief efforts in order for that entity to locate a family member or other persons that may be involved in some aspect of caring for you.

商业伙伴. Certain aspects and components of our services are performed through contracts with outside persons or organizations, 比如审计, 认证, 法律服务, 等. At times it may be necessary for us to provide certain of your personal health information to one or more of these outside persons or organizations who assist us with our health care operations. 在所有情况下, 我们要求这些商业伙伴适当地保护您的信息隐私.

筹款. 我们可能会使用某些信息(姓名), address, 电话号码或电子邮件信息, 年龄, 出生日期, 性别, 健康保险状况, 服务日期, 服务信息部, treating physician information or outcome information) to contact you for the purpose of raising money for Fairfield Medical Center and you will have the right to opt out of receiving such communications with each solicitation. 出于同样的目的，我们可能会将您的姓名提供给我们的机构相关基金会. The money raised will be used to expand and improve the services and programs we provide to the community. 您可以自由选择不参加筹款活动, and your decision will have no impact on your treatment or 付款 for services at Fairfield Medical Center.

如果您不希望将来收到支持bet356的筹款请求, 请在附件打印的方框上打勾, pre-addressed and prepaid card and mail in the alternative or you can call our telephone number (740-687-8107) or our toll free number (1-800-548-2627) and leave a mess年龄 identifying yourself and stating that you do not want to receive fundraising requests.

您不需要同意接受我们的筹款沟通, and we will honor your request not to receive any Fairfield Medical Center fundraising communications from us after the date we receive your decision.

个人健康信息的使用和披露限制. You have the right to request restrictions on certain of our uses and disclosures of your personal health information for treatment, 付款, 或者医疗保健业务. 限制申请表可以从bet356的合规部获得. 在大多数情况下, we are not required to agree to your restriction request but will attempt to accommodate reasonable requests when appropriate and we retain the right to terminate an agreed-to restriction if we believe such termination is appropriate. 在我方终止协议的情况下，我方将通知贵方. 你也有权终止合同, 书面或口头, an agreed-to restriction by sending such termination notice to the Compliance Department at Fairfield Medical Center.
病人要求限制使用及披露个人健康资料表格(PDF)

违反通知: 以防万一出现漏洞, 或未经授权发布您的个人健康信息, 您将收到通知和信息，告知您可以采取哪些措施来保护自己免受伤害.

投诉. 如果你认为你的隐私权被侵犯了, 你可向北尤因街401号的公司合规主任提出书面投诉, 俄亥俄州兰开斯特43130. 你也可以向美国商务部秘书提出投诉.S. 华盛顿卫生与公众服务部.C. 在你的权利受到侵犯后180天内以书面形式提交. 投诉不会受到报复.

收到通知的确认. 您将被要求签署一份确认表格，确认您已收到本隐私惯例通知.

进一步的信息. 如果您对本通知有任何疑问或需要进一步帮助, 您可致电(740)687-8194与公司合规官联系. 作为患者，您有权获得本隐私惯例通知的纸质副本, 即使您已通过电子邮件或其他电子方式要求该等副本.

隐私形式
私隐实务通知
修订要求表格
会计和披露请求表格
病人要求限制个人健康信息表的使用和披露

修改后的日期

本隐私惯例通知于2021年3月23日修订.