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Notice of Privacy Practices

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.

I. Who We Are

This notice describes the privacy practices of Fletcher Allen Health Care (FAHC) and our employees (including physicians, nurses, and technicians) and other individuals that work at FAHC facilities.  This notice applies to all of the medical records generated by any Fletcher Allen Health Care (FAHC) facility, including FAHC facilities at the Medical Center Campus (including the Vermont Children's Hospital), the Fanny Allen Campus, and the clinics, physician offices and other health care facilities owned and operated by Fletcher Allen Health Care.  

II. Our Privacy Obligations

We are required by law to maintain the privacy of your health information and provide you a description of our privacy practices.  When we use or disclose health information we are required to abide by the terms of this Notice or other Notice in effect at the time of the use or disclosure.

III. Uses and Disclosures With Your Consent or Authorization

A. Use and Disclosure With Your Consent.  Before we provide medical care to you, except in an emergency or other special circumstances, we will ask you to read and sign a written consent ("Your Consent") authorizing us to use and disclose your health information for the following purposes:

• To provide treatment;
• To obtain payment for the services we provide you;
• For our healthcare operations (for example, administrative activities, quality improvement, and customer service) as described below:

Treatment.  We may use medical information about you to provide you treatment or services and to send you appointment reminders.  We may disclose medical information about you to doctors, nurses, technicians, medical students, or other individuals who are involved in your care.  For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process.  Different departments in the hospital may share medical information about you in order to coordinate the different things you may need, such as prescriptions, lab work, meals, and x-rays.

Payment.  We may use and disclose medical information about you to bill and collect payment from you, your insurance company or a third party payer.  For example, we may need to give your insurance company information about your surgery so they will pay us or reimburse you for the treatment.  We may also tell your health plan about the treatment you are going to receive to determine whether your plan will cover it.

Health Care Operations.  We may use and disclose medical information about patients for health care system operations.  These uses and disclosures are necessary to run our health care facilities and make sure that our patients receive quality care.  For example, members of the medical staff and/or quality improvement teams may use information in your health record to assess the care and outcomes in your case and others like it.  The results will then be used to continually improve the quality of the care for all patients we serve.  We may also combine medical information about many patients to evaluate the need for new services.  We may disclose information to doctors, nurses, and students for educational purposes.  And we may combine medical information we have with that of other hospitals to see where we can make improvements.  We may remove information that identifies you from this set of medical information to protect your privacy.

B. Use or Disclosure With Your Authorization.  As described above, Your Consent only permits us to use your health information to treat you, receive payment for services we provide you, and our health care operations.  We may use or disclose your health information for any reason other than treatment, payment and health care operations only when (1) you authorize us to use or disclose this information by signing an Authorization Form ("Your Authorization") or (2) there is an exception described in Section IV below.

IV. Uses and Disclosures Without Your Consent or Your Authorization

A. Use or Disclosure for Treatment, Payment, and Health Care Operations Without Your Consent or Your Authorization.  At FAHC we may use or disclose your health information for treatment purposes, obtaining payment, and our health care operations without your consent or your authorization under the following three circumstances:  (1) when you require emergency treatment; (2) when we are required by law to disclose your health information; and (3) when we attempt to obtain Your Consent but are unable to obtain it due to substantial barriers communicating with you (for example, you are unconscious or otherwise incapacitated) and we reasonably infer that you would have consented in the absence of the communication barriers.

B. Use or Disclosure for a FAHC Hospital Directory.  Unless you disagree or object, we may include certain limited information about you in a hospital directory while you are a patient in a FAHC inpatient facility.  The information may include your name, room number, general condition (e.g., good, fair, etc.) and your religious affiliation.  Information in the directory may be disclosed to anyone who asks for you by name or members of the community clergy.  However, your religious affiliation will only be disclosed to members of the community clergy.  You have these options in regard to the facility directory:

1. You may opt out of the facility directory and request that we not disclose any information to anyone who asks for you by name;
   and/or
2. You may opt out of listing your religious affiliation on a list provided to community clergy who may visit you while you are hospitalized.

Please talk to the admissions staff if you would like to opt out of the facility directory or opt out of having your name and denomination provided to members of the community clergy.

C. Disclosures to Individuals Involved in Your Care or Payment for Your Care.  We may release relevant health information about you to a friend or family member who is involved in your medical care or who helps pay for your care.

D. Disaster Relief Efforts.   We may disclose medical information about you to an organization (e.g., Red Cross) assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.

E. Fundraising Communications.  We may contact you to request a tax deductible contribution to support important activities at FAHC.  In connection with any fundraising, we may disclose to our fundraising staff, demographic information about you (e.g., your name, address, phone number) and the dates when you received health care services at FAHC.

F. Marketing Communications.  We may use or disclose your health information to identify health-related services and products that may be beneficial to your health and then contact you about the services and products.

G. Business Associates.  There are some services provided at FAHC through contracts with business associates.  Examples include certain laboratory tests, and a copy service we use when making copies of your medical record.   When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we have asked them to do and bill you or your third party payer for the services that were provided to you.  To protect your health information, however, we require our business associates to protect your health information.

H. Public Health Activities.  We may disclose health information for the following public health activities and purposes:  (1) to report health information to public health authorities for the purposes of preventing or controlling disease, injury, or disability, as required by law and public health concerns; (2) to report suspected abuse, neglect, or exploitation of children or vulnerable adults to public health authorities or other government authorities authorized by law to receive such reports; (3) to report information about products under the jurisdiction of the U.S. Food and Drug Administration; (4) to alert a person who may have been exposed to a communicable disease or may otherwise be at risk for contracting or spreading a disease or condition; and (5) to report information to your employer as required under laws addressing work-related injuries or workplace medical surveillance.

I. Health Oversight Activities.  We may disclose your health information to a health oversight agency that oversees FAHC and ensures that FAHC is complying with the rules of government programs such as Medicare and Medicaid.

J. Judicial and Administrative Proceedings.  We may disclose your health information in the course of a judicial or administrative proceeding if we receive a legal order or other lawful process requiring us to disclose your health information.

K. Law Enforcement Officials.  We may disclose your health information to the police or other law enforcement officials as required by law or in compliance with a court order.  We may also disclose limited health information to police or law enforcement officials for certain identification and location purposes and to assist in certain criminal investigations.

L. Health or Safety.  We may disclose your health information if we reasonably believe that disclosure would prevent or lessen a serious and imminent threat to a person's or the public's health or safety.

M. Medical Examiner.  We may disclose your health information to a medical examiner as authorized by law.

N. Organ and Tissue Procurement.  We may disclose your health information to organizations that facilitate organ, eye, or tissue procurement, banking, or transplantation.

O. Research.  We may use or disclose your health information without your consent or authorization to researchers when an institutional review board has approved a waiver of authorization for disclosure and the researcher has established protocols to ensure the privacy of your health information.

P. Workers Compensation.  We may disclose your health information as necessary to comply with the Vermont Workers Compensation Statute.

V. Organized Health Care Arrangement. 

FAHC and its medical staff members have organized and are presenting you this document as a joint notice.  Your health information will be shared with members of our medical staff as necessary to carry out treatment, payment, and health care operations.  Physicians and other caregivers may have access to your health information in their offices to assist in reviewing past treatment as it may affect present and future treatment plans.  If your doctor is not employed by FAHC, he or she may have different policies or notices regarding the doctor's use or disclosure of the medical information created in the doctor's office or clinic. 

VI. Your Individual Rights.

1. For Further Information: Complaints.  If you desire further information about your privacy rights, are concerned that we have violated your privacy rights, or disagree with a decision that we have made about your health information, you may contact the FAHC Privacy Officer by calling the FAHC Patient Relations Department at (802) 847-3500.  You may also file written complaints with the Secretary of the U.S. Department of Health and Human Services.  Upon request, the Patient Relations Department will provide you with the correct address for the Director.  We will not retaliate against you if you file a complaint with the Director or us.
2. Right to Request Additional Restrictions.  You have the right to request a restriction or limitation on the medical information we use or disclose about you for treatment, payment, or health care operations.  You also have the right to request a limit on the medical 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.  For example, you could ask that we not use or disclose information about a surgical procedure you had. If you wish to request a restriction or limitation, you should discuss your request with the provider who is responsible for coordinating or managing your care. While we will consider all requests for restrictions carefully, 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.
3. Right to Receive 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 may ask that we contact you at work or by U.S. Mail. If you wish to receive confidential communications, you should discuss your request with the registration personnel at the FAHC facility where you are receiving your medical care.  FAHC will consider all requests for confidential communications carefully and will honor reasonable requests.
4. Right to Inspect and Copy Your Health Information.  You have the right to inspect and obtain a copy of the medical information that may be used to make decisions about your care.  Usually, this includes medical and billing records, but does not include psychotherapy notes. Under very limited circumstances, we may deny you access to your medical record file.  If you are denied access to your medical information, you may request that the denial be reviewed.  A licensed health care professional chosen by FAHC will review your request and the denial.  The person conducting the review will not be the person who denied your request.   We will comply with the decision of the reviewer. If you request a copy or copies of your record, you will be charged a fee for each copy.
5. Right to Amend Your Records.  If you feel that medical information about you is incorrect or incomplete, you may ask us to amend the information.  Your have a right to request the amendment for as long as the information is kept by or for FAHC.  While we will review each amendment request carefully, FAHC may deny your request if we believe that the information that you would like to amend is accurate and complete or other circumstances apply.  If your request for an amendment is denied, you will be notified of the reason for the denial.
6. Right to Receive a Paper Copy of This Notice.  Upon request, you may obtain a paper copy of this Notice, even if you agreed to receive this Notice electronically.
7. Right to An Accounting of Disclosures.  You have the right to request an accounting of disclosures.  This is a list of certain disclosures we make of your medical information for purposes other than treatment, payment, or health care operations.

VII. Effective Date and Duration of This Notice.

1. Effective Date.  This Notice describes the privacy policy of Fletcher Allen Health Care that will become effective on April 14, 2003.  Prior to the effective date, FAHC will continue to protect your health information as required by applicable state and federal laws, regulations, and policies.
2. Right to Change Terms of this Notice.  We may change the terms of this Notice at any time.  If we change this Notice, we may make the new terms effective for all health information that we maintain, including any information created or received prior to issuing the new notice.  If we change this Notice, we will post the new Notice in waiting areas or registration areas at all FAHC facilities and on our Internet site at www.fahc.org.  You may also obtain a new notice by contacting the FAHC Patient Relations Department at (802) 847-3500.