Patient Privacy

Our Privacy Obligations to You

Protecting your medical information is an important priority for Emerson Hospital. This Notice explains what information we collect, with whom we share it, and how you can direct us not to share information with certain parties. We are required by law to:

Maintain the privacy of your health and medical information.
Give you this Notice of our legal duties and privacy practices.
Follow the terms of this Notice that is currently in effect.

Information Collection and Use

The following categories describe different ways that we use and disclose medical information about you. Please note that 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 these categories.

For Treatment. We may use medical information about you to provide you with treatment and other services. With your consent, we may disclose medical information about you to doctors, nurses, technicians, medical students, or other personnel who are involved in taking care of you at the Hospital or who are involved in taking care of you for follow-up treatment. 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 of the Hospital also may share information in order to coordinate the different things you need, such as prescriptions, lab work and x-rays.

For Payment. We may use and, with your consent, disclose medical information about you so that the treatment and services you receive at the Hospital may be billed to and payment be collected from you, an insurance company, or a third party. For example, we may need to give your health plan information about surgery you received at the Hospital so your health plan will pay us or reimburse you for the cost of your surgery.

For Health Care Operations. We may use and, with your consent, disclose medical information about you for Hospital operations. These uses and disclosures 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 in caring for you. 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.

Appointment Reminders. We may use and disclose your medical information to contact you about appointments for treatment or for medical care at the Hospital.

Fundraising Activities. We may use certain information (name, address, telephone, dates of service, age, and gender) to contact you in the future to raise money for Emerson Hospital. The money raised will be used to improve the services and programs we provide to the community. If you wish to make a contribution now or if you do not want to receive any fundraising requests in the future, you may contact our Development office at 978-287-3080.

For the Hospital Public Directory. We may include certain limited information about you in the Hospital directory while you are a patient at the Hospital. This information may include your name, location in the Hospital, general health condition and your religious affiliation. The directory information, except for your religious affiliation, may be released to people who ask for you by name unless you instruct us to limit your information. You may also opt out of the public information directory. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they don’t ask for you by name.

Individuals Involved in Your Care or Payment for Your Care. Unless you object, we may share your medical information with a friend or family member who is involved in your medical care. If you are incapacitated or in an emergency circumstance, we may use our professional judgment to determine whether a disclosure is in your best interest. We may also give information to someone who helps pay for your care.

Public Health Risks. We may disclose your medical information for certain public health activities. These activities generally include the following:

To prevent or control disease, injury or disability.
To report births and deaths.
To report child abuse and neglect, elder abuse and disabled persons abuse.
To report information about products and services under the jurisdiction of the U.S. Food and Drug Administration.
To notify a person who may have been exposed to a sexually transmitted disease.
To report abortions to state government agencies as required by law.

Health Oversight Activities. Your medical information may be shared with a health oversight agency for activities authorized by law: for example, for audits, investigations, inspections, and licensing.

Law Enforcement. We may disclose your medical information to law enforcement as required by law: for example, gun wounds, dog bites, rape/sexual assault.

Judicial and Administrative Proceedings. We may disclose your medical information in response to a court order, subpoena, or other lawful process.

Coroners, Medical Examiners. We may release your medical information to a coroner or medical examiner as authorized by law.

Organ and Tissue Procurement. If you are an organ donor, we may disclose your medical information to organizations that facilitate organ, eye or tissue procurement, banking or transplantation.

Workers’ Compensation. We may release your medical information to your insurer or state agencies responsible for monitoring and processing claims for workers’ compensation.

Research. We may use or disclose your medical information for research purposes if our Institutional Review Board approves a waiver of authorization for such use or disclosure.

Health or Safety. We may use or disclose your medical information to prevent or lessen a serious danger to you or to others. In addition, we may disclose your medical information to an entity assisting in disaster relief effort.

Marketing. We may use your medical information to provide you with marketing materials in a face-to-face encounter. We are also permitted to use your medical information to give you a promotional gift of nominal value and to communicate with you about products or services relating to your treatment, care management or coordination, or alternative treatments, therapies, providers or care settings. In addition, we may use your medical information to identify Emerson Hospital health-related services and products that may be beneficial to your health and then contact you about the services and products.

As Required by Law. We may use and disclose your medical information when required to do so by federal, state or local law.

Authorization. If we want to use or disclose your medical information for any purpose not listed in this Notice, we may do so if you give us your written authorization.

Highly Confidential Information. Federal and state law require special privacy protections for certain highly confidential information including:

HIV/AIDS status.
Genetic testing information.
Confidential communications with a psychotherapist or other mental health professional.
Substance abuse treatment.
Venereal disease information.
Abortion consent.
Mammography records.
Family planning services.
Treatment or diagnosis of emancipated minors.
Mental health community program records.
Research involving controlled substances.

In order for us to disclose your Highly Confidential Information for any purpose, we must obtain your separate, specific written consent (or authorization) unless we are otherwise permitted by law to make such disclosure.

In addition, if you are an emancipated minor, certain information relating to your treatment or diagnosis may be considered Highly Confidential Information, and as a result will not be disclosed to your parent or guardian without your consent (or authorization). Your consent is not required if a physician reasonably believes your condition to be so serious that your life or limb is endangered. Under such circumstances, we may notify your parents or legal guardian of the condition and inform you of any such notification.

Your Rights Regarding Your Medical Information

You have the following rights regarding medical information we maintain about you.

Right to Inspect and Copy. You may request access to your medical information and your billing records. To inspect and copy billing records or medical information that may be used to make decisions about you, you must submit your request in writing. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances.

Right to Amend. If you feel that your medical information is incorrect or incomplete, you may submit a written request for an amendment.

Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is a list of certain types of disclosures we made of your medical information. To request this list of disclosures, you must submit your request in writing. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Requests made more than once during a 12-month period will incur a copying charge.

Right to Request Restrictions. You may request restrictions on our use and disclosure of your medical information. While we will consider all requests for additional restrictions carefully, we are not required to agree to all requested restrictions. If you wish to request additional restrictions, please submit a written request.

Right to Receive Confidential Communications. You may request, and we will accommodate, any reasonable written request to receive your medical information by alternative means of communication or at alternative locations: for example, information as to how payment, if any, will be handled and alternate address and/or contact information.

Right to Revoke Your Authorization. You may revoke any written authorization you have signed with a written request. We are unable to take back any disclosures that were made before you revoked your authorization.

Right to Receive Paper Copy of this Notice. Upon request, you may obtain a paper copy of this Privacy Notice. You may also print and copy the Notice from our website at www.emersonhospital.org.

Changes to this Privacy Notice

The hospital may change the terms of this Notice at any time. If we change this Notice, we may make the new Notice terms effective for all medical information that we maintain, including any information created or received prior to issuing the new Notice. Changes to this Notice will be posted at Emerson Hospital, the Emerson Hospital Health Centers in Westford and Groton, Emerson Hospital Radiology at Concord Hillside and on our web site at www.emersonhospital.org. You also may obtain any new Notice by contacting Emerson Hospital.

Questions and Complaints

If you would like more information about your privacy rights, are concerned that we have violated your privacy rights or disagree with a decision that we made about access to your medical information, you may contact our Privacy Officer. You may also file written complaints with the Director, Office for Civil Rights of the U.S. Department of Health and Human Services.

You will not be penalized for filing a complaint.

How to Contact Us

Patient Care Assessment Department
978-287-3095

Privacy Officer
978-287-3995
privacyofficer@emersonhosp.org

Medical Records Department
978-287-3720
978-287-3652 fax

Billing Department
978-287-3020

Please send your privacy request in writing to one of the departments listed above c/o Emerson Hospital, 133 ORNAC, Concord, MA 01742. Thank you.

Emerson Health Systems, Inc. and its related entities, are acting as an organized health care arrangement (OHCA). The following entities are included in the OHCA: Emerson Hospital, Emerson Hospital Health Centers in Westford and Groton, Emerson Practice Associates, Emerson Hospital Radiology at Concord Hillside, and the following:

Any health care professional providing services to you in the Hospital’s clinically integrated care setting, regardless of whether specific services are provided by the Hospital’s employees or by independent members of Emerson Hospital’s Medical Staff.
All department units of Emerson Hospital and the Westford and Groton Health Centers.
Any member of a volunteer group we allow to help you while you are in Emerson Hospital.
All employees, staff and other Emerson Hospital personnel.

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	Patient Privacy Our Privacy Obligations to You Protecting your medical information is an important priority for Emerson Hospital. This Notice explains what information we collect, with whom we share it, and how you can direct us not to share information with certain parties. We are required by law to: Maintain the privacy of your health and medical information. Give you this Notice of our legal duties and privacy practices. Follow the terms of this Notice that is currently in effect. Information Collection and Use The following categories describe different ways that we use and disclose medical information about you. Please note that 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 these categories. For Treatment. We may use medical information about you to provide you with treatment and other services. With your consent, we may disclose medical information about you to doctors, nurses, technicians, medical students, or other personnel who are involved in taking care of you at the Hospital or who are involved in taking care of you for follow-up treatment. 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 of the Hospital also may share information in order to coordinate the different things you need, such as prescriptions, lab work and x-rays. For Payment. We may use and, with your consent, disclose medical information about you so that the treatment and services you receive at the Hospital may be billed to and payment be collected from you, an insurance company, or a third party. For example, we may need to give your health plan information about surgery you received at the Hospital so your health plan will pay us or reimburse you for the cost of your surgery. For Health Care Operations. We may use and, with your consent, disclose medical information about you for Hospital operations. These uses and disclosures 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 in caring for you. 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. Appointment Reminders. We may use and disclose your medical information to contact you about appointments for treatment or for medical care at the Hospital. Fundraising Activities. We may use certain information (name, address, telephone, dates of service, age, and gender) to contact you in the future to raise money for Emerson Hospital. The money raised will be used to improve the services and programs we provide to the community. If you wish to make a contribution now or if you do not want to receive any fundraising requests in the future, you may contact our Development office at 978-287-3080. For the Hospital Public Directory. We may include certain limited information about you in the Hospital directory while you are a patient at the Hospital. This information may include your name, location in the Hospital, general health condition and your religious affiliation. The directory information, except for your religious affiliation, may be released to people who ask for you by name unless you instruct us to limit your information. You may also opt out of the public information directory. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they don’t ask for you by name. Individuals Involved in Your Care or Payment for Your Care. Unless you object, we may share your medical information with a friend or family member who is involved in your medical care. If you are incapacitated or in an emergency circumstance, we may use our professional judgment to determine whether a disclosure is in your best interest. We may also give information to someone who helps pay for your care. Public Health Risks. We may disclose your medical information for certain public health activities. These activities generally include the following: To prevent or control disease, injury or disability. To report births and deaths. To report child abuse and neglect, elder abuse and disabled persons abuse. To report information about products and services under the jurisdiction of the U.S. Food and Drug Administration. To notify a person who may have been exposed to a sexually transmitted disease. To report abortions to state government agencies as required by law. Health Oversight Activities. Your medical information may be shared with a health oversight agency for activities authorized by law: for example, for audits, investigations, inspections, and licensing. Law Enforcement. We may disclose your medical information to law enforcement as required by law: for example, gun wounds, dog bites, rape/sexual assault. Judicial and Administrative Proceedings. We may disclose your medical information in response to a court order, subpoena, or other lawful process. Coroners, Medical Examiners. We may release your medical information to a coroner or medical examiner as authorized by law. Organ and Tissue Procurement. If you are an organ donor, we may disclose your medical information to organizations that facilitate organ, eye or tissue procurement, banking or transplantation. Workers’ Compensation. We may release your medical information to your insurer or state agencies responsible for monitoring and processing claims for workers’ compensation. Research. We may use or disclose your medical information for research purposes if our Institutional Review Board approves a waiver of authorization for such use or disclosure. Health or Safety. We may use or disclose your medical information to prevent or lessen a serious danger to you or to others. In addition, we may disclose your medical information to an entity assisting in disaster relief effort. Marketing. We may use your medical information to provide you with marketing materials in a face-to-face encounter. We are also permitted to use your medical information to give you a promotional gift of nominal value and to communicate with you about products or services relating to your treatment, care management or coordination, or alternative treatments, therapies, providers or care settings. In addition, we may use your medical information to identify Emerson Hospital health-related services and products that may be beneficial to your health and then contact you about the services and products. As Required by Law. We may use and disclose your medical information when required to do so by federal, state or local law. Authorization. If we want to use or disclose your medical information for any purpose not listed in this Notice, we may do so if you give us your written authorization. Highly Confidential Information. Federal and state law require special privacy protections for certain highly confidential information including: HIV/AIDS status. Genetic testing information. Confidential communications with a psychotherapist or other mental health professional. Substance abuse treatment. Venereal disease information. Abortion consent. Mammography records. Family planning services. Treatment or diagnosis of emancipated minors. Mental health community program records. Research involving controlled substances. In order for us to disclose your Highly Confidential Information for any purpose, we must obtain your separate, specific written consent (or authorization) unless we are otherwise permitted by law to make such disclosure. In addition, if you are an emancipated minor, certain information relating to your treatment or diagnosis may be considered Highly Confidential Information, and as a result will not be disclosed to your parent or guardian without your consent (or authorization). Your consent is not required if a physician reasonably believes your condition to be so serious that your life or limb is endangered. Under such circumstances, we may notify your parents or legal guardian of the condition and inform you of any such notification. Your Rights Regarding Your Medical Information You have the following rights regarding medical information we maintain about you. Right to Inspect and Copy. You may request access to your medical information and your billing records. To inspect and copy billing records or medical information that may be used to make decisions about you, you must submit your request in writing. If you request a copy of the information, we may charge a fee for the costs of copying, mailing, or other supplies associated with your request. We may deny your request to inspect and copy in certain very limited circumstances. Right to Amend. If you feel that your medical information is incorrect or incomplete, you may submit a written request for an amendment. Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures.” This is a list of certain types of disclosures we made of your medical information. To request this list of disclosures, you must submit your request in writing. Your request must state a time period, which may not be longer than six years and may not include dates before April 14, 2003. Requests made more than once during a 12-month period will incur a copying charge. Right to Request Restrictions. You may request restrictions on our use and disclosure of your medical information. While we will consider all requests for additional restrictions carefully, we are not required to agree to all requested restrictions. If you wish to request additional restrictions, please submit a written request. Right to Receive Confidential Communications. You may request, and we will accommodate, any reasonable written request to receive your medical information by alternative means of communication or at alternative locations: for example, information as to how payment, if any, will be handled and alternate address and/or contact information. Right to Revoke Your Authorization. You may revoke any written authorization you have signed with a written request. We are unable to take back any disclosures that were made before you revoked your authorization. Right to Receive Paper Copy of this Notice. Upon request, you may obtain a paper copy of this Privacy Notice. You may also print and copy the Notice from our website at www.emersonhospital.org. Changes to this Privacy Notice The hospital may change the terms of this Notice at any time. If we change this Notice, we may make the new Notice terms effective for all medical information that we maintain, including any information created or received prior to issuing the new Notice. Changes to this Notice will be posted at Emerson Hospital, the Emerson Hospital Health Centers in Westford and Groton, Emerson Hospital Radiology at Concord Hillside and on our web site at www.emersonhospital.org. You also may obtain any new Notice by contacting Emerson Hospital. Questions and Complaints If you would like more information about your privacy rights, are concerned that we have violated your privacy rights or disagree with a decision that we made about access to your medical information, you may contact our Privacy Officer. You may also file written complaints with the Director, Office for Civil Rights of the U.S. Department of Health and Human Services. You will not be penalized for filing a complaint. How to Contact Us Patient Care Assessment Department 978-287-3095 Privacy Officer 978-287-3995 privacyofficer@emersonhosp.org Medical Records Department 978-287-3720 978-287-3652 fax Billing Department 978-287-3020 Please send your privacy request in writing to one of the departments listed above c/o Emerson Hospital, 133 ORNAC, Concord, MA 01742. Thank you. Emerson Health Systems, Inc. and its related entities, are acting as an organized health care arrangement (OHCA). The following entities are included in the OHCA: Emerson Hospital, Emerson Hospital Health Centers in Westford and Groton, Emerson Practice Associates, Emerson Hospital Radiology at Concord Hillside, and the following: Any health care professional providing services to you in the Hospital’s clinically integrated care setting, regardless of whether specific services are provided by the Hospital’s employees or by independent members of Emerson Hospital’s Medical Staff. All department units of Emerson Hospital and the Westford and Groton Health Centers. Any member of a volunteer group we allow to help you while you are in Emerson Hospital. All employees, staff and other Emerson Hospital personnel.