Sansum Clinic requests that you sign a one-time General Consent for Treatment form which allows the organization, including Sansum Clinic's Prescription Pharmacy, to use or disclose your health information for purposes relating to treatment, payment or health care operations, as outlined below:
We will use your health information for treatment. For example: Information obtained by a nurse, physician, health educator, or other member of your health care team will be recorded in your medical record and will be used to determine the appropriate course of treatment for your particular medical problems or concerns. Your medical record at Sansum Clinic will contain entries from all of the different providers that you have seen at Sansum Clinic to ensure that there is continuity in your care. Additionally, your record may also contain copies of results from tests performed at Sansum Clinic (e.g. laboratory and radiology studies) and correspondence from other health care professionals who have been treating you outside of Sansum Clinic (as long as you have authorized those providers to send information to Sansum Clinic). As a result, your physician will have an accurate and complete picture of your medical condition and will be better able to safely treat your medical problems.
We will use your health information for payment. For example: Following your treatment, a bill for services rendered is sent to you or to a third party payer (insurance company). The information on the bill may include information that identifies you, as well as your diagnosis, any procedures that were performed, and any medications or supplies used.
We will use your health information for regular health care operations. For example: Members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your medical record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the health care and services we provide.
- Business associates: There are some services provided in our organization through contracts with business associates. Examples include copy services we use when making copies of your health record, transcription services we use to transcribe physicians' notes, or consultants we may hire to assist us in various aspects of health care administration. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we've asked them to do. To protect your health information, however, we require the business associate to appropriately safeguard your information and they are contractually obligated to do so.
- Notification, Reminders: We may contact you by mail or phone to remind you about an upcoming appointment or to inform you about test results.
- Communication with family: Using their best judgment, health care professionals may disclose health information to your family member, close personal friend, or any other person you identify as involved in your care or payment related to your care. However, you have the right to choose to whom we disclose this information.
- Research: We may disclose information to researchers when an institutional review board (IRB) or "privacy board" that has reviewed the research proposal, and established protocols to ensure the privacy and confidentiality of your health information, has approved the research. Furthermore, Sansum Clinic is permitted to use or disclose PHI recorded or received for research prior to April 14, 2003, provided there exists on file an express legal permission or an informed consent from you or your representative.
- Funeral directors: We may disclose health information to funeral directors consistent with applicable law in order to assist them to carry out their duties.
- Marketing: We may contact you to provide information about treatment alternatives, new medications or other health-related benefits and services that may be of interest to you.
- Fundraising: We may contact you as part of a fundraising effort.
- Food and Drug Administration (FDA): We may disclose to the FDA any health information that relates to unusual or adverse events in connection with medications, supplements, or health care equipment in order to facilitate medication and/or equipment recalls.
- Workers compensation: We may disclose health information to the extent authorized by and to the extent necessary to comply with laws relating to workers compensation or other similar programs established by law.
- Public health: As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability. Such information may include, but is not limited to, the reporting of abuse or neglect, the reporting of communicable diseases, and the reporting of reactions to medications or problems with products or devices.
- Health oversight activities: We may disclose your health information to a health oversight agency for activities authorized by law. Oversight activities can include investigations, inspections, audits, surveys, licensure and disciplinary actions, criminal procedures or actions, or other activities necessary for the government to monitor programs, compliance with civil rights laws, and the health care system in general.
- Law enforcement: We may disclose your health information if asked to do so by a law enforcement official or in response to a valid subpoena, search warrant, court order or other similar legal process. For example, we may release your health information, if asked to do so by law enforcement officials, in the following circumstances: a suspicion of criminal conduct or a death potentially resulting from criminal conduct or in response to a warrant, summons, court order, subpoena or other similar legal process.