Our Legal Duty

Mid-Columbia Medical Center is required by applicable federal and state law to maintain the privacy of your medical information. Mid-Columbia Medical Center is also required to give you this notice about our privacy practices, our legal duties, and your rights concerning your medical information. Mid-Columbia Medical Center must follow the privacy practices that are described in this notice while it is in effect. This notice takes effect April 14, 2003, and will remain in effect until Mid-Columbia Medical Center replaces it.

Mid-Columbia Medical Center reserves the right to change our privacy practices and the terms of this notice at any time, provided such changes are permitted by applicable law. Mid-Columbia Medical Center reserves the right to make the changes in our privacy practices and the new terms of our notice effective for all medical information that Mid-Columbia Medical Center maintains, including medical information Mid-Columbia Medical Center created or received before we made the changes. Before Mid-Columbia Medical Center makes a significant change in our privacy practices, we will change this notice and make the new notice available upon request.

You may request a copy of our notice at any time. For more information about our privacy practices, or for additional copies of this notice, please contact us using the information listed at the end of this notice.

Who Will Follow This Notice

The following individuals and organizations share Mid-Columbia Medical Center’s commitment to protect your privacy and will comply with this Notice:

• Any health care professionals authorized to enter information into your Hospital medical records.
• Members of our medical staff, employees, volunteers, trainees, students, and other hospital personnel providing services in the Hospital or Hospital affiliated patient care settings listed below.
• All departments and units of the hospital, including our outpatient clinics.
• Patient care settings affiliated with Mid-Columbia Medical Center, and all medical staff, employees, volunteers, trainees, students or other personnel providing services in these patient care settings. These patient care settings include:
  • Celilo Cancer Center
  • Center for Mind and Body Medicine
  • Mid-Columbia Healthcare Equipment
  • Mid-Columbia Health Foundation
  • Diabetes Services
  • Planetree Health Resource Center
  • Visiting Health Services
  • Visiting Physician Services
  • Columbia Gorge Health Trust

How We May Use and Disclose Your Medical Information

Mid-Columbia Medical Center uses and discloses medical information about you for treatment, payment, and health care operations. For example:

Treatment: Mid-Columbia Medical Center may use or disclose your medical information to a physician or other health care provider in order to provide treatment to you.

Payment: Mid-Columbia Medical Center may use and disclose your medical information to obtain payment for services Mid-Columbia Medical Center provides to you. Mid-Columbia Medical Center may disclose your medical information to another health care provider or entity subject to the federal Privacy Rules so they can obtain payment. '

Health Care Operations: Mid-Columbia Medical Center may use and disclose your medical information in connection with our health care operations. Health care operations include:

• quality assessment and improvement activities;
• reviewing the competence or qualifications of health care professionals, evaluating practitioner and provider performance, conducting training programs, accreditation, certification, licensing or credentialing activities;
• medical review, legal services, and auditing, including fraud and abuse detection and compliance;
• business planning and development, and
• business management and general administrative activities, including management activities relating to privacy, customer service, resolution of internal grievances, and creating de-identified medical information or a limited data set.

Mid-Columbia Medical Center may disclose your medical information to another entity which has a relationship with you and is subject to the federal Privacy Rules, for their health care operations relating to quality assessment and improvement activities, reviewing the competence or qualifications of health care professionals, or detecting or preventing health care fraud and abuse.

On Your Authorization:You may give us written authorization to use your medical information or to disclose it to anyone for any purpose. If you give us an authorization, you may revoke it in writing at any time. Your revocation will not affect any use or disclosures permitted by your authorization while it was in effect. Unless you give us a written authorization, Mid-Columbia Medical Center cannot use or disclose your medical information for any reason except those described in this notice.

To Your Family and Friends: Mid-Columbia Medical Center may disclose your medical information to a family member, friend or other person to the extent necessary to help with your health care or with payment for your health care. Mid-Columbia Medical Center may use or disclose your name, location, and general condition or death to notify, or assist in the notification of (including identifying or locating), a person involved in your care.

Before Mid-Columbia Medical Center discloses your medical information to a person involved in your health care or payment for your health care, Mid-Columbia Medical Center will provide you with an opportunity to object to such uses or disclosures. If you are not present, if you are incapacitated or there is an emergency, Mid-Columbia Medical Center will disclose your medical information based on our professional judgment of whether the disclosure would be in your best interest.

Mid-Columbia Medical Center will also use our professional judgment and our experience with common practice to allow a person to pick up filled prescriptions, medical supplies, x- rays or other similar forms of medical information.

Facility Directory: Mid-Columbia Medical Center may use your name, your location in our facility, your general medical condition, and your religious affiliation in our facility directo- ries. Mid-Columbia Medical Center will disclose this information to members of the clergy and, except for religious affiliation, to other persons who ask for you by name. We provide you with an opportunity to restrict or prohibit some or all disclosures for facility directories unless emergency circumstances prevent your opportunity to object.

Public Benefit: Mid-Columbia Medical Center may use or disclose your medical information as authorized by law for the following purposes deemed to be in the public interest or benefit:

• as required by law;
• for public health activities, including disease and vital statistic reporting, child abuse reporting, FDA oversight, and to employers regarding work-related illness or injury;
• to report adult abuse, neglect, or domestic violence;
• to health oversight agencies;
• in response to court and administrative orders and other lawful processes;
• to law enforcement officials pursuant to subpoenas and other lawful processes, concerning crime victims, suspicious deaths, crimes on our premises, reporting crimes in emergencies, and for purposes of identifying or locating a suspect or other person;
• to coroners, medical examiners, and funeral directors;
• to organ procurement organizations;
• to avert a serious threat to health or safety;
• in connection with certain research activities;
• to the military and to federal officials for lawful intelligence, counterintelligence, and national security activities;
• to correctional institutions regarding inmates; and
• as authorized by state workers’ compensation laws.

Disaster Relief: Mid-Columbia Medical Center may use or disclose your medical information to a public or private entity authorized by law or by its charter to assist in disaster relief efforts.

Health Related Services:Mid-Columbia Medical Center may use your medical information to contact you with information about health-related benefits and services or about treatment alter- natives that may be of interest to you. Mid-Columbia Medical Center may disclose your medical information to a business associate to assist us in these activities. Mid-Columbia Medical Center may use or disclose your medical information to encourage you to purchase or use a product or service by face-to-face communication or to provide you with promotional gifts.

Fundraising:Mid-Columbia Medical Center may use your demographic information and the dates of your health care to contact you for our fundraising purposes. Mid-Columbia Medical Center may disclose this information to a business associate or foundation to assist us in our fundraising activities. Mid-Columbia Medical Center will provide you with any fundraising mate- rials and a description of how you may opt out of receiving future fundraising communications.

Appointment Reminders:Mid-Columbia Medical Center may use and disclose medical information to contact you as a reminder that you have an appointment for treatment or medical care at the hospital or any of our entities.

Treatment Alternatives:Mid-Columbia Medical Center may use and disclose medical information to tell you about or recommend possible treatment options or alternatives that we offer that may be of interest to you.

Research: Under certain circumstances, Mid-Columbia Medical Center may use and dis- close medical information about you for research purposes. All research projects, however, are subject to a special approval process through the Institutional Review board. Before we use or disclose medical information for research without your authorization, the project will have been approved through this research approval process.

Organ Procurement for Organ/Tissue Donation:If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue dona- tion and transplantation.

Military:If you are a member of the armed forces, Mid-Columbia Medical Center may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority.

Workers’ Compensation Program: Mid-Columbia Medical Center may release medical information about you for workers’ compensation or similar programs, to the extent author-

Public Health Activities: These activities typically include reports to such agencies as the Oregon Department of Human Services as required or authorized by state law. These reports may include, but not necessarily be limited to, the following:

• To prevent or control disease, injury or disability;
• To report births and deaths;
• To report child abuse or neglect;
• To notify a person who may have been exposed to a disease or may be at risk for con- tracting or spreading a disease or condition;
• To notify the appropriate government authority if we believe a patient has been the victim of abuse or neglect. We will only make this disclosure if the patient agrees or when required or authorized by law;
• To the Food and Drug Administration relative to adverse events concerning food, sup- plements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

Health Oversight Agencies: Mid-Columbia Medical Center may disclose medical informa- tion to a health oversight agency for activities authorized by law. These oversight activities include, for example, audits, investigations, inspections, and licensure. These activities are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws.

Pursuant to lawful subpoena or court order: If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a civil subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell patients about the request or to obtain an order protecting the information requested.

Law Enforcement Purposes: Mid-Columbia Medical Center may disclose your medical information to law enforcement officials as required by law or as directed by court order, warrant, criminal subpoena or other lawful process, and in other limited circumstances for purposes of identifying or locating suspects, fugitives, material witnesses, missing persons or crime victims.

Coroners, Medical Examiners, Funeral Directors: Mid-Columbia Medical Center may release medical information to a coroner or medical examiner as necessary to identify a deceased person or carrying out their duties as required by law. Oregon law specifically requires us to report to the medical examiner when an injury apparently results from a gunshot wound.

National Security and Intelligence: Mid-Columbia Medical Center may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary for the institution to provide you with health care, to protect your health and safety or the health and safety of others or for the safety and security of the correctional institution.

Incidental Disclosures: Certain incidental disclosures of your medical information occur as a byproduct of lawful and permitted use and disclosure of your medical information. These incidental disclosures are permitted if the hospital applies reasonable safeguards to protect your medical information.

Limited Data Set: Mid-Columbia Medical Center may disclose limited health information to third parties for purposes of research, public health and health care operation purposes. This health information includes only the following identifiers:

• Admission, discharge, and service dates;
• Date of birth and, if applicable, death;
• Age (including age 90 or over); and
• Five-digit zip code or any other demographic subdivision, such as state, county, city precinct and other equivalent geo-codes (except street address).

Before disclosing this information, we must enter into an agreement with the recipient of the information that limits who may use or receive the data and requires the recipient to agree not to re-identify the data or contact you.

Business Associates: Mid-Columbia Medical Center contracts with outside companies that perform business services for us, such as billing companies, management consultants, quality assurance reviewers, accountants or attorneys. In certain circumstances, we may need to share your medical information with a business associate so they can perform a service on our behalf. We will limit the disclosure of your information to a business associate to the amount of information that is the minimum necessary for the company to perform services for Mid-Columbia Medical Center. In addition, we will have a written contract in place with the business associate requiring it to protect the privacy of your medical information.

Oregon Law

Oregon law provides additional confidentiality protections in some circumstances: For example, in Oregon a health care provider generally may not release the identity of a person tested for HIV or the results of an HIV-related test without your consent and you must be notified of this confidentiality right. Drug and alcohol records are specially protected and typically require your specific consent for release under both federal and state law. Mental health records are specially protected in some circumstances, as is genetic information.

For more information on Oregon law related to these and other specially protected records, please refer to the Oregon Revised Statutes and the Oregon Administrative Rules. These documents are available on-line at www.oregon.gov.

Your Individual Rights

Inspect and Copy: You have the right to inspect and copy 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. To inspect and copy medical information that may be used to make decisions about patients, you must submit a 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. If you are denied access to medical information, you may request that the denial be reviewed.

Disclosure Accounting: You may request in writing, an accounting of disclosures Mid- Columbia Medical Center made of your medical information in the previous six years, begin- ning April 14, 2003. You are not entitled to an accounting of disclosures made for purposes of treatment, payment or healthcare operations, disclosures you authorized, disclosures to you, incidental disclosures, disclosures to family or other persons involved in your care, disclosures to correctional institutions and law enforcement in some circumstances, disclosures of limited data set information or disclosures for national security or law enforcement purposes.

Restriction: You have the right to request that Mid-Columbia Medical Center place addition- al restrictions on our use or disclosure of your medical information. Mid-Columbia Medical Center is not required to agree to these additional restrictions, but if Mid-Columbia Medical Center does agree, Mid-Columbia Medical Center will abide by our agreement (except in an emergency). Any agreement to additional restrictions must be in writing signed by a person authorized to make such an agreement on our behalf. Mid-Columbia Medical Center will not be bound unless our agreement is so memorialized in writing.

Confidential Communication: You have the right to request that Mid-Columbia Medical Center communicate with you about your medical information by alternative means or to alternative locations. You must make your request in writing.Mid-Columbia Medical Center must accommodate your request if it is reasonable, specifies the alternative means or location, and provides satisfactory explanation how payments will be handled under the alternative means or location you request.

Amendment: If you believe that medical information that may be used to make decisions about your care is incorrect or incomplete, you may ask us to amend the information. Your request must be in writing, and it must explain why the information should be amended. Mid-Columbia Medical Center may deny your request if Mid-Columbia Medical Center did not create the information you want amended and the originator remains available or for cer- tain other reasons. If Mid-Columbia Medical Center denies your request, Mid-Columbia Medical Center will provide you a written explanation. You have the right to respond in writ- ing to our explanation of denial, and to require that your request, our denial, and your state- ment of disagreement, if any, be included in future disclosures of the disputed record. If Mid- Columbia Medical Center accepts your request to amend the information, Mid-Columbia Medical Center will make reasonable efforts to inform others, including people you name, of the amendment and to include the changes in any future disclosures of that information.

Electronic Notice: If you receive this notice on our web site or by electronic mail (e-mail), you are entitled to receive this notice in written form. Please contact us using the informa- tion listed at the end of this notice to obtain this notice in written form.

Questions and Complaints

If you believe your privacy rights have been violated, you may file a complaint with the Secretary of the Department of Health and Human Services, or the Privacy Officer of Mid-Columbia Medical Center at:

Performance and Quality Systems
Mid-Columbia Medical Center
1700 East 19th Street
The Dalles, Oregon 97058

OR

Phone: 1-541-296-7380
Email: pqs@mcmc.net

The complaint must be received within 180 days of when you knew or should have known that the incident occurred. There will be no retaliation for filing a complaint.

If you want more information about our privacy practices or have questions or concerns, please contact us using the contact information listed above. PRIVACY PRACTICES NOTICE 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. THE PRIVACY OF YOUR MEDICAL INFORMATION IS IMPORTANT TO US.