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
If you have any questions about this Notice please contact our Privacy
Officer. Admitting or Emergency Room Registration Staff will provide you
with the name.
Who Will Follow This Notice: This notice describes our facility's practices and that of any programs
associated with Jupiter Medical Center, Inc. including but not limited
to its subsidiary organizations such as the Hospital and Jupiter Medical
Center Pavilion. Any health care professional authorized to enter information
into your file or record and all employees, staff and other personnel
will follow the terms of this notice. In addition, these entities, sites
and locations may share medical information with each other for treatment,
payment or operation purposes described in the notice.
Our Pledge Regarding Medical Information: We understand that medical information about you and your health is personal.
We are committed to protecting medical information about you. We create
a record of the care and services you receive in our facility. We need
this record to provide you with quality care and to comply with certain
legal requirements. This notice applies to all of the records of your care.
This notice will tell you about the ways in which we may use and disclose
medical information about you. It also describes your rights and certain
obligations we have regarding the use and disclosure of medical information.
We are required by law to:
- Make sure that medical information that identifies you is kept private.
- Give you this notice of our legal duties and privacy practices with respect
to medical information about you; and
- Follow the terms of the notice that is currently in effect.
This Notice of Privacy Practices describes how we may use and disclose
your protected health information to carry out treatment, payment or healthcare
operations and for other purposes that are permitted or required by law.
It also describes your rights to access and control your protected health
information. "Protected health information" is information about
you, including demographic information, that may identify you and that
relates to your past, present or future physical health, mental health
or condition and related health care services.
Changes to This Notice: We reserve the right to change this notice. We reserve the right to make
the revised or changed notice effective for medical information we already
have about you as well as any information we receive in the future. We
will post a copy of the current notice in our facility in key locations
and on our Internet site. This notice will contain the effective date.
In addition, each time you are in our facility for treatment we will offer
you a copy of the current notice in effect.
Complaints: If you believe your privacy rights have been violated, you may file a
complaint with our facility or with the Secretary of the Department of
Health and Human Services in Washington D.C. We will not retaliate or
penalize you for filing a complaint.
To file a complaint with us, please contact the Privacy Officer. Your complaint
should provide specific details to help us in investigating the potential problem.
To file a complaint with the Secretary of Health and Human Services, contact
the Office for Civil Rights,
U.S. Department of Health & Human Services, 61 Forsyth Street, SW.
- Suite 3B70, Atlanta, GA 30323, or as instructed on
How We May Use and Disclosure Your Medical Information
The following categories describe different ways that we use and disclose
medical information. Each category of uses or disclosures will be explained
but 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 the categories.
For Treatment: We may use medical information about you to provide you with medical
treatment. We may disclose medical information about you to doctors, nurses,
counselors, physician assistants, nurse practitioners, Admissions &
Billing Office staff, Health Information Services Office staff, Compliance
staff or other personnel who are involved in taking care of you. Different
departments of our facility also may share medical information about you
in order to provide for your needs, such as prescriptions, lab work or
dental work. We also may disclose medical information about you to people
outside the facility who may be involved in your medical care or others
we use to provide services that are part of your care, such as your HMO
and your DSS caseworker. When required to, we will obtain your authorization
before disclosing any of your information. Only the minimally necessary
information will be revealed during any disclosures.
Communication with Family: Health professionals, using their best judgment, may disclose to a family
member, close personal friend, or any other person you identify, health
information relevant to that person's involvement in your care or
payment related to your care.
For Health Care Operations: We may use medical information about you to support our quality assessment
and improvement activities, including outcomes evaluation and development
of clinical guidelines, population based activities relating to improving
health or reducing health care costs, protocol development, case management
and care coordination, contacting health care providers with information
about treatment alternatives; and related functions that do not include
We may use your medical information to review the competence or qualifications
of health care professionals, evaluating practitioner and provider performance,
health plan performance, conducting training programs in which students,
trainees, care providers, training of non-health care professionals, accreditation,
certification, licensing, or credentialing activities.
We may use your medical information to conduct or arrange health care review,
legal services, and auditing functions, including fraud and abuse detection
and compliance programs, underwriting, premium rating and other activities
relating to the creation, renewal or replacement of a contract of health
insurance or health benefits, and ceding, securing, or placing a contract
for reinsurance of risk relating to claims for health care including stop
loss and excess of loss insurance.
We may use your medical information for business planning and development,
such as cost-management and planning related analyses related to managing
and operating Jupiter Medical Center, Inc., including formulary development
and administration, development of improvement methods of payment or coverage
policies and business management and general administrative activities
of Jupiter Medical Center, Inc. including but not limited to: Management
activities relating to implementation of and compliance of the HIPAA privacy
rules, customer service including data analyses, resolution of internal
grievances and due diligence in the connection of the sale or transfer
of assets to a potential successor of interest.
For Payment: We may use and disclose medical information about you so that the treatment
and services you receive may be billed to and payment may be collected
from you, an insurance company, or a third party. For example, we may
need to give your health plan information about treatment you received
so your health plan will pay us or reimburse you. We may also tell your
health plan about a treatment you are going to receive to obtain prior
approval or to determine whether your plan will cover the treatment.
Appointment Reminders: We may also use and disclose medical information to contact you as a
reminder that you have an appointment or missed an appointment for treatment
in order to reschedule the appointment.
Treatment Aftercare Alternatives: We may use and disclose medical information to tell you about or recommend
possible treatment aftercare options that will benefit you.
Research: Under certain circumstances, we may use and disclose minimally necessary
medical information about you for research purposes. All research projects,
however, are subject to a special approval process through the Jupiter
Medical Center Institutional Review Board.
Fundraising: We may use certain information (name, address, telephone number, dates
of service, age, and gender) to contact you in the future to raise money
for our organization. We may also provide this information to our institutionally
related foundation, for the same purpose. The money raised will be used
to expand and improve the services and programs we provide the community.
If you do not wish to be contacted as part of our fundraising efforts,
please contact our Privacy Officer.
As Required By Law: We will disclose minimally necessary medical information about you when
required to do so by federal, state or local law.
To Avert A Serious Threat To Health Or Safety: We may use and disclose minimally necessary medical information about
you when necessary to prevent a serious threat to your health and safety
or the health and safety of the public or another person. Any disclosure,
however, would only be to someone able to help prevent the threat.
Worker's Compensation: We may release minimally necessary medical information about you for
worker's compensation or similar programs. These programs provide
benefits for work related injuries or illness. State and/or federal law
control the release of such information.
Public Health Risks: We may disclose minimally necessary medical information about you for
public health activities. These activities generally include the following:
- To prevent or control disease, injury or disability;
- To report child abuse or neglect by making a telephone report to the Child
Abuse Hotline and to follow this report with a written confirmation;
- To report reaction to medication or problems with products;
- To notify a person who may have been exposed to a disease or may be at
risk for contracting or spreading a disease or condition; or
- To notify the appropriate government authority if we believe a client has
been the victim of domestic violence. We will only make this disclosure
if you agree or when required or authorized by law.
Health Oversight Activities: We may disclose minimally necessary medical information 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.
Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose minimally
necessary medical information about you in response to a proper court
order or other lawful process by someone else involved in the dispute,
but only if efforts have been made to tell you about the request or to
obtain an order protecting the information requested.
Law Enforcement: We may release minimally necessary medical information about you if asked
to do so by a law enforcement official:
- In response to a proper court order or similar process.
- In response to a subpoena for a member of the Jupiter Medical Center staff.
- About criminal conduct involving our facility; and
- In emergency circumstances to report a crime; the location of the crime
or victims; or the identity, description, or location of person who committed
the crime if the crime is on agency premises or against agency personnel.
Medical Examiners: We may also release minimally necessary medical information about you
to a medical examiner. This may be necessary, for example, to identify
a deceased person or determine the cause of death.
National Security and Intelligence Activities: We may release minimally
necessary medical information about you to authorized federal officials
for intelligence, counterintelligence, and other national security activities
authorized by law.
Your Rights Regarding Medical Information About You
You have the following rights regarding medical information we maintain
Right to Inspect and Copy: You have the right to inspect and receive a copy of 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 receive a copy of medical information that may be used to
make decisions about you, you must submit your request to the Medical
Information Department. If you request a copy of the information, we may
charge a fee for the costs of retrieving, copying, mailing, and any other
supplies associated with your request.
Right to Amend: If you feel that any of the medical information we have about you is
incorrect or incomplete, you may ask us to amend the information. You
have the right to request an amendment for as long as the information
is kept by our facility.
To request an amendment, your request must be made in writing and submitted
to the Privacy Officer. In addition, you must provide a reason that supports
We may deny your request for an amendment if it is not in writing or does
not include a reason to support the request. In addition, we may deny
your request if you ask us to amend information that:
- was not created by us, unless the person or entity that created the information
is no longer available to make the amendment;
- is not part of the medical information kept by our facility;
- is not part of the information which you would be permitted to inspect
and copy; or
- is accurate and complete.
Right to an Accounting of Disclosures: You have the right to request an "accounting of disclosures".
This is a list of the disclosures we have made of your medical information.
We are not required to account for routine disclosures, for example disclosures
between Jupiter Medical Center staff regarding your care.
To request this accounting of disclosures, you must submit your request
in writing, to the Medical Information Department. Your request must state
a time period, which may not be longer than six years and may not include
dates before April 14, 2003. The first accounting you request within a
twelve-month period will not include a cost for providing the disclosure list.
For additional accountings, we may charge you for the costs of providing
the list. We will notify you of the cost involved and you may choose to
withdraw or modify your request at that time before any costs are incurred.
Right to Request 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 can
ask that we only contact you at work or by mail.
To request confidential communications, you must make your request in writing
to the Medical Information Department. We will not ask you the reason
for your request. We will accommodate all reasonable requests. Your request
must specify how or where you wish to be contacted.
Right to a Copy of This Notice: You have the right to a copy of this notice. You may ask us to give you
a copy of this notice at any time. To request a copy of this notice, you
must make your request in writing to the Privacy Officer.
Right to Request Restrictions: Even though all disclosures we already make are minimally necessary,
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. Finally, you have the right to request a
restriction on the people who are able to obtain the information we disclose.
However, 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.
To request a restriction or limitation, your request must be made in writing
and submitted to the Privacy Officer.
Version 2.0 - Effective April 30, 2003 | Revised Version 2.1 - Effective
June 16, 2008