THIS NOTICE DESCRIBES HOW HEALTH INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.  PLEASE REVIEW IT CAREFULLY. 

If you have any questions, please contact our Privacy Officer at the address or phone number listed on the bottom of this notice.

Our Responsibilities  

We take the privacy of your health information seriously, and we are committed to protecting your health information.  This Notice applies to all records of your care that we maintain, which contain your protected health information (PHI).  Protected health information is medical information that identifies you or may provide a basis for identifying you.  Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your health information created in the doctor’s office.  This Notice is provided to tell you about the duties and practices of GBMC Healthcare with respect to your health information.  We are required by law to provide you with this Notice, and we are required to follow the terms of the Notice that is currently in effect. 

Who This Notice Applies To  

This Notice describes the privacy practices of those individuals or entities listed below:

• Greater Baltimore Medical Center (GBMC) and all affiliated entities; and
• Hospice of Baltimore, Gilchrist Center and Hospice of Howard County.
  In addition, these individuals or entities may share PHI with each other for treatment, payment or health care operation purposes described in this Notice. 

Changes to this Notice  

We may change our policies at any time.  The changes will apply to PHI we already have as well as new information we receive.  Before we make a change that may impact your understanding of our current privacy practices, we will change our Notice to reflect our current practice of protecting your PHI.  The effective date of this Notice is listed just below the title.  We will post a copy of the current Notice in a clear and visible location to which you have access.  The Notice will be available on our website, www.gbmc.org.  The Notice is also available to you upon request.  You will be offered a copy of our Notice every time you register at our facility for treatment.  You do not need to take a copy every time, but we want you to understand that we are obligated to offer this to you.  You will be asked to acknowledge in writing your receipt of this Notice.

How we may use and disclose your health information  

The following categories describe and give examples of the different ways that we may use and disclose your health information.  All of the ways we are permitted to use and disclose your information will fall within one of these categories.

Treatment

We may use PHI about you to provide you with treatment.  We may disclose your PHI to doctors, nurses, aids, technicians, or members of the workforce (including contracted employees), pharmacists, suppliers of medical equipment or other health care professionals who are involved directly or indirectly with your care.  For example, we may use and disclose your PHI for treatment purposes if we need to request the services of an outside laboratory to perform blood tests that are more extensive than those that would be performed by our in-house pathology department. 

Payment

We may use and disclose your PHI for payment purposes.  We will bill and collect for the treatment and services we provide to you.  We may send your PHI to an insurance company or third party for payment purposes including a collection service. For example, we may use and disclose your PHI for payment purposes if we contact your insurance company in order to obtain approval for an admission or procedure. 

Health Care Operations  

We may use and disclose your PHI for health care operations.  These uses and disclosures are necessary to make sure that you receive competent, quality health care, and to maintain and improve the quality of health care that we provide.  For example, we may use your PHI for performance improvement activities, which would contribute to our mission of providing medical  care and service of the highest quality to each patient.

Permitted Uses without Prior Authorization  

We may use or disclose your PHI without your prior authorization for several other reasons.  Subject to certain requirements, we may give out health information about you without prior authorization for public health purposes, abuse or neglect reporting, health oversight audits or inspections, research studies (chart review only), funeral arrangements and organ donation, worker’s compensation purposes, and emergencies.  We also disclose health information when required by law, such as in response to a request from law enforcement in specific circumstances, or in response to valid judicial or administrative orders.

To Avert a Serious Threat to Health or Safety  

We may use and disclose your necessary PHI when we believe it is 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 or lessen the threat or to law enforcement authorities in particular circumstances.

Military
 
If you are a member of the armed forces (domestic or foreign), we may release your PHI as required by domestic military command authorities for domestic armed forces and by foreign military authority for foreign armed forces.

National Security and Intelligence Activities  

We may release your PHI to authorized federal officials for lawful intelligence, counterintelligence, and other national security activities authorized by law.

Protective Services for the President and Others  

We may disclose your PHI to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or for the conduct of special investigations.

Correctional Institution and Other Law Enforcement Custodial Situations

We may disclose to a correctional institution or law enforcement official having lawful custody of an inmate or other individual, PHI about the inmate or individual if the correctional institution or law enforcement authority makes certain representations to us, proving that the disclosure of the PHI is necessary.

Treatment Alternatives, Appointment Reminders, and Health-Related Benefits  

We may use and disclose your PHI to tell you about or recommend possible treatment alternatives or health-related benefits or services that may be of interest to you.  Additionally, we may use and disclose your PHI to provide appointment reminders.  If you do not wish us to contact you about treatment alternatives, health-related benefits or appointment reminders, you must notify the Privacy Officer in writing, and state from which of those activities you wish to be excluded.

Fundraising Activities  

We may use certain information (e.g. name, address, telephone number, dates of service, age, and gender) to contact you in an effort to raise money for our operations.  We may also provide this information to our related foundation for the same purpose.  The money raised will be used to expand and improve the services and programs we provide to the community.  We do not sell the information that we are allowed by law to receive.  If you do not want us to contact you for fundraising efforts, you must notify the Privacy Officer in writing.

Patient Information Directory  

We may include certain limited information about you in our patient information directory.  This information may include your name, location in the facility, your general condition (e.g., stable, guarded, serious, and critical) and your religious affiliation.  The directory information, except for your religious affiliation, may also be released to people who ask for you by name.  Your religious affiliation may be given to a member of the clergy, such as a priest, minister, or rabbi even if they do not ask for you by name.  You will be asked at the time of registration if you would like to be included in our patient information directory. 
If you choose not to be listed in our patient information directory, then callers and visitors who ask for you by name will be told, “There is no one listed by that name.”  However, if you do choose not to be listed in our patient information directory, but still wish to receive visitors or calls then you must release your room number and phone number yourself. We will gladly direct visitors to your room as long as you have provided them with that information prior to them entering our facility. 

Individuals Involved in Your Care or Payment for Your Care  

We may release health information about you to a family member, other relative, or any other person identified by you who is involved in your health care with your permission.  We may also give information to someone who helps pay for your care.  We may also tell your family, friends, personal representative or other person responsible for your health care your condition while you are at the facility.
  
Third Parties  

We may disclose your PHI to third parties with whom we contract to perform services on our behalf.  If we disclose your information to these entities, we will have an agreement with them to safeguard your information.

Other Uses of Health Information  

Other uses and disclosures of health information not covered by this Notice or the laws that apply to us will be made only with your written authorization.  If you provide us authorization to use or disclose your PHI, you may revoke that authorization, in writing, at any time.  If you revoke your authorization, we will no longer use or disclose PHI about you for the reasons covered by your written authorization.  You understand that we are unable to take back any disclosures we may have already made under the authorization.

Your Rights Regarding Your Health Information

All request forms relating to your rights as mentioned below may be obtained from the Medical Records department at the particular facility from where you have or had received treatment. 

You have the following rights regarding health information we maintain about you:

Right to Inspect and Copy  

You have the right to review or get a copy of health information that may be used to make decisions about your care. To inspect and copy health information that may be used to make decisions about you, you must make 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. 

Right to Amend  

You have the right to ask us to modify but not delete your health and/or billing information for as long as the information is kept by us.  You must submit your request in writing.  In addition, you must provide a reason that supports your request.  We will inform you of our decision in writing.  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 health information kept by or for us;
• 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 a list of those instances where we have disclosed health information about you other than for treatment, payment, health care operations, where you specifically authorized a disclosure, or other instances specifically noted in the Privacy Rule that are not subject to the Accounting of Disclosures standard.  You must submit a written request to obtain a copy of this disclosure list.  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 list you request within a twelve-month period will be free.  For additional lists, during such twelve-month period, 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.

Right to Request Confidential Communications  

You have the right to request that health information about you be communicated to you in a confidential manner.  For example, you may ask that we call your cell phone with appointment reminders instead of your home phone.  To request confidential communications, you must make your request in writing.  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.  We will inform you of our decision in writing.

Right to Request Restrictions  

You have the right to request that we do not use or disclose health information about you for treatment, payment or health care operations.  You also have the right to request a limit on the health information we disclose about you to someone who is involved in your care or the payment for your care. You must submit your request in writing.  We are not required to agree to your request.  We will inform you of our decision in writing.

Right to a Paper Copy of This Notice  

You have the right to a paper copy of this Notice.  You may ask us to give you a copy of this Notice at any time.  Even if you have agreed to receive this Notice electronically, you are still entitled to a paper copy of this Notice. 

Complaints

If you believe your privacy rights have been violated, or you disagree with a decision we made about access to your records, you may contact our Privacy Officer (listed below) or you may contact our Privacy Hotline, which operates 24-hours a day, seven days a week at 1-800-299-7991.  You may also send a written complaint to the U.S. Department of Health and Human Services, Office of Civil Rights.  Our Privacy Officer can provide you with the address.  You will not be penalized for filing a complaint.

If you have any questions about this Notice, please contact our Privacy Officer by using the information provided below.
 
Privacy Officer c/o Compliance Dept
Greater Baltimore Medical Center
6701 North Charles Street
Baltimore, Maryland 21204
  
Phone: 443-849-2000