Your Partner in Care
As our valued patient, we respect your dignity and rights. An important part of our patient-centered philosophy is to ensure that when you are in our care, you understand your rights as a patient. Because your care is a collaborative effort between you, your physician, and hospital staff, there are also patient responsibilities which we expect you’ll follow to the best of your ability.
- You have the right to receive considerate, respectful, and compassionate care in a safe setting regardless of your age, gender, race, national origin, religion, sexual orientation, gender identity, disabilities, or ability to pay.
- You have the right to receive care in a safe environment free from all forms of abuse, neglect, or mistreatment.
- You have the right to be told the names of your doctors, nurses, and all health care team members directing or providing you care.
- You have the right to have a family member or person of your choice, and your doctor notified promptly of your admission to the hospital.
- You have the right to have someone remain with you for emotional support during your hospital stay unless your visitor’s presence compromises your or others’ rights, safety, or health. You have the right to deny visitation at any time.
- You have the right to be told by your doctor about your diagnosis and possible prognosis, the benefits and risks of treatment, and the expected outcome of treatment, including unexpected outcomes. You have the right to give written informed consent before any non-emergency procedure begins.
- You have the right to have your pain assessed and to be involved in decisions about treating your pain.
- You have the right to be free from restraints and seclusion in any form that is not medically required.
- You can expect full consideration of your privacy and confidentiality in care discussions, exams, and treatments. You may ask for an escort during any exam.
- You have the right to access protective and advocacy services in cases of abuse or neglect. The hospital will provide a list of these resources.
- You, your family, and friends with your permission have the right to participate in decisions about your care, your treatment, and services provided, including the right to refuse treatment to the extent permitted by law. If you leave the hospital against the advice of your doctor, the hospital and doctors will not be responsible for any medical consequences that may occur.
- You have the right to communicate that you can understand. The hospital will provide sign language and foreign language interpreters as needed at no cost. Information given will be appropriate to your age, understanding, and language. If you have a vision, speech, hearing, or other impairments, you will receive additional aids to ensure your care needs are met.
- You have the right to make an advance directive and appoint someone to make healthcare decisions for you if you are unable. If you do not have an advance directive, we can provide you with information and help you complete one.
- You have the right to be involved in your discharge plan. You can expect to be told in a timely manner of your discharge, transfer to another facility, or transfer to another level of care. Before your discharge, you can expect to receive information about follow-up care that you may need.
- You have the right to receive detailed information about your hospital and physician charges.
- You can expect that all communication and records about your care are confidential unless disclosure is permitted by law. You have the right to see or get a copy of your medical records. You may add information to your medical record by contacting the Medical Records Department. You have the right to request a list of people to whom your personal health information was disclosed.
- You have the right to spiritual services. Chaplains are available to help you directly or to contact your own clergy.
You have the right to voice your concerns about the care you receive. If you have a problem or complaint, you may talk with your doctor, nurse manager, or a department manager. You may also contact the Patient Relations Department at 419-238-8623. If your concern is not resolved to your liking, you may also contact:
- The Joint Commission’s Office of Quality Monitoring at 800.994.6610; email: email@example.com
- The Ohio Department of Health at 800.342.0553; email: firstname.lastname@example.org; mail: ODH, PCSU, 246 N. High St. Columbus, OH 43215
- Ohio KePRO Beneficiary Helpline at 800.589.7337 to report concerns, disagreement with coverage decision, or to appeal a discharge decision for a Medicare beneficiary; mail: Ohio KePRO, Pock Run Center, Suite 100, 5700 Lombardo Center Drive, Seven Hills, OH 44131
- You are expected to provide complete and accurate information, including your full name, address, telephone number, date of birth, Social Security number, insurance carrier, and employer when required.
- You should provide the hospital or your doctor with a copy of your advance directive if you have one.
- You are expected to provide complete and accurate information about your health and medical history, including present condition, past illnesses, hospital stays, medicines, vitamins, herbal products, and any other matters that pertain to your health, including perceived safety risks.
- You are expected to ask questions when you do not understand information or instructions. If you believe you cannot follow through with your treatment plan, you are responsible for telling your doctor. You are responsible for outcomes if you do not follow the care, treatment, and service plan.
- You are asked to please leave valuables at home and bring only necessary items for your hospital stay.
- You are expected to treat all hospital staff, other patients, and visitors with courtesy and respect; abide by all hospital rules and safety regulations, and be mindful of noise levels, privacy, and number of visitors.
- You are expected to provide complete and accurate information about your health insurance coverage and to pay your bills in a timely manner.
- You have the responsibility to keep appointments, be on time, and call your health care provider if you cannot keep your appointments.
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.
I. Uses and Disclosures of Your Medical Information.
A. Treatment, Payment, and Operations. Van Wert Health (sometimes referred to as "we" or "us") is permitted to use your medical information for purposes of treating you, to obtain payment for providing medical services to you, and to assist in its health care operations. We may also use your medical records to assess the appropriateness and quality of care that you received, improve the quality of health care, and achieve better patient outcomes. An understanding of what is in your health records and how your health information is used helps you: ensure its accuracy and completeness; understand who, what, where, why, and how others may access your health information; and make informed decisions about authorizing disclosures to others.
(i) Use of your protected health information for treatment purposes. A physician or another member of your health care team will record information in your record to diagnose your condition and determine the best course of treatment for you. We will also provide your primary physician, other health care professionals, or a subsequent health care provider, copies of your records to assist them in treating you.
(ii) Use and disclosure of your protected health information for purposes of payment. We may send a bill to you or to a third-party payer, such as a health insurer. The information on or accompanying the bill may include information that identifies you, your diagnosis, treatment received, and supplies used.
(iii) Use and disclosure of your protected health information for healthcare operations. Health care operations consist of activities that are necessary to carry out our operations as a healthcare provider, such as quality assessment and improvement activities. For example, members of our medical staff, the risk or quality improvement manager, or members of the quality assurance team may use information in your health record to assess the care and outcomes in your cases and the competence of the caregivers. We will use this information in an effort to continually improve the quality and effectiveness of the health care and services that we provide.
B. Appointment Reminders. We may contact you at home to provide appointment reminders unless you specify otherwise in writing to us.
C. Other purposes for which we can use your protected health information without written authorization from you. In addition to using your protected health information for purposes of treatment, payment, and health care operations, we may use or disclose your protected health information without your written authorization and without giving you an opportunity to object in the following situations:
(i) As Required by Law. We may use or disclose your protected health information as required by law. We will limit the disclosure to those portions relevant to the requirements of the law.
(ii) Public Health Activities. We may use or disclose your protected health information to public health entities authorized to collect information for the purposes of controlling or preventing disease (including sexually transmitted diseases), injury, or disability. We may also disclose to governmental agencies authorized to receive reports of child abuse or neglect. We may disclose protected health information to the Food and Drug Administration relative to adverse effects/events with respect to food, drugs, supplements, product or product defects, or post-marketing surveillance information to enable product recalls, repairs, or replacement.
(iii) Medical Surveillance of the Workplace and Work-related Injuries. We may provide your protected health information to your employer if we are asked by your employer to provide medical services to you for purposes of medical surveillance of the workplace or a work-related illness or injury.
(iv) Victims of Abuse, Neglect, or Domestic Violence. To the extent authorized or required by law, and in the exercise of our doctor’s professional judgment, we believe the disclosure is necessary to prevent harm, we may disclose protected health information to law enforcement officials.
(v) Health Oversight Activities. We may disclose your protected health information to a governmental health oversight agency overseeing the health care system, governmental benefit programs, or compliance with governmental program standards.
(vi) Judicial and Administrative Proceedings. We may disclose your protected health information in response to an order of a court or a valid subpoena.
(vii) Law Enforcement Purposes. We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena or we may provide limited information for identification or location purposes.
(viii) Information About Deceased Individuals. We may disclose your protected health information to coroners and medical examiners to carry out their official duties, and to funeral directors as necessary to carry out their duties to the deceased individual.
(ix) Organ, Eye, or Tissue Donation. We may disclose protected health information to organ procurement agencies for the purpose of facilitating organ, eye, or tissue donation or transplantation.
(x) Research Purposes. We may disclose protected health information to researchers when their research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your protected health information.
(xi) Avoidance of Serious Threat to Health or Safety. We may disclose protected health information if we believe in good faith that such disclosure is necessary to prevent or lessen a serious and immediate threat to health and safety of a person or the public.
(xii) Certain Specialized Governmental Functions. If you are Armed Forces or foreign military personnel, we may disclose your protected health information to your appropriate military command. We may disclose your protected health information to a governmental agency as authorized by the National Security Act or for the protection of the President of the United States, as required by law.
(xiii) Correctional Institutions. If you are an inmate, we may disclose your protected health information to the correctional institution or law enforcement in the course of providing care to you or the health and safety of others responsible for your custody or other inmates.
(xiv) Disclosures for 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.
D. Other uses and disclosures of your protected health information will only be made with your prior written authorization. This includes, but is not limited to: (i) uses and disclosures of psychotherapy notes (if applicable); (ii) certain uses and disclosures for marketing purposes, including direct or indirect remuneration to the Van Wert County Hospital Association; (iii) uses and disclosures that constitute a sale of your protected health information; and (iv) other uses and disclosures not described herein. You may revoke an authorization at any time, provided you do so in writing. We will honor such a revocation except to the extent that we had already taken action in reliance upon your prior authorization.
E. Facility Directory. Unless you object (verbally or in writing) we may disclose to our resident directory your name, general condition, and your religious affiliation, Other than religious affiliation, this information may be disclosed to persons that contact us and ask for you by name.
II. Your Individual Rights.
You have the following rights under federal law with respect to your protected health information and may exercise them in the following manner:
A. The Right to Request Restrictions on the Use of Protected Health Information. You have the right to request that we restrict the use of your protected health information. You have the right to request that we limit our disclosure of your protected health information to treatment, payment, and healthcare operations and disclosures to individuals (family members) involved in your care. Such a restriction, if agreed to by us, will not prevent permitted or required uses and disclosures of protected health information. We are not required to agree to any requested restriction. You also have the right to restrict certain disclosures to a health plan if and when you pay out of pocket and in full for the health care item or service.
B. The Right to Receive Confidential Communications of Protected Health Information by Alternative Means. We must accommodate a reasonable written request by you to receive communications of your protected health information by alternative means (e.g., via e-mail) or at an alternative location (e.g., at your place of employment rather than at home).
C. The Right to Inspect and Copy your Medical Records. You have the right to inspect and obtain a copy from us of your protected health information in our possession, including an electronic copy of your protected health information that we maintain electronically in a designated record. We may impose a reasonable cost-based fee for the labor involved and supplies used for creating the copy of your medical records.
D. The Right to Amend Protected Health Information. You have the right to have us amend protected health information in our possession. You must make the request in writing and provide supporting reason(s) for the requested amendment. If we grant the request, we will notify you, and we will make the correction and distribute the correction to those who need it and those whom you identify to us that you want to receive the corrected information.
E. The Right to Receive an Accounting of Disclosures of Protected Health Information. You have the right to obtain an accounting of disclosures by us of your protected health information, other than for purposes of treatment, payment, and health care operations. Depending on whether your particular doctor has incorporated electronic health records into his or her medical practice, you may have the right to obtain an accounting of all disclosures of protected health information. The first accounting in any 12-month period is free. Thereafter, we reserve the right to charge a reasonable, cost-based fee.
F. The Right to Obtain a Paper copy of this Notice Upon Request. You have the right to receive a paper copy of this Notice upon request.
G. The Right to Opt-Out of Fundraising Communications. In the event we choose to contact you for purposes of fundraising, you will be given the opportunity to opt out of such fundraising communications.
III. Our Duties to Safeguard Your Protected Health Information.
A. Our Duties to You. We are required by federal law to maintain the privacy of protected health information and to provide you with notice of its legal duties and privacy practices with respect to your protected health information. We will maintain the privacy of your health information, including implementing reasonable and appropriate physical, administrative, and technical safeguards to protect the information. We have the duty to mitigate any breach of privacy regarding your protected health information. In the event of any breach of privacy regarding your protected health information, the Van Wert County Hospital Association is required to notify you.
B. Privacy Notice. The Van Wert County Hospital Association is required to abide by the terms of its Privacy Notice as currently in effect.
C. Complaints. You may complain to us or the Secretary of Health and Human Services if you believe your privacy rights have been violated. You may obtain and file a Patient Privacy Complaint with our Privacy Officer. You will not be retaliated against for filing a complaint.
D. Contact Person and Telephone Number. If you have questions and/or would like additional information, you may contact the Van Wert County Hospital Association’s Privacy Officer in writing at 1250 South Washington Street, Van Wert, Ohio 45891 or by calling the Privacy Officer at 419.238.2390 ext. 639 or faxing us at 419.238-0692.
E. Effective Date. This Privacy Notice is Effective September 23, 2013.
WE RESERVE THE RIGHT TO CHANGE THE TERMS OF OUR NOTICE OF PRIVACY PRACTICES AND TO MAKE THE NEW NOTICE PROVISIONS EFFECTIVE FOR ALL PROTECTED HEALTH INFORMATION THAT WE MAINTAIN. IF WE CHANGE OUR INFORMATION PRACTICES, WE WILL POST THE REVISED NOTICE IN THE OFFICE AND PROVIDE YOU WITH A COPY UPON REQUEST.
NOTICE ABOUT HEALTH INFORMATION EXCHANGE:
We participate in one or more Health Information Exchanges. Your healthcare providers can use this electronic network to securely provide access to your health records for a better picture of your health needs. We and other healthcare providers may allow access to your health information through the Health Information Exchange for treatment, payment or other healthcare operations. This is a voluntary agreement. You may opt-out at any time by notifying the Health Information Management Services at 419-238-8650.
Your Patient Experience is Our Top Priority
Van Wert Health is committed to providing accurate and honest information about clinical processes and the patient experience. We believe that well-informed patients take a more active role in improving their health condition.
Employees, patients, and visitors are encouraged to bring any concern or complaint to the manager at Van Wert Health. We will work to address and professionally resolve the issue.
If anyone has any unresolved patient safety or quality of care concerns, we encourage patients to contact the Director of Patient Relations at 419-238-8623 or email@example.com. We welcome direct contact and pride ourselves in responding to patient concerns. However, if the matter remains unresolved, we encourage patients to contact the Joint Commission on Accreditation at one of the following ways:
- Web: Visit jointcommission.org and use the "Report a Patient Safety Event" link
- Fax: 630-792-5636
- Mail: Office of Quality and Patient Safety, One Renaissance Boulevard, Oakbrook Terrace, IL 60181
Van Wert Health complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. Van Wert Health does not exclude people or treat them different because of race, color national origin, age, disability, or sex.
Van Wert Health:
- Provides free aids and services to people with disabilities to communicate effectively with us, such as:
- Qualified sign language interpreters
- Written information in other formats (large print, audio, accessible electronic formats, other formats)
- Provides free language services to people whose primary language is not English, such as:
- Qualified interpreters
- Information written in other languages
If you need these services, contact Mackenzie Cron at firstname.lastname@example.org or call (419) 238-2390 and ask for Mackenzie Cron.
If you believe that Van Wert Health has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with: Ellen Rager, 1250 South Washington Street, Van Wert, OH 45891, Phone: 419-238-8623, email: email@example.com. You can file a grievance in person or by mail or email. If you need help filing a grievance, Ellen Rager is available to help you.
You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, or by mail or phone at:
U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at from the United States Department of Human Health Services.
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