Our Pledge Regarding Protected Mental Health Information
This notice describes our healthcare system's practices and that
of all persons employed or contracted by The Brook Hospital.
We understand that your mental health information is personal
and confidential, and we pledge that we will protect this
information about you. We will create a record of the care and
services you receive at The Brook in order to provide you with
quality care and to comply with certain legal requirements. This
notice applies to all of the records of your care generated by the
healthcare system.
We are required by law to:
How We May Use & Disclose Medical Information About
You
Due to the confidentiality of your mental health and/or chemical
dependency information, The Brook Hospital will only disclose
information regarding your treatment upon receiving a proper
authorization from you. Exceptions include when the information is
needed for treatment, payment, or healthcare operations as well as
when required by federal, state, or local law.
For Treatment: We may
use medical information about you to provide you with medical
treatment or services. We may disclose medical information about
you to doctors, nurses, technicians, healthcare students, clergy,
or others who are involved in your care. Different departments of
the healthcare system may share medical information about you in
order to coordinate the different services you need. We may
disclose information to persons outside the hospital involved in
continuing your care (i.e., assisting you in scheduling follow-up
appointments) so long as you have given us authorization to do
so.
For Payment: We may use
and disclose medical information about you so that the treatment
and services provided to you by the healthcare system may be
billed. Payment may be collected from you, and insurance company,
or a third party. We may need to give your health plan information
about your treatment in order for your health plan to pay us or to
reimburse you. We may also tell your health plan about treatment
you are going to receive to obtain prior approval or to determine
if your plan will cover the treatment.
For Healthcare
Operations: We may use and disclose medical information
about you for healthcare system operations. Information used in
this sense may be to analyze the services we provide, to evaluate
staff performance, and for educational purposes.
Fund-raising Activities.
The hospital, or a foundation related to the hospital, may use
information about you in an effort to raise money for the hospital
and its operations. This information would include your name,
address, phone number, and the dates you received treatment or
services. If you do not want the system to contact you for
fund-raising efforts, you must notify our Privacy Officer in
writing.
Special Situations
Research and Health-Related
Alternatives: Under certain circumstances, we may use and
disclose medical information about you for research purposes,
notification of treatment alternatives, and/or health-related
benefits and services. We will remove information that identifies
you from this set of medical information in order to protect your
identity. We will ask for your specific permission if the situation
would require access to your name, address or other information
that reveals who you are.
Organ and Tissue
Donation: If you are an organ donor, we may release medical
information as necessary to facilitate organ or tissue donation and
transplantation.
Workers' Compensation:
We may release medical information about you to for workers'
compensation or similar programs upon receipt of a proper written
authorization from you or as required by law.
Reporting Public Health
Risks: We may use and disclose medical information about you
to agencies when required by law to prevent a serious threat to the
health and safety of you or another person. Examples of such
situations include:
Health Oversight
Activities: We may disclose medical information to a health
oversight agency for activities authorized by law. These include,
for example, audits, investigations, inspections, and licensure.
These activities are necessary for the government to monitor the
healthcare system, government programs, and compliance with civil
rights laws.
Coroners and Medical
Examiners: We may release medical information to a coroner
or medical examiner. This may be necessary to identify a deceased
person or determine the cause of death.
Legal Disclosures: If
you are involved in a lawsuit or a legal dispute, we may disclose
medical information about you in response to a court or
administrative order which has been signed by a judge or such
person given equal authority under the law.
Government/Law Enforcement
Agencies: We will disclose medical information about you
when required to do so by federal, state, or local law.
Military:
We may release medical
information about you:
Other Uses of Medical
Information:Other uses and disclosures of medical
information not covered by this notice or the laws that apply to us
will be made only with your written permission.
Changes to This Notice:
We reserve the right to change this notice. We reserve the right to
make the revised notice effective for medical information we
already have about you as well as any information we receive in the
future. The effective date of the notice will be located on the
first page in the top right-hand corner.
You have the following rights regarding the medical information
we maintain about you:
Complaints
If you believe your privacy rights have been violated, you may
submit your complaint in writing to the Privacy Officer at the
following addresses. KMI: 8521LaGrange Road, Louisville, KY 40242
or Dupont: 1405 Browns Lane, Louisville, KY 40207. If we cannot
resolve your concern, you also have the right to file a written
complaint with the Secretary of the Department of Health and Human
Services. The quality of your care will not be jeopardized nor will
you be penalized for filing a complaint.
Quality of Care / Safety Concerns
If you have a patient safety or quality of care concern you have
the right to contact Joint Commission on Accreditation of
Healthcare Organizations either by phone, sending a written letter,
or visiting their website. The information is below for your easy
reference:
JCAHO
One Renaissance Boulevard
Oakbrook Terrace, IL 60181
1-630-792-5800 / 1-800-994-6610
complaint@JCAHO.org