Call (970) 332-4811

Notice of Privacy Practices

Download as pdf

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. This notice is effective as of April 14, 2003, and was last revised on October 7, 2016

In this notice, ‘personal information’ refers to any medical or financial information that can be used to identify you and relates to your physical or mental health or condition, the provision of healthcare to you, or the payment for that care, including your medical record. Personal information may include your name, Social Security Number, address, telephone number, e-mail address, employment, medical history, health records, claims information, or credit card number.

This notice is based on state and federal law, as well as our code of ethics. It explains our responsibilities and privacy practices regarding your personal information. Wray Community Hospital District is required to protect the privacy of your personal information, provide you with this notice, and abide by the terms of this notice.

At Wray Community Hospital District, safeguarding your privacy and the confidentiality of your personal information is a priority. Wray Community Hospital District’s policies and procedures are designed to protect your personal information in written, verbal, and electronic forms. Access to your information is kept to a minimum for the intended purpose and provided only for legitimate business need. Physical, electronic, and other safeguards help to protect against unauthorized access to your information.

Your Health Information

We keep a record of healthcare services you receive from us, as well as medical records sent to us from other healthcare providers. We will not share your information with others unless directed by you or otherwise allowed by law.

How we may use and share your personal information

Wray Community Hospital District uses and shares your personal information to provide treatment, receive and provide payment for healthcare services, and conduct health care operations. Some examples of how we may use or share your personal information without your authorization are described below.

Treatment

We may use or share your personal information to provide you medical care. For example, our physicians, nurse practitioners, nurses, pharmacist, and lab technicians may share your personal information to provide you with healthcare services. In addition, we may share your personal information with healthcare providers or suppliers outside of Wray Community Hospital District for consultation, referral, or coordination of your care.

Payment and health care operations

We may use and share your personal information to carry out healthcare operations. Healthcare operations are business activities that support the delivery and payment of health care. Payment or healthcare operations purposes could include:

  • Determining benefit eligibility and coordinating benefits with other health plans
  • Reviewing services for medical necessity
  • Paying a claim
  • Performing utilization review
  • Obtaining premiums
  • Subrogating a claim
  • Collection activities
  • Providing care management
  • Educating health or other professionals
  • Conducting medical reviews
  • Providing customer service
  • Determining coverage policies
  • Performing business planning
  • Arranging for legal and auditing services
  • Obtaining accreditations and licenses

Wray Community Hospital District may also contract with individuals or entities known as Business Associates to work on our behalf, which may require us to use and share your personal information with them. Our Business Associates must agree in writing to safeguard the confidentiality of your personal information in accordance with federal law and this notice.

Disclosures required by law

Certain state and federal laws may require Wray Community Hospital District to share your personal information. For example, we may share your information with:

  • An authorized public health authority to protect public health and safety; to prevent or control certain diseases, injuries, or conditions; to report vital events such as births or deaths; or to participate in registries such as the cancer registry
  • The U.S. Food and Drug Administration (FDA) to investigate or track problems with prescription drugs and medical devices.
  • Workers’ Compensation programs, which provide benefits to you if you have a work-related injury or illness.
  • Government benefits programs, like Medicare and Medicaid, in order to review your eligibility and enrollment in these programs.
  • Government entities authorized to receive reports regarding child or vulnerable adult abuse or neglect.
  • Health oversight agencies. As health plans and health care providers, we must agree to oversight reviews by federal and state and other agencies. These agencies may conduct audits, perform inspections and investigations, license healthcare providers, health plans, and healthcare facilities, and enforce federal and state regulations.
  • Law enforcement officials in limited circumstances. For example, disclosures may be made to report a crime on Wray Community Hospital District property.
  • Armed forces personnel for military activities and to authorized federal officials for national security activities.
  • Funeral directors to assist with their responsibilities.
  • County coroners for the investigation of deaths.
  • Organ procurement organizations to the extent allowed by law.
  • Disaster relief organizations such as the Red Cross to assist in disaster relief efforts.
  • Correctional facilities if you are an inmate. We may share your personal information for your health and the health and safety of others.

Wray Community Hospital District may also use or share your personal information without your authorization in the following circumstances:

  • Family, domestic partner, or friend involved in your care or the payment of your care or a person you identify when you are present and agree, or when you are not present or incapacitated and in our professional judgment it is in your best interest to share information about your care.
  • Appointment reminders: If you are a patient, to remind you that you have a healthcare appointment with us.
  • Health Information Exchange: If you are a patient, we may make your health information available electronically through an information exchange network to other health care providers involved in your care. The purpose of this exchange is to deliver safer, better coordinated care to you by sharing your health information with other providers caring for you.
  • Services related to your healthcare and wellness: If you are a member or patient, to remind you about preventative health services or to let you know about treatment alternatives, providers, settings of care, or health and wellness products or services that are available for you.
  • Facility directory information: If you are a patient in the Wray Community Hospital District, we may share your name, your general health condition, and your religious affiliation in our facility directory unless you tell us that you wish to be excluded.
  • Fundraising: If you are a patient, we may contact you to raise funds for a nonprofit charitable organization supporting Wray Community Hospital District and the community. We only use limited information about you for fundraising appeals and communications. To direct us not to contact you for this purpose, call (970) 332-2211.
  • Research: If you are a patient, for medical and other research, certain steps are taken to protect your privacy. Generally, an institutional research review board evaluates each research project to ensure that researchers follow processes that will protect your privacy.
  • Education: We may use and share your information to teach and educate staff and students. For example, teaching physicians may review health information with medical students.
  • Public health and safety: We may use and share your personal information to avert a threat to the health and safety of a person or the public.

Wray Community Hospital District may share your personal information in response to a court order and, in certain cases, in response to a subpoena, discovery request, or other lawful process.

Other uses of your personal information

Except in the situations described above, we will use and share your personal information only with your written permission or authorization. This includes verbal authorization for the use of your personal e-mail or cell phone number in regards to the Patient Portal or other web-based exchanges excluding HIEs as described above. Wray Community Hospital District is not permitted to sell or rent your personal information and may not use or share your personal information for marketing purposes without your authorization. In some situations, federal and state laws provide special protections for sharing specific kinds of personal information and require authorization from you before we can share that specially protected medical information. For example, information about treatment for alcohol or drug abuse, sexually transmitted disease, and mental health is specially protected. In these situations and for any other purpose, we will contact you for the necessary authorization. If you sign an authorization to disclose your healthcare information, you may withdraw it at any time by letting us know in writing.

Your rights

You have rights regarding personal information that we maintain about you. You may get more information about exercising these rights by calling the Privacy Officer at (970) 332-2211.

  • Request restrictions: You may request that we limit the way we use or share your personal information. Please make your request to us in writing. Wray Community Hospital District will consider your request but is not required to agree to it.
  • Request restrictions to a health plan: You may request that certain healthcare services or items that you pay for fully at the time of service not be shared with your health plan. Please let your provider know before, or at the time of service or we may not be able to fulfill your request.
  • Confidential communication: You may ask that we contact you in a certain way or at a certain location, for example at a different address or phone number. We will usually be able to accommodate your request. Please make your request to us in writing.
  • Inspect and copy: We keep a record of the healthcare services we provide you. You may review and request a copy of information in your medical record and certain other records maintained by Wray Community Hospital District. We may ask you to make this request in writing. You may see your record or get more information about it at the Health Information Management Department at Wray Community Hospital District. We may charge a reasonable fee for the cost of producing and providing you with a paper or electronic copy. In certain situations we may deny your request and tell you why we are denying it. You have the right to ask for a review of our denial.
  • Amendments: You may ask us to correct or amend information in your records. Your request for a change to your record must be in writing and must give a reason for the request. We may deny your request, but you may respond by filing a written statement of disagreement and ask that the statement be included with your record.
  • Accounting of disclosures: You may seek an accounting of certain disclosures by asking us for a list of the times we have shared your personal information. Your request must be in writing.
  • Breaches: You may receive a notice from Wray Community Hospital District about a breach of unsecured personal information if you are affected. We may also inform you of ways you can protect yourself in the event of a breach.
  • Receive an additional copy of this notice: You may request a paper copy or ask general questions about this notice by calling Wray Community Hospital District at (970) 332-2211. You may also view this notice on our website at wrayhospital.org

Questions and complaints

If you have questions about this notice or want to file a complaint about our privacy practices, write or call:

Privacy Officer
Wray Community Hospital District
1017 W 7th Street
Wray, CO 80758
(970) 332-2211

For more information on how to file a written complaint, call the Privacy Office at (970) 332- 2211. You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services Office for Civil Rights. We will not retaliate against you if you file a complaint about our privacy practices.

Changes to privacy practices

We may change the terms of this notice at any time. If we change any of the privacy practices described in this notice, we will post the revised notice on our website, at wrayhospital.org and at all patient initial access points on Wray Community Hospital District’s campus. We may give you additional information about our privacy practices in other notices we provide.