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.

Understanding Your Health Record /Information
Each time you visit Southern Maine Medical Center (SMMC), a record of your visit is made. Typically, this record contains your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:

• basis for planning your care and treatment
• means of communication among the many health professionals who contribute to your care
• legal document describing the care you received
• means by which you or a third-party can verify that services billed were actually provided
• tool in educating health professionals
• source of information for public health officials charged with improving the health of the nation
• source of data for medical research.
• tool with which we can assess and continually work to improve the care we render and the outcomes we achieve

Understanding what is in your record and how your health information is used helps you to:

• ensure its accuracy
• better understand who, what, when, where, and why others may access your health information
• make more informed decisions when authorizing disclosure to others

Your Health Information Rights
Although your health record is the physical property of SMMC, the information belongs to you. You have the right to:

• request a restriction on your health information that is used or disclosed to carry out treatment, payment or health care operations and other permitted disclosures as provided by 45 CFR 164.522.
• obtain a paper copy of the notice of privacy practices upon request.
• inspect and receive a copy your health record as provided for in 45 CFR164.524.
• amend your health record as provided in 45 CFR 164.528
• obtain an accounting of disclosures of your health information as provided in 45 CFR 164.528.
• revoke your authorization to use or disclose health information except to the extent that action has already been taken.
• be notified if we are unable to agree to a requested restriction or alternate communication methods.

You may exercise these rights by contacting the Health Information Services Department at SMMC.

You also have the right to request that reasonable accommodations be made to have health information communicated to you by alternative means or at alternative locations. Such requests must be made to the Registration Department.

Our Responsibilities
Southern Maine Medical Center is required to:

• maintain the privacy of your health information
• provide you with a notice as to our legal duties and privacy practices with respect to information we collect and maintain about you
• abide by the terms of the notice currently in effect
• notify you when we cannot fulfill your request for restricted access or for alternate notification.

Except as described in this notice, we will not use or disclose your health information without your authorization, and you may revoke that authorization at any time as described in this notice.

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. Should our information practices change, we will make the notice available to you.

For More Information or to Report a Problem
If you have questions or would like additional information, please contact our Privacy Officer at (207) 283-6800.

If you believe that your privacy rights have been violated, you can file a complaint by calling (207) 283-6800, or by writing to: Privacy Officer, Southern Maine Medical Center, 1 Medical Center Drive, Biddeford, ME,  04005. You may also contact the Secretary of Health and Human Services. There will be no retaliation for filing a complaint.

Examples of Disclosures for Treatment, Payment and Healthcare Operations (T.P.O.)
We will use your health information for Treatment ~

• For example: Information obtained by a nurse, physician, or other member of your healthcare team will be recorded in your record and used to determine the course of treatment that should work best for you. Your physician will document in your record his or her expectations of the members of your healthcare team. Members of your healthcare team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment. We will also provide your physician or a subsequent healthcare provider with copies of various reports that could assist him or her in treating you once you’re discharged from this facility.

We will use your health information for Payment ~

• For example: A bill may be sent to you or to a third-party payer, such as a health insurer or health plan. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.

We will use your health information for regular Healthcare Operations ~

• For example: Members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the healthcare and service we provide.

Hospital Directories ~

• Unless you notify us that you object, we may use your name, location in the facility, general condition, and religious affiliation for directory purposes. This information may be provided to individuals who ask for you by name. Directory information may be provided to members of the clergy even if they do not ask for you by name.

Uses and Disclosures Made Without Authorization
Notification ~

• We may use or disclose information to notify, or assist in notifying, a family member, personal representative, or another person responsible for your care, your location, and general condition.

Communication with family ~

• Health professionals, using their best judgement, may disclose to a family member, other relative, 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.

Research ~

• We may disclose your 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 health information.

Funeral Directors, Coroners, and Medical Examiners ~

• We may disclose medical information to funeral directors consistent with applicable law to carry out their duties. We may also release information to Coroners and Medical Examiners for such activities as identifying a deceased person or determining a cause of death.

Organ procurement organizations ~

• Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking or transplantation of organs for the purpose of tissue donation and transplant.

Contacts ~

• We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

Food and Drug Administration (FDA) ~

• We may disclose to the FDA health information relative to adverse events with respect to food, supplements, product and product defects, or post marketing surveillance information to enable product recalls, repairs, or replacement.

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.

Public health ~

• As required by law, we may disclose your health information to public health or legal authorities charged with preventing or controlling disease, injury, or disability.

Correctional institution ~

• Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.

Law enforcement ~

• We may disclose health information for law enforcement purposes as required by law.

Health Oversight Activities ~

• We may disclose medical information to a health oversight agency for activities authorized by law. These oversight activities, for example, include audits, investigations, inspections, and licensure.

Fund Raising ~

• We may use demographic information (name, address, etc.) for fund-raising activities unless we are informed in writing that you object to this use.

We may, without authorization, use or disclose protected health information regarding:

• Victims of abuse, neglect or domestic violence.
• Judicial and administrative proceedings.
• Disclosures to avert a serious threat to health or safety.
• Specialized government functions.
• Circumstances when, in good faith, we believe the use or disclosure is necessary to prevent or lessen a serious or imminent threat to a person or to the public.
• Substance abuse in accordance with the regulations contained in 42 CFR part 2.

This Notice of Privacy Practices applies to all employees of SMMC, including physicians, nurses, other health care providers and administrative staff. It also applies to all other persons or entities who provide treatment and care to SMMC patients on-site even if they are not directly employed by SMMC. For example, this may include physicians and health care providers on SMMC’s medical or allied health staff, contract physicians who provide laboratory, anesthesia or radiology services, and crisis counselors, among others.

Effective Date: April 14, 2003