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. [164.520(b)(1)(i)]
I. Who We Are
This Notice describes the privacy practices of Trinitas Regional Medical Center and certain
of its affiliates, its physicians, nurses, and other personnel. It applies
to services furnished to you at Trinitas Regional Medical Center, a New Jersey Nonprofit
Corporation, and its affiliates, name-ly, the Marillac Corporation; Trinitas
Health Foundation, a New Jersey Nonprofit Corporation; The Auxiliary of
Trinitas Regional Medical Center, a New Jersey Nonprofit Corporation; Trinitas Healthcare
Corporation; and Diagnostic Imaging of Elizabeth, LLC. ("we" or "us").
II. Our Privacy Obligations
We are required by law to maintain the privacy of your health information
("Protected Health Information" or "PHI") and to provide you with this
Notice of our legal duties and privacy practices with respect to your
Protected Health Information. When we use or disclose your Protected Health
Information, we are required to abide by the terms of this Notice (or other
notice in effect at the time of the use or disclosure). [164.520(b)(1)(v)(A)]
III. Permissible Uses and Disclosures Without Your Written Authorization
In certain situations, which we will describe in Section IV below, we must
obtain your written authorization in order to use and/or disclose your PHI.
However, we do not need any type of authorization from you for the following
uses and disclosures:
A. Uses and Disclosures For Treatment, Payment and Health Care Operations.
We may use and disclose PHI (including, if any, your HIV/AIDS, venereal
disease or tuberculosis information), in order to treat you, obtain payment
for services provided to you and conduct our "health care operations" as
o Treatment. We use and disclose your PHI to provide treatment and other
services to you-for example, to diagnose and treat your injury or illness.
In addition, 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. We may also disclose PHI to
other providers involved in your treatment.
o Payment. We may use and disclose your PHI to obtain payment for services
that we provide to you-for example, disclosures to claim and obtain payment
from your health insurer, HMO, or other company that arranges or pays the
cost of some or all of your health care ("Your Payor") to verify that Your
Payor will pay for health care.
o Health Care Operations. We may use and disclose your PHI for our health
care operations, which include internal administration and planning and
various activities that improve the quality and cost effectiveness of the
care that we deliver to you. For example, we may use PHI to evaluate the
quality and competence of our physicians, nurses and other health care
workers. We may disclose PHI to our Patient Relations Coordinator in order
to resolve any complaints you may have and ensure that you have a
comfortable visit with us. We may also disclose PHI to another health care
facility to which you have been transferred when such PHI is required for
them to treat you, receive payment for services they render to you, or
conduct certain health care operations, such as quality assessment and
improvement activities, reviewing the quality and competence of health care
professionals, or for health care fraud and abuse detection or compliance.
B. Use or Disclosure for Directory of Individuals in Trinitas Regional Medical Center.
We may include your name, location in Trinitas Regional Medical Center, general health
condition and religious affiliation in a patient directory without obtaining
your authorization unless you object to inclusion in the directory [or
unless you are in a ward, wing or unit the identification of which would
reveal that you are receiving treatment for HIV/AIDS, a venereal disease or
tuberculosis.] Information in the directory may be disclosed to anyone who
asks for you by name or members of the clergy; provided, however, that
religious affiliation will only be disclosed to members of the clergy.
C. Disclosure to Relatives, Close Friends and Other Caregivers. We may use
or disclose your PHI to a family member, other relative, a close personal
friend or any other person identified by you when you are present for, or
otherwise available prior to, the disclosure, if we
(1) obtain your agreement;
(2) provide you with the opportunity to object to the disclosure and you do
not object; or
(3) reasonably infer that you do not object to the disclosure. [164.510(b)]
If you are not present, or the opportunity to agree or object to a use or
disclosure cannot practicably be provided because of your incapacity or an
emergency circumstance, we may exercise our professional judgment to
determine whether a disclosure is in your best interests. If we disclose
information to a family member, other relative or a close personal friend,
we would disclose only information that we believe is directly relevant to
the person's involvement with your health care or payment related to your
health care. We may also disclose your PHI in order to notify (or assist in
notifying) such persons of your location, general condition or death.
D. Fundraising Communications.
We may contact you to request a tax-deductible contribution to support
important activities of Trinitas Regional Medical Center. In connection with any
fundraising, we may disclose to our fundraising staff demographic
information about you (e.g., your name, address and phone number) and dates
on which we provided health care to you, without your written authorization.
If you [wish to make a tax-deductible contribution now or] do not want to
receive any fundraising requests in the future, you may contact The Trinitas
Health Foundation at (908) 994-8249
[164.514(e)] [164.514(f); 164.520(b)(1)(iii)(B)]
E. Public Health Activities.
We may disclose your PHI for the following public health activities:
(1) to report health information to public health authorities for the
purpose of preventing or controlling disease, injury or disability;
(2) to report child abuse and neglect to public health authorities or other
government authorities authorized by law to receive such reports;
(3) to report information about products and services under the jurisdiction
of the U.S. Food and Drug Administration;
(4) to alert a person who may have been exposed to a communicable disease or
may otherwise be at risk of contracting or spreading a disease or condition;
(5) to report information to your employer as required under laws addressing
work-related illnesses and injuries or workplace med-ical surveillance.
F.Victims of Abuse, Neglect or Domestic Violence.
If we reasonably believe you are a victim of abuse, neglect or domestic
violence, we may disclose your PHI to a governmental authority, including a
social service or protective services agency, authorized by law to receive
reports of such abuse, neglect, or domestic violence. [164.512(c)]
G. Health Oversight Activities.
We may disclose your PHI to a health oversight agency that oversees the
health care system and is charged with responsibility for ensuring
compliance with the rules of government health programs such as Medicare or
H. Judicial and Administrative Proceedings.
We may disclose your PHI in the course of a judicial or administrative
proceeding in response to a legal order or other lawful process, such as,
under New Jersey law, the request of a person (or his/her insurance carrier)
against whom you have com-menced a lawsuit for compensation or damages for
your personal injuries. [164.512(e)]
I. Law Enforcement Officials.
We may disclose your PHI to the police or other law enforcement officials as
required or permitted by law or in compliance with a court order or a grand
jury or administrative subpoena. [164.512(f)].
We may disclose your PHI to a medical examiner as authorized by law.
K. Organ and Tissue Procurement.
We may disclose your PHI to organizations that facilitate organ, eye or
tissue procurement, banking or transplantation. [164.512(h)]
We may use or disclose your PHI without your consent or authorization if our
Institutional Review Board approves a waiver of authorization for
M. Health or Safety.
We may use or disclose your PHI to prevent or lessen a threat of imminent,
serious physical violence against you or another readily identifiable
N. Specialized Government Functions.
We may use and disclose your PHI to units of the government with special
functions, such as the U.S. military or the U.S. Department of State under
certain circumstances. [164.512(k)]
O. Workers' Compensation.
We may disclose your PHI as authorized by and to the extent necessary to
comply with state law relating to workers' compensation or other similar
P. As required by law.
We may use and disclose your PHI when required to do so by any other law not
already referred to in the preceding categories.
IV. Uses and Disclosures Requiring Your Written Authorization
A. Use or Disclosure with Your Authorization.
For any purpose other than the ones described above in Section III, we only
may use or disclose your PHI when you grant us your written authorization on
our authorization form ("Your Authorization"). For instance, you will need
to execute an authoriza-tion form before we can send your PHI to your life
insurance company or to the attorney representing the other party in
litigation in which you are involved. [164.508(a)(1)]
We must also obtain your written authorization ("Your Marketing
Authorization") prior to using your PHI to send you any marketing materials.
(We can, however, provide you with marketing materials in a face-to-face
encounter without obtaining Your Marketing Authorization. We are also
permitted to give you a promotional gift of nominal value, if we so choose,
without obtaining Your Marketing Authorization.) In addition, we may
communicate with you about products or services relating to your treatment,
case management or care coordination, or alternative treatments, therapies,
providers or care settings without Your Marketing Authorization.
C. HIV/AIDS Related Information.
Your Authorization must expressly refer to your HIV/AIDS related information
in order to permit us to disclose your HIV/AIDS related information.
However, there are certain purposes for which we may disclose your HIV/AIDS
information, without obtain-ing Your Authorization:
(1) your diagnosis and treatment;
(2) scientific research;
(3) management audits, financial audits or program evaluation;
(4) medical education;
(5) disease prevention and control when permitted by the New Jersey
Department of Health and Senior Services;
(6) to comply with a certain type of court order; and
(7) when required by law, to the Department of Health and Senior Services or
another entity. You also should note that we may disclose your HIV/AIDS
related information to third party payors (such as your insurance company or
HMO) in order to receive payment for the services we provide to you.
D. Genetic Information.
Except in certain cases (such as a paternity test for a court proceeding,
anonymous research, newborn screening requirements, or pursuant to a court
order), we will obtain your special written consent prior to obtaining or
retaining your genetic informa-tion (for example, your DNA sample), or using
or disclosing your genetic information for treatment, payment or health care
operations purposes. We may use or disclose your genetic information for any
other reason only when Your Authorization expressly refers to your genetic
information or when disclosure is permitted under New Jersey State law
(including, for example, when disclosure is necessary for the purposes of a
criminal investigation, to determine paternity, newborn screening,
identi-fying your body or as otherwise authorized by a court order.
E. Venereal Disease Information.
Your Authorization must expressly refer to your venereal disease information
in order to permit us to disclose any information identifying you as having
or being suspected of having a venereal disease. However, there are certain
purposes for which we may disclose your venereal disease information,
without obtaining Your Authorization, including to a prosecuting officer or
the court if you are being prosecuted under New Jersey law, to the
Department of Health and Senior Services, or to your physician or a health
authority, such as the local board of health. Your physician or a health
authority may further disclose your venereal disease information if
he/she/it deems it necessary in order to protect the health or welfare of
you, your family or the public. Under New Jersey law, we may also grant
access to your venereal disease information upon the request of a person (or
his/her insurance carrier) against whom you have commenced a lawsuit for
compensation or damages for your personal injuries.
F. Tuberculosis Information.
Your Authorization must expressly refer to your tuberculosis information in
order to permit us to disclose any information identifying you as having
tuberculosis or refusing/failing to submit to a tuberculosis test if you are
suspected of having tuberculosis or are in close contact to a person with
tuberculosis. However, there are certain purposes for which we may disclose
your tuberculosis information, without obtaining Your Authorization,
including for research purposes under certain conditions, pursuant to a
valid court order, or when the Commissioner of the Department of Health and
Senior Services (or his/her designee) determines that such disclosure is
necessary to enforce public health laws or to protect the life or health of
a named person.
V. Your Rights Regarding Your Protected Health Information
A. For Further Information; Complaints.
If you desire further information about your privacy rights, are concerned
that we have violated your privacy rights or disagree with a decision that
we made about access to your PHI, you may contact our Privacy Office. You
may also file written com-plaints with the Director, Office of Civil Rights
of the U.S. Department of Health and Human Services. Upon request, the
Privacy Office will provide you with the correct address for the Director.
We will not retaliate against you if you file a complaint with us or the
Director. [164.520(b)(1)(vi); 164.530(a)(1)(ii)]
B. Right to Request Additional Restrictions.
You may request restrictions on our use and disclosure of your PHI
(1) for treatment, payment and health care operations,
(2) to individuals (such as a family member, other relative, close personal
friend or any other person identified by you) involved with your care or
with payment related to your care, or
(3) to notify or assist in the notification of such individuals regarding
your location and general condition. While we will consider all requests for
additional restrictions carefully, we are not required to agree to a
requested restriction. If you wish to request additional restrictions,
please obtain a request form from our Privacy Office and submit the
completed form to the Privacy Office. We will send you a written response.
C. Right to Receive Confidential Communications.
You may request, and we will accommodate, any reasonable written request for
you to receive your PHI by alternative means of communication or at
alternative locations. [164.522(b); 164.520(b)(1)(iv)(B)]
D. Right to Revoke Your Authorization.
You may revoke Your Authorization or Your Marketing Authorization, except to
the extent that we have taken action in reliance upon it, by delivering a
written revocation statement to the Privacy Office identified below. [A form
of Written Revocation is available upon request from the Privacy Office.]
E. Right to Inspect and Copy Your Health Information.
You may request access to your medical record file and billing records
maintained by us in order to inspect and request copies of the records.
Under limited circumstances, we may deny you access to a portion of your
records. If you desire access to your records, please obtain a record
request form from the Privacy Office and submit the completed form to the
Privacy Office. If you request copies, we will charge you $1.00 for each
page, plus a base fee of $10.00. We will also charge you for our postage
costs, if you request that we mail the copies to you. [164.524;
You should take note that, if you are a parent or legal guardian of a minor,
certain portions of the minor's medical record will not be accessible to you
(for example, records relating to pregnancy, abortion, sexually transmitted
diseases, substance use or abuse, or contraception and/or family planning
F. Right to Amend Your Records.
You have the right to request that we amend Protected Health Information
maintained in your medical record file or billing records. If you desire to
amend your records, please obtain an amendment request form from the Privacy
Office and submit the completed form to the Privacy Office. We will comply
with your request unless we believe that the information that would be
amended is accurate and complete or other special circumstances apply.
G. Right to Receive An Accounting of Disclosures.
Upon request, you may obtain an accounting of certain disclosures of your
PHI made by us during any period of time prior to the date of your request
provided such period does not exceed six years and does not apply to
disclosures that occurred prior to April 14, 2003. [164.528; 164.520(b)(1)(iv)(E)]
If you request an accounting more than once during a twelve (12) month
period, we will charge you $1.00 per page of the accounting statement.
H. Right to Receive Paper Copy of this Notice. Upon request, you may obtain
a paper copy of this Notice, even if you have agreed to receive such notice
electronically. [164.520(c)(3); 164.520(b)(1)(iv)(F)]
VI. Effective Date and Duration of This Notice
A. Effective Date.
This Notice is effective on April 14, 2003.
B. Right to Change Terms of this Notice.
We may change the terms of this Notice at any time. If we change this
Notice, we may make the new notice terms effective for all Protected Health
Information that we maintain, including any information created or received
prior to issuing the new notice. If we change this Notice, we will post the
new notice in waiting areas around Trinitas Regional Medical Center [and on our Internet
site at http://www.trinitas.com.] You also may obtain any new notice by
contacting the Privacy Office.
VII. Privacy Office [164.530(a)(1)] You may contact the Privacy Office at:
Trinitas Regional Medical Center
225 Williamson Street
Elizabeth, NJ 07207
Telephone Number: 908-994-5317
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