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  • 207-723-5161
  • info@mrhme.org

Your Rights & Concerns

MILLINOCKET REGIONAL HOSPITAL (MRH) NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THIS NOTICE CAREFULLY.
This notice serves as a Joint Notice of Privacy Practices for this location, our healthcare providers and staff, and all other MRH healthcare providers. We list contact information for our locations at the end of this Notice. You can also ask us for a complete list of all MRH locations.

We protect the privacy and confidentiality of your health information and so does the law. When you need medical care, you give information about yourself and your health to doctors, nurses, and other hospital and clinic workers and staff. This information, and the record of the care you receive, is called “protected health information” or “health information”. We share your health information to give you medical care, to get payment for services we provide to you, and to support our healthcare operations. We describe how we use your health information in this Notice. Federal law requires that we give you a copy of this Notice to learn about:
1. How, when and why we share your health information;
2. How the law requires us to protect your health information;
3. Your rights to your health information; and,
4. What happens if your health information is lost or improperly used or shared.

COPIES OF THE NOTICE – There is a copy of this Notice in the lobby area of places where we provide medical services. You can ask our staff for a copy of the Notice. You can also ask us to mail you a copy. If we change this Notice, you may ask us to give you a copy of the new Notice. You also can print a current copy of this Notice from our website at www.MRHme.org.

WHO FOLLOWS THIS NOTICE – Every MRH Member hospital and healthcare provider, and the staff who work there, follows the term of this Notice. This includes:
1. All employees, volunteers, and students;
2. All healthcare professionals allowed to enter information into your medical record;
3. All departments and units of MRH Member hospitals and other healthcare providers;
4. All employed physicians and their practice sites.
This Notice does not cover the privacy practices that your personal doctor may use in his or her private office unless your doctor works for us. Even if we do not employ your doctor, if your doctor treats you at any MRH Member hospital, your doctor will follow this Notice.

ACKNOWLEDGEMENT OF RECEIPT OF THIS NOTICE – We will ask you to sign a statement that you received this Notice (except in emergencies). The statement does not mean you agree with our Notice, only that you received it. We will treat you even if you do not sign the statement. We will share your health information as described in this Notice.

OUR DUTIES REGARDING YOUR HEALTH INFORMATION – The law requires that we:
1. Keep your health information private;
2. Give you this Notice to let you know how we share your health information and how you can get a copy of your health information;
3. Follow this Notice; and
4. Let you know of any changes to this Notice.
We may change our privacy practices and this Notice at any time. If we change this Notice, the new Notice will cover all health information we have. We will provide the new Notice to you upon request.

OUR DUTIES IF YOUR HEALTH INFORMATION IS LOST OR IMPROPERLY USED OR DISCLOSED – Under certain circumstances the law requires us to notify you if your health information is lost or if it is improperly used or shared. If this happens, we will send a letter to you to let you know what happened and how we are addressing the problem.
A. HOW WE MAY USE OR DISCLOSE (SHARE) YOUR HEALTH INFORMATION
Here are some of the ways that we may share your health information. We do not need to ask you for permission to do the things listed in this section. Other uses and disclosures not described in this Notice will be made only with your written permission.

FOR YOUR TREATMENT – We will share your health information to provide you with healthcare services. This means we can talk with other doctors about your healthcare. We can also send you to another doctor for treatment. For example, we will share your health information with a specialist to make sure the specialist has the information he or she needs to diagnose and/or treat you.
We belong to a state group of healthcare organizations called HealthInfoNet. This group works with each other to share electronic health information for your care. For example, you may be admitted to a non-MRH-hospital in an emergency and be unable to give information about your health condition. Those who treat you can see your health information held by an MRH member hospital. This means better care for you. You can decide not to share your health information by completing an “opt-out” form from any MRH location and sending it to HealthInfoNet.
If you participate in any MRH accountable care organization (“ACO”), including the Medicare Pioneer ACO, all of your health information (except for alcohol and drug abuse program treatment information) will be shared with providers and payers for the purposes of your care coordination and care management.

FOR APPOINTMENT REMINDERS – We may use your health information to remind you of an appointment.

TREATMENT ALTERNATIVES – We may share your health information to tell you about different medical treatments.

HEALTH BENEFITS AND SERVICES – We may share your health information to tell you about health benefits and services.

MRH-RELATED FUND-RAISING ACTIVITIES – We may share your health information to tell you about our fundraising efforts. You can ask us not to send you fundraising information. Any fundraising request you receive will tell you how you can ask not to receive these requests. We will not send you fundraising requests if you decide you do not want to receive them. If you change your mind, we will tell you how you can begin receiving fundraising information again.

PAYMENT FOR SERVICES YOU RECEIVE – We will share your health information to get payment for the health services we provide to you. For example, we may contact your insurance company to find out if it will pay for a treatment you will receive. After you receive treatment we may share your health information with your insurance company to make sure we are paid and you are reimbursed for your care. If you make full payment for your treatment yourself, you may ask that we not share health information about that treatment to your insurance. We must agree to your request unless a law requires us to share this information.

FOR OUR HEALTHCARE OPERATIONS – We may use your health information to improve the quality of care we provide to patients. We also use this information to improve how we run our facilities or for quality improvement. Your information also can be shared to review the qualifications of healthcare professionals and to train students. We sometimes share your health information with contractors who do work for us (for example, to do billing and transcribe information). These contractors are our “business associates”, and they must protect your health information the same way we do.

B. OTHER USES AND DISCLOSURES
WHEN REQUIRED BY LAW – We may share your health information if a law or regulation requires us to do so.
FOR PUBLIC HEALTH ACTIVITIES – We may share your health information with a public health agency or to law enforcement when required by law. For example, we may share your health information to:
1. Prevent a threat to the health and safety of any person;
2. Report births and deaths;
3. Tell a person who may have been exposed to a communicable disease or who could get or spread a disease or condition;
4. Report bad reactions to medications or medical products; and
5. Tell the appropriate government agency if we believe a patient has been the victim of abuse, neglect, or domestic violence.

TO THE FOOD AND DRUG ADMINISTRATION – We may share your health information with the Food and Drug Administration (“FDA”). This agency tracks the quality, safety and effectiveness of products it approves for use.

FOR HEALTH OVERSIGHT ACTIVITIES – We may share your health information with federal or state government. The government may need your health information for audits, investigations, and inspections. The government also uses this information to review how Medicare and MaineCare are working, and to make sure we follow the law.

FOR LEGAL PROCEEDINGS – We may share your health information to respond to a court order or some other legal process.

FOR LAW ENFORCEMENT– We may share your health information if the police ask for:
1. Information to identify or locate a victim, suspect, fugitive, material witness or missing person;
2. Medical records about victims of a crime;
3. Information about deaths caused by suspected criminal conduct; or
4. Information about crimes that occur at any of our locations.

TO CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS – We may share health information with a coroner or medical examiner to identify a person who has died, or to find out why a death happened. We may share health information with a funeral director to do his or her work.

FOR ORGAN AND TISSUE DONATION – If you are an organ donor, we may share your health information for organ, eye and tissue donation and transplant if you are near death or have died.

FOR MEDICAL RESEARCH – We may share your health information for research, such as studying how well a treatment worked. All research must protect the confidentiality of your health information. In most cases, we must ask you to allow us to use your health information.

TO THE MILITARY OR VA – If you are a member of the Armed Forces, we may share your health information as required by the military or with the Department of Veterans Affairs. If you are in a foreign military, we may also share your health information with the foreign military agency.

FOR NATIONAL SECURITY – We may share your health information with the government for national security reasons, or for the protection of the President.

IF YOU ARE AN INMATE – We may share your protected health information with a prison or jail or with a law enforcement official to: (1) provide healthcare to you; (2) protect your health and safety and the health and safety of others; and (3) ensure the safety and security of the prison or jail.

FOR WORKERS’ COMPENSATION – We may share your health information for workers’ compensation and other programs that provide benefits for work-related illnesses and injuries.

PARENTAL ACCESS – Some Maine laws about minors limit, allow, or require the sharing of health information with parents, guardians, and persons in a similar legal status. We will follow Maine law.

C. USES AND DISCLOSURES YOU MAY LIMIT OR ASK NOT BE MADE AT ALL.
This section lists some situations where you can agree to, or not allow, the sharing of your health information. Even if you allow us to share your health information in these situations, you always have the right to take back your permission at any time.

PATIENT DIRECTORY – To help family members and other visitors locate you while you are in the hospital, our hospitals use patient directories. The directories may include your name, location, general condition, and religion, if any. Your location (room number or department) will be shared with people who ask for you by name. Clergy can see your name and religion. You also can decide not to be listed in the directory. Let us know if you do not want to be listed in the patient directory.

TO FAMILY MEMBERS AND OTHERS INVOLVED IN YOUR CARE – We may share health information with a family member or friend who cares for you or who helps pay for your healthcare. We may share your health information during disasters so your family can find out about your condition and location. If you do not want us to share your health information with family members or others, please let us know.
If you are in an emergency condition and cannot make your wishes known, or if we cannot understand your wishes due to a communication difficulty, we will use our best judgment when deciding to share your health information with family members and others involved in your care.

D. USES AND DISCLOSURES THAT REQUIRE YOUR AUTHORIZATION
There are some situations when we will ask for your written permission before we share your health information. You have the right to ask us to stop sharing your health information at any time. This does not affect health information that you already allowed us to share. Types of situations that require your written permission include:
1. Sharing your protected health information for marketing purposes;
2. Communications with you that we are paid to make;
3. Selling health information; and
4. Most uses and disclosures of psychotherapy notes.

MRH does not sell health information.

Some types of health information have special protections under law. Examples include health information about HIV/AIDS and information from mental health and substance abuse treatment programs. In many situations we must have your written permission to share that information. One exception is in an emergency to provide you with the treatment you need.

E. YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION
This section gives you information about your health record. It describes what you can ask us to do with your health record. We must ask for your written permission if we want to share your information for any other reason that is not listed in this Notice.
RIGHT TO REQUEST RESTRICTIONS – You can ask that we not share your health record. If you do not want us to share your record, write a letter to the contact person at the end of this Notice where you receive your healthcare and tell us:

  • The information you do not want us to share;
  • How you want us to limit the sharing of your health record;
  • Who you do not want to see your health record; and
  • The date when your health information can be shared again.

We do not have to agree to your request. If we do agree with your request, we will not share your information unless we have to for emergency treatment or for legal reasons. You can decide to let us start sharing your information at any time by telling us in writing.
If you pay, or another person pays on your behalf, for your medical services out of pocket in full, you can ask us not to share information about those medical services with your insurance company. We must agree not to share this information unless the law requires us to share it.

RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS – If you want us to contact you in a certain way or at a certain place, you can ask us to do that. For example, you may ask us to call you on your cell phone instead of your home phone. We will do our best to honor your request.

RIGHT TO INSPECT AND COPY – You can look at and get a paper or electronic copy of your health record, billing records and other records we use to make decisions about your healthcare. Just send a letter to the contact person listed at the place where you receive your medical care. If you are not sure whom to contact, any person on the list can help you. Sometimes there is a small fee to cover the cost of making copies and providing you the records.
If we think there is information that could put your health and safety in danger, or put the health and safety of others in danger, we can say no to your request to look at and get a copy of your records.

RIGHT TO AMEND – If you think something is wrong or missing in your health record, you can ask us to change it. Write to us and tell us what needs to be changed. You can send your changes to the contact person where you receive your medical services. This information is at the end of this Notice. You can also call any contact person for help. We may send you a letter about your changes.

RIGHT TO AN ACCOUNTING OF DISCLOSURES – You can ask us to tell you who we shared your health information with. The list we give to you will not have information about:

  • When we shared your health record for your medical care;
  • When we shared your health record to receive payment;
  • When we shared your health record for our business operations, or,
  • When we shared your health record because you asked us to share it with you or with other people.To ask us about how we shared your health record, send a letter to the contact person listed at the end of this Notice where you receive most of your medical care, or contact any person on the list.

RIGHT TO OBTAIN A COPY OF THIS NOTICE – You can get a paper copy of this Notice from us at any time. Just ask for a copy from the place where you receive your medical care. You can print this Notice from our website at www.MRHme.org.

COMPLAINTS – You may write to us or to the Department of Health and Human Services if you have concerns about your privacy. To send a letter to us, please write to the contact person listed at the end of this Notice for the place where you receive medical services. We will answer your questions about this Notice and look into your concerns. To write to the Secretary of the United States Department of Health and Human Services, use this address:
Secretary, Department of Health and Human Services
JFK Federal Building, Room 1875
Boston, MA 02203
Phone: (617) 565-1340 or (617) 565-1343 (TDD)

NO ONE WILL TAKE ANY ACTION AGAINST YOU FOR RAISING A CONCERN.
If you have questions about your privacy rights or this Notice, please call or write to any listed contact person.

This Notice of Privacy Practices is effective as of April 1, 2015.