Patient Information
Patient Information
Welcome to Trinity Health System!
Contact
a Current Patient using our Patient E-mail Form!
Whether
we have served you in the past or if you are planning your first
visit, we extend to you our sincere welcome.
While your visit to the Emergency Department, diagnostic
testing or therapeutic services are seldom pleasant experiences,
be assured that your well-being is the primary concern of our entire
staff.
We work hard to make your visit with us here as pleasant
as possible. If you will be visiting us soon, take a moment to review
the information on this web site. If we're missing something you
would find helpful—let
us know!
NOTICE OF PRIVACY PRACTICES
THIS NOTICE DESCRIBES HOW 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 a hospital, physician, or other healthcare provider,
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:
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; and,
- make more informed decisions when authorizing disclosure to
others.
Your Health Information Rights:
Although your health record is the physical property of the healthcare
practitioner or facility that compiled it, the information belongs
to you. You have the right to:
- request a restriction on certain uses and disclosures of your
information, upon written request, as provided by 45 CFR 164.522
and organization policy
- receive confidential communications of protected health information,
as provided by 45 CFR 164.522 (b) as applicable;
- obtain a paper copy of the notice of privacy practices upon
request;
- inspect and copy your health record, upon written request, as
provided for in 45 CFR 164.524 and organization policy (a copy
fee applies);
- amend or correct your health record, upon written request, as
provided in 45 CFR 164.528 and organization policy;
- obtain an accounting of disclosures of your health information,
upon written request, as provided in 45 CFR 164.528 and organization
policy;
- request communications of your health information by alternative
means or at alternative locations;
- revoke your authorization to use or disclose health information
except to the extent that action has already been taken; and,
- file a complaint with our organization and/or with the Secretary
of Health and Human Services.
Our Responsibilities:
This organization 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 this notice;
- notify you if we are unable to agree to a requested restriction;
and
- accommodate reasonable requests you may have to communicate
health information by alternative means or at alternative locations.
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 provide notice
of such change on our website and by updating this Notice, which
will be available at our organization.
We will not use or disclose your health information without your
authorization, except as described in this notice.
For More Information or to Report a Problem
If have questions and would like additional information, you may
contact our organization’s Privacy Officer at (740) 282-5323.
If you believe your privacy rights have been violated, you can
file a complaint with our organization’s Privacy Officer or with
the Secretary of Health and Human Services. There will
be no retaliation for filing a complaint.
Examples of Disclosures for Treatment, Payment and Health Operations
(made without your authorization)
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 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 should assist him/her
in treating you once you're discharged from this hospital.
We will use your health information for payment. For example: A
bill may be sent to you or a third party payer. 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 health 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.
Other Uses or Disclosures
(made without your authorization) Business Associates:
There are some services provided in our organization through contacts
with business associates. Examples include physician services in
the Emergency Department and Radiology, certain laboratory tests,
and a copy service we use when making copies of your health record.
When these services are contracted, we may disclose your health
information to our business associate so that they can perform the
job we've asked them to do and bill you or your third party payer
for services rendered. So that your health information is protected,
however, we require the business associate to appropriately safeguard
your information.
Directory: Unless you notify us that you object, we
will use your name, location in the facility, general condition,
and religious affiliation for directory purposes. This information
may be provided to members of the clergy and, except for religious
affiliation, to other people who ask for you by name.
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 judgment, 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 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: We may disclose health information to
funeral directors consistent with applicable law to carry out their
duties.
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.
Marketing: 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.
Fund Raising: We may contact you as part of a fund-raising
effort.
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 Risks: As required by law, we may disclose
medical information about you for public health activities.
These activities generally include the following:
- to prevent or control disease, injury, or disability;
- to report births and deaths;
- to report child abuse or neglect;
- to report reactions to medications or problems with products;
- to notify people of recalls of products they may be using;
- to notify a person who may have been exposed to a disease or
may be at risk for contracting or spreading a disease or condition;
- to notify the appropriate government authority if we believe
a patient has been the victim of abuse, neglect, or domestic violence.
We will only make this disclosure if you agree or when required
or authorized by law.
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, or in response to a
valid subpoena, warrant, summons, or court order.
Appointment Reminders: We may use and disclose medical
information to contact you as a reminder that you have an appointment
for treatment or medical care at the hospital.
Treatment Alternatives: We may use and disclose medical
information to tell you about or recommend possible treatment options
or alternatives that may be of interest to you.
Health-Related Benefits and Services: We may use and
disclose medical information to tell you about health-related benefits
or services that may be of interest to you.
Military and Veterans: If you are a member of the
armed forces, we may release medical information about you as required
by military command authorities. We may also release medical
information about foreign military personnel to the appropriate
foreign military authority.
Health Oversight Activities: We may disclose medical
information to a health oversight agency for activities authorized
by law. These oversight activities include, for example, audits,
investigations, inspections, and licensure. These activities
are necessary for the government to monitor the health care system,
government programs, and compliance with civil rights laws.
National Security and Intelligence Activities: We
may release medical information about you to authorized federal
officials for intelligence, counterintelligence, and other national
security activities authorized by law.
Protective Services for the President and Others:
We may disclose medical information about you to authorized federal
officials so they may provide protection to the President, other
authorized persons, or foreign heads of state or conduct special
investigations.
Federal law makes provision for your health information to be released
to an appropriate health oversight agency, public health authority
or attorney, provided that a workforce member or business associate
believes in good faith that we have engaged in unlawful conduct
or have otherwise violated professional or clinical standards and
are potentially endangering one or more patients, workers or the
public.
Effective Date: April 14, 2003
Acknowledgement
of Receipt of Notice
I understand that Trinity Health System, Steel Valley
Emergency Physicians, LLC,
Ohio Valley Pathology Associates, Inc., Steuben Radiology
Associates, Inc., Allegheny
Specialty Practice Network, Trinity Anesthesiology
Associates, and Trinity Medical
Staff is part of an organized healthcare arrangement
and that these providers may
share my health information for treatment, billing
and healthcare operations. I have
been given the opportunity to receive a copy of the
organization's Notice of Privacy
Practices that describes how my health information
is used and shared. I understand
the organized healthcare arrangement has the right
to change this notice at any time. I
may obtain a current copy by contacting the hospital
registration office or by visiting
the Web site at www.trinityhealth.com.
My signature below constitutes my acknowledgement
that I have been provided with
an opportunity to receive a copy of the Notice of
Privacy Practices.
________________________________________
_____________________
Signature of Patient or Legal Representative
Date
If signed by legal representative, relationship to patient:__________________________ |
(4000-110 Rev. 04/2003)
Healthcare Checklist
Trinity Health System
Health Care Checklist for Patients
The single most important thing you can do to ensure good care
and prevent medical errors is to be an active partner in your
own health care – that means getting involved in your care and
asking questions of your physician, your nurse, your technician.
Here are some guidelines that may help you. We encourage you to
use these tips.
Medical Care:
- Speak up if you have questions or concerns. You have a right
to ask questions of anyone who is involved with your care.
- Make a list of your symptoms and any questions you may have
to take with you to your doctor’s office or while you are in
the hospital. Take notes to help you remember information.
- Make sure you share important health information with all
of the professionals involved in your care. Keep a copy of your
health history, including prior illnesses, tests and test results,
surgeries, medicines – including how and when you take your
medicines, and other treatments and share this information with
the people caring for you.
- Ask a family member or a friend to be with you and to be your
advocate when you speak with a health care professional or when
you are receiving care.
- Find out why a test or treatment is required.
- Ask about the results of your tests. If you do not receive
your test results within the time frame that your doctor said
you would, call the doctor’s office to follow up.
- Learn about your condition and treatment. Ask your doctor
and his staff about where you can find out additional information.
Hospitalization:
- Make sure that all medicines you take are intended for you.
Your nurse should check your identity by looking at your wristband
before giving any medication. Before the nurse gives you the
medication, ask what medicine they are providing.
- Make sure that those caring for you wash their hands. Hand
washing is an important way to prevent the spread of infection.
If necessary, remind your caregiver.
- If you are having surgery, make sure you and your doctor
are clear on exactly what should be done. The American Academy
of Orthopedic Surgeons urges physicians to mark the site where
surgery is to be performed with a permanent marker before surgery.
- Understand your treatment plan and what you should and should
not do when you go home. Ask questions and repeat answers
back to your doctor, nurse or technician to make sure you understand.
Research shows that health care professionals think patients
understand more than they really do about their care.
- Make sure your caregiver at home understands the treatment
plan and is able to take care of your health care needs. If
not, tell your doctor or the nurse who helps with your discharge.
Medicines:
- Make sure your doctor knows about ALL the medicines you are
currently taking – prescriptions, and over the counter medicines
as well as dietary supplements such as herbs and vitamins. Take
a list of your medicines, including dosages, with you.
- Make sure your doctor knows about any allergies you have
and previous reactions you have experienced from medicines.
- When your doctor writes a prescription, make sure you can
read it. Ask the doctor to print the name of the drug on the
prescriptions and the purpose for taking it.
- Ask if the generic brand is appropriate.
- Ask for information about your medicines in terms you can
understand:
- How am I supposed to take this medicine and for how long?
- Are side effects likely? What should I do if they occur?
- Is this safe to take with other medicines or supplements
I already take?
- Are there foods, drinks or activities I should avoid
while taking this medicine?
- When you pick up your medicine at the pharmacy:
- Ask if this is the medicine your doctor ordered.
- Inform your pharmacist of any allergies and other medicines,
vitamins and dietary supplements you are currently taking.
- Make sure you understand the directions on the prescription
label.
- Ask for written information about possible side effects.
- Ask for a device to measure liquid medicines.
- Be sure to throw away outdated medicines or those medicines
that your doctor has discontinued.
|