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Bingham Memorial Hospital**

Notice of Privacy Practices (Regulation §164.520)

THIS NOTICE DESCRIBES HOW PROTECTED MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED, AND HOW YOU CAN GAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.

1. Bingham Memorial Hospital is permitted to make uses and disclosures of protected health information for treatment, payment and health care operations, as described in the following examples:

  1. Treatment – ie. X-ray’s, laboratory testing, surgeries.
  2. Payment – ie. Charges to Insurance Companies, co-payments, Medicare/Medicaid.
  3. For health care operations – ie. Health Information Management, Information Systems.

2. Bingham Memorial Hospital is permitted or required, under specific circumstances, to use or disclose protected health information without the individual’s written authorization, including the following: [If a use or disclosure for any purpose prescribed in the Privacy Regulation is prohibited or materially limited by other applicable State law, the description of such use or disclosure must reflect the more stringent law.]

  1. To avoid a serious threat to your health or safety or the health or safety of others.
  2. As required by state or federal law such as reporting abuse, neglect or certain other events.
  3. As allowed by workers compensation laws for use in workers compensation proceedings.
  4. For certain public health activities such as reporting certain diseases.
  5. For certain public health oversight activities such as audits, investigations, or licensure actions.
  6. In response to a court order, warrant or subpoena in judicial or administrative proceedings.
  7. For certain specialized government functions such as the military or correctional institutions.
  8. For research purposes if certain conditions are satisfied.
  9. In response to certain requests by law enforcement to locate a fugitive, victim or witness, or to report deaths or certain crimes.
  10. To coroners, funeral directors, or organ procurement organizations as necessary to allow them to carry out their duties.


3. Other uses and disclosures not described in this Notice will be made only with your written authorization, including most uses or disclosures of psychotherapy notes; for most marketing purposes; or if we seek to sell your information. You may revoke your authorization by submitting a written notice to the Privacy Contact identified below. The revocation will not be effective to the extent we have already taken action in reliance on the authorization.

4. Bingham Memorial Hospital intends to engage in one or more of the following activities:              

  1. Bingham Memorial Hospital may contact the individual to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to the individual or patient.
  2. Bingham Memorial Hospital may contact the individual/patient to raise funds for  the Idaho Doctors’ Hospital; or
  3. A group health plan, or a health insurance issuer or HMO with respect to a group health plan, may disclose protected health information to the sponsor of the plan.
  4. To a member of your family, relative, friend, or other person who is involved in your healthcare or payment for your healthcare. We will limit the disclosure to the information relevant to that person’s involvement in your healthcare or payment.
  5. To maintain our facility directory. If a person asks for you by name, we will only disclose your name, general condition, and location in or facility. We may also disclose your religious affiliation to clergy.

5. The Individual has the following rights regarding protected health information:

  1. The right to request restrictions on certain uses and disclosures of protected health information.
  2. The right to receive confidential communications of protected health information, as applicable.
  3. The right to inspect and copy protected health information, as provided in the Privacy Regulation. We may charge you a reasonable cost-based fee for providing the records. We may deny your request under limited circumstances, e.g., if we determine that disclosure may result in harm to you or others
  4. The right to amend protected health information, as provided in the Privacy Regulation. We may deny your request to certain reasons, e.g., if we did not create the record or if we determine that the record is accurate and complete.
  5. The right to receive an accounting of disclosures of protected health information.
  6. The right to obtain a paper copy of the Notice from the covered entity upon request. This right extends to an individual who has agreed to receive the Notice electronically.

6. Bingham Memorial Hospital is required by law to maintain the privacy of protected health information and to provide individuals with notice of its legal duties and Privacy practices with respect to protected health information.

7. Bingham Memorial Hospital is required to abide by the terms of the Notice currently in effect.

8. Bingham Memorial Hospital reserves the right to change the terms of this Notice. The new Notice provisions will be effective for all protected health information that it maintains.

9. Bingham Memorial Hospital will provide individuals or patients with a revised Notice by posting the new notice, and replacing with an updated notice and also being distributed to the patient at time of admission.

10. Individuals may complain to Bingham Memorial Hospital and to the Secretary of the Department of Health and Human Services, without fear of retaliation by the organization, if they believe their privacy rights have been violated. A brief description of how the individual may file a complaint follows:

There are two ways that the complaint could be filed:

  1. The first option being the patient or individual may contact the Privacy Officer listed in number 11
  2. The second option is for the patient or individual to request a grievance form which may be obtained from any admissions personnel. The grievance form may then be returned to the admissions personnel or mailed to Idaho Doctors’ Hospital at the address provided in number 11

11. Bingham Memorial contact person for matters relating to complaints is:

a. Privacy Officer (208) 785-3850

98 Poplar Street, Blackfoot, ID 83221

b. Customer Liaison (208) 785-3804

98 Poplar Street, Blackfoot, ID 83221

12. This Notice is first in effect on September 23, 2013. The effective date must not be earlier than the date on which the Notice is printed or otherwise published.

13. Bingham Memorial Hospital elects to limit the uses or disclosures that it is permitted to make, as according to policy.

**Here after “Bingham Memorial Hospital” refers to Bingham Memorial Hospital, Idaho Doctors’ Hospital, Skilled Nursing and Rehabilitation Center and the Medical Office Building.

Form # 0171  Revisions: 09/27/2013

 Downloadable Copy