Privacy Practices | Holy Cross Hospital

Notice of Privacy Practices

This notice describes how your medical information may be used and disclosed and how
you can gain access to this information. Please review it carefully.

The Importance of Privacy at Holy Cross Hospital
At Holy Cross Hospital, we strive to be the most trusted provider of health care in the
area. That means we are committed to protecting the privacy of your medical information. We believe that you are entitled to understand how your medical information is used at Holy Cross Hospital and how it is shared with our partners in your care. Please read this Notice of Privacy Practices (the “Notice”) thoroughly. If you have any questions or need additional information about issues covered in this Notice, please contact the Holy Cross Hospital Privacy Official at 1500 Forest Glen Road, Silver Spring, MD 20910 or at (301) 754-7870.

I. Permitted Uses or Disclosures of Your Medical Information
Treatment, Payment, and Healthcare Operations: To function as a hospital, we will need to use and disclose your medical information for treatment, payment, and healthcare operations. Examples of each are listed below:

Treatment:
- Disclose that you have diabetes to a physician treating you for a joint replacement because diabetes may slow the healing process. In addition, the physician may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. It is important to note that physicians providing care at our hospital are required to abide by the terms of this Notice.
- Disclose your medical information to people or entities outside Holy Cross Hospital who are involved in your treatment while at the Hospital or will be caring for you after you are discharged.
- Use and disclose your name, address, employment, insurance carrier, emergency contact information, and appointment scheduling information in an effort to coordinate your treatment with us and with other healthcare providers.
Payment:
- Share copies or excerpts of your medical records which are necessary for
  payment of your account with an insurance company, third party administrator, health plan, another healthcare provider, or collection agency.
  - Disclose information to obtain pre-approval for payment of treatment from your insurance company.
  - Healthcare Operations:
    - In order for us to operate our business in an efficient, safe and legal manner, we may need to use or disclose your medical information for activities including monitoring the effectiveness of our services, managing costs, obtaining accreditation, and training personnel. In cases where medical information is shared with Trinity Health, our corporate parent, they will abide by the terms, of this Notice.

Fundraising Activities: We may contact you in an effort to raise money to benefit
Holy Cross Hospital. We will seek your permission if we want to use medical information related to your specific treatment. If we use a related foundation or company to assist us with our fundraising efforts, that foundation or company may only use your information for the purposes of fundraising for Holy Cross Hospital and must keep your information private. Any fundraising materials we send you will let you know how to opt out of receiving similar communications in the future or you may do so by contacting the privacy Official at (301) 754-7870.
Educational and Health Promotional Activities: We may contact you to provide
information about our services and health improvement education. We may send you newsletters or contact you by other means regarding treatment options, health related information, disease-management programs, wellness programs, or other community based initiatives or activities.
Family/Friends: We may disclose medical information about you to a family member or a close personal friend who you have designated to be involved in your medical care or who helps you pay for your health care. During the registration process, you will be asked to provide the names of these individuals. You have a right to request that your medical information not be shared with some or all of your family members or friends. In addition, we may disclose medical information about you to an agency assisting in a disaster relief effort so that your family can be notified about your condition, status, and location.
Holy Cross Hospital Directory: We will include certain limited medical information,
(name, location, Hospital phone number, and general condition), about you in the Holy Cross Hospital Directory while you are a patient. We will only disclose directory information to people who ask for you by name. During the registration process, we will ask you if you would like to be included in our directory. If you request to opt out of our directory, we cannot inform visitors of your presence, location, phone number in the Hospital or condition.
Clergy: Directory information may be given to members of the clergy, such as a priest or rabbi, even if they do not ask for you by name. Spiritual care providers are members of our healthcare team and you have a right to request that your name not be given to any member of the clergy.
Media: We may update the media by releasing medical information about you only if the request identifies you by your name. Prior to disclosing medical information to the media, we will give you an opportunity to agree or object to the disclosure. If you agree to the disclosure to the media, the Hospital will disclose only your condition described in general terms that do not communicate specific medical information, such as “good,, “fair,” “serious,” or “critical.” If you would like for us to disclose more information to the media, you will need to sign an authorization.
Research: During your stay with us, you may be asked to participate in a research study. Your involvement in the study is completely voluntary. Before you are part of a research study, we will inform you about the study and seek your consent to participate in the study. If the research study involves your treatment, we will ask for your written permission to allow us and the researchers to use and disclose your medical information for the research study. In rare cases, we are allowed by law to use your medical information without your consent as long as a special review board authorizes the research study and ensures your privacy will be protected.
Required by Law: We may disclose medical information about you when required by federal or state law.
Public Health Activities: We may use or disclose your medical information for public health activities, including:
- Preventing or controlling injury or disease.
- Reporting child abuse, neglect, or domestic violence.
- Reporting quality, safety, or effectiveness issues of FDA-regulated
  products and activities.
- Reporting to employers about work related illness or injury.
Health Oversight: We may disclose your medical information to government
agencies as authorized or required by law.
Judicial and Administrative Proceedings: We are required to disclose your medical information in response to a court order, subpoena, discovery request, or other lawful process.
Law Enforcement Purposes: We may disclose your medical information for law
enforcement purposes. For example, we may provide information to law enforcement officials relating to a criminal investigation.
Coroners, Medical Examiners, and Funeral Directors: We may share your medical information with a coroner or medical examiner. For example, this disclosure will be necessary to identify a deceased person or to determine a cause of death. We may also disclose your medical information to funeral directors as necessary to carry out their duties.
Organ Donation: We may disclose medical information to an organ procurement
organization or entity for organ, eye, or tissue donation purposes.
Military: If you are a member of the Armed Forces or a Veteran, we may release medical information about you to military authorities.
National Security and Intelligence Activities: We may disclose your medical information to authorized federal officials for lawful intelligence and other national security activities.
Protective Service for the President and Others: We may disclose your medical
information to authorized federal officials for the purpose of providing protective services to the U.S. President, heads of state or others, or to conduct special investigations.
Workers’ Compensation: We will make certain disclosures that are required in order to comply with workers’ compensation or similar programs.
Other Uses of Medical Information: Any uses or disclosures that are not for treatment, payment, healthcare operations or permitted by law will be made only after obtaining your signed authorization. A written authorization will let you know why we are using or disclosing your medical information. You have the right to revoke an authorization at any time, except to the extent that we have relied on an authorization.

II. Your Rights Regarding Your Medical Information
You have the following rights concerning your medical information. To exercise any of
these rights, please make a written request to the Holy Cross Medical Records D
Department, 1500 Forest Glen Road, Silver Spring, MD 20910.

Right of Access: You have the right to inspect and receive a copy of your medical
information as long as we maintain it. You do not have a right to inspect or copy:
- Psychotherapy notes.
- Information that will be used in a civil, criminal, or administrative action or proceeding.
- Information prohibited or protected by law.
- You will be charged a reasonable copying fee.
Right to Amend: You have the right to amend your medical information for as long
as we maintain it. Your request must include justification for the amendment. We may deny your request for an amendment, if:
- We did not create the information.
- The information is not part of your medical record.
- The information would not be available for your inspection (due to its condition or nature).
- The information is accurate and complete.
- If we deny your amendment request, we will notify you in writing with the reason for the denial. We will also inform you of your right to submit a written statement disagreeing with the denial. We may prepare a rebuttal to your statement of disagreement and will provide you with a copy of that rebuttal. You may ask that Holy Cross Hospital include your request for amendment and the denial any time that we disclose the information that you wanted changed.
Right to an Accounting of Disclosure: You have the right to receive an accounting
of disclosures we made of your medical information for six years from the date you make the request. This list will not include disclosures:
- To carry out treatment, payment, or healthcare operations.
- To you or your personal representative.
- To family and friends you authorized to receive the information.
- For national security or intelligence purposes.
- To correctional institutions or law enforcement officials.
- If you signed an authorization to release the information.
- Any disclosures that occurred prior to April 14, 2003.
- In any given 12-month period, Holy Cross Hospital will provide you with an accounting of the disclosures of your medical information at no charge. Any additional requests for an accounting within that time period will be subject to a reasonable fee for preparing the accounting.
Right to Request Restrictions: You have the right to request restrictions of certain
uses and disclosures of your medical information. For example, you may restrict to only certain family members, relatives, close personal friends, or other individuals involved in your care.
Right to Confidential Communications: You have the right to receive confidential
communications of your medical information by alternative means or at an alternative location. For example, you may request that we only contact you by mail or at work. We will consider all reasonable requests.
Right to Receive a Copy of this Notice: You have the right to receive a paper copy of this Notice of Privacy Practices, upon request.

III. How to File a Complaint and Contact Information
If you believe your privacy rights have been violated, you may file a complaint with Holy Cross Hospital or with the Secretary of the Department of Health and Human Services.

For information about filing a complaint, please contact the Holy Cross Hospital Privacy
Official at (301) 754-7870. All complaints filed with us must be submitted in writing
directly to the Holy Cross Hospital Privacy Official at 1500 Forest Glen Road, Silver
Spring, MD 20910. We will not retaliate against you for filing a complaint.

IV. Changes to this Notice
We will abide by the terms of the Notice currently in effect. We reserve the right to
change the terms of this Notice. We will provide you with the revised Notice at your first
visit following the revision of the Notice. The effective date of this Notice is August 15,
2003.

Holy Cross Hospital is a non-profit, full-service community teaching facility with expertise in a wide variety of clinical and support services. We are committed to meeting the healthcare needs of our community, especially those who are most vulnerable and
underserved.

Experts in Medicine, Specialists in Caring.™
1500 Forest Glen Road
Silver Spring, MD 20910-1484
www.holycrosshealth.org