Privacy Practices for Protected Health Information

This notice describes how medical information about you may be used and disclosed and how you can get access to this inofrmation. Please review carefully.

Effective Date: April 14, 2003

WHY YOU ARE RECEIVING THIS NOTICE
New federal requirements regarding the privacy of your health information became effective on April 14, 2003. This Notice of Privacy Practices contains important information regarding the federal requirements.

OUR LEGAL DUTY
We are required by law to restrict the uses and disclosures of your health information. We are also required to give you this Notice about our privacy practices, our legal duties and your rights concerning your health information. We will follow the privacy practices that are described in this Notice while it is in effect. Our privacy practices, as described in this Notice, will remain in effect until we change this Notice.

We reserve the right to change our privacy practices and the terms of this Notice, at any time, as may be permitted by applicable law. We reserve the right to make the changes in our privacy practices and the new terms of our Notice effective for all health information that we maintain, including health information we created or received before we made the changes. Before we make significant change to our privacy practices, we will change this Notice and make the new Notice available upon request.

You may request a copy of our Notice at any time. For more information about or privacy practices, or for additional copies of this Notice, please contact us by using the information listed at the end of this Notice.

USES AND DISCLOSURES OF YOUR HEALTH INFORMATION
Health Information About You for Treatment, Payment and our Healthcare Operations May be Used or Disclosed Without Your Written Authorization in the Following Circumstances:

For Treatment. We may use or disclose your health information to a physician or other healthcare provider to provide you with medical treatment and services. For example, we may need to arrange for medical services for you after you have been discharged from our facility.
For Payment. We may use or disclose your health information to obtain payment for services that we provide to you. For example, in order for us to receive payment from your insurance company, we will need to tell your insurance company about the services we have provided to you.
For Health Care Operations. We may use and disclose your health information for our operational purposes. Some of the ways in which we use your health information include monitoring the quality of care we deliver; checking compliance with laws and other legal obligations; education of our staff; health care contracting; business planning and development; business management and administration; and underwriting and other insurance-related activities.
To Our Business Associates. We may disclose your health information to organizations or individuals who carry out certain key functions or processes for us, such as accreditation, auditing, and legal services. Before we disclose your health information under these circumstances, we will require the “business associate” to which we make such a disclosure to give us written assurance that it will take reasonable measures to safeguard and protect the privacy of your health information.
Appointment Reminders. We may use and disclose your health information to provide you with appointment reminders (such as voicemail messages, postcards or letters).
Treatment Alternatives; Health-Related Benefits and Services. We may use and disclose your health information to tell you about or recommend possible treatment options or alternatives or about health-related benefits or services that may be of interest to you.
Development and Fundraising Activities. We may contact you to provide information to you about Cooper Health System-sponsored activities, including fundraising programs and events. For this purpose, we only would use contact information, such as your name, address and phone number and the dates you received treatment or services at Cooper Health System (CHS). You have no obligation to respond to these communications, and you will be given the opportunity to opt-out of receiving such communications in the future.

Health Information About You May be Used or Disclosed Only If You have Had an Opportunity to Agree or to Object in the Following Circumstances:

Hospital Directory. We may include your name, location in the hospital, your general condition and your religious affiliation in the hospital directory while you are a patient at the hospital, so that your family, friends and clergy can visit you in the hospital and generally know how you are doing. Except for your religious affiliation, we may also release this information to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, even if they don’t ask for you by name. You may restrict or prohibit the use or disclosure of this information.
Individuals Involved in Your Care or Payment for Your Care. We may release your health information to your family members, close personal friends or others who are involved in your care, or who help to pay for your care. You may restrict or prohibit us from doing so if you are able to do so before we make such a disclosure.
Disaster Relief Efforts. We may disclose your health information to an agency assisting in a disaster relief effort so that your family can be notified about your condition, status and location.

Health Information About You may be Used or Disclosed Without Your Authorization or Without Giving You an Opportunity to Agree or Object in the Following Circumstances:

Research. CHS is a research institution. Your health information may be important to further research efforts and the development of new knowledge. Although we will generally only use your health information in connection with research when we have first received your authorization to do so, we may use your information for research purposes without first obtaining your authorization when an institutional review board or privacy board that has reviewed the research proposal and established protocols to ensure the privacy of your health information has approved the research.
To Avert A Serious Threat to Health or Safety. We may use and disclose your health information when necessary to prevent or lessen a serious threat to your health and safety or the health and safety of the public or another person. Any disclosure, however, would only be to someone able to help prevent or lessen the threat.
Organ and Tissue Donation. If you are an organ donor, we may release your health information to organizations that handle organ, eye or tissue transplantation, to facilitate organ or tissue donation and transplantation.
Military and Veterans. If you are or were a member of the armed forces, we may release your heath information to military command authorities as required by law. We may also release health information about foreign military personnel to the appropriate foreign military authority as required by law.
Workers’ Compensation. We may use or disclose your heath information for workers’ compensation or similar programs as permitted or required by law. These programs provide benefits for work-related injuries or illness.
Public Health Risks. We may disclose your health information for public health purposes, including the prevention and control of disease, injury or disability; reporting vital events such as births and deaths; reporting abuse, neglect or domestic violence; and reporting adverse events or surveillance related to food, medications, or defects and other problems with products; notifying persons of recalls, repairs or replacements of products they may be using.
Health Oversight Activities. We may disclose your health information to governmental, licensing, auditing and accrediting agencies for activities authorized by law.
Lawsuits and Other Legal Actions. We may disclose your health information in response to a court or administrative order, or in response to a subpoena, discovery request, warrant, summons or other lawful process.
Law Enforcement. If asked to do so by a law enforcement official, and in accordance with state and federal law, we may release your health information in order to assist law enforcement officials to carry out their responsibilities.
Coroners, Medical Examiners and Funeral Directors. In most circumstances, we may disclose your health information to a coroner or medical examiner, for example, to identify a deceased person or determine the cause of death.
National Security and Intelligence Activities. As required by law, we may disclose your health information to authorized federal officials for intelligence, counterintelligence and other national security activities authorized by law, or so they may provide protection to the President and other domestic and foreign high-ranking officials, or to conduct special investigations.
Inmates. If you are an inmate of a correctional institution under the custody of law enforcement officials, we may release your health information to the correctional institution, if required by law.
As Required by Law. We will disclose your health information when we are required to do so by law.

YOUR RIGHTS REGARDING HEALTH INFORMATION ABOUT YOU
The medical record that we create about you is the property of CHS. You have the following rights, however, regarding health information we maintain about you.

Right to Inspect and Copy. With certain exceptions, you have the right to inspect and/or receive a copy of your health information. To inspect and/or receive a copy of your heath information, you must submit your request in writing to the Director of Medical Records whose name appears at the end of this Notice. If you request a copy of the information, we may charge a fee. We may deny your request to inspect and/or to receive a copy in certain limited circumstances. If you are denied access to your health information, we will explain the reason(s) to you. In most cases you may have the denial reviewed. Another licensed health care professional chosen by us will review your request and the denial. The person conducting the review will not be the person who first denied your request. We will comply with the outcome of the review.
Right to Request an Amendment or Addendum. You have the right to request that we amend your health information, if you believe that the health information we have about you is incorrect or incomplete. Your request must be in writing, and it must explain why the information should be amended. We may deny your request under certain circumstances.
Right to an Accounting of Disclosures. You have the right to receive a list of instances in which we or our business associates disclosed your health information for purposes other than treatment, payment, healthcare operations and the other reasons listed above, for the past six (6) years (but not before April 14, 2003). If you request this accounting more than once in a 12-month period, we may charge you a fee for responding to these additional requests.
Right to Request Restrictions. You have the right to request that we restrict or limit some of our uses and disclosures of your health information. We are not required to agree to these restrictions, but if we agree, we will abide by our agreement.
Right to Request Confidential Communications. You have the right to request that we communicate with you about medical matters in a certain way or at a certain location. For example, you can ask that we contact you only at work or by mail. Your request must be in writing, and must specify the alternative means or location, and provide satisfactory explanation of how payments will be handled under the alternative means or location you request.
Right to a Paper Copy of This Notice. If you received this Notice on our website or by electronic mail (e-mail), you are entitled to receive this Notice in written form. To obtain a paper copy of this Notice, use the contact information at the end of this Notice.

COMPLAINTS AND FURTHER INFORMATION
If you believe your privacy rights have been violated, you may file a complaint with CHS or with the Secretary of the United States Department of Health and Human Services. To file a complaint with CHS, or to receive further information on our privacy practices or the content of this Notice, contact: Chief Privacy Officer; Cooper Health System; One Cooper Plaza, Camden, NJ 08103-1489. You will not be penalized for filing a complaint. All complaints to CHS must be in writing.

OTHER USES OF HEALTH INFORMATION
Other uses and disclosures of your health information not covered by this Notice or the laws that apply to us will be made only with your written permission. If you provide us with permission to use or disclose health information about you, you may revoke that permission, in writing, under certain circumstances. If you revoke your permission, we are unable to take back any disclosures we have already made with your permission.