Notice of Privacy Practice

Notice of Privacy Practice

Patient Right to Privacy at Madera Community Hospital

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

If you have any questions about this notice, please contact the Privacy Officer at Madera Community Hospital, (559) 675-5400.

AVISO DE LAS PRÁCTICAS DE PRIVACIDAD DE LA LEY HIPAA

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What Is This Notice And Why Is It Important?

This notice is required by law to describe how our hospital uses and discloses medical information about you (our “privacy practices”), and also describes the privacy practices of:

  • Any health care professional authorized to enter information into your hospital chart (medical record).
  • All departments and units of the hospital and rural health clinics associated with Madera Community Hospital.
  • Any member of a volunteer group we allow to help you while you are in the hospital.
  • All employees, staff and other hospital personnel.

All these entities, sites and locations follow the privacy practices described in this notice. In addition, these entities, sites and locations may share medical information with each other for treatment, payment or health care operation purposes described in this notice.

Who Will Follow This Notice

This notice describes our hospital’s practices and that of:

  • Any health care professional authorized to enter information into your hospital chart.
  • All departments and units of the hospital and rural health clinics.
  • Any member of a volunteer group we allow to help you while you are in the hospital.
  • All employees, staff and other hospital personnel.

Our Pledge Regarding Medical Information

We understand medical information about you and your health is personal, and we are committed to protecting medical information about you. We create a record of the care and services you receive at the hospital. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all records of your care generated by the hospital and clinics, whether made by hospital personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your medical information created in the doctor’s office or clinic.

This notice will tell you about the ways in which we may use and disclose medical information about you. We also describe your rights and certain obligations we have regarding the use and disclosure of medical information.

We are required by law to: Maintain the privacy of your health information, give you this notice of our legal duties and privacy practices with respect to medical information we collect and maintain about you, and abide by the terms of the notice that is currently in effect.

How We May Use and Disclose Medical Information About You

The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures, we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of the following categories:

  • For Treatment: We may use medical information about you to provide you with medical treatment and/or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you at the hospital. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to tell the dietitian if you have diabetes so that we can arrange for appropriate meals. Different departments of the hospital also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work and x-rays. We may also disclose medical information about you to people outside the hospital who may be involved in your medical care after you leave the hospital, such as family members, clergy or others we use to provide services that are part of your care.
  • For Payment: We may use and disclose medical information about you so that the treatment and services you receive at the hospital may be billed to and payment may be collected from you, an insurance company or a third party. For example, we may need to give your health plan information about surgery you received at the hospital so your health plan will pay us or reimburse you for the surgery. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment.
  • For Health Care Operations: We may use and disclose medical information about you for hospital operations. These uses and disclosures are necessary to run the hospital and make sure that all of our patients receive quality care. For example, we may use medical information to review our treatment and services, and to evaluate the performance of our staff in caring for you. We may also combine medical information about many hospital patients to decide what additional services the hospital should offer, what services are not needed, and whether certain new treatments are effective. We may also disclose information to doctors, nurses, technicians, medical students, and other hospital personnel for review and learning purposes. We may also combine the medical information we have with medical information from other hospitals to compare how we are doing and see where we can make improvements in the care and services we offer. We may remove information that identifies you from this set of medical information so others may use it to study health care and health care delivery without learning who the specific patients are.
  • 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.
  • Hospital Directory: We may include certain limited information about you in the hospital directory while you are a patient at the hospital. This information may include your name, location in the hospital, your general condition (e.g., fair, stable, etc.) and your religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they don’t ask for you by name. This is so your family, friends and clergy can visit you in the hospital and generally know how you are doing.
  • Individuals Involved in Your Care or Payment for Your Care: With your permission, we may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care. We may also tell your family or friends your condition and that you are in the hospital. In addition, we may disclose medical information about you to an entity assisting in a disaster relief eff ort so that your family can be notified about your condition, status and location.
  • Research: Under certain circumstances, we may use and disclose medical information about you for research purposes. For example, a research project may involve comparing the health and recovery of all patients who received one medication to those who received another, for the same condition. All research projects, however, are subject to a special approval process. This process evaluates a proposed research project and its use of medical information, trying to balance the research needs with patients’ need for privacy of their medical information. Before we use or disclose medical information for research, the project will have been approved through this research approval process. But we may, however, disclose medical information about you to people preparing to conduct a research project, for example, to help them look for patients with specific medical needs, so long as the medical information they review does not leave the hospital. We will almost always ask for your specific permission if the researcher will have access to your name, address or other information that reveals who you are, or will be involved in your care at the hospital.
  • As Required By Law: We will disclose medical information about you when required to do so by federal, state or local law.
  • To Avert a Serious Threat to Health or Safety: We may use and disclose medical information about you when necessary to prevent 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 the threat.

Special Situations

Organ and Tissue Donation: If you are an organ donor, we may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank, as necessary to facilitate organ or tissue donation and transplantation.

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.

Workers’ Compensation: We may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or illness.

Public Health Risks: 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.

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.

Lawsuits and Disputes: If you are involved in a lawsuit or a dispute, we may disclose medical information about you in response to a court or administrative order. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if eff orts have been made to tell you about the request or to obtain an order protecting the information requested.

Law Enforcement: We may release medical information if asked to do so by a law enforcement official:

  • In response to a court order, subpoena, warrant, summons or similar process
  • To identify or locate a suspect, fugitive, material witness, or missing person
  • About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person’s agreement
  • About a death we believe may be the result of criminal conduct
  • About criminal conduct at the hospital
  • In emergency circumstances to report a crime; the location of the crime or victims; or the identity, description or location of the person who committed the crime.

Coroners, Medical Examiners and Funeral Directors: We may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or determine the cause of death. We may also release medical information about patients of the hospital to funeral directors as necessary to carry out their duties.

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 to conduct special investigations.

Inmates: If you are an inmate of a correctional institution or under the custody of a law enforcement officials, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary:

  1. For the institution to provide you with health care
  2. To protect your health and safety or the health and safety of others
  3. For the safety and security of the correctional institution.

Your Rights Regarding Medical Information About You

Patient Rights & Responsibilities

Medical Services in Madera & Chowchilla

Every patient is entitled to certain privileges and rights while staying at Madera Community Hospital. Read over our full list of patient rights and responsibilities so you can learn more about that to expect during your time at our facility.

You have the right to:

  1. Considerate and respectful care, and to be made comfortable. You have the right to respect for your cultural, psychosocial, spiritual, and personal values, beliefs and preferences.
  2. Have a family member (or other representative of your choosing) and your own physician notified promptly of your admission to the hospital.
  3. Know the name of your licensed health care practitioner acting within the score of his or her professional licensure who has primary responsibility for coordinating your care, and the names and professional relationships of physicians and non-physicians who will see you.
  4. Receive information about your health status, diagnosis, prognosis, course of treatment, prospects for recovery and outcomes of care (including unanticipated outcomes) in terms you can understand. You have the right to effective communication and to participate in the development and implementation of your plan of care. You have the right to participate in ethical questions that arise in the course of your care, including issues of conflict resolution, withholding resuscitative services, and forgoing or withdrawing life-sustaining treatment.
  5. Make decisions regarding medical care, and receive as much information about any proposed treatment or procedure as you may need in order to give informed consent or to refuse a course of treatment. Except in emergencies, this information shall include a description of the procedure or treatment, the medically significant risks involved, alternate courses of treatment tor non-treatment, and the risks involved in each, and the name of the person who will carry out the procedure or treatment.
  6. Request or refuse treatment, to the extent permitted by law. However, you do not have the right to demand inappropriate or medically unnecessary treatment or services. You have the right to leave the hospital even against the advice of members of the medical staff, to the extent permitted by law.
  7. Be advised if the hospital/licensed health care practitioner acting within the scope of his or her professional licensure proposes to engage in or perform human experimentation affecting your care or treatment. You have the right to refuse to participate in such research projects.
  8. Reasonable responses to any reasonable requests made for service.
  9. Appropriate assessment and management of your pain, information about pain, pain relief measures and to participate in pain management decisions. You may request or reject the use of any or all modalities to relieve pain, including opiate medication, if you suffer from severe chronic intractable pain. The doctor may refuse to prescribe the opiate medication, but if so, must inform you that there are physicians who specialize in the treatment of pain with methods that include the use of opiates.
  10. Formulate advance directives. This includes designating a decision maker if you become incapable of understanding a proposed treatment or become unable to communicate your wishes regarding care. Hospital staff and practitioners who provide care in the hospital shall comply with these directives. All patients’ rights apply to the person who has legal responsibility to make decisions regarding medical care on your behalf.
  11. Have personal privacy respected. Case discussion, consultation, examination and treatment are confidential and should be conducted discreetly. You have the right to be told the reason for the presence of any individual. You have the right to have visitors leave prior to an examination and when treatment issues are being discussed. Privacy curtains will be used in semi-private rooms.
  12. Confidential treatment of all communications and records pertaining to your care and stay in the hospital. You will receive a separate “Notice of Privacy Practices” that explains your privacy rights in detail and how we may use and disclose your protected health information.
  13. Receive care in a safe setting, free from mental, physical, sexual or verbal abuse and neglect, exploitation or harassment. You have the right to access protective and advocacy services including notifying government agencies of neglect or abuse.
  14. Be free from restraints and seclusion of any form used as a means of coercion, discipline, convenience or retaliation by staff.
  15. Reasonable continuity of care and to know in advance the time and location of appointments as well as the identity of the persons providing the care.
  16. Be informed by the physician or a delegate of the physician, of continuing health care requirements and options following discharge from the hospital. You have the right to be involved in the development and implementation of your discharge plan. Upon your request, a friend or family member may be provided this information also.
  17. Know which hospital rules and policies apply to your conduct while a patient.
  18. Designate a support person as well as visitors of your choosing, if you have decision-making capacity, whether or not the visitor is related by blood, marriage, or registered domestic partner status, unless:
    • No visitors are allowed.
    • The facility reasonably determines that the presence of a particular visitor would endanger the health or safety of a patient, a member of the health facility staff, or other visitor to the health facility, or would significantly disrupt the operations of the facility.
    • You have told the health facility staff that you no longer want a particular person to visit.

However, a health facility may establish reasonable restrictions upon visitation, including restrictions upon the hours of visitation and number of visitors. The health facility must inform you (or your support person, where appropriate) of your visitation rights, including any clinical restrictions or limitations. The health facility is not permitted to restrict, limit, or otherwise deny visitation privileges on the bases of race, color, national origin, religion, sex, gender identity, sexual orientation or disability.

  1. Have your wishes considered, if you lack decision-making capacity, for the purposes of determining who may visit. The method of that consideration will comply with federal law and be disclosed in the hospital policy on visitation. At a minimum, the hospital shall include any persons living in your household and any support person pursuant to federal law.
  2. Examine and receive an explanation of the hospital’s bill regardless of the source of payment.
  3. Exercise these rights without regard to sex, economic status, educational background, race, color, religion, ancestry, national original, sexual orientation, gender identity/expression, disability, medical condition, marital status, age, registered domestic partner status, genetic information, citizenship, primary language, immigration status (except as required by federal law) or the source of payment for care.
  4. File a grievance. If you want to file a grievance with this hospital, you may do so by writing or by calling:

Madera Community Hospital

1250 E. Almond Avenue
Madera, CA 93637
(559) 675-2573

www.maderahospital.org

The Grievance Committee will review each grievance and provide you with a written response within 7 days. The written response will contain the name of a person to contact at the hospital, the steps taken to investigate the grievance, the results of the grievance process, and the date of completion of the grievance process. Concerns regarding quality of care or premature discharge will also be referred to the appropriate Utilization and Quality Control Peer Review Organization (PRO).

  1. File a complaint with the California Department of Public Health regardless of whether you use the hospital’s grievance process. The California Department of Public Health’s phone number and address is:

California Department of Public Health

Licensing and Certification

285 W. Bullard Avenue, Suite 101

Fresno, CA 93704

(559) 437-1500

This Patient Rights document incorporate the requirements of HFAP (Healthcare Facilities Accreditation Program); Title 22; California Code of Regulations, Section 70707; Health and Safety Code Sections 1262.6, 12884, and 124960; and 42 C.F.R. Section 482.13 (Medicare Conditions of Participation).

QUESTIONS AND CONCERNS: If you have concerns about the care you have received, we encourage you or a family member to speak with your physician or with the nursing Director/Supervisor. If you feel that your issue was not resolved, please contact the Patient Liaison at (559) 675-2573 from 8:30 a.m. to 4:30 p.m., Monday through Friday, excluding Holidays.

DERECHOS DEL PACIENTE

Usted tiene el derecho a:

  1. Recibir una atención considerada y respetuosa, y a sentirse cómodo. Usted tiene derecho a ser respetado por sus valores, creencias y preferencias culturales, psicosociales, espirituales y personales.
  2. Que le avisen de inmediato a un familiar (u otro representante de su elección) y a su propio médico que ha sido admitido en el hospital.
  3. Saber el nombre del profesional de atención médica certificado que actúa en el marco de su certificación profesional y que tiene la responsabilidad principal de coordinar su atención, y los nombres y las relaciones profesionales de los médicos y empleados de salud que lo verán.
  4. Recibir información acerca de su estado de salud, diagnóstico, prognosis, tratamiento, posibilidades de recuperación y resultados de la atención (incluidos los resultados no esperados) con términos que usted pueda comprender. Tiene derecho a tener una comunicación efectiva

y participar en el desarrollo e implementación de su plan de atención. También puede participar en cuestiones éticas que surjan durante su atención, incluidos temas sobre resolución de conflictos, negación a recibir servicios de resucitación, y continuación o retiro del tratamiento para mantener la vida.

  1. Tomar decisiones sobre su atención y recibir toda la información sobre cualquier tratamiento o procedimiento propuesto que pueda necesitar para dar su consentimiento informado o negarse al tratamiento. Excepto en casos de emergencia, esta información incluirá una descripción del procedimiento o tratamiento, los riesgos médicamente significativos que implican, los tratamientos alternativos o no tratamientos, y los riesgos que cada uno incluye, y el nombre de la persona que realizará el procedimiento o tratamiento.
  2. Solicitar o negarse a recibir tratamiento, en la medida que lo permita la ley. Sin embargo, usted no tiene derecho a exigir tratamientos o servicios inadecuados o que no sean médicamente necesarios. Tiene derecho

a abandonar el hospital incluso en contra de la recomendación de los miembros del personal médico, en la medida que lo permita la ley.

  1. Ser notificado si el hospital o el profesional de atención médica certificado que actúa en el marco de su certificación profesional proponen participar o realizar experimentos en humanos que afecten su atención o tratamiento. Tiene derecho a negarse a participar en tales proyectos de investigación.
  2. Recibir respuestas razonables a toda solicitud razonable que realice sobre los servicios.
  3. Recibir una evaluación y un control adecuados de su dolor, información sobre el dolor y medidas para el alivio del dolor, y a participar en decisiones acerca del control del dolor. También puede solicitar o rechazar el uso de cualquiera o de todas las modalidades para aliviar el dolor, incluidos los medicamentos opiáceos si sufre de dolor crónico grave persistente. El médico puede negarse a recetar medicamentos opiáceos, pero si es así, debe informarle a usted que existen médicos que se especializan en el tratamiento del dolor con métodos que incluyen el uso de opiáceos.
  4. Formular instrucciones anticipadas. Esto incluye designar a una persona que tome las decisiones si usted no puede comprender un tratamiento propuesto o si no puede comunicar sus deseos con respecto a la atención.

El personal y los profesionales de la salud que proporcionan atención en el hospital cumplirán dichas instrucciones. Todos los derechos del paciente se aplican a la persona que tiene la responsabilidad legal de tomar las decisiones relacionadas con la atención médica en su nombre.

  1. Que su privacidad sea respetada. La discusión del caso, las consultas, los exámenes y el tratamiento son confidenciales y se deben realizar con discreción. Tiene derecho a que le indiquen la razón de la presencia de cualquier persona. También tiene derecho a que las visitas se

retiren antes de un examen y cuando se habla de temas relacionados con el tratamiento. Se usarán cortinas para privacidad en habitaciones semiprivadas.

  1. Recibir tratamiento confidencial de todas las comunicaciones y registros relacionados con su atención y permanencia en el hospital. Usted recibirá un “Aviso sobre prácticas de privacidad” (Notice of Privacy Practices) por separado que explica en detalle sus derechos a la privacidad y cómo podemos utilizar y divulgar la información protegida sobre su salud.
  2. Recibir atención en un entorno seguro, donde no haya abuso mental, físico, sexual ni verbal, ni tampoco abandono, explotación o acoso. Usted tiene derecho a acceder a servicios de protección y defensa, lo que incluye notificarles a las agencias del gobierno sobre abandono o abuso.
  3. No tener restricciones ni estar aislado de ninguna forma por decisión del personal como medio de coerción, disciplina, conveniencia o represalia.
  4. Recibir una atención razonablemente continua y saber por adelantado la hora y el lugar de las citas, así como también la identidad de las personas que proporcionan la atención médica.
  5. Ser informado por el médico, o un representante del médico, de los requisitos y opciones de atención médica continua luego de ser dado de alta del hospital. También tiene derecho a participar en el desarrollo e implementación de su plan para ser dado de alta. Si lo solicita, un amigo o un familiar también pueden recibir esta información.
  6. Conocer las reglas y políticas del hospital que se aplican a su conducta mientras sea paciente del hospital.
  7. Designar un acompañante así como también visitas que usted elija, si tiene la capacidad de tomar decisiones, independientemente de que la visita sea un familiar de sangre, por matrimonio o una pareja de hecho registrada, a menos que:
    • No se permitan visitas.
    • El establecimiento determine de manera razonable que la presencia de una visita en particular podría poner en peligro la salud o la seguridad de un paciente, de un miembro del personal del establecimiento de salud o de otras visitas en el establecimiento, o podría interrumpir de manera significativa las funciones de dicho establecimiento.
    • Usted le haya notificado al personal del establecimiento de salud que

ya no desea que una persona determinada lo visite.

Sin embargo, un establecimiento de salud puede establecer restricciones razonables para las visitas, incluidas restricciones sobre los horarios

de visita y la cantidad de personas. El establecimiento de salud debe informarle a usted (o a su acompañante, cuando corresponda) sobre sus derechos de visita, incluidas las restricciones o limitaciones clínicas. El establecimiento de salud no puede restringir, limitar o, de otro modo, negar los privilegios de visita por razones de raza, color, nacionalidad, religión, sexo, identidad de género, orientación sexual o discapacidad.

  1. Que sus deseos sean tenidos en cuenta si no tiene la capacidad de tomar decisiones para determinar quién lo puede visitar. El método de dicha consideración cumplirá con la ley federal y se divulgará en las políticas del hospital sobre las visitas. Como mínimo, el hospital incluirá toda persona que viva en su hogar y acompañante de conformidad con la ley federal.
  2. Evaluar y recibir una explicación de la cuenta del hospital, independientemente de la fuente de pago.
  3. Ejercer estos derechos sin importar su sexo, situación económica, nivel de educación, raza, color, religión, ascendencia, nacionalidad de

origen, orientación sexual, identidad/expresión de género, discapacidad, condición médica, estado civil, edad, concubinato registrado, información genética, ciudadanía, idioma primario, estatus migratorio (excepto según lo requerido por ley federal) o la fuente de pago para su atención médica.

  1. Presentar una queja. Si desea presentar una queja con este hospital, puede hacerlo por escrito o por teléfono (nombre, dirección y número de teléfono del hospital):

Madera Community Hospital
1250 E. Almond Avenue
Maedera, CA 93637
(559) 675-2573
www.maderahospital.org

El comité de quejas analizará cada queja y le dará una respuesta por escrito dentro de 7 días. La respuesta por escrito incluirá el nombre de la persona con la que debe comunicarse en el hospital, las medidas tomadas para investigar la queja, los resultados del proceso conciliatorio, y la fecha de finalización del proceso conciliatorio. Las inquietudes relacionadas con la calidad de la atención o el haber sido dado de alta prematuramente también se derivarán a la Organización de Revisión Profesional de la Utilización y Calidad de los Servicios (Utilization and Quality Control Peer Review Organization [PRO]) correspondiente.

  1. Presentar una queja en el Departamento de Salud Pública de California (California Department of Public Health, CDPH), independientemente de que utilice el proceso de quejas del hospital. El número de teléfono y la dirección del Departamento de Salud Pública de California son: (dirección local y número de teléfono del CDPH)

California Department of Public Health

Licensing and Certification

285 W. Bullard Avenue, Suite 101

Fresno, CA 93704

(559) 437-1500


Este documento de Derechos del Paciente incorpora los requisitos de HFAP (Healthcare Facilities Accreditation Program); Title 22; California Code of Regulations, Section 70707; Health and Safety Code Sections 1262.6, 12884, and 124960; and 42 C.F.R. Section 482.13 (Medicare Conditions of Participation).

PREGUNTAS Y PREOCUPACIONES: Si le preocupa la atención que recibió, lo alentamos a usted oa un miembro de su familia a hablar con su médico o con el Director / Supervisor de enfermería. Si siente que su problema no se resolvió, comuníquese con el Enlace de el paciente al (559) 675-2573 de 8:30 a.m. a 4:30 p.m., de lunes a viernes, excepto los días festivos.

Last update: October 2019

Changes to This Notice

We reserve the right to change this notice. We reserve the right to make the revised or changed notice effective for medical information we already have about you as well as any information we receive in the future. We will post a copy of the current notice in the hospital and at our website www.maderahospital.org. The notice will contain on the first page, in the top right-hand corner, the effective date. In addition, each time you register at or are admitted to the hospital for treatment or health care services as an inpatient or outpatient, we will offer you a copy of the current notice in effect.

Complaints

If you believe your privacy rights have been violated, you may file a complaint with the hospital or with the Secretary of the Department of Health and Human Services. To file a complaint with DHHS, contact the Office for Civil Rights, U.S. Department of Health and Human Services, 50 United Nations Plaza, Room 322, San Francisco, CA 94102. Phone 415-437-8310 or Fax 415-437-8329 or TDD 415-437-8311.

To file a complaint with the hospital, all complaints must be submitted in writing to:

Madera Community Hospital

Compliance Officer

1250 E. Almond Avenue

Madera, CA 93637

If you are presently a patient and have a concern, please speak with your nursing supervisor or phone 559-675-2857.

Madera Community Hospital guarantees you will not be penalized, nor will the care you receive at our facilities be negatively impacted for filing a complaint.

Other Uses Of Medical Information

Other uses and disclosures of medical 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 permission to use or disclose medical information about you, you may revoke that permission, in writing, at any time. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission, and that we are required to retain our records of the care that we provided to you.

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