Dr. Brian C. Reuben
7001 South 900 East #100
Midvale, UT 84047
Phone: (801) 937-9650
Salt Lake Clinic
389 S 900 E.
Salt Lake City, UT 84102
Phone: (385) 282-2900
8th Ave C St
Salt Lake City, UT 84143
Phone: (801) 408-1100
Intermountain Healthcare Detailed Notice of Privacy Practices
Effective: April 14, 2003; updated Jan 2007
This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.
I. Intermountain Healthcare Privacy Practices
Intermountain desires to protect your privacy and the confidentiality of your medical and health information. This notice describes the privacy practices of IHC Health Services, Inc., its hospitals, doctors, and other healthcare providers that work together to provide your healthcare. This Notice also describes the privacy practices of affiliated providers while they are providing services in an Intermountain facility, unless they provide you with a notice of their own specific privacy practices. “Intermountain Healthcare” refers to IHC Health Services, Inc., hospitals, clinics, doctor offices, and other healthcare facilities owned by IHC Health Services, Inc., as well as the Intermountain employees at those facilities. SelectHealth, Inc. is owned by Intermountain Healthcare but legally operates as a separate company. “SelectHealth” refers to the company, and its employees, that offers SelectHealth health insurance coverage plans. SelectHealth does not include health insurance coverage plans offered by other companies that contract to use the SelectHealth panel of providers. “Affiliated Providers” are doctors and other healthcare practitioners who are not employed by Intermountain but are either authorized to provide services to patients to an Intermountain facility or are approved participants on the panel of SelectHealth providers.
II. Our Privacy Responsibilities
Intermountain understands that your medical and health information is personal. Protecting your health information is important. We follow strict federal and state laws that require us to maintain the confidentiality of your health information. The law refers to your medical and health information as “Protected Health Information.” One requirement of the law is to give you this Notice that describes the way we may use and share your Protected Health Information.
III. Uses and Disclosures of Protected Health Information Permitted by Law
The law permits us to use and share your Protected Health Information for treating you, billing for services, for healthcare operations, and other situations, all of which are explained below. Some health records, including confidential communications with a mental health professional, some substance abuse treatment records, some genetic test results, and some health information of minors, may have additional restrictions for use and disclosure under state and federal laws. Your Protected Health Information may be used and disclosed only for the following purposes:
a. Treatment. To provide treatment and other services to you – for example, to diagnose and treat your injury or illness, to send you appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you. If you do not wish to be reminded of appointments, notify the scheduler;
b. Payment. To obtain payment for services provided to you – for example, disclosures to claim and obtain payment from your health insurer or Medicare;
c. Healthcare Operations. To conduct healthcare operations – for example, to evaluate the quality of treatment and services provided by our physicians, nurses, and other healthcare workers;
d. Business Associates. To share information with third parties who assist us with providing treatment, obtaining payment, and conducting healthcare operations. Our business associates must protect your information by following our privacy practices. For example, a billing company who uses information about the treatment services provided to assist us in sending out bills and processing payments.
e. Directory of Individuals in an Intermountain Healthcare Facility. To include your name, location in an Intermountain facility, general health condition, and religious affiliation in a patient directory, unless you disagree or object. Information in the directory, except for religious affiliation, may be disclosed to anyone who asks for you by name. Directory information, including religious affiliation, may be disclosed to members of the clergy, even if they do not ask for you by name. If you do not wish to be listed in the directory, notify the admitting clerk;
f. Individuals Involved in Your Care or Payment for Your Care. To a family member, a close personal friend, or any other person identified by you if we (1) obtain your agreement; (2) provide you with the opportunity to object to the disclosure and you do not object; or (3) reasonably infer that you do not object to the disclosure;
g. Fundraising Communications. To request a tax-deductible contribution to support important activities of Intermountain. Note: Only your name, address, phone number, and dates of healthcare service that we provided to you will be disclosed to Intermountain’s fundraising office. If you do not want to receive any fundraising requests in the future, notify Intermountain at 1-800-442-4845 or the Privacy Coordinator at the facility where you received care;
h. Healthcare Communications. To identify health-related services and products that may be beneficial to you and then contact you about the services and products.
i. Public Health Activities. To report: (a) health information to public health authorities for the purpose of preventing or controlling disease, injury, or disability; (b) child, adult, or elder abuse and neglect, domestic violence, to public health authorities, government authorities, or other services authorized by law to receive such reports; (c) information about products under the jurisdiction of the U.S. Food and Drug Administration; (d) communicable disease risks to a person who may have been exposed or be at risk to contracting or spreading a disease or condition; and (e) information to your employer as required under laws addressing work-related illnesses and injuries or workplace medical surveillance;
j. Health Oversight Activities. To a health oversight agency that oversees the healthcare system and ensures compliance with the rules of government health programs such as Medicare or Medicaid;
k. Judicial and Administrative Proceedings. In the course of a judicial or administrative proceeding in response to a legal order or other lawful process.
l. Threat to Health and Safety. To reduce or prevent a serious threat to public health and safety.
m. Law Enforcement Officials; Specialized Government Functions. To: (a) the police or other law enforcement officials as required by law or in compliance with a court order; (b) Military authorities the personal and health information of Armed Forces personnel under certain circumstances; or (c) authorized federal officials personal and health information required for lawful intelligence, counterintelligence, and other national security activities.
n. Decedents. To a coroner, medical examiner, or funeral director as authorized by law;
o. Organ and Tissue Procurement. To organizations that facilitate organ, eye, or tissue procurement, banking, or transplantation.
p. Research. To an authorized researcher if our Institutional Review Board or Privacy Board approves release under very strict government guidelines; and
q. Workers Compensation. To comply with Workers Compensation laws.
IV. Uses and Disclosures With Your Authorization
Intermountain cannot use your Protected Health Information for anything other than the reasons mentioned above, without your signed “Authorization”. An Authorization is a written document signed by you that permits Intermountain to use your Protected Health Information for a specific purpose. You may revoke an Authorization by delivering a written revocation statement to the Privacy Office identified below. If you revoke an Authorization, Intermountain will no longer use or disclose your Protected Health Information as permitted by that Authorization. Of course, your revocation of Authorization will not reverse the use or disclosure of your Protected Health Information while your Authorization was in effect.
V. Your Individual Rights
a. For Further Information; Complaints. Please contact us (see address and telephone number in Section VII, below) if you desire further information about your privacy rights, are concerned that your privacy rights have been violated, or disagree with a decision that we made about access to Protected Health Information. You may also file written complaints with the Director of the Office of Civil Rights of the U.S. Department of Health and Human Services. (Intermountain’s Privacy Office can provide you with the Director’s address.) Be assured that no retaliation or diminution of service will result if you file a complaint with the Director or us.
b. Right to Request Additional Restrictions. You may request restrictions on our use and disclosure of Protected Health Information (1) for treatment, payment, and healthcare operations, (2) to individuals (such as a family member, other relative, close personal friend, or any other person identified by you) involved with your care or with payment related to your care, or (3) to notify or assist in the notification of such individuals regarding your location and general condition. We will consider all requests for additional restrictions carefully but are not required to agree to a requested restriction. To request additional restrictions, ask our Privacy Office for a request form and submit the completed form to the Privacy Office. We will send you a written response of our decision on your request.
c. Right to Receive Confidential Communications. You may request, and we will accommodate, any reasonable written request for you to receive Protected Health Information by alternative means of communication or at alternative locations, such as by mail to an address other than your home.
d. Right to Inspect and Copy Your Health Information. You may request access to our records that we use for decision-making purposes about you and contain your Protected Health Information. You may request access in order to inspect and ask for copies of the records. Under limited circumstances, we may deny you access to a portion of your records. If your request is denied, you will receive a written response and may request that the denial be reviewed. If you desire access to your records, please obtain a record request form from the Privacy Office and submit the completed form to the Privacy Office. If you request copies of your records, we are allowed to charge a fee for the costs of copying, mailing, or other services associated with your request. Determination of the fee will be made at the time your request is processed. If you desire access to Protected Health Information maintained by an Affiliated Provider or SelectHealth, please contact them directly.
e. Right to Amend Your Records. You have the right to request an amendment to your Protected Health Information that we created and use for decision-making purposes. If you desire to amend your records, please obtain an amendment request form from the Privacy Office and submit the completed form to the Privacy Office. We will comply with your request unless we believe that the information that would be amended is accurate and complete or other circumstances apply. If you desire to amend Protected Health Information maintained by an Affiliated Provider or SelectHealth, please contact them directly.
f. Right to Receive An Accounting of Disclosures. You may request an accounting of certain disclosures of Protected Health Information made by us. Your request must state the period of time desired for the accounting, which must be within the six (6) years prior to the date of your request and exclude dates prior to April 14, 2003. If you desire to receive an accounting of disclosures, please obtain an accounting of disclosures request form from the Privacy Office and submit the completed form to the Privacy Office. If you request an accounting more than once during a twelve (12) month period, we may charge a fee based on the cost of fulfilling your request. You will be notified of the fee at the time of your request and will be given the opportunity to withdraw or modify your request.
g. Right to Receive Paper Copy of This Notice. Upon request, you may obtain a paper copy of this Notice, even if you agreed to receive such notice electronically.
VI. Effective Date and Duration of This Notice
b. Right to Change Terms of This Notice. We may change this Notice at any time. If we do, the new Notice may apply to any information (including Protected Health Information) created or received prior to issuing the new Notice. We post current Notices in waiting areas around Intermountain facilities, and on our Internet site. You also may obtain a copy of any Notice by contacting the Privacy Office.
For more information, please contact Intermountain’s Privacy Office:
4646 W. Lake Park Blvd.
Salt Lake City, UT 84120