Notice of Privacy Practices
This notice describes how medical information about you may be used and
disclosed and how you can get access to this information.
The terms of this Notice of Privacy Practices apply to Bozeman Health Deaconess
Hospital (BHDH) which is operating as a clinically integrated organized
healthcare arrangement that includes Bozeman Health Medical Group and
the physicians and other licensed professionals seeing and treating patients
at each of these facilities. Bozeman Health Deaconess Hospital, Bozeman
Health Big Sky Medical Center, Bozeman Health Urgent Care, and Advanced
Medical Imaging are designated as affiliated covered entities. All of
the entities and persons listed will share protected health information
as necessary to carry out treatment, payment, and healthcare operations
as permitted by law.
We are required by law to maintain the privacy of our patients’
protected health information (PHI) and to provide patients with notice
of our legal duties and privacy practices with respect to your protected
health information. We are required to abide by the terms of this Notice
so long as it remains in effect. We reserve the right to change the terms
of this Notice of Privacy Practices as necessary and to make the new Notice
effective for all protected health information maintained by us. You may
receive a copy of any revised notices at BHDH Patient Registration or
a copy may be obtained by mailing a request to: BHDH Privacy Officer,
915 Highland Blvd., Bozeman, MT 59715-6999.
EXAMPLES OF DISCLOSURE FOR TREATMENT, PAYMENT AND HEALTH OPERATIONS
BHDH will use your protected health information for your treatment: For
instance, doctors and nurses and other professionals involved in your
care will use information in your medical record and information that
you provide about your symptoms and reactions to plan a course of treatment
for you that may include procedures, medications, tests, etc. We may also
release your protected health information to another healthcare facility
or professional who is not affiliated with our organization but who is
or will be providing treatment to you. We may contact you to provide appointment
reminders, test results or information about treatment alternatives or
other health-related benefits and services that may be of interest to you.
We will use your health information for payment: For instance, we may
forward information regarding your medical procedures and treatment to
your insurance company to arrange payment for the services provided to
you or we may use your information to prepare a bill to send to you or
to the person responsible for your payment.
We will use and disclose your protected health information for our healthcare
operations: For instance, clinical improvement, professional peer review,
business management, accreditation and licensing, etc. We may from time
to time use your protected health information to communicate with you
about health products and services necessary for your treatment, to advise
you of new products and services we offer, and to provide general health
and wellness information.
USES & DISCLOSURES THAT REQUIRE AN AUTHORIZATION
•Psychotherapy notes unless it is to carry out treatment, payment,
or healthcare options.
•Sale of PHI
PERMITTED USES AND DISCLOSURES
Your Authorization: Except as outlined below, we will not use or disclose
your protected health information for any purpose unless you have signed
a form authorizing the use or disclosure. You have the right to revoke
that authorization in writing unless we have taken any action in reliance
on the authorization.
Facility Directory: We maintain a facility directory listing the name,
room number, general condition and, if you wish, your religious affiliation.
Unless you choose to have your information excluded from this directory,
the information, excluding your religious affiliation, will be disclosed
to anyone who requests it by asking for you by name. This information,
including your religious affiliation, may also be provided to members
of the community clergy. You have the right during registration to have
your information excluded from this directory.
Family and Friends Involved In Your Care: With your approval, we may from
time to time disclose your protected health information to designated
family, friends, and others who are involved in your care or in payment
of your care in order to facilitate that person’s involvement in
caring for you or paying for your care. If you are unavailable, incapacitated,
or facing an emergency medical situation, and we determine that a limited
disclosure may be in your best interest, we may share limited protected
health information with such individuals without your approval. We may
also disclose limited protected health information to a public or private
entity that is authorized to assist in disaster relief efforts in order
for that entity to locate a family member or other persons that may be
involved in some aspect of caring for you.
Business Associates: Certain aspects and components of our services are
performed through contracts with outside persons or organizations, such
as auditing, accreditation, legal services, etc. At times it may be necessary
for us to provide certain aspects of your protected health information
to one or more of these outside persons or organizations who assist us
with our healthcare operations. In all cases, we require these business
associates to appropriately safeguard the privacy of your information.
Fundraising Activities: We may release information about you to Bozeman
Health Foundation. Allowable information that may be released includes:
name, address, phone number, age, gender, insurance status, dates of service,
department of service, treating physician, and outcome of treatment information.
Information regarding illnesses and/or treatments will not be released.
If you do not want to receive direct solicitations regarding current fundraising
efforts you have the right to opt out of receiving such communications.
Research: In limited circumstances, we may use and disclose your protected
health information for research purposes. For example, a research organization
may wish to compare outcomes of all patients that received a particular
drug and will need to review a series of medical records. In all cases
where your specific authorization has not been obtained, your privacy
will be protected by strict confidentiality requirements applied by an
Institutional Review Board or privacy board which oversees the research
or by representations of the researchers that limit their use and disclosure
of patient information.
REQUIRED USES AND DISCLOSURES
We are permitted or required by law to make certain other uses and disclosures
of your protected health information without your consent or authorization,
including but not limited to the following:
• We may release your protected health information for any purpose
required by law.
• We may release your protected health information for public health
activities, such as required reporting of disease, injury, and birth and
death, and for required public health investigations.
• We may release your protected health information as required by
law if we suspect child abuse or neglect; we may also release your protected
health information as required by law if we believe you to be a victim
of abuse, neglect or domestic violence.
• We may release your protected health information to the Food and
Drug Administration if necessary to report adverse events, product defects
or to participate in product recalls.
• We may release your protected health information to your employer
when we have provided healthcare to you at the request of your employer
to determine workplace-related illness or injury; in most cases you will
receive notice that information is disclosed to your employer.
• We may release your protected health information if required by
law to a government oversight agency conducting audits, investigations
or civil or criminal proceedings.
• We may release your protected health information if required to
do so by subpoena or discovery request; in some cases you will have notice
of such release.
• We may release your protected health information to law enforcement
officials as required by law to report wounds and injuries and crimes.
• We may release your protected health information to coroners and/or
funeral directors consistent with law.
• We may release your protected health information if necessary to
arrange an organ or tissue donation from you or a transplant for you.
• We may release your protected health information if, in limited
instances, we suspect a serious threat to health or safety.
• We may release your protected health information if you are a member
of the military as required by armed forces services; we may also release
your protected health information if necessary for national security or
• We may release your protected health information to workers’
compensation agencies if necessary for your workers’ compensation
YOUR HEALTH INFORMATION RIGHTS
Although your health record is the physical property of BHDH, the information
belongs to you. You have the right:
• To copy and/or inspect much of the protected health information
that we retain on your behalf. All requests for access must be made in
writing and signed by you or your representative. You may obtain an access
request form from: BHDH Health Information Management, 915 Highland Blvd.,
Bozeman, MT 59715.
• To request in writing that protected health information
that we maintain about you be amended or corrected. We
are not obligated to make all requested amendments but will give each
request careful consideration. All amendment requests, in order to be
considered by us, must be in writing, signed by you or your representative,
and must state the reasons for the amendment/correction request. If an
amendment or correction you request is made by us, we may also notify
others who work with us and have copies of the uncorrected record if we
believe that such notification is necessary. You may obtain an amendment
request form from: BHDH Health Information Management, 915 Highland Blvd.,
Bozeman, MT 59715.
• To receive an accounting of certain disclosures made by us of your
protected health information 6 years prior to the date of request. Requests
must be made in writing and signed by you or your representative. Accounting
request forms are available from: BHDH Health Information Management,
915 Highland Blvd., Bozeman, MT 59715. The first accounting in any 12-month
period is free; you will be charged a fee for each subsequent accounting
you request within the same 12-month period.
• To request a restriction on certain uses and disclosures of your
information as provided by 45 CFR 164.522. BHDH will honor your request
for restrictions to the extent possible. A restriction request form can
be obtained from BHDH Health Information Management, 915 Highland Blvd.,
Bozeman, MT 59715. We are not required to agree to your restriction request,
unless required by law or you request a restriction to a health plan if
you have paid for the services out of pocket and in full. We will attempt
to accommodate reasonable requests when appropriate and we retain the
right to terminate an agreed-to restriction if we believe such termination
is appropriate. In the event of a termination by us, we will notify you
of such termination. You also have the right to terminate, in writing
or orally, any agreed-to restriction.
• To be notified of a breach of unsecured PHI in the event you are
• To obtain additional copies of the Notice of Privacy Practices
You will be asked to sign an acknowledgment form that you received this
Notice of Privacy Practices.
FOR MORE INFORMATION OR TO REPORT A PROBLEM
If you believe your privacy rights have been violated, you can file a
complaint with the BHDH Privacy Officer or with the Secretary of Health
and Human Services. There will be no retaliation for filing a complaint.
If you have questions and/or would like additional information, please
contact the BHDH Privacy Officer at (406) 414-5584.
Effective April 14, 2003
Revised August 7, 2013; October 22, 2015