At Fairfield Memorial Hospital, we recognize that the basis of each patient relationship is trust. The basis of trust comes not only from the ability of Fairfield Memorial Hospital to provide the quality care and services that are expected, but also from the ability to maintain the personal privacy of the patients/residents we serve.
Embedded in our culture is a tradition of protecting your health information, personal privacy, and confidential information. It has always been and will always be a top priority to maintain standards and procedures that are designed to prevent misuse of your confidential information.
THE FOLLOWING NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED, AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW THE INFORMATION CAREFULLY.
Your confidential healthcare information may be released to other healthcare professionals within the hospital for the purpose of providing you with quality healthcare.
Your confidential healthcare information may be released to your insurance provider for the purpose of the hospital receiving payment for providing you with needed healthcare services.
Your confidential healthcare information may be released to public or law enforcement officials in the event of an investigation in which you are a victim of abuse, a crime, or domestic violence.
Your confidential healthcare information may be released to other healthcare providers in the event you need emergency care.
Your confidential healthcare information may be released to other healthcare providers or facilities for concurrent care or referral or transfer of care from our hospital or providers.
Your confidential healthcare information may be released to a public health organization or federal organization in the event of a communicable disease or to report a defective device or untoward event to a biological product (food or medication).
Your confidential healthcare information may not be released for any other purpose than that which is identified in this notice.
Your confidential healthcare information may be released only after receiving written authorization from you. You may revoke your permission to release confidential healthcare information at any time.
You may be contacted by the hospital to remind you of any appointments, healthcare treatment options or other health services that may be of interest to you.
You may be contacted by the hospital for the purposes of raising funds to support the hospital’s operations.
You have the right to restrict the use of your confidential healthcare information. However, the hospital may choose to refuse your restriction if it is in conflict of providing you with quality healthcare or in the event of an emergency situation.
You have the right to receive confidential communication about your health status.
You have the right to review and receive a photocopy any/all portions of your healthcare information.
You have the right to make an amendment to your healthcare information.
You have the right to know who has accessed your confidential healthcare information and for what purpose.
You have the right to possess a copy of this Privacy Notice upon request. This copy can be in the form of an electronic transmission or on paper.
The hospital is required by law to protect the privacy of its patients. It will keep confidential any and all patient healthcare information and will provide patients with a list of duties or practices that protect confidential healthcare information.
The hospital will abide by the terms of this notice. The hospital reserves the right to make changes to this notice and continue to maintain the confidentiality of all healthcare information.
You have the right to complain to the hospital if you believe your rights to privacy have been violated. If you feel your privacy rights have been violated, please mail your complaint to the hospital:
ATTN.: Dana Shantel Taylor LCSW ACSW
HIPAA Privacy Officer
Fairfield Memorial Hospital
303 NW 11th Street
Fairfield, IL 62837
All complaints will be investigated. No personal issue will be raised for filing a complaint with the hospital.
This notice is effective as of April 14, 2003. Revised on June 15, 2011.