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Ellis Hospital - privacy 1a (Page 2)

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Ellis Hospital - privacy 1a
F. USES OR DISCLOSURES REQUIRED BY LAW: We may use or disclose your health information when we
are required to do so by law, including for public health reasons (e.g., disease reporting). In some instances, and in
agreement with applicable law, we may be required to disclose your health information to appropriate authorities if we
reasonably believe that you are a possible victim of abuse, neglect or domestic violence or the possible victim of other
G. PATIENT AND THIRD PARTY PROTECTION: Only as permitted by law, we may disclose your health
information to avoid a serious threat to your health or safety or to the health or safety of others.
H. LAW ENFORCEMENT/NATIONAL SECURITY: We may disclose health information in response to properly
issued subpoenas, judicial proceedings and law enforcement inquiries as permitted by law. Under certain
circumstances we may disclose health information relating to members of the Armed Forces, to military authorities
and to authorized federal officials if such information is required for lawful intelligence, counterintelligence and other
national security activities. Under certain circumstances we also may disclose health information relating to inmates
or patients to correctional institutions or to law enforcement personnel having lawful custody of those individuals.
I. APPOINTMENT REMINDERS: We may use or disclose your health information to provide you with
appointment reminders (such as voicemail messages, postcards or letters).
J. FOOD AND DRUG ADMINISTRATION ("FDA"): We may disclose to the FDA health information relative to
unfavorable events with respect to food, supplements, products and product defects or post marketing study
information to enable product recalls, repairs or replacement.
K. WORKERS' COMPENSATION: We may disclose health information to the extent authorized by laws relating
to workers' compensation or to other similar programs established by law.
L. FUNDRAISING: You may be contacted by the hospital for the purposes of raising funds to support the hospital's
operation. You will be given the opportunity to opt out of any future fundraising contacts.
M. BUSINESS ASSOCIATES: There are some services provided in Ellis through contracts with our business
associates. Examples include contracted physician services in certain specialty departments and laboratory tests.
When these services are contracted, we may disclose your health information to our business associates so that they
can perform the job we have asked them to do and bill you or your insurance company for services rendered. To
protect your health information, however, we require the business associate to appropriately safeguard your
A. ACCESS TO RECORDS: Upon submission of a written request to us, you have the right to review or receive
copies of your health information, with limited exceptions. You may obtain a form to request access by using the
contact information listed at the end of this Notice. If you request copies, we will charge you a reasonable copying
fee. If you request that the records be mailed, we may charge you for postage. If you prefer, we will prepare a
summary or an explanation of your health information for a fee. Contact us using the information listed at the end of
this Notice if you are interested in receiving a summary of your information instead of copies.
You may request that we provide copies in a non-photocopy format, and we will supply records in that format if it is
readily available. If you request records in an alternative format, we will charge a reasonable fee for providing your
health information in that format.
B. ACCOUNTING OF CERTAIN DISCLOSURES: Upon written request, 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 other activities authorized by you for the last six (6) years, but not before April 14,
2003. If you request this accounting more than once in a twelve (12)-month period, we may charge you a reasonable
fee for responding to these additional requests.

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