Effective July, 2021 Revised Date: February 2, 2024
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.
Your Rights
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get an electronic or paper copy of your medical record
• You can ask to see or get an electronic or paper copy of your medical record and other health information we have about you. Ask us how to do this. • We will provide a copy or a summary of your health information, usually within 30 days of your request. We may charge a reasonable, cost-based fee.
Ask us to correct your medical record
• You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do this. • We may say “no” to your request, but we’ll tell you why in writing within 60 days.
Request confidential communications
• You can ask us to contact you in a specific way (for example, home or office phone) or to send mail to a different address. • We will say “yes” to all reasonable requests.
Ask us to limit what we use or share
• You can ask us not to use or share certain health information for treatment, payment, or our operations. – We are not required to agree to your request, and we may say “no” if it would affect your care. • If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. – We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we’ve shared information
• You can ask for a list (accounting) of the times we’ve shared your health information for six years prior to the date you ask, who we shared it with, and why. • We will include all the disclosures except for those about treatment, payment, and health care operations, and certain other disclosures (such as any you asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
• You can ask for a paper copy of this notice at any time, even if you have agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act for you
• If you have given someone medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information. • We will make sure the person has this authority and can act for you before we take any action.
File a complaint if you feel your rights are violated
• You can complain if you feel we have violated your rights by contacting us using the information at the bottom of this page. • You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting www.hhs.gov/ocr/privacy/hipaa/complaints/ • We will not retaliate against you for filing a complaint.
Your Choices
For certain health information, you can tell us your choices about what we share. If you have a clear preference for how we share your information in the situations described below, talk to us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
• Share information with your family, close friends, or others involved in your care. • Share information in a disaster relief situation. • Include your information in a hospital directory. • Contact you for fundraising efforts. (If you are not able to tell us your preference, for example if you are unconscious, we may share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.)
In these cases we never share your information unless you give us written permission:
• Marketing purposes. • Sale of your information. • Sharing of psychotherapy notes, except as may be required by law.
In the case of fundraising:
• We may contact you to raise funds for our hospital. • You may opt out of receiving such communications at any time by notifying the Columbus Regional Health Foundation at (812) 376-5100 or by emailing your opt out to [email protected].
Our Uses and Disclosures
How do we typically use or share your health information? We typically use or share your health information in the following ways.
Treat you
• We can use your health information and share it with other professionals who are treating you. (Example: A doctor treating you for an injury asks another doctor about your overall health condition.)
Run our organization
• We can use and share your health information to run our practice, improve your care, and contact you when necessary. (Example: We use health information about you to manage your treatment and services.)
Bill for your services
• We can use and share your health information to bill and get payment from health plans or other entities. (Example: We give information about you to your health insurance plan so it will pay for your services.)
How else can we use or share your health information? We are allowed or required to share your information in other ways – usually in ways that contribute to the public good, such as public health and research. We have to meet many conditions in the law before we can share your information for these purposes. For more information see: https://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.htm
Help with public health and safety issues
We can share health information about you for certain situations such as: • Preventing disease. • Helping with product recalls. • Reporting adverse reactions to medications. • Reporting suspected abuse, neglect, or domestic violence. • Preventing or reducing a serious threat to anyone’s health or safety.
Do research
• We can use or share your information for health research.
Comply with the law
• We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Respond to organ and tissue donation requests
• We can share health information about you with organ procurement organizations.
Work with a medical examiner or funeral director
• We can share health information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers’ compensation, law enforcement, and other government requests
We can use or share health information about you: • For workers’ compensation claims. • For law enforcement purposes or with a law enforcement official with health oversight agencies for activities authorized by law. • For special government functions such as military, national security, and presidential protective services.
Respond to lawsuits and legal actions
• We can share health information about you in response to a court or administrative order, or in response to a subpoena.
Organized Health Care Arrangements
• Members of the hospital’s medical staff participate in the Columbus Regional Hospital Organized Healthcare Arrangement (OHCA). An OHCA is an arrangement that involves clinical and/or operational integration among legally separate covered entities in which it is often necessary to share protected health information for the joint management and operations of the OHCA. By participating in the OHCA, the hospital’s medical staff will use this Notice of Privacy Practices. The medical staff may also share your protected health information for treatment, payment, and healthcare operations without obtaining a written authorization for you. The medical staff are required to use all appropriate safeguards when using your protected health information or disclosing it to other providers.
Our Responsibilities
• We are required by law to maintain the privacy and security of your protected health information. • We will let you know promptly if a breach occurs that may have compromised the privacy or security of your information. • We must follow the duties and privacy practices described in this notice and give you a copy of it. • We will not use or share your information other than as described here unless you tell us we can in writing. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind.
For more information see: https://www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html
Changes to the Terms of This Notice We can change the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our web site.
This Notice of Privacy Practices applies to the following organizations: • Columbus Regional Hospital, 2400 E. 17th Street, Columbus, IN 47201, (812) 376-5653 • Columbus Regional Health Physicians, 2400 E. 17th Street, Columbus, IN 47201, (812) 375-3595
Aviso de Prácticas de Privacidad Versión en Español
Esta información está disponible en español en la recepción o en el lugar de registro.
Privacy Officer Work phone: 812-376-5653
Information Security Officer Work phone: 812-376-5224
Mailing Address: 2400 East 17th Street, Columbus, IN 47201
This Notice of Privacy Practices applies to all Columbus Regional Health locations. A complete list of locations follows:
Ambulance Services - 1101 Jackson Street, Columbus, IN 47201 - 2702 Central Avenue, Columbus, IN 47201 - 935 Repp Drive, Columbus, IN 47203 - 100 Goeller Court, Columbus, IN 47201 - 1900 W 450 S, Columbus, IN 47201 - 53 E. State Road 46, Nashville, IN 47448 Audiology Services 2100 25th Street, Suite L, Columbus, IN 47201 Breast Health Center 2326 18th Street, Columbus, IN 47201
Columbus Family Medicine 3581 Central Avenue, Columbus, IN 47203
Columbus Internal Medicine Associates 4050 Central Avenue Suite 100, Columbus, IN 47203
Columbus Pediatric Associates 1120 North Marr Road, Columbus, IN 47201
Columbus Regional Health Breast Surgery Medical Office Building North 2326 18th Street, Ste. 230 Columbus, IN 47201 Columbus Regional Health General Surgery Medical Office Building South 2325 18th Street, Ste. 220 Columbus, IN 47201 Columbus Regional Health Gastroenterology 2326 18th Street, Ste. 210 Columbus, IN 47201 Columbus Regional Health Geriatrics 3581 Central Ave Columbus, IN 47203 Columbus Regional Health Nephrology and Hypertension - 2400 E. 17th Street, Columbus, IN 47201 - 2475 Northpark Drive, Suite 20, Columbus, IN 47201 - 1159 W. Jefferson Street, Franklin, IN 46131 - 325 Henry Street Bldg. 2, North Vernon, IN 47265 - 200 East Third Street, Seymour, IN 47274 - 720 N. Lincoln St., 2nd Floor, Greensburg, IN 47240 Columbus Regional Health Orthopedics and Sports Medicine Medical Office Building North 2326 18th Street, Ste. 130 Columbus, IN 47201
Columbus Regional Health Urology 2326 18th Street, Ste. 230 Columbus, IN 47201
Columbus Regional Physiatry 2400 17th Street, Columbus, IN, 47201
DaVita Dialysis 2430 North Highway 7, North Vernon, IN 47265
Doctors Park Family Medicine 3201 Middle Road, Columbus, IN 47203 Employer Health Partners BCSC 2100 25th Street, Suite I, Columbus, IN 47201 Employer Health Partners City of Columbus 2100 25th Street, Suite I, Columbus, IN 47201 Family and Internal Medicine 2100 25th Street, Suite C, Columbus, IN 47201
Fresenius Medical Care Bartholomew 2325 18th Street Suite 120, Columbus, IN 47201
Fresenius Medical Care Franklin 1159 Jefferson Street Suite 201, Franklin, IN 46131
Fresenius Medical Care Seymour 200 East Third Street, Seymour, IN 47274
Fresenius Medical Care Tree City 999 North Michigan Avenue, Greensburg, IN 47240
Hospital Care Physicians 2400 17th Street, Columbus, IN 47201 IU Health Cardiovascular Surgeons 2326 18th Street, Columbus, IN 47201
Laboratory Services at NexusPark 2100 25th Street, Suite 230, Columbus, IN 47203 Mill Race Center (Wellness) 900 Lindsey Street, Columbus, IN 47201
Mental Health Services 2075 Lincoln Park Drive, Columbus, IN 47201 MyCare Family Med 4001 Goeller Boulevard, Columbus, IN 47201 Nashville Physical Therapy 103 Willow Street, Suite C, Nashville, IN 47448
Neurology and Sleep Sciences 2100 25th Street, Suite F, Columbus, IN 47201
OB/GYN Associates of Columbus 2114 25th Street, Suite A, Columbus, IN 47201 Occupation Health 237 Washington Street, Columbus, IN 47201 PT Solutions Physical, Occupational, and Speech Therapy 2100 25th Street, Suite K, Columbus, IN 47201
PromptMed 2502 25th Street, Columbus, IN 47201
Rau Family Medicine 2100 25th Street, Suite H, Columbus, IN 47201
Sandcrest Family Medicine 2100 25th Street, Suite E, Columbus, IN 47201
Sleep Diagnostic Center 2626 E. 17th Street, Columbus, IN 47201
Southeastern Indiana Behavioral Services 2400 E. 17th Street, Columbus, IN 47201
Southeastern Indiana Cancer Care 2400 E. 17th Street, Columbus, IN, 47201
Southeastern Indiana Respiratory and Critical Care 2400 E. 17th Street, Columbus, IN 47201
Southern Indiana Heart and Vascular - 2325 18th Street, Suite 130, Columbus, IN 47201 - 955 North Michigan Avenue Specialist's Suite II, Greensburg, IN 47240 - 31 E. Poplar Street, North Vernon, IN 47265 - 225 South Pine Street Suite 330, Seymour, IN 47274
Southern Indiana OB/GYN - 2450 North Park Drive Suite A, Columbus, IN 47203 - 31 East Poplar Drive, North Vernon, IN, 47265
Treatment and Support Center (TASC) 2630 22nd Street Columbus, IN 47201
VIMCare 2100 25th Street, Suite J, Columbus, IN 47201 Weight Loss Institute 2325 18th Street, Columbus, IN 47201 WellConnect 2100 25th Street, Columbus, IN 47201