Cumberland Memorial Hospital is a 40 bed hospital that offers an extensive list of on-staff and consulting physicians specializing in Family Practice, Urology, Orthopedics, General Surgery, Ophthalmology, Psychiatry, Radiology and Neurology. CMH is a financially independent hospital that maintains close referral relationships with specialty facilities in Eau Claire, Minneapolis-St. Paul, and Rochester, Minnesota. The hospital provides primary Medical and Surgical care, 24-hour Emergency care, and Obstetrical services.
Cumberland Memorial Hospital and Extended Care Unit has provided quality health care services to families in our community since 1956. We strive to provide community health care for all in a caring and competent way. The personal dedication of our staff as well as our recently expanded hospital and clinic are only a part of our commitment to meeting your health care needs.
Choosing your family's health care provider is an important decision. Please use our web pages as a guide to the comprehensive health care services we offer and the staff that is here to help you.
CUMBERLAND MEMORIAL HOSPITAL & ECU'S MISSION STATEMENT
The primary function of Cumberland Memorial Hospital and Extended Care Unit, Inc. (CMH-ECU) is the provision of high quality community-based health care to all people without regard to disability, race, creed, color, national origin or ability to pay.
Quality care encompasses curative, restorative, supportive and preventative aspects. In providing this care, the rights, dignity and privacy of the patient/resident will be held in highest regard.
Quality health care can best be provided by fostering a quality work environment to attract and retain competent and caring employees. CMH-ECU accepts a leadership role in the community in assessing needs, instituting changes to meet those needs, and planning with other agencies for continuity and comprehensive health care in a cost effective manner.
NOTICE OF HEALTH CARE PRIVACY PRACTICES
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.
As a patient, it is your right to be informed of the privacy practices of your health care provider and to be informed of your privacy rights with respect to your personal health information. Your personal health information is information that constitutes “protected health information” as defined in the Privacy Rule of the Administrative Simplification provisions of the Health Insurance Portability and Accountability Act of 1996. This Notice of Privacy Practices is intended to provide you information regarding your rights and Cumberland Memorial Hospital & Extended Care Unit, Inc.’s (“CMH-ECU”) privacy practices.
DUTIES OF CMH-ECU
CMH-ECU is required by law to maintain the privacy of your health information and to provide to you and your representative this Notice of its duties and privacy practices regarding your health information. CMH-ECU is required to abide by the terms of this Notice as may be amended from time to time. CMH-ECU will not use or disclose your health information without your authorization, except as described in this Notice. CMH-ECU reserves the right to change the terms of its Notice and to make the new Notice provisions effective for all health information that it maintains. CMH-ECU also reserves the right to change the terms of its Notice with respect to any applicable more limited uses and disclosures. If CMH-ECU makes a material change to this Notice, CMH-ECU will distribute a copy of the revised Notice.
YOUR RIGHTS WITH RESPECT TO YOUR HEALTH INFORMATION
You have the following rights regarding your health information that CMH-ECU maintains:
Right to Request Restrictions. You may request restrictions on certain uses and disclosures of your health information, even if the restriction affects your treatment or CMH-ECU’s payment or health care operations. For example, however, CMH-ECU is not required to agree to your request. If you wish to make a request for restrictions, please contact CMH-ECU at 715-822-6197.
Right to Receive Confidential Communications. You have the right to request that CMH-ECU communicate with you about your health information by alternative means or at alternative locations and CMH-ECU shall accommodate reasonable requests. For example, you may ask that CMH-ECU contact you at work rather than at home. If you wish to receive confidential communications, your request must be in writing and addressed to CMH-ECU.
Right to Inspect and Copy your Health Information. You have the right to inspect and copy your health information, including billing records. This right may not apply to certain types of psychotherapy notes. A request to inspect and copy records containing your health information must be submitted in writing to CMH-ECU. If you request a copy of your health information, CMH-ECU may charge a reasonable fee for copying costs associated with your request.
Right to Amend Your Health Information. You have the right to request that CMH-ECU amend your records, if you believe your health information records are incorrect or incomplete. That request may be made as long as the information is maintained by CMH-ECU. A request for an amendment of records must be made in writing and include a reason to support the requested amendment to Medical Records at CMH-ECU. CMH-ECU may deny the request if the health information you wish to amend 1) was not created by CMH-ECU; 2) is not part of CMH-ECU’s records; 3) is not part of the health information you are permitted to inspect and copy; or 4) is, in the opinion of CMH-ECU, accurate and complete. For example, if you believe information in your medical history is incorrect, such as your birth date, you may request that this information be amended.
Right to an Accounting. You have the right to request an accounting of disclosure of your health information made by CMH-ECU for certain purposes, which may include disclosures authorized by law. The request should specify the time period for the accounting starting on or after April 14, 2003. Accounting requests may not be made for periods of time in excess of six (6) years. The accounting shall include the date of the disclosure, the name of the entity or person who received the health information, a brief description of the health information disclosed, and the reason for the disclosure. CMH-ECU will provide the first accounting you request during any 12-month period without charge. Subsequent accounting requests may be subject to a reasonable cost-based fee. For example, you may request an accounting of disclosures made from your health care record in the last year to the State for disease reporting.
Right to a Paper Copy of this Notice. You have a right to a separate paper copy of this Notice at any time even if you received this Notice previously.
USES AND DISCLOSURES OF YOUR HEALTH INFORMATION
CMH-ECU may use your health information for purposes of providing you treatment, obtaining payment for your care and conducting health care operations. CMH-ECU has established a policy to guard against unnecessary disclosure of your health information.
THE FOLLOWING IS A SUMMARY OF THE CIRCUMSTANCES UNDER WHICH AND PURPOSES FOR WHICH YOUR HEALTH INFORMATION MAY BE USED AND DISCLOSED:
To Provide Treatment. CMH-ECU may use or disclose your health information in the provision, coordination or management of your health care. For example, your health information may be disclosed to other physicians involved in your care and treatment.
To Obtain Payment. CMH-ECU may use or disclose your health information to obtain reimbursement from third parties for the care you may receive from CMH-ECU. The bill may include information that identifies you, your diagnosis and your treatment. For example, CMH-ECU may be required by your health insurer to provide information regarding your health care status so that the insurer will reimburse you or CMH-ECU.
To Conduct Health Operations. CMH-ECU may use and disclose health information for its own operations in order to evaluate the function of CMH-ECU and as necessary to provide quality care to all of CMH-ECU’s patients. Health care operations include activities such as: quality improvement activities, activities designed to reduce health care costs, professional review and performance evaluation, business management and general administrative activities of CMH-ECU and certain marketing activities. For example, CMH-ECU may use your health information to evaluate its staff performance.
USES AND DISCLOSURES OF YOUR HEALTH INFORMATION PERMITTED WITHOUT YOUR AUTHORIZATION
For Appointment Reminders. CMH-ECU may use and disclose your health information to contact you as a reminder that you have an appointment for treatment or medical care with CMH-ECU.
When Legally Required. CMH-ECU will disclose your health information when it is required to do so by and Federal, State or local law.
Public Health Risks. Law or public policy may require us to disclose medical information, excluding mental health, alcohol or drug abuse or developmental disabled or HIV test, unless specified, about you for public health activities. These activities generally include the following:
To prevent or control disease, injury or disability;
To report births and deaths;
To report child abuse or neglect;
To report reactions to medications or problems with products;
To notify people of recalls of products they may be using;
To notify a person who may have been exposed to a disease, including HIV, and may be at risk for contracting or spreading a disease or condition;
To notify the appropriate government authority if we believe a patient has been the victim of abuse, neglect or domestic violence; we will only make this disclosure if you agree or when required or authorized by law;
To notify the Food and Drug Administration.
For Worker’s Compensation. CMH-ECU may release your health information for worker’s
compensation or similar programs.
To Conduct Health Oversight Activities. CMH-ECU may disclose your health information to a health oversight agency for activities including: audits, civil, administrative or criminal investigations; inspections; licensure of disciplinary action. CMH-ECU, however, may not disclose your health information if you are the subject of an investigation and the investigation does not arise out of or is not directly related to your receipt of health care or public benefits.
Judicial and Administrative Proceedings. CMH-ECU may disclose your health information in response to a court order. CMH-ECU may disclose your health information in response to a subpoena if CMH-ECU is a party to a court action, CMH-ECU has received your authorization to disclose and has not complied within two business days or CMH-ECU failed to respond to a request for worker’s compensation records. CMH-ECU may disclose your health information excluding mental health, alcohol or drug abuse or developmental disabled or HIV test result in response to a subpoena from a State or Federal agency.
For Law Enforcement. CMH-ECU may disclose your health information, excluding HIV test results to county law enforcement officials for the reporting and investigation of elder and/or child abuse. CMH-ECU may disclose your health information except for mental health, alcohol or drug abuse or developmental disabled or HIV test results to State and Federal law enforcement officials. CMH-ECU may disclose mental health, alcohol or drug abuse or developmental disabled health information for limited law enforcement purposes as required by law. CMH-ECU may disclose your health information in response to a court order.
To Funeral Directors. CMH-ECU may use or disclose your HIV test result to a funeral director.
For Cadaveric Organ, Eye or Tissue Donation Purposes. CMH-ECU may use or disclose your HIV test result to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of cadaveric organs, eyes or tissue for the purpose of facilitating organ, eye or tissue donation and transplantation.
To Coroners and Medical Examiners. CMH-ECU may disclose your health information to coroners and medical examiners for purposes of determining your cause of death or for other duties, as authorized by law.
In the Event of a Serious Threat to Health or Safety. CMH-ECU may, consistent with applicable law and ethical standards of conduct disclose your health information if CMH-ECU, in good faith, believes that such disclosure is necessary to prevent or lessen a serious and imminent threat to your health or safety or to the health and safety of the public.
For Specified Governmental Functions. In certain circumstances, the Federal regulations authorize CMH-ECU to use or disclose your health information excluding mental health, alcohol or drug abuse, or developmental disabled or HIV test result to facilitate specified governmental functions relating to the military and veterans, national security and intelligence activities, protection services for the President and others, medical suitability determination and inmates and law enforcement custody.
AUTHORIZATION TO USE OR DISCLOSE YOUR HEALTH INFORMATION
Other than as stated above, CMH-ECU will not disclose your health information other than with your written authorization. If you or your representative authorizes CMH-ECU to use or disclose your health information, you may revoke that authorization in writing at any time by submitting your written withdrawal to CMH-ECU’s Privacy Officer.
IF YOU HAVE A COMPLAINT
You have the right to express complaints to CMH-ECU or to the Secretary of Health and Human Services if you believe that your privacy rights have been violated. Any complaints to CMH-ECU should be made in writing to CMH-ECU. CMH-ECU encourages you to express any concerns you may have regarding the privacy of your information. You will not be retaliated against in any way for filing a complaint.
IF YOU HAVE ANY QUESTIONS REGARDING THIS NOTICE, PLEASE CONTACT
Please address all correspondence regarding patient privacy to: Privacy Officer, CMH-ECU, 1110 7th Avenue, Cumberland, WI 54829.
