CHN 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. PLEASE REVIEW IT CAREFULLY.

Community Health Network (CHN) uses health information about you for treatment, to obtain payment for treatment, for administrative purposes, and to evaluate the quality of care that you receive. Your health information is contained in a medical record that is the physical property of CHN.

How CHN May Use or Disclose Your Health Information

For Treatment:
CHN may use and disclose information about you as required by law. For example, CHN may disclose information for the following purposes:CHN may use your information to contact you to raise funds for the CHN Foundation. CHN may use your information to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

For Payment:
CHN may use and disclose your health information to others for purposes of receiving payment for treatment and services that you receive. For example, a bill may be sent to you or a third-party payor, such as an insurance company or health plan. The information on the bill may contain information that identifies you, your diagnosis, and treatment or supplies used in the course of treatment.

For Health Care Operations:
CHN may use and disclose health information about you for operational purposes. For example, your health information may be disclosed to members of the medical staff, risk or quality improvement personnel, and others to:

• Evaluate the performance of our staff;

• Assess the quality of care and outcomes in your case(s) and similar cases;

• Learn how to improve our facilities and services; and

• Determine how to continually improve the quality and effectiveness of the health care we provide. (Examples include reviews by outside peers, including but limited to MetaStar, NCQA, RWHC, and OHCI, to provide continuing education to staff. Audit trails may not be available).

For Appointments:
CHN may use your information to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

For Fundraising:
CHN may use your information to contact you to raise funds for the CHN Foundation.

As Required by Law.
CHN may use and disclose information about you as required by law. For example, CHN may disclose information for the following purposes:

• For judicial and administrative proceedings pursuant to legal authority;
• To report information related to victims of abuse, neglect or domestic violence; and
• To assist law enforcement officials in their law enforcement duties.

For Public Health:
Your health information may be used or disclosed for public health activities, such as assisting public health authorities or other legal authorities to prevent or control disease, injury, or disability, or for other health oversight activities.

For Decedents:
Health information may be used or disclosed for cadaveric organ, eye, or tissue donation purposes. Your health information may be used or disclosed for public health activities, such as assisting public health authorities or other legal authorities to prevent or control disease, injury, or disability, or for other health oversight activities.

For Research:
CHN may use your health information for research purposes when an institutional review board or privacy board that has reviewed the research proposal and, has established protocols to ensure the privacy of your health information has approved the research.

For Health and Safety:
Your health information may be disclosed to avert a serious threat to the health or safety of you and any other person pursuant to applicable law.

For Government Functions:
Your health information may be disclosed for specialized government functions such as protection of public officials or reporting to various branches of the armed services.

For Workers’ Compensation Issues:
Your health information may be used and disclosed in order to comply with laws and regulations related to Workers’ Compensation.

For Other Uses:
Other uses and disclosures will be made only with your written authorization and you may revoke the authorization except to the extent CHN has taken action in reliance on such.

Your Health Information Rights

You have the right to:

• Request a restriction on certain uses and disclosures of your protected health information and you have the right to request that we limit our disclosure of your information to individuals involved in your care or the payment for your care; however, CHN is not required to agree to a requested restriction;

• Obtain a paper copy of the notice of information practices upon request;

• Inspect and obtain a copy of your health record – our organization may charge a fee for costs of copying, mailing, labor and supplies associated with your request;

• Request that your health record be amended;

• Request confidential communications of your health information by alternative means or at alternative locations; and

• Receive an accounting of disclosures made of your health information other than for payment, treatment, and healthcare operations.

More information may be found in 45 C.F.R. (Code of Federal Register)

Concerns/Complaints:
You may file a concern with CHN and with the Department of Health and Human Services if you believe your privacy rights have been violated. You will not be retaliated against for filing a complaint.

Community Health Network
225 Memorial Drive
Berlin, WI 54923
(920) 361-5551 

Department of Health and Human Services
Attn: Privacy Officer
200 Independence Ave., S.W.
Washington, DC 20201 
(202) 690-7000

Obligations of CHN:
CHN is required by law to:

• Maintain the privacy of protected health information;

• Provide you with this notice of its legal duties and privacy practices with respect to your health information;

• Abide by the terms of this notice;

• Notify you if we are unable to agree to a requested restriction on how your information is used or disclosed;

• Accommodate reasonable requests you may make to communicate health information by alternative means or at alternative locations; and

CHN reserves the right to change its information practices and make the new provisions effective for all protected health information it maintains. Revised notices will be made available to you upon request, at your next registration, or at our website.

Contact Information

If you have any questions or concerns, please contact:

Community Health Network
Attn: Health Information Services Director / Privacy Officer
225 Memorial Dr, Berlin, WI 54923
(920) 361-5551

You may download a copy of the CHN Privacy Policy <HERE>