We are required by law to maintain the privacy of your protected health information and to provide you with a notice of our legal duties and privacy practices with respect to your protected health information. This notice summarizes our legal duties, privacy practices, and certain rights you have regarding your protected health information.

Throughout this Notice, "we" or "our" refers to the hospital, its departments, employees and volunteers, and members of its Medical Staff while they are performing services at the hospital. "You" or "your" refers to you or your personal representative or other person legally authorized to make health care decisions for you.

1. We may use and disclose your protected health information for treatment, payment and health care operations, as described in the following examples:
   a. For treatment - We may use your protected health information to treat you or to allow other health care providers to treat you. For example, we may ask you to have laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis. We might use your protected health information in order to write a prescription for you, or we might disclose your protected health information to a pharmacy when we order a prescription for you. Many of the people who work for our Hospital - including, but not limited to, our doctors and nurses - may use or disclose your protected health information in order to treat you or to assist others in your treatment.
   b. For payment - We may use and disclose your protected health information in order to bill and collect payment for the services and items you may receive from us or to allow other health care providers to obtain payment. For example, we may contact your health insurer to certify that you are eligible for benefits (and for what range of benefits), and we may provide your insurer with details regarding your treatment to determine if your insurer will cover, or pay for, your treatment. We also may use and disclose your protected health information to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your protected health information to bill you directly for services and items.
   c. For health care operations - We may use and disclose your protected health information for certain functions related to the operation of the hospital. As examples of the ways in which we may use and disclose your information for our operations, we may use your protected health information to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities.
2. We may use or disclose protected health information without your written authorization under the following circumstances.
   a. Disclosure required by law. We may disclose your protected health information to the extent disclosure is required by law.
   b. Public Health Risks. We may disclose your protected health information to public health authorities that are authorized by law to collect information for the purpose of:
   * Maintaining vital records, such as births and deaths
   * Reporting child abuse or neglect
   * Preventing or controlling disease, injury or disability
   * Notifying a person regarding potential exposure to a communicable disease
   * Notifying a person regarding a potential risk for spreading or contracting a disease or condition
   * Reporting reactions to drugs or problems with products or devices
   * Notifying individuals if a product or device they may be using has been recalled
   * Notifying appropriate government agency(ies) and authority(ies) regarding the potential abuse or neglect of an adult patient (including domestic violence); however, we will only disclose this information if the patient agrees or we are required or authorized by law to disclose this information
   * Notifying your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.
   c. Health Oversight Activities. We may disclose your protected health information to a health oversight agency for activities authorized by law. Oversight activities can include, for example, investigations, inspections, audits, surveys, licensure and disciplinary actions; civil, administrative, and criminal procedures or actions; or other activities necessary for the government to monitor government programs, compliance with civil rights laws and the health care system in general.
   d. Lawsuits and Similar Proceedings. We may use and disclose your protected health information in response to a court or administrative order. We also may disclose your protected health information in response to a discovery request, subpoena, or other lawful process by another party involved in a dispute, but only if we have made an effort to inform you of the request or to obtain an order protecting the information the party has requested.
   e. Law Enforcement. We may release protected health information if asked to do so by a law enforcement official:
   * Regarding a crime victim in certain situations, if we are unable to obtain the person's agreement
   * Concerning a death we believe has resulted from criminal conduct
   * Regarding criminal conduct at the Hospital
   * In response to a warrant, summons, court order, subpoena or similar legal process
   * To identify/locate a suspect, material witness, fugitive or missing person
   * In an emergency, to report a crime (including the location or victim(s) of the crime, or the description, identity or location of the perpetrator)
   f. Deceased Patients. We may release protected health information to a medical examiner or coroner to identify a deceased individual or to identify the cause of death. If necessary, we also may release information in order for funeral directors to perform their jobs.
   g. Organ and Tissue Donation. We may release protected health information to organizations that handle organ, eye or tissue procurement or transplantation, including organ donation banks, as necessary to facilitate organ or tissue donation and transplantation if you are an organ donor.
   h. Serious Threats to Health or Safety. We may use and disclose your protected health information when necessary to reduce or prevent a serious threat to your health and safety or the health and safety of another individual or the public. Under these circumstances, we will only make disclosures to a person or organization able to help prevent the threat.
   i. Military. We may disclose your protected health information if you are a member of U. S. or foreign military forces (including veterans) and if required by the appropriate authorities.
   j. National Security. We may disclose your protected health information to federal officials for intelligence and national security activities authorized by law. We also may disclose your protected health information to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.
   k. Inmates. We may disclose your protected health information to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (1) for the institution to provide health care services to you, (2) for the safety and security of the institution, and/or (3) to protect your health and safety or the health and safety of other individuals.
   l. Workers' Compensation. We may release your protected health information for Workers' Compensation and similar programs to the extent allowed by law.
   m. Marketing. We may use or disclose your protected health information for limited marketing activities, including face-to-face communications with you about services.
   n. Business Associates. We may disclose your protected health information to our business associates who perform various activities involving protected health information on our behalf. Our contracts with such business associates will require them to comply with relevant privacy laws.
3. Unless you instruct us not to, we may use or disclose your protected health information for the following purposes:
   a. Facility Directory. Unless you object, we will include your name, location in the hospital, your general condition, and your religious affiliation in our facility directory. We may disclose the foregoing information to clergy and, except your religious affiliation, to people who ask for you by name.
   b. Persons Involved in Your Health Care. Unless you object, we may disclose your protected health information to a member of your family, close friend, or other person identified by you who is involved in your health care or the payment for your health care.
   c. Notification. Unless you object, we may use or disclose your protected health information to notify or assist in notifying a family member, personal representative or other person responsible for your care of your location, general condition or death. Among other things, we may disclose protected health information to a disaster relief agency to assist in notifying family members.
4. We may use or disclose your protected health information to engage in one or more of the following activities:
   a. We may contact you to provide appointment reminders or information about treatment alternatives or other heath-related benefits and services that may be of interest to you; and
   b. We may contact you to raise funds for the Hospital.
5. Other uses and disclosures will be made only with your written authorization, and you may revoke such authorization at anytime by submitting a written revocation except to the extent we have taken action in reliance on your authorization.
6. You have the following rights regarding your protected health information:
   a. The right to request additional restrictions on the use and disclosure of protected health information for treatment, payment and health care operations. You must submit your request for additional restrictions in writing to the HIM (Health Information Management) Department. We are not required to agree to a requested restriction.
   b. The right to receive confidential communications of protected health information by reasonable alternative means or at alternative locations. You must submit your request in writing to the HIM (Health Information Management) Department. We may condition this right on information as to how payment will be handled or specification of an alternative address or other method of contact.
   c. The right to inspect and copy protected health information that is used to make decisions about your care. You may access your protected health information by submitting a written request to the HIM (Health Information Management) Department. We may charge you a reasonable cost-based fee for providing the records to you. We may deny your request under limited circumstances.
   d. The right to request an amendment of your protected health information. You may request an amendment by submitting a written request to the HIM (Health Information Management) Department. We may deny your request under limited circumstances. If we deny your request, you have a right to submit a statement of disagreement and have the statement attached to your protected health information.
   e. The right to receive an accounting of certain disclosures we have made of your protected health information. You may request an accounting by submitting a written request to the HIM (Health Information Management) Department. We may deny your request under certain circumstances. You have a right to receive the first accounting within a 12-month period free of charge. We may charge you a reasonable cost-based fee for all subsequent requests during that 12-month period.
   f. The right to obtain a paper copy of the Notice from the covered entity upon request. You have this right even if you have agreed to receive this Notice electronically.
7. We are required to abide by the terms of our Notice of Privacy Practices currently in effect. We reserve the right to change the terms of this Notice, and to apply those changes retroactively. The new Notice provisions will be effective for all protected health information we maintain. A copy of our revised Notice will be available at the Hospital. In addition, we will make a copy of the revised Notice available to you upon request.
8. This Notice applies to the hospital (including its departments and units wherever located); its employees, staff and other hospital personnel; and all volunteers whom we allow to help you while you are in the hospital. This Notice of Privacy Practices also applies to all members of the Medical Staff of the hospital concerning the services they perform at the hospital or at a hospital department. We may share and exchange protected health information with members of the Medical Staff for treatment, payment and health care operations. However, members of the Medical Staff, including your personal physician, may have different privacy policies and practices relating to their use or disclosure of protected health information created or maintained in their clinic or office.
9. You may complain to us and to the Secretary of 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. To lodge a complaint, please submit the complaint in writing to:
   

1. If you have any questions regarding this notice of our health information privacy policies, please contact the Privacy Officer and/or HIM/Medical Records Dept., Bear Lake Memorial Hospital, 164 South 5th Street, Montpelier, ID, 83254 or at 208-847-1630.