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.

This Notice of Privacy Practices ("Notice") describes the privacy practices of Madonna Rehabilitation Hospital and its Medical Staff for patients receiving services at Madonna Rehabilitation Hospital and other facilities it owns and operates ("Madonna").

Understanding Your Health Record / Information

Each time you are registered at Madonna, a record is made. Typically, this record includes demographic data, your symptoms, examination and test results, diagnoses, treatment, and a plan for future care or treatment. This information, known as your "medical record" or "health information" includes your medical and financial information. This information may be in written or electronic form. We use this information to

Plan for and provide your treatment;
Communicate with other health professionals who also care for you;
Educate health professionals;
Supply data for medical research;
Provide information to public health officials to protect the public health;
Develop facility planning and marketing strategies;
Improve the care we provide;
Obtain payment for our services; and
Document your care.

You will want to understand what is included in your medical record and how your health information is used. Doing so will help you ensure its accuracy and help you make informed decisions about sharing your health information with others.

Your Health Information Rights

You have the following rights concerning the health information we maintain about you:

- Right to Request Restrictions. You have the right to ask us to limit how we use and disclose your health information for treatment, payment, or health care operations. You may also ask us to limit the information we provide to your family, other close relatives, close friends, or others you identify concerning your care, payment for your care, or how we notify them about your location, general condition, or death. Your request must be in writing. In making your request, we will need to know what information you want us to limit, whether you want us to limit our uses or disclosures, or both, and to whom the limits should apply. We do not have to agree to your request.
- Right to Access. Except for certain types of records, you have the right to inspect and obtain a copy of your health information.
- Right to Request Amendments. You have the right to ask us to amend your health information if you think it is incorrect or incomplete. You must provide us a reason to support your request. We may deny your request if it is not in writing or if it does not include a supporting reason. We may also deny a request for amendment if the information was not created by Madonna, is not part of the health information we keep, is not part of the health information you are allowed to inspect or copy, or is accurate and complete.
- Right to Confidential Communications. You have the right to request that we communicate with you about your health information confidentially using alternative means to do so or at alternative locations.
- Right to Revoke Authorization. You have the right to revoke an authorization you have given to us to use or disclose your health information except if the information has already been used or disclosed in reliance on your authorization; and
- Right to an Accounting. You have the right to receive an accounting of certain disclosures made of your health information.

In addition to these rights, you have a right to receive a copy of Madonna's Notice of Privacy Practices upon request. Your health information rights are subject to the requirements of the federal privacy regulations found at 45CFR subpart 164.

Our Responsibilities

Madonna is required to:

- Protect the privacy of your health information according to the law's requirements;
- Provide you with a current copy of its Notice of Privacy Practices upon request; and
- Follow its Notice of Privacy Practices currently in effect.

How Madonna May Use or Disclose Your Health Information without Your Authorization

- We may use or disclose your health information for treatment purposes.

For Example: Information obtained by a nurse, physician, therapist or other member of your health care team in caring for you will be documented in your record and used to determine your future treatments. We will provide other facilities or providers involved in your care with information that may assist in your treatment, including your physicians and your next care facility/provider if you are not able to go home directly from Madonna. Copies of your medical record are provided to them to help them continue your plan of care.

- We may use or disclose your health information for payment purposes.

For Example: We will send a bill to you and/or your insurance company for the services we provide. The information may include your name, Social Security Number, diagnosis, procedures, and supplies used. We may also provide your health information to other health care providers such as ambulance services, medical supply agencies, or physicians for their billing purposes.

- We may use or disclose your health information for Madonna's health care operations.

For Example: Madonna staff may use information in your medical record to assess the results of your care. This information is used to improve the services we provide. We may also disclose your health information to our business associates who help us with our business operations, such as our attorneys, accountants, or software vendors.

- We may use or disclose your health information for the hospital directory.

For Example: Unless you tell us not to, we will share your name and location in the facility with other people who ask for you by name. Such persons may include:

A family member or friend who is involved in your care;
Persons or entities who are helping to pay for your care;
News media who ask for you by name for your condition; or
An organization assisting in disaster relief efforts so that your family can be told about your location and condition.

We also may give your name and location to members of the clergy.

- We may use or disclose your health information for research.

For Example: We may use or disclose your health information for research purposes, but only if the research is approved by an institutional review board or a privacy board that has reviewed the research proposal and has established ways to ensure the privacy of your health information.

- We may use or disclose your health information to coroners, medical examiners, and funeral directors so they may carry out their lawful duties.

- We may use or disclose your health information for organ retrieval or transplant purposes. We may share your health information with organizations or groups that manage, bank, or transplant organ and tissue donations.

- We may use or disclose your health information to schedule appointments or provide appointment reminders to you or information about treatment alternatives or other health-related benefits and services that may be of interest to you.

- We may use or disclose your health information for fundraising activities. We may use your health information to contact you to raise money for Madonna and its operations.

- We may use or disclose your health information for Workers' Compensation purposes. If you are injured on the job, we may share your health information about a work-related injury to comply with laws and regulations related to Workers' Compensation.

- We may use or disclose your health information as required by law.

For Example:

- To respond to a court order, subpoena, warrant, summons or similar legal process for judicial and administrative proceedings;

- To report information related to victims of abuse, neglect or domestic violence;

- To assist law enforcement officials in their law enforcement duties;

- To notify the appropriate authorities if we suspect you are a victim of an accident or crime or if we suspect that a death has occurred as a result of a crime;

- To report a crime committed at Madonna or to avert a serious threat to the health or safety of you or any other person.

If you are an inmate or in the custody of law enforcement, your information may be used or disclosed to provide you with medical care and to protect your health and safety. This information may also be used or disclosed to protect the health and safety of others and to assist in the safety and security of the correctional institution.

- We may use or disclose your health information to public health authorities to prevent or control disease, injury, or disability, or child abuse and neglect.

- We may use or disclose your health information to provide information to health oversight agencies that are authorized by law to oversee the health care system, government benefit programs, and the like, using audits, license investigations, legal proceedings, and other activities.

- We may use or disclose your health information as required by law to protect public officials or report to various branches of the armed services that may require the use or disclosure of your health information.

Other uses or disclosures of your health information that are not described in this Notice or are not otherwise allowed by law will be made only with your written authorization.

We reserve the right to change this Notice at any time. If we change this Notice we will apply it to the health information we already have about you and any additional information we may create or receive about you in the future. After a revised Notice becomes effective, it will be available upon request and will be posted at Madonna facilities. The revised Notice will also be available at patient registration.

For More Information or to Report a Concern

If you have a question about this Notice, and/or would like additional information about Madonna's privacy practices, you may contact Madonna's Privacy Officer at 402-489-7102, extension 6516.

If you believe your privacy rights have been violated and/or not addressed by Madonna, you have the right to file a complaint with Madonna and with the Secretary of Health and Human Services. There will be no retaliation for filing a complaint. Concerns or complaints may be sent in writing to Madonna's Corporate Compliance Officer at the following address:

Corporate Compliance Officer
Madonna Rehabilitation Hospital
5401 South Street
Lincoln, NE 68506

Madonna Rehabilitation Hospital
5401 South St.
Lincoln, NE 68506
Phone: (402) 413-3000
Toll-Free: (800) 676-5448