This notice describes how information about you may be disclosed and how you may obtain access to this information... please read it carefully.
Vernon Memorial Healthcare values you as a customer and respects your right to privacy. We require that medical information that identifies you is kept private. The reason we collect information is to create and foster a health care relationship. Our goal is to keep your information accurate and up-to-date. You may request access to a list of disclosures by writing to us at our address:
Vernon Memorial Healthcare
Manager of Health Information
507 S. Main St.
Viroqua, WI 54665
Vernon Memorial Healthcare facilities: Vernon Memorial Hospital, Bland Clinic-VMH, Hirsch Clinic-VMH, Kickapoo Valley Medical Clinic-VMH, VMH Family Practice & Complementary Medicine, LaFarge Medical Clinic-VMH, VMH Home Health/Hospice, VMH Outpatient Specialty Care, VMH Pharmacy, Solar Town Pharmacy, and Vernon Memorial Pharmacy-Westby.
How We May Use and Disclose Information About You
All providers comply with our privacy practices. The following categories describe different ways that we may use and disclose medical information. Not every use or disclosure in a category will be listed.
We use information about you to provide medical treatments or services. That information is available to authorized employees such as doctors, nurses, technicians, medical students, or other hospital personnel. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. In addition, the doctor may need to tell the dietician you have diabetes so that we can arrange for appropriate meals. VMH has an organized health care agreement with all of its providers which include: Gundersen Health System, Mayo Clinic Health System-Franciscan Healthcare, Scenic Bluffs and Viola Health Services. All providers will abide by our privacy practices.
We may use and disclose information about you so that the treatment and services you receive can be billed to, and payment can be collected from you, an insurance company or a third party. We may also tell your health plan about a treatment you are going to receive to obtain prior approval or to determine whether your plan will cover the treatment. You may request restrictions on any services paid for out of pocket. With payment, VMH will restrict PHI disclosure of your PHI to a health plan.
For Health Care Operations
We may use medical information to review our treatment and services and to evaluate the performance of our staff in caring for you. We may also combine medical information about many hospital patients to decide what additional services VMH should offer, what services are not needed, and whether certain new treatments are effective. We may disclose information to doctors, nurses, technicians, medical students, and other VMH personnel for review and educational purposes. We may also combine the medical information from other health care systems to compare how we are doing and see where we can make improvements in the care and services we offer.
Appointment Reminders/Test Results
We may contact you with appointment reminders by mail or phone, including answering machines, unless you request a different method of notification.
We may use your protected health care information when we have face to face conversations with you, or send you information about possible treatment options or alternatives that may be beneficial to you.
We may use or disclose medical information about you when we have face to face conversations with you about products or services that may be beneficial to you. Any other disclosures including any that constitute the sale of PHI requires an authorization from you.
We may use certain medical information about you to contact you in an effort to raise money for VMH and it’s operations. We may disclose medical information to a foundation related to VMH so that the foundation may contact you in raising money for our facilities. We would only release contact information, such as your name, address, and phone number, dates of service, department of service or treating provider. If you do not want to be contacted for fund-raising efforts, you may opt out by notifying the Development Coordinator at Vernon Memorial Healthcare, 507 S. Main Street, Viroqua, WI 54665, 608-637-4374 or email@example.com.
Llimited information about you may be included in the hospital directory while you are a patient at the hospital. This information may include your name, location in the hospital, your general condition (e.g. fair, stable, etc.) and your religious affiliation. The directory information, except for your religious affiliation, may also be released to people who ask for you by name. Your religious affiliation may be given to a member of the clergy, such as a priest or rabbi, even if they do not ask for you by name. This is so your family, friends, and clergy may visit you in the hospital, and generally be aware of how you are doing. If you do not want to be listed in the directory or do not want your information to be given out, you must notify Patient Registration in writing at the time you sign your consent.
Individuals Involved in your Care or Payment for your Care
We may release medical information about you to a friend or family member who is involved in your medical care. We may also give information to someone who helps pay for your care, i.e. workers compensation or similar programs.
Before we use or disclose medical information for research, the project will be approved by an approval process. We may, however, disclose medical information about you to people preparing to conduct a research project, for example, to help them look for patients with specific medical needs, so long as the medical information they review does not leave our facilities. We will always ask for your specific permission if the researcher will have access to your name, address, or other information that reveals your identity.
As Required by Law
We may provide certain health information to others as permitted by law, such as: regulatory agencies, court order, and public health agencies and disaster relief efforts.
To Avert a Serious Threat to Health or Safety
We may use and disclose your medical information when necessary to prevent a serious threat to your health and safety or the health and safety of the public. Any disclosure would only be to someone able to help prevent the threat
Medical information may be released only as necessary to:
- Organ and Tissue Donation or Transplantation Centers
- Military and Veterans - as required by military command
- Public Health Activities:
- To prevent or control disease, injury or disability
- To report births and deaths;
- To report reactions to medications or product problems
- To notify people of product recalls
- To notify a person of potential disease exposure
- To notify the appropriate government authority if a patient, adult or child, has been the victim of abuse, neglect, or domestic violence.
- Sale of Protected Health Information (PHI)
VMH will not sell any or part of your PHI without a written authorization from you.
Health Oversight Activities
We may disclose medical information to a health oversight agency for activities authorized by law. These activities include audits, investigations, inspections, licensure, and disciplinary actions. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
Lawsuits and Disputes
We may disclose medical information about you in response to a court order.
Coroners, Medical Examiners & Funeral Directors
We may release information to identify a deceased person or to determine cause of death or to enable them to carry out their duties.
We may disclose information to a law enforcement official for the following reasons:
- As required by law;
- To identify or locate a suspect, fugitive, material witness, or missing person
- About the victim of a crime, if under certain limited circumstances, we are unable to obtain the person’s agreement
- In emergency circumstances, to report a crime; location of the crime or victims; or identity, description, or location of the person who committed the crime
If you are an inmate of a criminal institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This would be necessary for the institution to provide you with health care, to protect your health and safety, or that of others, or for the safety of the correctional institution.
You have the right:
- To request restrictions on certain uses and disclosures of your health information. We are not required to agree to a requested restriction.
- To receive a list of confidential communications of your protected health information.
- To inspect and copy your protected health information.
- To amend your health information.
- To be notified of a breach of your PHI.
If you believe your privacy rights have been violated, you may file a complaint with VMH or with the Secretary of the Department of Health and Human Services (DHHS). To file a complaint with VMH, contact:
Sue Sullivan, Compliance Officer
507 S. Main St.
Viroqua, WI 54665
Phone: (608) 637-4312
All complaints are required in writing. You will not be penalized for filing a complaint.
To file a complaint with DHHS call the toll free complaint line at 1-800-642-6552. The internet form for submitting a complaint may be found at: http://dhs.wisconsin.gov/bqaconsumer/HealthCareComplaints.htm
To understand HIPAA laws better, access: