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.
The terms of this Notice of Privacy Practices apply to Bozeman Health Big
Sky Medical Center which is operating as a clinically integrated healthcare
arrangement that includes the physicians and other licensed professionals
seeing and treating patients at this facility. Bozeman Health Big Sky
Medical Center, Bozeman Health Deaconess Hospital, Bozeman Health Urgent
Care, and Advanced Medical Imaging are designated as affiliated covered
entities. All of the entities and persons listed will share protected
health information as necessary to carry out treatment, payment, and healthcare
operations as permitted by law.
We are required by law to maintain the privacy of our patients’ protected
health information (PHI) and to provide patients with notice of our legal
duties and privacy practices with respect to your protected health information.
We are required to abide by the terms of this Notice so long as it remains
in effect. We reserve the right to change the terms of this Notice of
Privacy Practices as necessary and to make the new Notice effective for
all protected health information maintained by us. You may receive a copy
of any revised notices at Bozeman Health Big Sky Medical Center (BSMC)
Patient Registration or a copy may be obtained by mailing a request to:
Bozeman Health BSMC Privacy Officer, 334 Town Center Ave., Big Sky, MT 59716.
Examples of disclosure for treatment, payment and health operations
Bozeman Health BSMC will use your protected health information for your
treatment: For instance, doctors and nurses and other professionals involved in your
care will use information in your medical record and information that
you provide about your symptoms and reactions to plan a course of treatment
for you that may include procedures, medications, tests, etc. We may also
release your protected health information to another healthcare facility
or professional who is not affiliated with our organization but who is
or will be providing treatment to you. We may contact you to provide appointment
reminders, test results or information about treatment alternatives or
other health-related benefits and services that may be of interest to you.
We will use your health information for payment: For instance, we may forward information regarding your medical procedures
and treatment to your insurance company to arrange payment for the services
provided to you or we may use your information to prepare a bill to send
to you or to the person responsible for your payment.
We will use and disclose your protected health information for our healthcare
operations: For instance, clinical improvement, professional peer review, business
management, accreditation and licensing, etc. We may from time to time
use your protected health information to communicate with you about health
products and services necessary for your treatment, to advise you of new
products and services we offer, and to provide general health and wellness
Uses & Disclosures that require an Authorization
- Psychotherapy notes unless it is to carry out treatment, payment, or healthcare options.
- Sale of PHI
Permitted uses and disclosures
Your Authorization: Except as outlined below, we will not use or disclose your protected health
information for any purpose unless you have signed a form authorizing
the use or disclosure. You have the right to revoke that authorization
in writing unless we have taken any action in reliance on the authorization.
Facility Directory: We maintain a facility directory listing the name, room number, general
condition and, if you wish, your religious affiliation. Unless you choose
to have your information excluded from this directory, the information,
excluding your religious affiliation, will be disclosed to anyone who
requests it by asking for you by name. This information, including your
religious affiliation, may also be provided to members of the community
clergy. You have the right during registration to have your information
excluded from this directory.
Family and Friends Involved In Your Care: With your approval, we may from time to time disclose your protected health
information to designated family, friends, and others who are involved
in your care or in payment of your care in order to facilitate that person’s
involvement in caring for you or paying for your care. If you are unavailable,
incapacitated, or facing an emergency medical situation, and we determine
that a limited disclosure may be in your best interest, we may share limited
protected health information with such individuals without your approval.
We may also disclose limited protected health information to a public
or private entity that is authorized to assist in disaster relief efforts
in order for that entity to locate a family member or other persons that
may be involved in some aspect of caring for you.
Business Associates: Certain aspects and components of our services are performed through contracts
with outside persons or organizations, such as auditing, accreditation,
legal services, etc. At times it may be necessary for us to provide certain
aspects of your protected health information to one or more of these outside
persons or organizations who assist us with our healthcare operations.
In all cases, we require these business associates to appropriately safeguard
the privacy of your information.
Fundraising Activities: We may release information about you to Bozeman Health Foundation. Allowable
information that may be released includes: name, address, phone number,
age, gender, insurance status, dates of service, department of service,
treating physician, and outcome of treatment information. Information
regarding illnesses and/or treatments will not be released. If you do
not want to receive direct solicitations regarding current fundraising
efforts you have the right to opt out of receiving such communications.
Research: In limited circumstances, we may use and disclose your protected health
information for research purposes. For example, a research organization
may wish to compare outcomes of all patients that received a particular
drug and will need to review a series of medical records. In all cases
where your specific authorization has not been obtained, your privacy
will be protected by strict confidentiality requirements applied by an
Institutional Review Board or privacy board which oversees the research
or by representations of the researchers that limit their use and disclosure
of patient information.
Required uses and disclosures
We are permitted or required by law to make certain other uses and disclosures
of your protected health information without your consent or authorization,
including but not limited to the following:
- We may release your protected health information for any purpose required by law.
- We may release your protected health information for public health activities,
such as required reporting of disease, injury, and birth and death, and
for required public health investigations.
- We may release your protected health information as required by law if
we suspect child abuse or neglect; we may also release your protected
health information as required by law if we believe you to be a victim
of abuse, neglect or domestic violence.
- We may release your protected health information to the Food and Drug Administration
if necessary to report adverse events, product defects or to participate
in product recalls.
- We may release your protected health information to your employer when
we have provided healthcare to you at the request of your employer to
determine workplace-related illness or injury; in most cases you will
receive notice that information is disclosed to your employer.
- We may release your protected health information if required by law to
a government oversight agency conducting audits, investigations or civil
or criminal proceedings.
- We may release your protected health information if required to do so by
subpoena or discovery request; in some cases you will have notice of such release.
- We may release your protected health information to law enforcement officials
as required by law to report wounds and injuries and crimes.
- We may release your protected health information to coroners and/or funeral
directors consistent with law.
- We may release your protected health information if necessary to arrange
an organ or tissue donation from you or a transplant for you.
- We may release your protected health information if, in limited instances,
we suspect a serious threat to health or safety.
- We may release your protected health information if you are a member of
the military as required by armed forces services; we may also release
your protected health information if necessary for national security or
- We may release your protected health information to workers’ compensation
agencies if necessary for your workers’ compensation benefit determination.
Your Health Information Rights
Although your health record is the physical property of Bozeman Health
BSMC, the information belongs to you. You have the right:
- To copy and/or inspect much of the protected health information that we
retain on your behalf. All requests for access must be made in writing
and signed by you or your representative. You may obtain an access request
form from: Bozeman Health BSMC, Patient Registration, PO Box 161529, 334
Town Center Ave, Big Sky, MT 59716.
- To request in writing that protected health information that we maintain
about you be amended or corrected. We are not obligated to make all requested
amendments but will give each request careful consideration. All amendment
requests, in order to be considered by us, must be in writing, signed
by you or your representative, and must state the reasons for the amendment/correction
request. If an amendment or correction you request is made by us, we may
also notify others who work with us and have copies of the uncorrected
record if we believe that such notification is necessary. You may obtain
an amendment request form from: Bozeman Health BSMC Patient Registration,
PO Box 161529, 334 Town Center Ave, Big Sky, MT 59716.
- To receive an accounting of certain disclosures made by us of your protected
health information 6 years prior to the date of request. Requests must
be made in writing and signed by you or your representative. Accounting
request forms are available from: Bozeman Health BSMC Patient Registration,
PO Box 161529, 334 Town Center Ave. Big Sky, MT 59716. The first accounting
in any 12-month period is free; you will be charged a fee for each subsequent
accounting you request within the same 12-month period.
- To request a restriction on certain uses and disclosures of your information
as provided by 45 CFR 164.522. Bozeman Health BSMC will honor your request
for restrictions to the extent possible. A restriction request form can
be obtained from Bozeman Health BSMC Patient Registration, PO Box 161529,
334 Town Center Ave, Big Sky, MT 59716. We are not required to agree to
your restriction request, unless required by law or you request a restriction
to a health plan if you have paid for the services out of pocket and in
full. We will attempt to accommodate reasonable requests when appropriate
and we retain the right to terminate an agreed-to restriction if we believe
such termination is appropriate. In the event of a termination by us,
we will notify you of such termination. You also have the right to terminate,
in writing or orally, any agreed-to restriction.
- To be notified of a breach of unsecured PHI in the event you are affected.
- To obtain additional copies of the Notice of Privacy Practices upon request.
You will be asked to sign an acknowledgment form that you received this
Notice of Privacy Practices.
For More Information or to report a Problem
If you believe your privacy rights have been violated, you can file a complaint
with the Bozeman Health BSMC Privacy Officer or with the Secretary of
Health and Human Services. There will be no retaliation for filing a complaint.
If you have questions and/or would like additional information, please
contact the Bozeman Health BSMC Privacy Officer at (406) 995-6888.
Effective December 10, 2015