SECTION B - HOW WE MAY USE AND DISCLOSE YOUR MEDICAL INFORMATION

(IF YOU ARE RECEIVING BEHAVIORAL HEALTH SERVICES, PLEASE SEE SECTION C OF THIS NOTICE.)

The following categories describe the different ways in which we may use and disclose your medical information. Please note that each particular use or disclosure is not listed below. However, the different ways we are permitted to use and disclose your medical information do fall within one of the categories.

Treatment: The covered entity may use and disclose your medical information to treat you. For example, we may ask you to undergo laboratory tests (such as blood or urine tests), and we may use the results to help us reach a diagnosis. Many of the people who work for the covered entities may use or disclose your medical information in order to treat you or to assist others in your treatment. Additionally, we may disclose your medical information to others that may assist in your care, such as your physician, therapists, spouse, children or parents. Physicians may share your medical information with other physicians to facilitate consultation, referral or followup as part of your treatment.

Payment: The covered entity may use and disclose your medical information in order to bill and collect payment for the services and items you may receive from us. 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 medical information to obtain payment from third parties that may be responsible for such costs, such as family members. Also, we may use your medical information to bill you directly for services and items.

Health Care Operations: The covered entity may use and disclose your medical information to operate our business. These uses and disclosures are important to ensure that you receive quality care and that our organization is well run. As examples of the ways in which we may use and disclose your information for our operations, our organization may use your medical information to evaluate the quality of care you received from us, or to conduct cost-management and business planning activities for our organization. Further, we may disclose your information to doctors, nurses, health care students, and other personnel of the covered entity for review and learning purposes.

Appointment Reminders: The covered entity may use and disclose your medical information to remind you that you have an appointment.

Treatment Alternatives/Health Related Benefits and Services: The covered entity may use and disclose your medical information to inform you of treatment alternatives and/or health-related benefits and services that may be of benefit to you.

Fundraising: It is the policy of the covered entities not to participate in fundraising activities.

Marketing: We may use your medical information to make a marketing communication to you that (1) occurs in a face-to-face encounter with you; (2) concerns products or services of nominal value: or (3) concerns our health-related products or services or those of another party, provided that we tell you if we have received, or will receive directly or indirectly, any money or other remuneration for making the communication to you. If you don’t want to receive marketing communications (other than those that are in a newsletter or other general communication device), please contact the Privacy Officer.

For any other marketing communications, we will need an authorization for release of information signed by you, specifically for this purpose.

Facility Directory: Memorial Medical Center may include certain limited information about you in our facility directory while you are a patient. This information may include your name, location, your general condition and your religious affiliation. The directory information, except for your religious affiliation, may be released to family and friends who ask for you by name. Your religious affiliation may be given to a member of the clergy even if they do not ask for you by name. If you do not want your information included in our directory, you should inform the registrar upon your admission to the hospital.

THE FOLLOWING CATEGORIES DESCRIBE ADDITIONAL CONDITIONS IN WHICH WE MAY USE OR DISLCOSE YOUR MEDICAL INFORMATION:

Required by Law: We will use or disclose medical information about you when required by applicable federal or state law.

Public Health Activities: The covered entity may disclose your medical information for public health activities including generally:

• to prevent or control disease, injury or disability;
• to maintain vital records, such as births and deaths:
• to report child abuse or neglect;
• to notify a person regarding potential exposure to a communicable disease;
• to notify a person regarding a potential risk for spreading or contracting a disease or condition;
• to report reactions to drugs or problems with products or devices;
• to notify 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; and
• to notify your employer under limited circumstances related primarily to workplace injury or illness or medical surveillance.

Abuse, Neglect, and Domestic Violence: We may disclose your medical information if we believe you are a victim of abuse, neglect, or domestic violence. The covered entity will only make this disclosure if you agree, or when required or authorized by law.

Health Oversight Activities: The covered entity may disclose your medical information to a health oversight agency for activities authorized by law for appropriate oversight of the health care system, governmental benefit programs and regulatory or statutory compliance. 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.

Administrative Proceedings: The covered entity may use and disclose your medical information in response to a court or administrative order, if you are involved in a lawsuit or similar proceeding. We also may disclose your medical information in response to a discovery request, subpoena, or other lawful process by another party involved in the 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.

Law Enforcement: Wisconsin law allows the covered entity to release confidential information to law enforcement officials in the following circumstances:

• concerning a death we believe might have 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; and
• 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).

In all other circumstances regarding law enforcement, Wisconsin law requires a court order for the release of confidential medical information.

Coroners, Medical Examiners, and Funeral Directors: The covered entity may release medical information to a coroner or medical examiner. This may be necessary, for example, to identify a deceased person or to determine the cause of death. We may also release medical information about patients of the hospital to funeral directors as necessary to carry out their duties.

Organ and Tissue Donation: We will use or disclose your medical information to organizations that handle organ and tissue procurement, banking or transplantation as required by law.

Research: Under certain circumstances we may use and disclose medical information about you for research purposes. We will always ask for your specific authorization if medical information that identifies you will be used or disclosed in connection with a research project.

Serious Threats To Health or Safety: The covered entity may use and disclose your medical 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.

Specialized Government Functions: The covered entity may disclose your medical information if you are a member of U.S. or foreign military forces (including veterans) and if required by the appropriate military command authorities. In addition, the covered entity may disclose your medical information to federal officials for intelligence and national security activities authorized by law. We also may disclose your medical information to federal officials in order to protect the President, other officials or foreign heads of state, or to conduct investigations.

Furthermore, the covered entity may disclose your medical 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.

Workers’ Compensation: The covered entity may release your medical information for workers’ compensation and similar programs established by law to provide benefits for work related injuries or illness.