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Notice of Privacy Practices

Notice of Privacy Practices

This Notice describes how information about you may be used and disclosed by the Saint Raphael Healthcare System and its Medical Staff and how you may get access to this information. 

Please review it carefully.



Please direct questions about this notice to the 
Health Information Management Department at 203-789-3739

Effective Date: April 1, 2003

The Saint Raphael Healthcare System has always been committed to respecting the privacy of you, other patients and your health information. New federal laws further strengthen these protections, and require that we provide you with our legal duties about privacy practices. This “Notice of Privacy Practices” explains how our organization protects and uses your health information, and your rights about your health information while you receive care from our facility and even afterward.

This Notice applies to the Saint Raphael Healthcare System, its entities and departments, including but not limited to, the Hospital of Saint Raphael, Sister Anne Virginie Grimes Health Center, the Father Michael J. McGivney Center for Cancer Care, Occupational Health, Outpatient Drawing Stations, Project ElderCare, Project MotherCare, Smiles to Go dental van, Saint Raphael Foundation, Xavier Services Corporation, and DePaul Health Services Corporation. It does not apply to the MRI Center and dialysis centers, which have their own privacy notices.

The privacy practices in this Notice, our organization’s privacy policies and procedures, and federal and state privacy laws, must be followed by all members of the Saint Raphael community (employees, volunteers, students, etc.) in the entities and departments identified above. Additionally, business associates or partners who have access to health information because of the work they do with us must follow these practices, policies and procedures.

Since the Notice of Privacy can change, a current Notice is displayed at entrances to all facilities covered by this Notice and is also on our web site. A printed current Notice is also offered to all patients; you will be asked to sign a form stating you were offered a notice. We reserve the right to change the terms of this Notice which applies to all your health information we already have about you and information we receive in the future. 

Your protected health information may be used or disclosed for treatment, payment, healthcare operations, and other purposes without prior authorization

Protected health information is information about you that may identify you; relate to your past, present or future health condition; was obtained when you received services at Saint Raphael’s; or was received from other providers (doctors, hospitals, etc.). Entities of the Saint Raphael Healthcare System often must share your information for treatment, payment, healthcare operations, and other purposes as described in this Notice. This is done in a safe, secure, and responsible manner. 

The law states your protected health information may be used or disclosed, without your authorization, in the following ways:

  • By physicians and other healthcare team members to treat you (for example, we may send your medical information to another physician when you are referred for additional treatment or evaluation).

  • For payment of your healthcare bills (for example, billing information may be sent to your insurance company).

  • To support healthcare operations (for example, in teaching physicians or nursing students or for quality improvement studies).

  • Subject to certain requirements, it can be released to various agencies or for specific purposes, including: public health purposes; abuse or neglect reporting; audits, inspections, licensing, accreditation, state and other surveyors; required notifications of death; workers’ compensation; the Food and Drug Administration; health oversight; judicial and administrative proceedings; law enforcement; specialized government functions; quality oversight agencies, and emergencies.

There are other ways we may use or release your information, unless you disagree and let us know that in writing:

  • If you are seen in one of our clinics or other areas and need to return for another visit, we will help you remember the next visit by sending you an appointment reminder. If you missed an appointment we may call you to reschedule. We will use the mailing address and contact phone number you give us. 

  • We may contact you to talk about different ways of treating your condition so that you and your provider (doctor, nurse, physical therapist, etc.) can decide what will be most helpful to you.

  • We may contact you to talk about services we offer that may improve your health condition. For example, if you are a patient in our cancer center a counselor may contact you to offer our support group services.

  • To a family member or friend involved with your medical care.

  • In the event of a disaster, to inform disaster relief authorities so your family can be notified of your location and condition.

  • To be listed in the hospital directory, if you are admitted. This directory is used to locate patients so they can receive visitors, phone calls, mail, flowers, etc. 

  • In response to specific requests for information by friends, the media, etc., we will provide only a one-word description of your general condition (good, fair, etc.) and your location within the hospital, unless you are here for psychiatric services. Persons seeking information must tell us your full name. 

  • When a clergy member from your designated church, temple, synagogue, mosque or other house of worship contacts us for information about you, we will let them know you were admitted to our facility. 

  • We may use certain information in cooperation with the Saint Raphael Foundation to contact you in the future about your possible interest in contributing to Saint Raphael’s. Money raised is used to expand and improve the services and programs we provide to the community. Please write to: Saint Raphael Foundation, c/o Information Coordinator, 1450 Chapel Street, New Haven, CT 06511 if you wish to have your name removed from the list to receive fundraising requests supporting Saint Raphael’s.

These examples do not include all the ways the Saint Raphael Healthcare System may use or disclose your protected health information. 

Use and disclosure of your protected health information to business associates
Saint Raphael’s often must share your protected health information with third party business associates that do various activities for our organization (examples: a billing service or a company that types medical reports). In those instances, we will have a written contract with statements that protect the privacy of your health information. 

Use and disclosure of your protected health information for research purposes
We may review your health information to see if you are eligible to participate in a research study. All research projects must be reviewed and approved by members of our organization. Except under limited circumstances, we will obtain your approval in writing before we use and disclose your information for approved research projects. 

Use and disclosure of protected health information based on your written authorization
We may use and disclose your protected health care information for treatment, payment, operations and if the law requires us to do so. In all other instances, your health information will not be used or disclosed to others unless you give us a written request. You may cancel this request at any time. Requests to cancel an authorization must be in writing and directed to the Health Information Management Department.

Your rights regarding your medical information

You have a right to:
* Request a copy of or to see medical information we use to make decisions about your care. If a request is denied, you have a right to appeal that decision. You may be charged a reasonable fee for copies of your record. Written requests for copies of your medical information should be sent to the Health Information Management Department.
* Request that we correct your record if you believe it contains wrong information or if important information is missing. We may deny your request under certain circumstances and you have a right to appeal that denial. Written requests to correct your medical file should be sent to the Health Information Management Department.
* A list of when we released your medical information in response to state, federal or local laws. Disclosures for treatment, payment or healthcare operations and requests you gave us in writing to release your information are not included in this listing. You may be charged a reasonable fee for copies of this information. You must request this list by completing a form. Contact our Health Information Management Department to assist you with your request. 
* Request that your medical information be communicated to you in a confidential manner by using a mailing address that is different from your home address or a telephone number that is different from your home phone number. We have the right to ask you for contact information if we need it to bill for services you received in our facility. Our staff will help obtain this information each time you register for a service at the Saint Raphael Healthcare System or as soon as possible if you receive emergent care. 
* Request that we not use or disclose medical information about you to persons involved in your care except when required by law or in an emergency. Our staff will help obtain this information when you register for a service at the Saint Raphael Healthcare System or as soon as possible if you receive emergent care.
* Request restrictions on use and disclosure of your personal health information for treatment, payment and healthcare operations. If Saint Raphael’s agrees to a reasonable restriction, we will comply with your request. We do not have to agree to a requested restriction. Our staff will help obtain this information when you register for a service at the Saint Raphael Healthcare System or as soon as possible if you receive emergent care.

The above requests should be sent to:

Health Information Management Department
Saint Raphael Healthcare System
1450 Chapel Street
New Haven, CT 06511

How to file a complaint
If you believe your privacy rights have been violated, you have the right to complain to Saint Raphael’s. All complaints must be in writing and directed to:

Patient Relations Department
Saint Raphael Healthcare System
1450 Chapel Street
New Haven, CT 06511

There will be no penalty or retaliation against you or any individual for filing a complaint. For more information, call (203) 789-3508 or visit our web site at: 

https://www.srhs.org/

If you wish to file a complaint with the Secretary of the Department of Health and Human Services, Office of Civil Rights, you may send a letter to:

Office of Civil Rights
Region 1 Room 1875
JF Kennedy Federal Building
Government Center
Boston, MA 02203

The members of the Saint Raphael Healthcare System understand how important it is to keep your information confidential. We are committed to keeping your health information private and support your privacy rights.

Page last updated on May. 12, 2009