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Patients > While at Stamford > Patient Privacy

Patient Privacy

Joint Notice of Privacy Practices

This joint 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. Click here for an English version of the Joint Notice of Privacy Practices and here for a Spanish translation.

Click here to download a Medical Release Form
Click here to download a Medical Amendment Form

Click here to refer to Advanced Directive patient information

Click here to refer to a document that will help you learn more about Understanding Your Medical Record

Organized Health Care Arrangement

This joint notice applies to services provided to you by the following facilities (including all their locations) and their medical staffs:
  • Stamford Hospital
  • Center for Continuing Care of Greater Stamford, Inc. (The William and Sally Tandet Center for Continuing Care)
  • Continuing Care Retirement Community of Greater Stamford, Inc. (Edgehill)
The medical staffs of each of these facilities have elected to join in this Joint Notice of Privacy Practices and participate with the above facilities in an Organized Health Care Arrangement. The persons and facilities listed above may share your medical information as necessary to coordinate your care, to carry out the treatment, payment or healthcare operations of the covered entities covered by this notice and for other purposes described in this notice.
The persons and facilities listed above are independent of one another and are acting together only for the purpose of obeying the laws relating to the privacy of your medical information. Nothing in this joint notice creates a partnership, joint venture or agency relationship between or among the participating facilities and their medical staffs.

Understanding Your Medical Record

Each time you visit a hospital, doctor or other healthcare provider, a record of your visit is made. Usually this record includes the reasons you came for treatment, the physical exam, test results, what was found, the treatment and the plan for future care. This is called your Medical Record. Your Medical Record is used in many ways:

  • It is the basis for planning your care and treatment.
  • It is a way for the health team involved in your care to communicate.
  • It is a legal document that describes the care you got.
  • It is a way for the health insurance payers to check to see that they are paying for the services you got.
  • It is a tool used to educate health professionals.
  • It is a source of facts for research.
  • It is a source of health facts for public health officials.
  • It is a source of data for planning and marketing.
  • It is a way that we can check on our work and improve the care that we give.
Your Medical Record has personal health information. Both state and federal laws protect the privacy of this information. We hope that if you understand how this information is used and shared, it will help you to:
  • Make sure the information you give us is correct.
  • Better understand who, what, when, where and why your healthcare providers and others may see your personal health information.
  • Be able to make better decisions about who can use your personal health information.

Your Health Information Rights

Your Medical Record is the property of the healthcare center where you went for care. But the information in the Record belongs to you. Under the Federal Privacy Rules, 45 CFR Part 164, you have the right to:
  • Get a paper copy of this notice. Or you could get an email copy if you ask for it.
  • Ask to have the use of your Medical Record restricted in some way. We will consider your request. But we are not bound by law to do as you ask.
  • Ask that we send confidential information to you at another address - or in another way.
  • Look at and get a copy of your Medical Record - unless you cannot by law. There may be a fee to get a copy of your Medical Record.
  • Ask that changes/amendments be added to your Medical Record.
  • Get a record of who saw your Medical Record after April 14, 2003, and how it was used. There may be a fee for this.
  • Contact information is at the end of this notice if you want to make any of these requests.

Our Responsibilities

We are required by the Federal Privacy Rules to:
  • Keep your health information private.
  • Give you notice about how we will obey the privacy laws and keep your health information private.
We promise to follow our responsibilities as described in this Notice. But we keep the right to:
  • Change the way we handle your health information and give a date by which these new changes will start. (These changes will affect all your health information, old and new.)
  • Change the terms of this Notice.
We will tell you if we change the way we handle your health information. In the meantime, we will use or share it only as stated in this Notice - unless you give us your permission to use it in other ways.

How Your Medical Record Will Be Used and Shared

1. We will use your health information for treatment.

For example: Information you give a nurse, doctor or other healthcare provider will be put in your Medical Record. It will be used to plan your treatment. Your healthcare team will keep a record of your care and treatment in this Record.
We may give copies of reports from your Medical Record to your primary care doctor or other provider once you leave the hospital or treatment center. We may give copies of parts of your Medical Record to your specialists. Or we may need to give them to a treatment center to which you are being transferred.
We may use information about you to call you or send you a reminder letter or phone call:
  • About an appointment.
  • To set up a regular check-up.
  • To give you information about other kinds of treatments.
  • To tell you about health products and services we can give you.

2. We will use your health information for payment.

For example: A bill may be sent to you or your health insurance plan. The information on the bill will include your personal facts (such as your name and address). It will also have medical information so the payers can see what they are paying for.

3. We will use your health information to improve our services.

We may use your health information to see that all our patients get quality care. We want to see if our staff gives the care they should. We often want to see if we need to offer more services to people, or to see if the treatments we give are working. We may also use your health information as a way to train our medical staff.

4. Business associates may see some of your health information.

We have companies that work for us. Examples of these are companies that do billing, type medical reports, copy records and do patient surveys. Some of them may need to see parts of your Medical Record in order to do their work. Every company that works with us and sees parts of your Medical Record must sign a privacy contract with us.

5. A patient directory could have some information about you.

Unless you tell us not to, we may place your name, room number, general health condition and religion on our patient or client directory. There is no medical information in this directory. Except for religion, this information may be given to family members, friends or others who ask for you by name. We may give this information and religion to the clergy. If you do not want to be in this directory, please tell the Admissions department. It will not be put in - unless we have given it out before you told us.

6. Family or friends involved in your care may get information about you.

Unless you tell us not to, healthcare providers may give information about you to members of your family, close personal friends or other persons that you name. They will be told only as much about you as is needed for your care - or for payment for your care.

7. We may use your contact information to raise funds.

We may use such information as your name, address and dates you received care to contact you when we try to raise funds for the facility. Any fundraising letters or calls will ask if you want us to stop these contacts.

Other Ways Your Health Information May Be Used or Shared Without Your Consent

  • When required by state or federal law.
  • To any public health officials who work to prevent or control disease.
  • To government officials who check out charges of abuse, neglect and domestic violence.
  • To government officials who monitor and license healthcare providers and facilities.
  • When needed for a court hearing.
  • To law enforcement officials so they can: report on wounds or injuries caused by a crime or accident; find fugitives, suspects and missing persons; and identify a witness, victim, missing person or suspect.
  • To coroners or funeral directors to identify a deceased person or other legal duty.
  • To persons responsible for checking on organs that can be donated.
  • For research approved by a Privacy Board (IRB) of a healthcare institution. Each Privacy Board has a duty to protect the privacy of your health information.
  • When needed to prevent a threat to health or safety.
  • When needed for special lawful government work including by the military.
  • As required by law for workers compensation programs.

Rules About Release of Your Health Information

Federal Privacy Rules state that we must release your health information for two reasons:
  • You request it
  • The U.S. Department of Health and Human Services (or its contractors) asks for it for legal reasons or to review some special problem.

Uses You Agree To

We may ask to use your personal health information in other ways as well. But we will only do it if we have your written permission/authorization. You have the right to end this permission at any time. But we have the right to use your health information until the time you tell us that you take back your consent.

For More Information or to Report a Problem

  • If you have questions about this notice, or
  • If you have concerns about these privacy practices, or
  • If you believe your privacy rights have been abused, please contact:
Karen Lawler
Privacy Officer at Stamford Hospital
Shelburne Road at West Broad Street
Stamford, CT 06904
or call 203.276.7454.
If you believe your privacy rights have been abused, you may also file a complaint with the Office of Civil Rights, U.S. Department of Health and Human Services, Government Center, J.F. Kennedy Federal Building, Room 1875, Boston, MA 02203.

There will be no action against you if you file a complaint.

Please direct requests about your medical records to:

Stamford Hospital, Release of Information Specialist
Health Information Management Department
P.O. Box 9317
Shelburne Road at West Broad Street
Stamford, CT 06904-9317
Effective Date: September 23, 2013
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