CRMC-West 214 E. 23 St. Cheyenne, WY 82001
CRMC-East 2600 E. 18 St. Cheyenne, WY 82001
Health & Fitness 1620 E. Pershing, Cheyenne, WY 82001

(307) 634-CARE

Notice of Privacy Practices 

Please review this Notice carefully

This Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information.  Please review it carefully.

Each time you visit a hospital, physician, or other health care provider, a record of your visit is made.  Typically, this record contains your symptoms, examination and test results, diagnosis, treatment, a plan for future care or treatment, and billing information.  This Notice applies to all of the records of your care generated by Cheyenne Regional Medical Center (Cheyenne Regional), whether made by Cheyenne Regional personnel, agents of Cheyenne Regional, or your physician.  Cheyenne Regional and its Medical Staff members comprise an Organized Health Care Arrangement (OHCA) and are presenting you this document as a joint notice related to services provided at one of the Cheyenne Regional campuses.  Information will be shared among the members of your health care team as necessary to carry out treatment, payment, and health care operations relating to the OHCA.

Our responsibility to our patients

Cheyenne Regional is committed to maintaining the privacy of your health information and to abiding by the laws that protect you as a health care consumer.  In fact, we are required by law to do so for any information created or kept by Cheyenne Regional.  We are also required to provide you with this Notice describing our legal duties and our practices concerning your health information.  Cheyenne Regional is required to abide by the terms of the Notice currently in effect.  We reserve the right to revise this Notice and to make the revised Notice effective for medical information Cheyenne Regional already has about you, as well as any information received in the future.  A copy of the current Notice is available at Cheyenne Regional, as well as on Cheyenne Regional’s website (www.crmcwy.org).

Cheyenne Regional Medical Center provides its services without regard to race, color, national origin, religion, creed, age sex, or handicap.

Effective date of this Notice: December 1, 2007.

Uses and disclosures of health information for treatment, payment, and health care operations

The following section describes different ways that Cheyenne Regional uses and discloses information for treatment, payment, and health care operations.  Not every use or disclosure is noted, and there may be incidental disclosures as a consequence of the listed uses and disclosures.

Treatment
Your health information will be used and disclosed in the course of providing, coordinating, and/or managing your health care and related services provided at Cheyenne Regional by one or more health care providers.  For example, information obtained by your health care team will be recorded in your medical record and used in determining the course of your treatment.  This information may be shared with other departments in Cheyenne Regional to ensure that all your needs are met, such as prescriptions, laboratory tests, x-rays, and meals.  When you are discharged, your medical information will be provided to your physician or other health care providers who will be treating you after your hospitalization.  In certain circumstances, your health information may also be disclosed to your family members, your personal representative, or other persons identified by you who are involved in your health care.

Payment
We will use your health information in order to bill and collect payment from you, your health insurance company, or other third-party payers for services you receive at Cheyenne Regional. 

Health care operations
We may use the health information in your medical record to assess the care and outcomes in your case and others like it.  The results will then be used to continually improve the quality of care for all our patients.  Our health care operations include, but are not limited to:  quality assessment and improvement activities; review of our health care providers’ competence; education and training programs; compliance auditing and monitoring; and business planning and development.

Special circumstances

Treatment, payments, and health care operations include uses and disclosures in the circumstances listed below:

Patient care
You may be contacted by Cheyenne Regional nursing personnel to inquire about your recovery and to answer any questions you may have after your discharge from Cheyenne Regional.

Patient surveys
You may receive a survey after discharge from Cheyenne Regional requesting your evaluation of the care and other services provided to you while a patient at Cheyenne Regional.

Appointment reminders
You may be contacted by Cheyenne Regional personnel for a pre-admission interview, to schedule surgery or other procedures, or to remind you of an appointment for care at Cheyenne Regional.

Fund raising
You may be contacted as part of a fund-raising campaign for Cheyenne Regional.  If you do not want to be contacted for this purpose, please notify the Cheyenne Regional Medical Center Foundation.

Uses and disclosures you can limit

Patient directory
Unless you request to be excluded from the patient directory, your name, location in Cheyenne Regional, and your general condition may be included in the patient directory in order for Cheyenne Regional staff to respond to inquiries from friends, clergy, or others who inquire about you while you are a patient in the hospital.  Your religious affiliation may be provided to a member of your religious affiliation’s clergy, even if the clergy member does not ask for you by name.

If you request to be excluded from the patient directory, you are considered a “privacy patient”.  Your name will not appear in the patient directory and no information about you will be disclosed by Cheyenne Regional staff to any visitors or callers.

You may request to become a privacy patient at any time during your hospital stay.

Family and friends
Unless you notify us that you object, we may provide your health information to individuals, such as family and friends, who are involved in your care or who help pay for your care.  We may do this if you tell us we can do so, or if you know we are sharing your health information with these people and you do not object.  There may also be circumstances when we can assume, based on our professional judgment, that you would not object.

Also, if you are not able to approve or object to disclosure, we may make disclosures to a particular individual (such as a family member or friend), that we feel are in your best interest and that relate to that person’s involvement in your care.  For example, we may tell someone who comes with you to the emergency room that you suffered a heart attack and provide updates on your condition.

Other permitted uses and disclosures of health information 

Your health information may be used or disclosed without your permission in the following circumstances, subject to all applicable legal requirements and limitations: 

• as required by federal, state, or local law;
• to law enforcement officials as required by law or in response to a valid court order, subpoena, or warrant, or in response to a official request for the purpose of identifying or locating a missing person, suspect, or fugitive; 
• for judicial or administrative proceedings in response to an order, subpoena, discovery request, or other lawful process; 
• for public health reasons in order to prevent or control disease, injury or disability; or to report births, deaths, suspected abuse or neglect, non-accidental physical injuries, reactions to medications or problems with products. 
• to a health oversight agency for audits, investigations, inspections, licensing purposes, or as necessary for certain government agencies to monitor the health care system, government programs, and compliance with civil rights laws; 
• to avert a serious threat to your health or safety, or that of the public or of another person able to help prevent the threat; or to notify your family members or persons responsible for you in a disaster relief effort; 
• as required by military or Department of Veterans Affairs authorities, if you are a current member of the military or a veteran; 
• to authorized federal officials for conduct of intelligence or national security activities, including protective services to the President or other persons as authorized by law; 
• to researchers when their research has been approved by an Institutional Review Board that has reviewed the research proposal and consent form and has established protocols to ensure the privacy of your health information; 
• to the Food & Drug Administration (FDA) relative to adverse events with respect to food, medications, products, and product defects to facilitate product recalls, repairs, or replacement, or for post-marketing surveillance; 
• to funeral directors and/or coroners as necessary for them to carry out their duties; 
• to organ procurement organizations or other entities engaged in procurement, banking, or transplantation of organs and/or tissues for the purpose of transplant and/or donation; 
• to your employer via a workers’ compensation or similar work-related injury program; or 
• to a correctional institution (if you are an inmate) or a law enforcement official (if you are in that person’s custody) as necessary for the institution to provide you with health care; to protect your or others’ health and safety; or for the safety and security of the correctional institution.

When written authorization is required

 Uses and disclosures of your health information that are not covered by this Notice or laws that apply to Cheyenne Regional will be made only with your written authorization to use or disclose information about you.  You may revoke your authorization in writing at any time.  If you revoke your authorization, such information will not be used or disclosed.  However, a revocation of an authorization does not apply to uses and disclosures made prior to the date of the revocation.  You can revoke your authorization at any time by delivering or faxing a written notice of revocation to Cheyenne Regional’s Health Information Management Department at the following address:

Cheyenne Regional Medical Center
Health Information Management Department
214 East 23^rd Street
Cheyenne, WY   82001
facsimile:  307-432-3108 

Your rights 

Although your medical record is the property of Cheyenne Regional, the information belongs to you.  You have the right to: 

• request a restriction on certain uses and disclosures of your health information as described above in this Notice.  Although you have the right to make such a request, please note that we are not required to agree to a requested restriction; 
• with some exceptions, inspect and obtain a copy of your health information.  We may deny your request to inspect and/or copy health information in certain limited circumstances; if we do this, you may ask that the denial be reviewed; 
• obtain an accounting of disclosures of your health information in the six years prior to your request.  An accounting will not include disclosures for treatment, payment, and health care operations described in this Notice or disclosures made pursuant to your written authorization; 
• request confidential communications.  For example, you have the right to request that we contact you about medical matters in a certain way or at a certain location; 
• obtain a paper copy of this Notice upon request;
• request amendment of your health information record.  If you feel that medical information in your record is incorrect or incomplete, you may ask that the information be amended.  You have this right for as long as the information is maintained by Cheyenne Regional.  Your request must be in writing to Cheyenne Regional’s Health Information Management Department, and must state the reason(s) supporting your request.  Your request to amend your medical record may be denied if: 

1) it is not in writing;
2) it does not include a reason to support the request;
3) the information was not created by a provider while you were a patient at Cheyenne Regional;
4) the information is not part of the medical record;
5) the information is not part of the record which you would be permitted to inspect or copy;
6) the information is already accurate and complete. 

The Cheyenne Regional Health Information Management Department is available to assist you with obtaining a copy of your medical record and with any other matters related to your health information.  To obtain a copy of your medical information, please submit a written request to:

Cheyenne Regional Medical Center
Health Information Department
214 East 23^rd Street
Cheyenne, WY   82001

                                reception desk: 307-633-7925
                                facsimile:         307-432-3108

Cheyenne Regional may charge a reasonable, cost-based fee to cover the expense of providing the copies.

If you have questions or need assistance 

Please feel free to contact the Cheyenne Regional Health Information Management Department, as given above, or Cheyenne Regional’s Privacy Officer, at 307-432-6622, if you have any questions about the information contained in this Notice or if you have questions about how to exercise your rights described above. 

Filing a complaint 

If you believe your privacy rights have been violated, you may file a complaint with Cheyenne Regional or with the Secretary of the Department of Health and Human Services.  To file a complaint with Cheyenne Regional, please either contact the Privacy Officer, at 307-432-6622, or at the following address:

Privacy Officer
Cheyenne Regional Medical Center
214 East 23^rd Street
Cheyenne, WY   82001
facsimile:  307-432-6626 

If delivering a complaint in person, please call the Privacy Officer, at 307-432-6622, so that the Privacy Officer can be certain to be available to you.

Disclaimer - CRMC's core values are to provide quality patient care and outstanding patient satisfaction to all our patients. Part of providing quality patient care and outstanding patient satisfaction is respecting your privacy rights and maintaining the confidentiality of your medical records. For more information on patient privacy please read our patient privacy policy. CRMC will not use or disclose your health information for any purpose not described in this Notice without your written authorization.

Health information provided on Cheyenne Regional Medical Center's web page is intended as a guideline and not as a specific medical protocol. Every actual medical situation - emergency or non-emergency - is unique to each individual, and requires the clinical judgment of a qualified physician. For more information, or clarification, we recommend that individuals contact their personal physician.

Our Web site may include information and other material prepared by other sources. We also link to other Internet sites and resources. This information and links are provided as a courtesy. We are not responsible for the availability, updating, and accuracy of any information provided on these outside sites or for the privacy or security of these outside sites.

The information on this Web site is general in nature and is not intended as a substitute for consultation with a doctor and a particular treatment plan. The material provided is not intended to create, and the receipt of it does not constitute, a doctor-patient relationship. Should you have any health-care-related question, you should contact a doctor and arrange a consultation. Any e-mail generated from this Web site may not be secure and is not intended to create, and the receipt of it does not constitute, a doctor-patient relationship. E-mail communication is not intended as a substitute for consultation with a doctor.