Notice of Privacy and Confidentiality Practices
This notice describes how your health information may be used and disclosed, and how you can get access to this information. Check it carefully.
Instructions: Please check carefully
- You will read this document. If you do not agree with some clauses, you can cross them out before signing the "Acknowledgment of Receipt of Notice".
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If you need some clauses or the document to be explained to you in full, you may ask the Hospital Officer who gave it to you to contact the Privacy Officer or an assigned representative.
- Privacy Officer: email: jugarcia@dchpr.com, phone: 787-621-3322 Ext. 1050
Description of Notification
Every time you visit any service of our hospital, information is generated and compiled in a medical record. This medical record usually contains symptoms, tests, lab results, x-rays, other tests performed, diagnoses, treatment received, plans for care and future treatments, and administrative information related to billing for the treatment received. This information includes confidential and private patient information.
This document applies to all confidential and private patient information generated by the institution and includes hospital staff, hospital representatives or your primary care physician. Your primary care physician may have a separate policy or notice regarding privacy and disclosure of information generated in their office.
Our Responsibility
We are required by law to maintain the confidentiality and privacy of your health information and to provide you with a description of our privacy policy. You have the right to restrict the use and disclosure of your health information, but we are not required to agree to the requested restrictions. We will notify you if we do not agree or are unable to comply with any request made by you. We may reach a reasonable agreement to accommodate your request to disclose health information.
Your Rights Regarding Your Health Information
You have the following rights:
- Get a copy of your medical records.
- Correct your medical records on paper or electronically.
- Request confidential communication.
- Ask us to limit the information we share.
- Receive a list of those with whom we have shared your information.
- Get a copy of this privacy notice.
- Choose someone to act on your behalf.
- File a complaint if you believe your privacy rights have been violated.
Your Choices
You have a few choices in the way that we use and share information when:
- Choose who you want to notify about your personal status, be it your family and/or friends.
- We provide relief in the event of a disaster.
- We include it in a hospital directory.
- We provide mental health care.
- We market our services and sell your information.
- We raise funds.
Our Uses and Disclosures
We may use and share your information when:
- We treat you.
- We run our organization.
- We bill for your services.
- We help with public health and safety issues.
- We conduct medical research.
- We comply with the law.
- We respond to organ and tissue donation requests.
- We work with a medical examiner or funeral director.
- We address workers' compensation, law enforcement, and other government requests.
- We respond to lawsuits and legal actions.
To the extent that we have your substance use disorder patient records, subject to 42 CFR part 2, we will not share that information for investigations or legal proceedings against you without (1) your written consent or (2) a court order and a subpoena.
Your Rights Regarding Your Health Information
When it comes to your health information, you have certain rights. This section explains your rights and some of our responsibilities to help you.
Get a copy of your medical records
- You can ask to see or get a copy of your medical records and other medical information we have about you. Ask us how to do it.
- We will provide you with a copy or summary of your health information, generally within 15 business days of your request, for a reasonable fee not to exceed seventy-five (.75) cents per page up to a maximum of twenty-five (25) dollars per medical record. In accordance with Act No. 194 of 25 August 2000, as amended.
Ask us to correct your medical records
- You can ask us to correct health information about you that you think is incorrect or incomplete. Ask us how to do it.
- We can say "no" to your request, but we will tell you why in writing within 60 days.
Request confidential communications
- You can ask us to contact you in a specific way (e.g. by home, office, or cell phone) or to send mail to a different address.
- We will say "yes" to all reasonable requests.
Ask us to limit what we use or share
- You may limit all or part of the disclosure of your health information that we use for your treatment, payment for services, and administrative operations by means of a written request to the institution.
- Example: You can request that the information about a surgery you had not be released.
- We are not obliged to comply with your request. If you agree, we will comply with the agreement as long as the information is not necessary for emergency treatment.
- If you pay for a service or health care item out-of-pocket in full, you can ask us not to share that information for the purpose of payment or our operations with your health insurer. We will say “yes” unless a law requires us to share that information.
Get a list of those with whom we have shared information
- You can ask for a list (accounting) of the times we have shared your health information for six years prior to the date of your request, who we shared it with, and why.
- We will include all disclosures except those about treatment, payment, and health care operations, and certain other disclosures (such as any you have asked us to make). We’ll provide one accounting a year for free but will charge a reasonable, cost-based fee if you ask for another one within 12 months.
Get a copy of this privacy notice
- You can ask for a paper copy of this notice at any time, even if you agreed to receive the notice electronically. We will provide you with a paper copy promptly.
Choose someone to act on your behalf
- If someone has authority to act as your personal representative, such as if someone has your medical power of attorney or if someone is your legal guardian, that person can exercise your rights and make choices about your health information.
- We will make sure the person has this authority and can act for you before take any action.
File a complaint if you believe your rights are violated
- You can complain if you feel we have violated your rights by contacting us using the information on page 1.
- You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights by sending a letter to 200 Independence Avenue, S.W., Washington, D.C. 20201, calling 1-877-696-6775, or visiting https://www.hhs.gov/hipaa/filing-a-complaint/index.html.
- We will not retaliate against you for filing a complaint.
Your Choices
For certain health information, you can tell us your choices about what we share.
If you have a clear preference for how we share your information in the situations described below, please contact us. Tell us what you want us to do, and we will follow your instructions.
In these cases, you have both the right and choice to tell us to:
- Share information with your family, close friends, or others involved in your care or payment for your care.
- Share information in a disaster relief situation.
- Include your information in a hospital directory.
NOTE: If you are not able to tell us your preference, for example if you are unconscious, we may go ahead and share your information if we believe it is in your best interest. We may also share your information when needed to lessen a serious and imminent threat to health or safety.
In these cases, we will never share your information unless you give us written permission:
- Marketing purposes.
- Sale of your information.
- Most sharing of psychotherapy notes.
In the case of fundraising:
- We may contact you for fundraising efforts, but you can tell us not to contact you again.
If we have your substance use disorder patient records, subject to 42 CFR part 2, we will give you clear and obvious notice in advance and a choice about whether to receive fundraising communications that use your Part 2 information.
Our Uses and Disclosures
How do we use or share your health information?
We generally use or share your health information in the following ways.
Treat you
- We can use your health information and share it with other professionals who are treating you.
Example: A doctor who is treating you for an injury asks another doctor about your general health.
Running our organization
- We can use and share your health information to run our practice, improve your care, and contact you when necessary.
Example: We use medical information about you to manage your treatment and services.
Bill for your services
- We may use and share your information to bill and obtain payment from health plans and other entities.
Example: We give information about you to your health insurance plan so that it will pay for your services.
How else may we use or share your health information?
We are permitted or required to share your information in other ways (usually in ways that contribute to the public good, such as public health and medical research). We have to meet many legal conditions before we can share your information for these purposes. For more information, visit: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/factsheets_spanish.html, available in Spanish.
In all cases, including those listed below, if we have substance use disorder patient records about you, subject to 42 CFR part 2, we cannot use or share information in those records in civil, criminal, administrative, or legislative investigations or proceedings against you without (1) your consent or (2) a court order and a subpoena.
Help with public health and safety issues
We may share your health information in certain situations, such as:
- Preventing disease.
- Helping with product recalls.
- Reporting adverse reactions to medications.
- Reporting suspected abuse, neglect, or domestic violence.
- Preventing or reducing a serious threat to anyone's health or safety.
Conduct medical research
- We can use or share your information for health research.
Comply with the law
- We will share information about you if state or federal laws require it, including with the Department of Health and Human Services if it wants to see that we’re complying with federal privacy law.
Responding to organ and tissue donation requests
- We can share your health information with organ procurement organizations.
Work with a medical examiner or funeral director
- We can share medical information with a coroner, medical examiner, or funeral director when an individual dies.
Address workers' compensation, law enforcement, and other government requests
- We may use or share your health information:
- For workers' compensation claims.
- For law enforcement purposes or with a law enforcement official.
- With health oversight agencies for activities authorized by law.
- For special government functions, such as military, national security, and presidential protective services.
Respond to lawsuits and legal actions
- We can share health information about you in response to a court or an administrative order, or in response to a subpoena.
Our Responsibilities
- We are required by law to maintain the privacy and security of your protected health information.
- We will let you know immediately if a breach occurs that may have compromised the privacy or security of your information.
- We must follow the privacy duties and practices described in this notice and give you a copy of it.
- We will not use or share your information in any manner other than as described herein, unless you tell us in writing that we may do so. If you tell us we can, you can change your mind at any time. Let us know in writing if you change your mind.
For more information, visit: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/factsheets_spanish.html, available in Spanish.
Changes to the Terms of this Notice
We may modify the terms of this notice, and the changes will apply to all information we have about you. The new notice will be available upon request, in our office, and on our website.
Complaints
If you believe that your right to privacy is being violated, you may file a complaint in writing with the institution's Privacy Officer or the Performance Improvement Department. You will not be penalized for filing a complaint.
Additional information
- Effective date of this Notice: June 25, 2026
- Privacy Officer: email: jugarcia@dchpr.com, phone: 787-621-3322 Ext. 1050