Colon Cancer HealthRisk Assessment

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Medically Reviewed By: Expert-24 Medical Review Board on March 27, 2014 | References | Terms of Use & Privacy

HEALTHTOOLS™ (HEALTHRISK™ AND HEALTHAGE™) DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.

Expert Review Panel – Expert-24 Ltd

Terms of reference

The aim of the Expert Review Panel is to ensure that all Expert-24 clinical and epidemiological content is robust, independent and up to date.

Qualifications

Medical Director and Editor

Dr. Timothy Dudley

Chairman of the Expert Review Panel

Dr. Robin Christie

Current authors and reviewers for the Health Risk Assessment

Dr. Martin Dawes

Dr. Jonathan Mant

Emeritus authors and reviewers for the Health Risk Assessment

The following individuals were deeply involved in the creation of the health risk assessment at its inception, but are no longer active reviewers on the panel:

Dr. John Fletcher

Dr. Emma Boulton

Professor Larry Ramsay

Professor Klim McPherson



Patient-centered health risk using an Evidence Based Medicine approach

Who created it and how often is it reviewed and updated?


This health risk assessment is brought to you by Expert-24 Limited. Expert-24 Ltd has full editorial control over content and strives to ensure that the content is: 


Why is this health risk assessment different than others?

Most health risk assessments say if a person is at high, medium or low risk of either dying from or developing a given medical condition. Most also indicate what lifestyle factors contribute to this risk. What they do not say is the magnitude of each risk for an individual and how much that person’s risk will decrease if they change their lifestyle. For example, if one is at moderate risk of two diseases, say bowel cancer and heart disease, most people would be unaware that their risk of heart disease is still five times higher than their risk of bowel cancer. 

In order to construct an electronic risk assessment tool for health and disease states, it is necessary to provide supporting research evidence and a method of encapsulating the best estimate of relative risk. For each medical condition, it is necessary to present credible estimates of risk, based on evidence from relevant, peer reviewed medical research. Important features of the risk assessment tool are: 

The aim of this project is to provide healthy people with a quantitative assessment of their personal risk of developing some important diseases and some of the factors that influence their risk. This is an ambitious task and we would not claim to have produced the definitive approach. Although we believe this is the most informative collection of disease prediction equations available at the present time they do have limitations. The ones we are aware of are outlined below.

What exactly does a given percentage risk mean?

Someone looking at their risk of lung cancer until the age of 50 should read this model as saying, "Assuming survival to age 50 the chance of developing lung cancer during that time would be (some predicted value)". This approach has the appeal that changing risk factors will have the expected impact on cumulative risk and the mathematics remains transparent. We chose the risk of developing a certain condition rather than the risk of dying from it because for many people the fear of living and dealing with a disabling disease is as frightening as dying from it. 

This is different than lifetime risk calculations, which generally calculate the risk of dying from a given condition. Lifetime risk must take account of the fact that we all die of something in the end and calculating the relative contribution of common competing causes of death at various ages is difficult. Not only that, but the interpretation by users is complex. For example, a user of an interactive model predicting lifetime risk of lung cancer would see their individual risk of lung cancer fall with increasing cigarette consumption, because they would be dying of heart disease and chronic lung disease before they could get lung cancer.


How accurate are these percentages?

These models are good for illustrating the change in risk due to the presence or absence of single risk factors for prediction times of up to 5 years. They are likely to be reasonably good for 15 or 20 years and for combinations of several risk factors. For longer prediction times and varying more than, say, four risk factors the results should be regarded as illustrative rather than precise. The absolute level of risk for an individual may also be wide of the mark because the majority of overall risk remains unexplained in most research studies. This is why "confidence intervals" have not been included. That said these prediction equations do calculate the best estimate of risk that can be provided on the data given. 

Is this useful in the end? We believe it is. We believe that putting some quantification on risk allows users to explore the possible impact on their health of altering what they do. We find this approach more informative than a bland statement of "high risk" that is often value laden or that a certain action will "cut down" a risk without any indication of by how much.

Is risk really reversible?

This is a difficult question to answer, but in many cases the answer seems to be, "yes". This is good news for people with high risks who are older. Intuition might tell you that you are constantly doing damage to your body that accumulates over time, and in many cases that may be true. An example of this is in skin cancer, where the earlier and more often you are badly burned in life, the higher your risk of skin cancer. Staying out of the sun when you are old cannot reverse this risk. 
However, there is good evidence that for heart disease, for example, your risks can be significantly reduced no matter what your age. Cholesterol reduction by medications called "statins" reduces the risk of heart attack, angina or sudden death from heart problems by up to 30%, and this is entirely independent of age. Similarly, blood pressure reduction by drugs reduces the risk of stroke and heart disease by 25% - again entirely independent of age. Because in general it is older people who have the highest risks, they actually stand to benefit the most from treatment. 

The risk for developing heart disease in tobacco users has been shown to decline to a level comparable with a person who has never smoked within 2-3 years of giving up. Furthermore, the risk of having a stroke is reversed after 5-10 years of stopping. Studies have also shown that life expectancy improves even in people who stop smoking later in life (i.e. at 65 years or older). 

The reduction of risk that can be obtained from changing lifestyle habits such as diet, alcohol consumption and exercise is largely unknown. Therefore, the amount of risk reduction that can be expected from optimizing these habits needs to be viewed with caution. Certainly they should not take the place of blood pressure control, cholesterol control, and smoking cessation as goals.


How good is the evidence?

Our aim in searching for evidence was to identify up to ten high quality, relevant research studies for each topic. We used Medline to search using free text, MeSH terms and thesaurus search terms specific to each medical condition. To narrow the documents we used filters using "risk" and study design type; cohorts, case control, longitudinal, follow up. Searches were limited to studies published in English language and human studies. Although a comprehensive systematic review of the literature on each disease was not possible due to the scope of this project, we feel that the evidence used represents a reasonable cross-section of high-quality literature on the subjects in question. 
What we have done is to seek out plausible values of relative risk to use in the prediction equations. We have used an approach that searches for high quality research studies and have then applied our judgment tempered by Austin Bradford Hill's criteria for causation when selecting which risks to use. Hill's criteria are: strength, consistency, specificity, temporality, biological gradient, plausibility, coherence, experimental evidence and analogy. 

If this sometimes appears somewhat subjective then that is because at times it is a matter of judgment. The judgments have seldom altered the relative risk by more than a small amount. For each risk factor we had to choose a value to use in the model and have been faced at times with a range from which to choose. While a meta-analysis may provide the best point estimate, one is not always available and would be spurious to conduct on the sample of studies we have used for each condition. Given the level of uncertainty surrounding an individual's absolute personal risk we are comfortable with a comparatively lesser degree of uncertainty regarding a risk factor's relative risk.

What is the mathematical model that is used?

The actual mathematical and statistical models and risk coefficients that are used to determine risk are proprietary at this time, but have been validated by the authors and reviewers to be appropriate for use in this setting. 

References: Colon Cancer

Most recently reviewed:

  1. 1. Gonzalez CA and Riboli E. Diet and Cancer Prevention: Contributions from the European Prospective Investigation into Cancer and Nutrition Study. Euro J Cancer 46 (2010) 2555 –2562.
  2. Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective. World Cancer Research Fund and the American Institute for Cancer Research. 2007 Part
  3. Chapter 4.
  4. Park et al. Dairy Food, Calcium, and Risk of Cancer in the NIH-AARP Diet and Health Study. Arch Intern Med. 2009;169(4):391-401
  5. Fedirko V et al. Alcohol Drinking and Colorectal Cancer Risk: an Overall and Dose-Response Meta-analysis of Published Studies. Annals Onc. Feb. 2011: 2-15.

Guidelines reviewed annually:

  1. NHS Cancer screening programmes at: http://www.cancerscreening.nhs.uk/
  2. US National Cancer Institute at: www.cancer.gov and http://www.cancer.gov/colorectalcancerrisk/

Selected articles from previous reviews:

  1. Limsui D et al. Cigarette smoking and colorectal cancer risk by molecularly defined subtypes. JNCI 2010; 102(14): 1012-1022
  2. Gonzalez CA and Riboli E. Diet and cancer prevention: Contributions from the European Prospective Investigation into Cancer and Nutrition (EPIC) study. European Journal of Cancer 2010; 46: 2555-2562.
  3. Soderlund S et al. Inflammatory bowel disease confers a lower risk of colorectal cancer to females than to males. Gastroenterology Vol 138, Issue 5, 1697-1703, May 2010.
  4. Peter M Rothwell et al. Long-term effect of aspirin on colorectal cancer incidence and mortality: 20-year follow-up of five randomised trials Lancet 2010; 376: 1741–50
  5. Van Duijnhoven, FJB et al. Fruit, vegetables, and colorectal cancer risk: the European Prospective Investigation into Cancer and Nutrition. Am J Clin Nutr 2009; 89: 1441-1452.
  6. Wolin KY et al. Physical Activity and colon cancer prevention: a meta-analysis. British J Cancer (10 Feb. 2009) 100, 611-616.
  7. Freedman, AN et al. Colorectal Cancer Risk Prediction Tool for White Men and Women Without Known Susceptibility. J Clin Onc 2009 (vol.27 no.5): 686-693
  8. Edoardo Botteri, M.Sc. et al. Smoking and Colorectal Cancer: a meta-analysis. JAMA 2008; 300(23): 2765-2778.
  9. Levin, B et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008. A joint guideline from the American Cancer Society, the US Multi-society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin 2008; 58: 130-160.
  10. Larsson DC, Wolk A. Obesity and colon and rectal cancer risk: meta-analysis of prospective studies. Am. J. Clin. Nutr. 2007 Sep; 86 (3): 556-65.
  11. Park Y et al. Fruit and Vegetable Intakes and Risk of Colorectal Cancer in the NIH-AARP Diet and Health Study. Am J Epidemiology 2007; 166(2): 170-180
  12. Itzkowitz SH and Yio X. Inflammation and Cancer IV. Colorectal cancer in inflammatory bowel disease: the role of inflammation. Am J Physiol. Gastro Liver Physio 287:G7-G17, 2004
  13. Benetou, V. et al. Conformity to traditional Mediterranean diet and cancer incidence: Greek EPIC cohort. British J. Ca. (1 July, 2008) 99, 191-195
  14. Segnan N, Senore C, Andreoni B, et al, for the SCORE3 Working Group-Italy. Comparing attendance and detection rate of colonoscopy with sigmoidoscopy and FIT for colorectal cancer screening. Gastroenterology 2007;132(7):2304-2312.
  15. Kushi, L.H. et al. American Cancer Society Guidelines on Nutrition and Physical Activity for Cancer Prevention: Reducing the Risk of Cancer With Healthy Food Choices and Physical Activity CA Cancer J. Clin. 2006; 56 (5):254-281
  16. Sanjoaquin MA et al. "Folate intake and colorectal cancer risk: a meta-analytical approach", Int J Cancer Feb 2005, 113(5): 825-8.
  17. Cho E et al. :Dairy foods, calcium and colorectal cancer: a pooled analysis of 10 cohort studies", J Natl Cancer Inst. July 2004, 96(13): 1015-22.
  18. Colangelo LA et al. "Cigarette smoking and colorectal carcinoma mortality in a cohort with long-term follow-up", Cancer Jan 2004 100(2): 288-93
  19. Key TJ et al. "Diet, nutrition and the prevention of cancer", Public Health Nutr. Feb 2004 7(1A): 187-200
  20. Weingarten MA et al. "Dietary calcium supplementation for preventing colorectal cancer and adenomatous polyps. Cochrane Database 2004 (1)CD 003548.
  21. Flanders WD et al. "Meat consumption and risk of colorectal cancer", JAMA Jan 12, 2005 293(2):172-82.
  22. Giovannucci, E., "Modifiable risk factors for colon cancer", Gastroenterology Clinics of North America, 01 Dec 2002; 31(4): 925-43.
  23. Slattery, M.L., "Physical activity and colon cancer: confounding or interaction?" Medicine and Science in Sports and Exercise. 01 June 2002; 34(6): 913-9.
  24. Juarranz, M., "Physical exercise, use of Plantago ovata and aspirin, and reduced risk of colon cancer", European Journal of Cancer Prevention, 01 Oct 2002; 11(5): 465-72.
  25. Bianchini, F., "Overweight, obesity, and cancer risk", Lancet Oncology, 01 Sep 2002; 3(9): 565-74.
  26. Wu, K., "Calcium intake and risk of colon cancer in women and men", Journal of the National Cancer Institute, 20 March 2002; 94(6): 437-46.
  27. Almendingen, K., "Lifestyle-related factors and colorectal polyps: preliminary results from a Norwegian follow-up and intervention study", European Journal of Cancer Prevention, 01 April 2002; 11(2): 153-8.
  28. Jarvinen et al, "Dietary fat, cholesterol and colorectal cancer in a prospective study", Br J Cancer 2001:85:357-61
  29. Fuchs et al, "Dietary fibre and the risk of colorectal cancer and adenoma in women", NEJM 1999:340:169-76
  30. Fernandez et al, "Oral contraceptives and colorectal cancer risk: a meta analysis", Br. J Cancer 2001 84:722-7
  31. Lund Nilsen et al, "Prospective study of colorectal cancer risk and physical activity, diabetes, blood glucose, and BMI: exploring the hyperinsulinaemia hypothesis", Br. J of Cancer 2001 84:417-22
  32. Michels et al, "Prospective study of fruit and vegetable consumption and incidence of colon and rectal cancers", J Natl Cancer Inst 2000; 92:1740-52
  33. Terry et al, "Fruit, vegetables, dietary fibre and risk of colorectal cancer", J of Natl Cancer Inst. 2001; 93 525-33
  34. Terry et al, "Prospective study of major dietary patterns and colorectal cancer risk in women", American Journal of Epidemiology 2001 154:1143-49
  35. Terry et al, "Coffee consumption and risk of colorectal cancer in a population based prospective cohort of Swedish women", Gut 2001 49:87-90
  36. Lindgren et al Gut, "Adenoma prevalence and cancer risk in familial non polyposis colorectal cancer", 2002 50:228-34
  37. Singh et al, "Dietary risk factors for colon cancer in a low risk population", American Journal of Epidemiology 1998 148:761-4
  38. Giovannucci E et al. Physical Activity, Obesity and Risk for Colon Cancer and Adeoma in Men. Ann Inter Med 1995;122:327-334
  39. Fuchs et al, "A prospective study of family history and the risk of colorectal cancer", NEJM 1994 331:1669-74
  40. Howe et al, "Dietary intake of fibre and decreased risk of cancers of the colon and rectum: evidence from the combined analysis of 13 case control studies", J Natl Cancer Inst 1992; 84:1887-1894
  41. Thun et al, "Risk factors for fatal colon cancer in a large prospective study", J Natl Cancer Inst 1992; 84:1491-1499
  42. Shibata et al, "Intake of vegetables, fruits, beta carotene, vitamin C and vitamin supplements and cancer incidence among the elderly: a prospective study", Br. J of Cancer 1992; 66:673-679

ABOUT

The HealthTools™ assessment is an educational tool made available to you at no charge.  It is designed for adults 18 years and older living in the United States.  It was developed using current national standard guidelines.

Your participation in completing the HealthTools assessment is voluntary and you may exit the HealthTools assessment at any time. The HealthTools assessment is for personal use only.  It is not intended to diagnose, treat or prevent medical or other health conditions.  If you have a medical emergency, call 911 immediately.

The HealthTools assessment questionnaire is a series of questions about important personal health behaviors that can put you at increased risk for injury, illness and disease. It identifies your specific modifiable health risks and suggests simple actions you can take to maintain or improve your current and future health. It does not cover all of the health risks that could be of concern to you, especially if you are pregnant or have a serious health problem.

The Health Risk Assessment is not a substitute for information given to you by a licensed healthcare provider, nor is it a substitute for a medical exam. If you have any concerns about your health or if the Health Risk Assessment raises any questions consult a licensed healthcare professional.  Always consult a licensed healthcare professional for diagnosis and treatment of any medical condition or before starting a diet or exercise program.

The HealthTools assessment is strictly voluntary. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) ensures that the security and privacy of your personal health information remains confidential.  The HealthTools assessment is compliant with Title II of the Genetic Information Nondiscrimination Act of 2008. When questions about family medical history are included, you will not be required to answer those questions in order to complete the HealthTools assessment.

A personalized summary of the results and recommendations based on your responses to the HealthTools assessment questionnaire will be ready for you within minutes after completing the questionnaire. Your personalized summary will be displayed on a webpage within the HealthTools assessment and you may choose to use the “email my report” function from the results page send a copy of your personalized summary to an email address that you provide.  The webpage displaying your personalized summary will expire when you close your web browser and will not be retrievable via HealthTools assessment.  Please note, if you do not close your web browser, your personalized summary may be accessible by a subsequent user utilizing the web browser’s “back” button.

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This HealthTools assessment is for general information purposes only.  It should not be used during a medical emergency or for diagnosis or treatment purposes.  If you have a medical emergency, call 911 immediately.  Always consult a licensed healthcare professional for diagnosis and treatment of any medical condition or before starting a diet or exercise program.

TERMS OF USE & PRIVACY POLICY

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Privacy Policy

NOTICE OF SOUTHEAST HEALTH’S PRIVACY PRACTICES

Effective: April 14, 2003

THIS 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.

This notice is provided on behalf of Southeast Health and its Medical Staff. This notice is intended to inform you about our practices related to the protection of the privacy of your medical records. Generally, we are required by law to ensure that medical information that identifies you is kept private. Further, we must give you this information related to our legal duties and privacy practices with respect to any medical information we create or receive about you. We are required by law to follow the terms of the notice that is currently in effect.

This notice will explain how we may use and disclose your medical information and your rights related to any medical information that we have about you. This notice applies to the medical records that are generated in or by this hospital, whether made by hospital personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your medical information created in the doctor’s office or clinic.

With few exceptions, we are required to obtain your authorization for the use or disclosure of the information. Most uses and disclosures of psychotherapy notes, uses and disclosures of protected health information for marketing purposes, and disclosures that constitute a sale of protected health information require authorization. We have listed some of the reasons why we might use or disclose your medical information and some examples of the types of uses or disclosures below. Not every use or disclosure is covered, but all of the ways that we are allowed to use and disclose information will fall into one of these categories.

If you have any questions about the content of this Notice of Privacy Practices, please contact the Hospital’s Privacy Officer at 573-651-5505.

In addition to hospital departments, employees, Medical Staff and other hospital personnel, the following persons will also follow the practices described in this Notice of Privacy Practices:

• Any health care professional who is authorized to enter information in your medical record;

• Any member of a volunteer group that we will allow to help you while you are in the Hospital;

• Students and faculty of Southeast Health College or Health Sciences and other educational facilities for which the hospital provides practice sites; and

• The employees and staff of Southeast Home Health, Southeast Hospice, Southeast Outpatient Rehab, Southeast Medical Equipment, Southeast Missouri Hospital Physicians LLC (all entities), Southeast Health Pharmacy, Southeast Health Retail Pharmacy, Healthpoint and HealthPoint Plaza, and Southeast Health Center of Ripley County, Southeast Health Center of Reynolds County, and Southeast Health Center of Stoddard County will follow this Notice of Privacy Practices. In addition, other entities may share medical information for treatment, payment or health care operations as they are described in this Notice of Privacy Practices. These other entities are hereinafter referred to collectively with the hospital as “Hospital.”

Uses and Disclosures of Medical Information That Do Not Require Your Authorization:

We can use or disclose medical information about you regarding your treatment, payment for services or for Hospital operations without your authorization.

For Treatment: To provide you with medical treatment or services, we may need to use or disclose information about you to doctors, nurses, technicians, medical students or other Hospital personnel who are involved in your treatment. For example, a doctor may need to know what drugs you are allergic to before prescribing medications. Departments within the Hospital may share medical information about you to coordinate your care. For instance, the laboratory may request information to complete lab work. We may also disclose medical information about you to people who may be involved in your medical care after you leave the Hospital, such as home health agencies, medical equipment companies and family members.

For Payment: We may use and disclose your medical information for the Hospital to bill and receive payment for the treatment that you received here. For example, we may use or disclose your medical information to your insurance company so that your insurance company can pay us or reimburse you for services received at the Hospital. We may also ask your insurance company for prior authorization for a service to determine whether the insurance company will cover it.

For Health Care Operations: We can use and disclose medical information about you for Hospital operations. These include uses and disclosures that are necessary to run the Hospital and make sure that our patients receive quality care. For example, we may use or disclose medical information about you to evaluate our staff’s performance in caring for you. Medical information about you and other Hospital patients may also be combined to allow us to evaluate whether the Hospital should offer additional services or discontinue other services and whether certain treatments are effective. We may use or disclose your information for the purpose of coordinating your prescription history from other healthcare providers. We may

also compare this information with other hospitals to evaluate whether we can make improvements in the care and services that we offer. To best protect your privacy when we are comparing medical information with that of other hospitals, we will remove information that identifies you.

Other Permitted Uses and Disclosures of Your Medical Information:

We can use or disclose health information about you without your authorization when there is an emergency, when we are required by law to treat you, when we are required by law to use or disclose certain information or when there are substantial communication barriers to obtaining consent from you.

Further, we may use or disclose your health information without your consent or authorization in any of the following circumstances:

• When it is required by law;

• When it involves use and disclosure for public health activities, such as mandated disease reporting, etc;

• When reporting information about victims of abuse, neglect or domestic violence;

• When disclosing information for the purpose of health oversight activities, such as audits, investigations, licensure, or disciplinary actions or legal proceedings or actions;

• When disclosing information for judicial and administrative proceedings in accordance with state and/or federal law, for instance, in response to a court order, such as a court-ordered subpoena and to permit service of legal process such as a summons issued by a court;

• When disclosing information for law enforcement purposes, for instance, to locate or identify a suspect, fugitive, witness or missing person; regarding a victim of a crime who cannot give consent or authorization because of incapacity; regarding a death believed to be the result of criminal conduct or regarding suspected criminal conduct at the hospital;

• When disclosing information about deceased persons to medical examiners, coroners and funeral directors;

• When disclosing or using information for organ and tissue donation purposes;

• When disclosing information related to a research project when a waiver of authorization has been approved by the Institutional Review Committee. For more information about this right, see 45 Code of Federal Regulations (C.F.R.) §164.512 (i);

• When we believe in good faith that the disclosure is necessary to avert a serious health or safety threat to you or to the public;

• When disclosure is necessary for specialized government functions, such as military service, for the protection of the President or for national security and intelligence activities;

• When required by military command authorities, if you are a member of the armed forces (or if foreign military personnel, to appropriate foreign military authorities);

• In the case of a prison inmate, information can be released to the correctional facility in which he or she resides for the following purposes: (1) for the institution to provide the inmate with health care; (2) to protect the health and safety of the inmate or the health and safety of others; (3) for the safety and security of the correctional facility; and

• When disclosure is necessary to comply with worker’s compensation laws or purposes.

Planned Uses or Disclosures to Which You May Object:

We will use or disclose your health information for any of the purposes described in this section unless you affirmatively object to or otherwise restrict a particular release. You must direct your written objections or restrictions to the Hospital’s Privacy Officer at the following address:

Privacy Officer

SoutheastHEALTH

1701 Lacey Street

Cape Girardeau, MO 63701

• We may use or disclose your health information to contact and remind you that you have an appointment for treatment or medical care.

• We may use or disclose your health information to provide you with information about or recommendations of possible treatment options or alternatives that may interest you.

• We may use or disclose your health information to inform you about health benefits or services that may interest you.

• Patient directory: We may include the following protected health information about you in the facility's directory: name, location in the facility, and general condition with no specific medical information. We may provide this same information to people who ask for you by name. In addition to this directory information, we may also provide your religious affiliation to members of the clergy. You have the right to object to being included in the directory. Please note that if you choose not to be included in the patient directory, callers seeking information at the lobby or through the switchboard will not be told information about you.

• Fundraising: We will give your name, address and dates of service to the SoutheastHEALTH Foundation for the purpose of conducting fundraising activities that benefit the hospital. You have the right to opt-out of receiving such communications.

• Ministers, Churches, Clergy: Members of the clergy may be told your religious affiliation along with other information contained in the facility directory. If you object to being included in the directory, no information about you will be given to church staff members, ministers or other members of the clergy who may seek to call on you in the hospital. If you desire for a minister, lay minister, church member or other clergy to be involved in your care, it is advisable to tell one of your nurses so they can note this in your chart. Otherwise, no information about you will be disclosed to members of the clergy without your authorization.

• We may release health information about you to a friend and/or family member who is involved in your care. We can tell your family and/or friends of your condition and that you are in the Hospital for treatment or services. We can also give this information to someone who will help or is helping to pay for your care.

• We can disclose health information about you to a public or private entity that is authorized by law or its charter to assist in disaster relief efforts, i.e., the American Red Cross, for the purpose of notification of family and/or friends of your whereabouts and condition.

Health Information Exchange

We may make your protected health information available electronically through a secure health information exchange service to facilitate the exchange of your health information between and among other healthcare providers or other health care entities for your treatment, payment, or other healthcare operations purposes. This means we may share information we obtain or create about you with outside entities (such as hospitals, physician offices, pharmacies or insurance companies) or we may receive information they create or obtain about you (such as medication history, medical history, or other information) so each of us can provide better treatment and coordination of your healthcare services. You have the right to opt-out of participation in the Health Information Exchange.

Other Uses or Disclosures Not Covered by This Notice:

Uses or disclosures not covered in this Notice of Privacy Practices will not be made without your written authorization. If you provide us written authorization to use or disclose information, you can change your mind and revoke your authorization at any time, in writing. If you revoke your authorization, we will no longer use or disclose the information. However, we will not be able to take back any disclosures that we have made pursuant to your previous authorization.

Your Rights with Respect to Health Information:

Although your medical information record is the physical property of the Hospital, the information in our medical information record belongs to you. You have the following rights:

Right to Request Restrictions: You have the right to request that we restrict any use or disclosure of your health information. We are not required to agree to any restriction that you request. If we do agree to adhere to your restrictions, we will comply with your request unless the information is needed to provide you treatment. Any request to restrict uses or disclosures must be made in writing to the Hospital’s Privacy Officer. Your request must indicate (1) what information you want limited; (2) whether you want to limit our use, disclosure or both; and (3) to whom you want the limits to apply.

For more information about this right, see 45 Code of Federal Regulations (C.F.R.) § 164.522(a).

Right to Restrict Certain Disclosures to a Health Plan: You have the right to restrict certain disclosures of protected health information to a health plan where you pay out of pocket in full for the health care item or service. Any request to restrict uses or disclosures must be made in writing to the Hospital’s Privacy Officer. Your request must indicate (1) what information you want limited and (2) to whom you want the limits to apply.

Right to Receive Information in Certain Form and Location: You have the right to receive information about your health in a certain form and location. For instance, you can request that we not contact you at your work. To request confidential communications, you must make your request in writing to the Hospital’s Privacy Officer. The request must tell us how and/or where you want to receive the information. We will accommodate reasonable requests.

For more information about this right, see 45 C.F.R. § 164.522(b).

Right to Inspect and Copy Protected Health Information: You have the right to inspect and copy your health information that may be used to make decisions about your care, with the exception of psychotherapy notes. If you want to see or copy your medical information, you must submit a request in writing to the Hospital’s Medical Records Department (HIM). If you request copies of information, we may charge a fee for any costs associated with your request, including the cost of copies, mailing or other supplies.

In limited circumstances we can deny access to your health information. If access is denied, you can request that the denial be reviewed. A licensed health care professional chosen by the Hospital will review your request and the denial. We will adhere to the decision of the reviewer.

For more information about this right, see 45 C.F.R. §164.524.

Right to an Accounting of Disclosures: You have the right to an accounting of disclosures of medical information that we have made, with some exceptions. You must submit your request in writing to the Hospital’s Privacy Officer. Your request must state a time period that may not be longer than six (6) years and may not include date before April 14, 2003. You should include how you want the information reported to you, i.e., by paper, electronically, etc. You have the right to an accounting every twelve (12) months. If you request more than one (1) accounting in a twelve (12) month period, we may charge you a reasonable fee for the cost of providing the accounting. We will notify you of the charge for such a request and you can choose to withdraw or change your request before any costs are incurred.

For more information about this right, see 45 C.F.R. §164.528.

Right to Request Amendment to Protected Health Information: You have a right to request that your health information be changed if you believe that it is incorrect or incomplete. You have a right to request a change for as long as the information is kept by the Hospital. To request a change in your information, you must submit it in writing to the Hospital’s Privacy Officer; you must give the reason that you want the information changed, including why you think the information is incorrect or incomplete.

We can deny your request if it is not in writing or does not include a reason why the information should be changed. We can also deny your request for the following reasons: (1) the information was not created by the Hospital, unless the person or entity that did create the information is no longer available; (2) the information is not part of the medical record kept by or for the Hospital; (3) the information is not part of the information that you would be permitted to inspect or copy; or (4) we believe the information is accurate and complete.

For more information about this right, see 45 C.F.R. §164.526.

Right to Receive a Copy of this Notice of Privacy Practices: You have the right to a paper copy of this Notice of Privacy Practices. Even if you have agreed to receive this notice in another form, you can still have a paper copy of this notice. To obtain a paper copy of this notice, contact the Privacy Officer. You can obtain a copy of this notice at our Web site, www.sehealth.org.

Right to be Notified Following a Breach: You have the right to be notified of or receive notifications if you are affected by a breach of unsecured protected health information.

Complaints

If you believe that we have violated any of your privacy rights or have not adhered to the information contained in this Notice of Privacy Practices, you can file a complaint by putting it in writing and sending it to the Hospital’s Privacy Officer.

You may also file a complaint with the Secretary of the U.S. Department of Health and Human Services. You will not be retaliated against for filing a complaint with either the Hospital or the U.S. Department of Health and Human Services.

Changes to This Notice of Privacy Practices

We reserve the right to change or modify the information contained in this Notice of Privacy Practices. Any changes that we make can be effective for any health information that we have about you and any information that we might obtain. Each time you receive services from the Hospital, we will provide the most current copy of our Notice of Privacy Practices. The most recent version of the Privacy Practices will be posted in our building. Also, you can call or write our contact person, whose information is included on the first page of this Notice of Privacy Practices, to obtain the most recent version of this notice.

License

Subject to the terms and conditions of these Terms of Use & Privacy Policy, Hospital grants you a non-exclusive, non-transferable license to access and use the HealthTools assessment and any reports provided to you via the HealthTools assessment solely for your personal information purposes.  Hospital and its licensors retain all intellectual property rights in the HealthTools assessment, including any reports, and any enhancements to it.  Hospital, in its sole discretion, may terminate your license to access and use the HealthTools assessment at any time, for any reason and without any prior notice; provided, that, you may continue to access and use any reports in accordance with this license that you saved outside of the HealthTools assessment.   

Reservation of Rights

Hospital and its licensors are the exclusive suppliers of the HealthTools assessment and the exclusive owners of all right, title and interest in and to the HealthTools assessment, including reports, and all intellectual property related to the HealthTools assessment, any enhancements thereto, and any materials provided to you in connection with the HealthTools assessment.  You may not use the HealthTools assessment, including reports, except pursuant to the limited rights expressly granted in these Terms of Use & Privacy Policy.

Warranties Disclaimer

Hospital provides the HealthTools assessment and reports to you via the HealthTools assessment on an “AS IS “BASIS WITHOUT ANY WARRANTIES OF ANY KIND.  TO THE FULLEST EXTENT PERMITTED BY LAW, HOSPITAL DISCLAIMS ALL IMPLIED WARRANTIES, INCLUDING THE WARRANTIES OF MERCHANTABILITY, NONINFRINGEMENT AND FITNESS FOR A PARTICULAR PURPOSE.  HOSPITAL MAKES NO WARRANTIES ABOUT (i) THE ACCURACY, RELIABILITY, ACCESSIBILITY, COMPLETENESS, OR TIMELINESS OF ANY INFORMATION SUPPLIED TO YOU VIA THE HEALTHTOOLS assessment.

Limitation of Liability

IN NO EVENT SHALL HOSPITAL OR ITS AFFILIATES, OFFICERS, DIRECTORS, EMPLOYEES, AGENTS OR LICENSORS BE LIABLE TO YOU FOR INCIDENTAL AND CONSEQUENTIAL DAMAGES, RESULTING FROM YOUR USE OR INABILITY TO USE THE HEALTHTOOLS assessment OR ANY REPORTS OR OTHER INFORMATION PROVIDED VIA THE HEALTHTOOLS assessment, OR FOR ANY DAMAGES WHATSOEVER, WHETHER SUCH LIABILITY IS BASED ON WARRANTY, CONTRACT, TORT, NEGLIGENCE OR ANY OTHER LEGAL THEORY, AND WHETHER OR NOT HOSPITAL OR ITS LICNESORS ARE ADVISED OF THE POSSIBILITY OF SUCH DAMAGES.

Responsibility for Safety

The HealthTools assessment may advocate or involve physical activity.  You hereby expressly assume all risk associated with any physical activity you undertake in connection the HealthTools assessment or any reports or other information provided via the HealthTools assessment. It is your responsibility to consult with a physician to determine your fitness to engage in any physical activities. It is also your responsibility to use appropriate equipment, clothing and techniques.

Governing Law

THIS USER AGREEMENT, AND YOUR USE AND ACCESS OF THE ASSESSMENT IS GOVERNED BY THE LAWS OF THE STATE OF COLORADO, WITHOUT REGARD TO ITS CONFLICT OF LAWS RULES. JURISDICTION AND VENUE FOR ANY CAUSE OF ACTION ARISING UNDER THIS AGREEMENT SHALL BE IN DENVER, COLORADO. “HOSPITAL” makes no representation that the Assessment is appropriate or available for use in locations outside the United States of America. You agree not to access the Assessment from any country or jurisdiction where its content is illegal or prohibited. If you choose to access the Assessment from outside the United States, you do so on your own initiative and you are responsible for compliance with local laws.

Entire Agreement

You agree that these Terms of Use & Privacy Policy set forth the entire understanding between you and Hospital with respect to the HealthTools assessment. You further agree that if any provision of these Terms of Use & Privacy Policy is held invalid, the remaining provisions shall continue in full force and effect.

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