This Notice of Privacy Practices has been prepared to reflect your rights under HIPAA. If
THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ IT CAREFULLY.
Understanding Your Health Record/Information
Each time you are admitted to a
1. Basis for planning your care and treatment;
2. Means of communication among the many health professionals who contribute to your care;
3. Legal document describing the care you received;
4. Means by which you or a third-party payer can verify that services billed were actually provided;
5. A tool in educating health professionals;
6. A source of data for medical research;
7. A source of information for public health officials charged with improving the health of this state
8. A source of data for planning and marketing, and;
9. A tool with which we can assess and continually work to improve the care we render and the
Understanding what is in your record and how your health information is used helps you to: ensure its accuracy, better understand who, what, when, where, and why others may access your health information, and make more informed decisions when authorizing disclosures to others.
Your Health Information Rights
Although your health record is the physical property of
1. Obtain a paper copy of this Notice of Privacy Practices on request;
2. Inspect and receive a copy of your health record;
3. Amend your health record;
4. Obtain an accounting of disclosures of your health information;
5. Request communications of your health information by alternative means or at alternative locations;
6. Request a restriction on certain uses and disclosures of your information, and;
7. Revoke your authorization for the use or disclosure of your health information unless that action has
1. Maintain the privacy of your health information;
2. Provide you with this Notice as to our legal duties and privacy practices with respect to information
3. Abide by the terms of this Notice;
4. Notify you if we are unable to agree to a requested restriction, and;
5. Accommodate reasonable requests to communicate health information by alternative means or at
We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. You may obtain a revised copy of this Notice of Privacy Practices from our Privacy Officer, Randall E. Roberts, at:
We will not use or disclose your health information without your authorization, except as described in this Notice. We will also discontinue using or disclosing your health information once we have received a written revocation of the authorization according to the procedures included in the authorization.
Description of Required and Permitted Disclosures of Your Health Information Without Your Authorization:
Required Disclosures –
1.) an individual patient or client or their personal representative if they request access to, or an accounting of the disclosures, of their protected health information;
2.) the Department of Health and Human Services when it is undertaking a compliance investigation, review, or enforcement action.
Permitted Disclosures –
1.) To the individual – a covered entity may disclose protected health information to the individual who is the subject of the information.
2.) Treatment, Payment, Healthcare Operations
We will use your health information for treatment.
For example: Information obtained by a nurse, physician, or other member of your health care team will be recorded in your record and used to determine your course of treatment. Your physician will document in your record his or her expectations and the members of your health care team will then record the actions they took and their observations. In that way, the physician will know how you are responding to treatment.
We will use your health information for payment.
For example: A bill may be sent to you or a third-party payer. The information on or accompanying the bill may include information that identifies you, as well as your diagnosis, procedures, and supplies used.
We will use your health information for regular healthcare operations.
For example: Members of the medical staff, the risk or quality improvement manager, or members of the quality improvement team may use information in your health record to assess the care and outcomes in your case and others like it. This information will then be used in an effort to continually improve the quality and effectiveness of the health care and service we provide.
Fundraising: We may contact you to ask for your authorization to use some of your information as part of our fundraising efforts.
Business Associates: There are some services provided in our organization through contracts with business associates. Examples include physician services in the emergency department and radiology, laboratory tests, and referrals to other specialists. When these services are contracted, we may disclose your health information to our business associate so that they can perform the job we've asked them to do and bill you or your third-party payer for services rendered. To protect your health information, however, we require the business associate to appropriately safeguard your information.
3.) For our facility directories, notifications, and for communication with your family and friends:
· Facility Directories – We do not give any information to unknown callers or inquiries, including whether or not you are in one our facilities, without your written consent or the written consent of your parent or guardian, or that is authorized by law.
· For notification – We will not use or disclose your health information to notify or assist in notifying a family member of your location and condition without your written consent or that of your parent or guardian, or that is authorized by law.
· Communication with family and friends - You may want to identify a family member, other relative, close personal friend or some other person so that person can become involved in your care or payment related to your care. We will not disclose your health information to such a person without your written consent or that of your parent or guardian, or that is authorized by law.
4.) Incident to an otherwise permitted use or disclosure – We may use or disclose protected health information that occurs as a result of, or as "incident to," an otherwise permitted use or disclosure.
5.) Public interest and benefit activities – We may use and disclose protected health information for 12 national priority purposes. These disclosures are permitted, although not required. Specific conditions or limitations apply to each national priority purpose. The 12 national priority purposes are:
· One – Required By Law – We may use and disclose protected health information as required by law, including statute, regulation, or court order.
· Two – Public Health Activities – We may disclose protected health information to public health authorities to prevent or control disease, to the Food and Drug Administration for product recalls, to individuals who may have contracted a communicable disease when notification authorized by law, employers, regarding employees, when requested by employees, for information concerning a work-related illness or injury.
· Three – We may report on a victim of abuse, neglect or domestic violence – in certain circumstances, we may disclose protected health information to appropriate government authorities if we receive information that a person is a victim of abuse and/or neglect.
· Four – Health Oversight Activities – We may disclose protected health information to health oversight agencies for purposes of legally authorized oversight activities, such as audits and investigations.
· Five – Judicial and Administrative Proceedings – We may disclose protected health information in a judicial or administrative proceeding to comply with a court order. Such information may also be disclosed in response to a subpoena or other lawful process if certain assurances regarding notice to the individual or protective order are provided.
· Six – Law Enforcement Purposes – We may disclose protected health information to law enforcement officials for law enforcement purposes under specified conditions.
· Seven – Decedents – We may disclose protected health information to funeral directors as needed, and to coroners or medical examiners to identify a deceased person, determine the cause of death, and perform other functions authorized by law.
· Eight – Cadaveric, Organ, Eye, Or Tissue Donation – We may use or disclose protected health information to facilitate the donation and transplantation of cadaveric organs, eyes and tissue.
· Nine – Research – We may use and disclose protected health information for research purposes, provided that certain conditions are met by the covered entity and researchers.
· Ten – Serious Threat to Health or Safety – We may disclose protected health information that we believe is necessary to prevent or lessen a serious and imminent threat to a person or the public, when such a disclosure is made to someone they believe can prevent or lessen the threat.
· Eleven – Essential Government Functions – We may use or disclose protected health information for certain essential government functions. Such functions include: military operations, national security activities authorized by law, providing protective services for the President, and determining eligibility for or conducting enrollment in certain government benefit programs.
· Twelve – Workers' Compensation – We may disclose protected health information to comply with workers' compensation laws.
For More Information or to Report a Problem
If you have questions and would like additional information, you may contact our Privacy Officer:
If you believe your privacy rights have been violated, you can file a written complaint with the Privacy Officer, or with the Regional Manager, Office for Civil Rights, U.S. Department of Health and Human Services,