Effective Date: 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.
Jackson County Memorial Hospital, its medical staff, and
other health care providers at the hospital are part of a
clinically integrated care setting that constitutes an
organized health care arrangement (“OHCA”) under the Health
Insurance Portability and Accountability Act of 1996 (“HIPAA”).
This arrangement involves participation of legally separate
entities in which no entity will be responsible for the
medical judgment or patient care provided by the other
entities in the arrangement. Sharing information allows us
to enhance the delivery of quality care to our patients. All
entities, however, have agreed to abide by this Notice of
Privacy Practices (NPP) while working in the Hospital
setting. These physicians and health care providers will be
able to access and use your Protected Health Information
(“PHI”) to carry out treatment, payment or hospital
operations. You may receive another NPP from each physician
and other health care providers upon your first encounter in
their office, which may be different from this NPP and which
will govern the PHI maintained by that provider.
This Organized Health Care Arrangement creates a record of
the care and services you receive in the hospital. Your
medical records and billing information are systematically
created and retained on a variety of media that may include
electronic, paper and films. This information is accessible
to hospital personnel and members of the medical staff.
Proper safeguards are in place to discourage improper use or
access. We are required by law to protect your privacy and
the confidentiality of your personal and protected health
information and records. This Notice describes your rights
and our legal duties regarding your PHI. The entities
covered by this Notice include this hospital and all health
care providers who are members of its medical, dental and
ancillary services staff.
This Organized Health Care Arrangement may use and disclose
your PHI without your authorization for the following:
- Treatment. We may use your PHI to provide you with medical
treatment or services. We may disclose your PHI to doctors,
nurses, technicians, medical students, or other hospital
personnel who are involved in taking care of you at the
hospital. For example, a surgeon treating you for a broken
leg may need to know if you have diabetes because diabetes
may slow the healing process. In addition, the surgeon may
need to tell the dietitian if you have diabetes so that we
can arrange for appropriate meals. We may tell your primary
care physician about your hospital stay.
- Payment. We may use and disclose your PHI so that the
treatment and services you receive at the hospital may be
billed to and payment may be collected from you, an
insurance company or a third party. For example, we may need
to give your health plan information about surgery you
received at the hospital so your health plan will pay us or
reimburse you for the surgery. We may also tell your health
plan about a treatment you are going to receive to obtain
prior approval or to determine whether your plan will cover
the treatment. We may also provide your hospital physicians
or their billing agents with information so they can send
bills to your insurance company or to you.
- Health Care Operations. We may use and disclose PHI about
you for Hospital operations. These uses and disclosures are
necessary to run the hospital and make sure that all of our
patients receive quality care. For example, we may use PHI
about your high blood pressure to review our treatment and
services, to evaluate the performance of our staff in caring
for you and to train health professionals. We may also
combine PHI about many hospital patients to decide what
additional services the hospital should offer, what services
are not needed and whether certain new treatments are
effective. We may also combine PHI we have with PHI from
other hospitals to compare how we are doing and see where we
can make improvements in the care and services we offer.
- Business Associates. We may disclose your PHI to Business
Associates independent of the Hospital with whom we contract
to provide services on our behalf. However, we will only
make these disclosures if we have received satisfactory
assurance that the Business Associate will properly
safeguard your privacy and the confidentiality of your PHI.
For example, we may contract with a company outside of the
hospital to provide medical transcription services for the
hospital, or to provide collection services for past due
accounts.
- Appointment Reminders. We may use and disclose your PHI to
contact you as a reminder that you have an appointment for
treatment or medical care at the hospital. This may be done
through an automated system or by one of our staff members.
If you are not at home, we may leave this information on
your answering machine or in a message left with the person
answering the telephone.
- Health Related Benefits and Services. We may use and
disclose your PHI to tell you about health-related benefits
or services or recommend possible treatment options or
alternatives that may be of interest to you.
- Fundraising Activities of the Hospital. We may use or
disclose your PHI to contact you in an effort to raise money
for the hospital and its operations. We would only release
contact information, such as your name, address and phone
number and the dates you received treatment or services at
the hospital. If you do not want the hospital to contact you
for fundraising efforts please notify the Director of
Marketing/Public Relations, 1200 East Pecan Street, Altus,
Oklahoma, 73521, in writing.
- Hospital Directory. We may include certain limited
information about you in the hospital directory while you
are a patient at the hospital. This information may include
your name, location in the hospital, your general condition
(e.g., fair, serious, etc.) and your religious affiliation.
Information may also be released to people who ask for you
by name. Your religious affiliation may be given to a member
of the clergy, such as a priest or rabbi, even if they don’t
ask for you by name. This directory information is so your
family, friends and clergy can visit you in the hospital and
generally know how you are doing.
- Individuals Involved in Your Care or Payment for Your Care.
We may release PHI to a friend or family member who is
involved in your medical care or to someone who helps pay
for your care. We may also disclose PHI about you to an
entity assisting in a disaster relief effort so that your
family can be notified about your condition, status and
location.
- Research. Under certain circumstances, we may use and
disclose your PHI for research purposes, such as studying
the effectiveness of a treatment you received. All research
projects are subject to a special approval process that
protects the confidentiality of your PHI.
- As Required by Law. We will disclose PHI about you when
required to do so by federal, state or local law. For
example, Oklahoma law requires us to report all births and
deaths that occur in the hospital to the Oklahoma Department
of Health.
- To Avert a Serious Threat to Health or Safety. We may use
and disclose PHI about you when necessary to prevent a
serious threat to your health and safety or the health and
safety of the public or another person. Any disclosure,
however, would only be to someone able to help prevent the
threat.
- Organ and Tissue Donations. If you are an organ donor, we
may release PHI to organizations that handle organ
procurement or organ, eye or tissue transplantation or to an
organ donation bank, as necessary to facilitate organ or
tissue donation and transplantation.
- Military. If you are a member of the armed forces, we may
release PHI about you as required by military command
authorities. We may also release PHI about foreign military
personnel to the appropriate foreign military authority.
- Workers Compensation. We may release PHI about you for
workers’ compensation or similar programs as authorized by
state laws. These programs provide benefits for work-related
injuries or illness.
- Public Health Reporting. As required by law, we may disclose
your PHI to public health or legal authorities charged with
preventing or controlling disease, injury or disability. For
example, we are required to notify the Oklahoma State
Department of Health that a person may have been exposed to
a disease or may be at risk for contracting or spreading a
disease or condition such as HIV, Syphilis or other sexually
transmitted diseases.
- Health Oversight Activities. We may disclose PHI to a health
oversight agency responsible for governmental activities
such as monitoring the health care system, government
programs, and compliance with applicable laws. These
oversight activities include, for example, audits,
investigations, inspections, medical device reporting and
licensure.\
- Lawsuits and Disputes. If you are involved in a lawsuit or a
dispute, we may disclose PHI about you in response to a
valid court or administrative order, subpoena, discovery
request or other lawful process.
- Law Enforcement. We may disclose your PHI for law
enforcement purposes as required by law or in response to a
valid subpoena or court order.
- Coroners, Medical Examiners and Funeral Directors. We may
release PHI to a coroner or medical examiner. This may be
necessary, for example, to identify a deceased person or
determine the cause of death. We may also release PHI about
patients of the hospital to funeral directors as necessary
to carry out their duties.
- National Security and Intelligence Activities. We may
release PHI about you to authorized federal officials for
intelligence, counterintelligence and other national
security activities authorized by law.
- Protective Services for the President and Others. We may
disclose PHI about you to authorized federal officials so
they may provide protection to the President, other
authorized persons or foreign heads of state or to conduct
special investigations.
- Inmates. If you are an inmate of a correctional institution
or under the custody of a law enforcement official, we may
release PHI about you to the correctional institution or law
enforcement official. This release would be necessary (1)
for the correctional institution to provide you with health
care; (2) to protect your health and safety or the health
and safety of others; or (3) for the safety and security of
the correctional institution.
YOUR RIGHTS REGARDING PROTECTED HEALTH INFORMATION ABOUT
YOU.
You have the following rights regarding protected health
information we maintain about you:
1. Right to Inspect and Copy. You have the right to inspect
and request a copy of your PHI, except as prohibited by law.
To inspect and/or request a copy of your PHI that may be
used to make decisions about you, you must submit your
request in writing. If you request a copy of the
information, we may charge a fee of 25 cents a page to
offset the costs associated with the request.
We may deny your request to inspect and copy in certain
circumstances. If you are denied access to certain PHI, you
may request that the denial be reviewed. Another licensed
health care professional chosen by the hospital will review
your request and the denial. The person conducting the
review will not be the person who denied your request. We
will comply with the outcome of the review.
2. Right to Amend. You have the right to amend your PHI as
provided by law. Such a request must be made in writing and
you must state the reason or reasons for the amendment. We
are not required by federal law to honor your request for
amendment if we determine, among other things, that the PHI
is accurate and complete.
3. Right to an Accounting of Disclosures. You have the right
to request one free accounting every 12 months of the
disclosures we made of your PHI. To request this list, you
must submit your request in writing to the JCMH Health
Information Management Department, 1200 East Pecan, Altus,
Oklahoma 73521. Your request must state a time period that
may not be longer than six years and may not include dates
before April 14, 2003.
4. Right to Request Restrictions. You have the right to
request a restriction or limitation on the PHI we use or
disclose about you for treatment, payment or health care
operations. You also have the right to request a limit on
the PHI we disclose about you to someone who is involved in
your care or the payment for your care, like a family member
or friend. For example, you could ask that we not use or
disclose information about a surgery you had.
We are not required to agree to your request. If we do
agree, we will comply with your request unless the
information is needed to provide you emergency treatment.
To request restrictions, you must make your request in
writing. In your request, you must tell us (1) what
information you want to limit; (2) whether you want to limit
our use, disclosure or both; and (3) to whom you want the
limits to apply.
5. Right to Request Confidential Communications. You have
the right to request that we communicate with you about
medical matters in a certain way or at a certain location.
For example, you can ask that we only contact you at work or
by mail. To request confidential communications, you must
make your request in writing. We will not ask you the reason
for your request. We will accommodate all reasonable
requests. Your request must specify how or where you wish to
be contacted.
6. Right to a Paper Copy of This Notice. You have the right
to a paper copy of this notice. You may ask us to give you a
copy of this notice at any time. Even if you have agreed to
receive this notice electronically, you are still entitled
to a paper copy of this notice.
To obtain a paper copy of this notice, contact: Privacy
Officer, Jackson County Memorial Hospital, 1200 East Pecan
Street, Altus, Oklahoma 73521 (580) 477-7269.
You may obtain a copy of this notice at our web site,
www.jcmh.com.
CHANGES TO THIS NOTICE
We reserve the right to change this notice. We reserve the
right to make the revised or changed notice effective for
PHI we already have about you as well as any information we
receive in the future. We will post a copy of the current
notice in the hospital. The notice will contain on the first
page, near the top, the effective date. In addition, each
time you register at the hospital for treatment or health
care services we will make available to you a copy of the
current notice in effect.
AUTHORIZATION FOR OTHER USES OF PROTECTED HEALTH
INFORMATION.
Other uses and disclosures of PHI not covered by this notice
or the laws that apply to us will be made only with your
written authorization. If you provide us authorization to
use or disclose PHI about you, you may revoke that
authorization, in writing, at any time. If you revoke your
authorization, we will no longer use or disclose PHI about
you for the reasons covered by your written authorization.
Please understand that we are unable to take back any
disclosures we have already made with your authorization,
and that we are required to retain our records of the care
that we provided to you.
COMPLAINTS
If you believe your privacy rights have been violated, you
may file a written complaint with the Hospital or with the
Secretary of the Department of Health and Human Services.
To file a complaint with the Hospital, write: Privacy
Officer, Jackson County Memorial Hospital, 1200 East Pecan
Street, Altus, Oklahoma 73521, (580) 477-7269.
To file a complaint with the Secretary of the Department of
Health and Human Services, contact: The U.S. Department of
Health and Human Services, 200 Independence Avenue, S.W.,
Washington, D.C. 20201, or email them at
HHS.Mail@hhs.gov.
The complaint to the Secretary must be filed within 180 days
of when the complainant knew or should have known that the
act or omission complained of occurred. The complaint must
be in writing, either on paper or electronically, name the
entity that is the subject of the complaint and describe the
acts or omissions believed to be in violation of the
standards.
You will not be penalized for filing a complaint. |
