THIS NOTICE DESCRIBES HOW YOUR MEDICAL INFORMATION MAY BE USED AND DISCLOSED AND HOW YOU CAN REQUEST ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
This Notice of Privacy
Practices describes our hospitalÕs practices and that of:
NOTE: The doctors who treat you at the hospital are not
employees or agents of the hospital.
They are either independent doctors engaged in the private practice of
medicine who have staff privileges at the hospital, or independent doctors who
are independent contractors and have staff privileges at the hospital.
We reserve the right to
change this notice. We reserve the
right to make the changed notice effective for medical information 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 will contain the effective date on the top right-hand side of the
first page. Each time you come to
the hospital for care, we will offer you a copy of the notice that is currently
in effect.
If you believe your privacy
rights have been violated, you may file a complaint with the hospital, by
contacting the Privacy Officer at 817-288-1300. All complaints must be submitted in writing A complaint can also be filed to the Secretary of Health and Human Services, OCR Division
at 1-800-368-1019
We understand that your medical
information and your health are personal
and we promise to protect your medical information. We create a record of the
care and services you receive at the hospital. We need this record to provide
quality care and to obey certain laws. This notice applies to all of the
records of your care created by the hospital, whether made by hospital employees
or your personal doctor. Your personal doctor(s) may have different policies or
notices regarding how they use or give out or share the medical information
created in their office or clinic.
This Notice describes the ways in which we are allowed
by laws and rules to use or to give out your medical information. This Notice also describes the
rights that you have to control the use or release of your health information.
It also describes the duties that we have in using or giving out your personal medical
information.
We are required by law to:
Each time you visit a hospital,
physician, or other healthcare provider, the provider makes a record of your
visit. Usually your records
contain your health history, current symptoms, examination, test results,
diagnosis, treatment, and a plan for further care or treatment. This information, is called your
medical record and it serves as:
Understanding what is in your
health records and how your health information is used helps you to:
The following categories or groups describe different ways that we use or share or give out medical information. For each category of uses and disclosures, we have explained what they mean and have provided examples. Not every use or disclosure in a category is listed. All of the ways that we are permitted by law to use and share or give out information will fall within one of the categories
CATEGORY
I: TREATMENT,
PAYMENT AND OPERATIONS
¯ For Treatment
We are allowed to use your medical information to
plan and provide care and treatment to you. The doctors, nurses, technicians,
healthcare students, or other hospital personnel who take care of you at the
hospital are allowed to see and read your medical information. For example:
á
A doctor treating you
for a broken leg may need to know if you have diabetes because diabetes may
slow the healing process. In addition, the doctor may need to tell the
dietitian if you have diabetes so that we can arrange for appropriate meals.
á
Different departments of
the hospital also are allowed to look at your medical information in order to
coordinate the different services, such as medications, lab tests and x-rays.
á
We also are allowed to
share or give out your medical information when arranging for your medical care
after you leave our hospital.
á
We are allowed to use
your medical information to tell you about or recommend possible treatment choices
or alternatives (substitutes) that may be of interest to you or that are
provided by your health plan.
¯ For Payment
We are allowed to use and share or give out your medical information so we can bill for the treatment and services you receive at the hospital and collect payment from you, from your insurance company or a third party payer. For example:
á
Your health
plan will need information about surgery you received at the hospital so your
health plan will pay us or reimburse you for the surgery. We also are allowed
to tell your health plan about a treatment you are going to receive to get approval before we do the treatment or to see
if your plan will cover the treatment.
á
We may also give
information to someone who helps pay for your care.
¯ For Health Care Operations
We are allowed to use and share or give out your medical information as necessary to operate the hospital and make sure that you and all of our patients receive quality care. For example:
á
We might use
your medical information to evaluate (check
on) how our staff took care for you.
á
We might also combine
some of your medical information with other hospital patients to decide, for
example, what other services the hospital should offer or whether new
treatments are effective. The doctors, nurses, technicians, healthcare
students, and other hospital personnel are allowed to review your medical
information learning purposes.
á
We work with other
hospitals to compare how we are doing and how we can make improvements in the
health in our community. We will take away (delete) information that identifies
you or links you to the medical information so the other hospitals may use the
information to study health care and health care delivery without learning who
you are.
We must
share or give out your medical information when asked in order to comply with federal, state or local law.
¯ To Avert a Serious Threat to Health
and Safety
We are permitted to use and share or give out your medical information when necessary to prevent a serious threat to your health and safety or the health and safety of another person or of the public. Any disclosure, however, would only be to someone who is able to help prevent the threat.
¯ Public Health Risks
We must disclose your personal medical information for public health
activities. These activities
generally include the following to:
á
Prevent or control
disease, injury, or disability
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Report births and deaths
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Report the abuse or
neglect of children, elders, and dependent adults
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Report reactions to
medications or problems with products
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Notify people of recalls
of products they may be using
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Notify a person who may
to exposed to a disease or may be at risk for getting or spreading the disease
or condition
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Notify the police, FBI
Officer or others who enforce the law (appropriate government authority) if we
believe a patient has been a victim of abuse, neglect or domestic violence.
¯ Organ and Tissue
We required to give your medical information to the organization that handles organ procurement, transplantation or donation, as necessary to facilitate the donation and transplantation at the time of death.
¯ WorkersÕ Compensation
We
are allowed to give your medical information for a workersÕ compensation claim.
¯ Health Oversight Activities
We can share your health information with agencies that audit, investigate, and inspect health care programs for the publicÕs health. These include, for example, agencies that inspect or license our hospital or that investigate a complaint about our hospital.
¯ Coroners, Medical Examiners and
Funeral Directors
We
must give medical information to a coroner or medical examiner upon
request. We are allowed to give
medical information needed by a funeral director to carry out his duties
¯ Protective Services for the
President
We may be required to release your medical information to authorized federal officials so they may provide protection to the President, or other authorized persons or foreign heads of state or conduct special investigations.
¯ Inmates
If
you are a prisoner of a jail or a prison under the custody of a laws
enforcement official, we may be required to release medical information about
you to the jail, prison or law enforcement official. This release would be needed for the jail or prison to give
you health care, to protect your health and safety, the health and safety of
others, or for the safety and security of the jail or prison.
¯ Military and Veterans
If
you are a member of the armed forces, we must give your medical information
when required by military command authorities. We must release your medical information if you are a member
of a foreign military to the appropriate foreign military authority.
¯ Law Suits and Disputes
If
you are part of a law suit or dispute, we must give your medical
information to some one else in
the law suit or disputed if we receive a court or administrative order, a
subpoena, a discovery request or other lawful process. We will make reasonable efforts to tell
you about these requests or to get an order to protect the information
requested.
¯ Law Enforcement
We
are required to release medical information to a police officer, FBI officer or
others who enforce the law when asked to do so:
á
If we are given a court
order, subpoena, warrant, summons, or similar process or
á
If it is needed to identify
or locate a suspect, fugitive, material witness, or missing person or
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If it is about the
victim of a crime, if under certain circumstances, we are unable to obtain the
personÕs agreement
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If it is about a death
we believe may be the result of criminal conduct
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In emergency
circumstances to report a crime, the location of the crime or victims, of the
identity, description, or location of the person who committed the crime
All requests listed
in this category must be in writing. The hospital will provide a form for you
to complete or will assist you in completing the form when you want to ask for
any of the following:
¯ Right to Inspect or to Receive a Copy of Your Medical
Record
You have the right
to ask to see (inspect) your medical records or to ask for a copy of the
medical information that was used in making decisions about your health
care. Usually, this includes
medical and billing records, but it may not include some mental health
information. Instead of asking for
a copy of your records, you can also ask for a written summary of your medical
records.
If you ask for a
copy of your records, a fee will be charged to cover our costs for copying,
mailing, and for other supplies needed.
If you ask for a summary of your medical records, a fee will be charged
to cover our costs. We will tell
you what the costs will be and you can decide if you still want the copy of the
summary, before any work is done.
We are permitted by
law to deny (say ÒnoÓ to) your request to see or get a copy of your medical
records in very limited certain circumstances. If we say Òno,Ó you may ask that the denial be
reviewed. Another licensed
healthcare professional picked by the hospital will review your request and the
denial. This person will not be
the person who denied your request.
We will comply with the outcome of the review.
¯ Right to Request and Amendment
If you feel that
your medical information is wrong or not complete, you have the right to ask us
to change the information. You
have a right to ask for the change as long as the information was created by
the hospital. Our form must be
completed and you must provide a reason why you believe the information is not correct.
The law allows us to
say no to your request for a change if you do not give a reason for your
request. We are allowed by law to say
no to your request if you ask us to change information that:
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We did not create the
information. If the person, facility or organization that created the
information is no longer available to make the change, the law allows us to
make the change.
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Is not a part of the
medical information kept by or for the hospital
á
Is correct and complete.
¯ Right to an Accounting of
Disclosures
Your have the right
to ask for a list of disclosures.
This is a list of the disclosures of your health information that we are
required by federal, state or local laws as listed above.
You can request a time for six years or less.The time
period must be after April 13, 2002. The first list that you request in a 12
month period will be provided free.
If you request additional list within the 12 month period, we are
permitted to charge you for the costs of providing the list. We will notify you of the costs and you
can decide if you still want the list prepared before the work is started.
¯ Right to Request Restrictions
You have the right
to ask us not to use or give out or limitation the type of your medical
information for treatment, payment or operations. You also have the right to ask us to limit your medical
information we give out to the person who is responsible for the payment of
your care.
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 emergency care to you. You must tell us what information you want to limit; whether you want to limit our use, disclosure or both; and to whom you want the limits to apply.
¯ Right to Confidential Communications
You have the right
to ask that we get in touch with you about your care in a certain way or at a
certain location. For example, you
can ask us to call you only at work or to mail any information to an address
different than your home address.
Your request must be in writing.
We will not ask the why you are asking. We will comply with a reasonable
request.
¯ Right to Involve Individuals in Your
Care
Unless there is written instructions from you,
we are allowed to give out information about you to family member or a friend
who is involved in your medical care.
If a disaster happens, we can give out information to a disaster relief
agency such as the Red Cross so that your family can be notified about your
location or condition
RESEARCH
We may be asked to share or give out your medical information if
you are participating in a medical research project. Before we share or give out this information, we will ask
you for specific permission.
Other
uses and disclosures of medical information not covered by this notice or the
laws that apply to us will be made only with your permission. If you give us permission to give out
your medical information, you can change your mind at any time at any time. You
must tell us in writing and give us the reasons why you changed your mind. We
will no longer use or share or give out medical information about you for the
reasons you listed. We are not
able to take back any disclosure that we have already made with your
permissions. We are required to
retain all our records of the care that we provided to you.