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Effective Date: April 14, 2003
NOTICE OF PRIVACY PRACTICES
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.
MHTC
is committed to protecting your medical information. We are required by law to:
►Maintain
the privacy of your medical information;
►Give
you a notice of our legal duties and privacy practices with respect to your
medical information; and
►
Follow the terms of the notice currently in effect.
What
is this document?
This
Notice of Privacy Practices describes how we may use and disclose your medical
information. It also describes your rights to access and control your medical
information.
This
Notice of Privacy Practices applies to all of your medical information
used to make decisions about your care that we generate or maintain,
including sensitive information such as mental health, communicable disease and
drug and alcohol abuse information. Different privacy practices may apply to
your medical information that is created or kept by other people or entities.
This
Notice of Privacy Practices will be followed by:
►All
Hospital employees;
►Any
health care professional who treats you at
the Hospital and who is a member
of our organized health care arrangement;
►All
departments and units of the Hospital;
►
Any member of a volunteer group that provides help to patients
What
will you do with my medical information?
The
following categories describe the ways that we may use and disclose
your medical information. In order
to assure compliance with Oklahoma law, we will obtain your consent to the use
and disclosure of your medical information.
Not every use or disclosure in a category will be listed. You will give
us your consent by signing the PATIENT AGREEMENTS ON ADMISSION form.
If
you do not consent, we cannot provide you with treatment except in an emergency
situation or when we cannot communicate with you for some other reason.
If you are concerned about a possible use or disclosure of any part of
your medical information, you may request a restriction. Your right to request a
restriction is described in the section regarding patient rights below.
Treatment.
We will use your medical
information to provide you with medical treatment and services.
Examples:
(1) Your medical information may be disclosed to doctors, nurses, technicians,
students, or other hospital personnel who are involved in taking care of you at
the Hospital. (2) Different
departments of the Hospital also may share medical information about you in
order to coordinate specific services, such as prescriptions, lab work and
x-rays.
We
may disclose your medical information
for the treatment activities of any other health care providers.
Examples:
(1) We may send a copy of your medical record to a physician who needs to
provide follow-up care. (2) We may
send a copy of your health care instructions to a nursing home to which you have
been transferred to facilitate coordination of care.
Payment.
We
may use medical information about you
for our payment activities. Common
payment activities include, but are not limited to:
►Determining
eligibility or coverage under a plan;
►Billing
and collection activities; and
►Disclosures
to consumer reporting agencies.
Examples:
(1) Your
medical information may be released to an insurance company to obtain payment
for services. (2) We may 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 disclose medical information about you to another health care
provider or covered entity for its payment activities.
Examples:
(1) We may send your health plan coverage information to an outside
laboratory that needs the information to bill for tests that it provided to you.
(2) We may give your payment information to an ambulance service provider that
transported you to the Hospital in order for the ambulance provider
to bill for its transportation and treatment services.
Operations.
We may use your medical
information for hospital operations. These
uses are necessary to run the Hospital and to make sure patients receive quality
care. Common operation activities
to include, but are not limited to:
►Conducting
quality assessment and improvement activities;
►Reviewing
the competence of health care professionals;
►Training
health care professionals;
►Arranging
for legal or auditing services;
►Business
planning and development;
►Business
management and administrative activities; and
►Communicating
with patients about Hospital services.
Examples:
(1) We may use your medical information to conduct internal audits to verify
that billing is being conducted properly. (2)
We may use your medical information to contact you for the purposes of
conducting patient satisfaction surveys or to follow-up on the services we
provided. (3) We might use a patient
list to announce the arrival of a new specialist or the purchase of a new piece
of equipment.
We
may disclose medical information about you to another health care
provider or covered entity for its operation activities under certain
circumstances.
Example:
We may disclose your medical information to your health plan for its
utilization review analysis.
Business
Associates.
We may disclose your medical information to other entities that provide a
service to us or on our behalf that requires the release of patient medical
information. However, we only will
make these disclosures if we have received satisfactory assurance that the other
entity will properly safeguard your medical information.
Example:
We may contract with another entity to provide transcription or billing
services.
Treatment
Alternatives.
We may use and disclose your medical information to tell you about or recommend
possible treatment options or alternatives that may be of interest to you.
Individuals
Involved in Your Care or Payment for Your Care.
We may release medical information about you to a friend, family member
or legal guardian who is involved in your medical care or who helps pay for your
care. We may tell your family or
friends your condition and that you are in the Hospital. In
addition, we may disclose medical information about you to an entity assisting
in a disaster relief effort so that your family can be notified about your
condition, status and location.
Appointment
Reminders.
We may use and disclose medical information to contact you as a reminder
that you have an appointment for medical treatment or services.
Health-Related
Benefits and Services.
We may use and disclose medical information to tell you about
health-related benefits or services that may be of interest to you.
Directory.
We may include certain information about you in our directory
while you are a patient at the Hospital. This
information may include your name, location in the Hospital, your general
condition and your religious affiliation. The directory information, except for
your religious affiliation, 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 minister, priest or rabbi,
even if they don’t ask for you by name. This
is so your family, friends and clergy can visit you in the Hospital and
generally know how you are doing. If
you do not want to be in our directory, you will need to notify
hospital personnel at registration. You
will be asked to complete an “opt out” form.
Research.
We may use and disclose medical information about you to researchers.
In most circumstances, you must sign a separate form specifically
authorizing us to use and/or disclose your medical information for
research. However, there are
certain exceptions. Your medical
information may be disclosed without your authorization for research if the
authorization requirement has been waived or altered by a special
committee that is charged with ensuring that the disclosure will not pose a
great risk to your privacy or that measures are being taken to protect your
medical information. Your medical information also may be disclosed to
researchers to prepare for research as long as certain conditions are met.
Medical information regarding people who have died can be released without
authorization when certain circumstances. Limited
medical information may be released to a researcher who has signed an agreement
promising to protect the information released.
Organ
and Tissue Donation.
If you are an organ donor, we may release medical information 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.
Fundraising.
We may use medical information about you to contact you in the
future to raise money for the Hospital. We
may disclose medical information to a foundation related to the Hospital so that
the foundation may contact you to raise money on our behalf.
We only will release contact information, such as your name, address and
phone number and the dates you received treatment or services at the Hospital
for fundraising purposes. If you do
not want us, or a related foundation, to contact you for fundraising efforts,
you must notify our Privacy Official in writing by regular mail or e-mail.
Can
you ever use and disclose my medical information without my consent?
Yes. The
following categories describe the ways that we may be required to use and
disclose your medical information without your consent. Not every use or
disclosure in a category will be listed.
Required
by Law.
We may disclose your medical information when required to do so by
federal, state or local law.
Examples:
(1) We may release your medical information for workers’ compensation
or similar programs. These programs
provide benefits for work-related injuries or illness. (2) We are required by
law to report criminally inflicted injuries and cases of abuse and neglect.
These reports may include your medical information.
Public
Safety.
We may use and disclose medical information 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 would only be to someone able to help prevent the threat.
Public
Health.
We may disclose medical information about you for public health
activities intended to:
►Prevent
or control disease, injury or disability;
►Report
births and deaths;
►Report
abuse, neglect or violence as required by law;
►Report
reactions to medications or problems with products;
►Notify
people of recalls of products they may be using; or
►Notify
a person who may have been exposed to a disease or may be at risk for
contracting or spreading a disease or condition.
Example:
Oklahoma law requires us to report, among other things, tumors, birth
defects, cases of venereal disease, infant eye infections, infants born exposed
to alcohol and other harmful substances, and abortions.
Food
and Drug Administration (FDA).
We may disclose to the FDA and to manufacturers health information
relative to adverse events with respect to food, supplements, product and
product defects, or post-marketing surveillance information to enable product
recalls, repairs or replacements.
Health
Oversight Activities.
We may disclose medical information to a health oversight agency for
activities authorized by law. These
oversight activities include, for example, audits, investigations, inspections,
and licensure. These activities are
necessary for the government to monitor the health care system, government
programs, and compliance with civil rights laws.
Example:
We may be required to disclose patient medical information to the
Oklahoma State Department of Health to maintain our hospital license.
Lawsuits
and Disputes.
If you are involved in a lawsuit or a dispute, we may disclose
medical information about you in response to a court or administrative order.
In limited circumstances, we may disclose medical information about you
in response to a subpoena or discovery request, but only if efforts have been
made to inform you about the request or to obtain an order protecting the
information requested.
Law
Enforcement.
We may release medical information if asked to do so by law enforcement
official:
►
In response to a court order, warrant, summons or other similar process;
►
To identify or locate a suspect, fugitive, material witness, or missing person;
►
About the victim of a crime if, under certain limited circumstances,
we are unable to obtain the person’s agreement;
►
About a death we believe may be the result of criminal conduct;
►
About criminal conduct at the hospital; and
►
In emergency circumstances to report a crime; the location of the crime or
victims; or the identity, description or location of the person who
committed the crime.
Coroners,
Medical Examiners and Funeral Directors.
We may release medical information to a coroner or medical examiner.
This may be necessary, for example, to identify a deceased person or
determine the cause of death. We also may release medical information about
patients of the hospital to funeral directors as necessary to carry out their
duties.
National
Security and Intelligence Activities. We
may release medical information 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 medical information about you to authorized federal
officials so they may provide protection to the President, other authorized
persons or foreign heads of state or conduct special investigations.
Military/Veterans.
We may disclose your medical information as required by military command
authorities, if you are a member of the armed forces.
Inmates.
If you are an inmate of a correctional facility or under the custody of
law enforcement official or agency, we may release your medical information to
the correctional facility or law enforcement official or agency.
This release may be necessary to: (1) enable the correctional facility to
provide you with health care; or (2) protect the health and safety of you and/or
other people.
What
if you want to use and/or disclose my medical information for a purpose not
described in this Notice?
We
must obtain a separate, specific authorization from you to use and/or
disclose your medical information for any purpose not covered by this notice or
the laws that apply to us.
In other words, the consent you already provided will not be enough to use
and/or disclose your information for any purpose that is not described in this
Notice.
If
you provide us with authorization to use or disclose your medical information,
you may revoke the authorization, in writing, at any time. If you revoke your
authorization, we will not use or disclose your medical information for the
reasons covered by your authorization. However,
your revocation will not apply to disclosures already made by us in reliance
on your authorization.
What
are my rights regarding my medical information?
You
have the rights described below in regard to the medical information that we
maintain about you. You are
required to submit a written request to exercise any of these rights.
You may contact our medical record department or Privacy Official to
obtain a form that you can use to exercise any of the rights listed below.
Right
to Inspect and Copy.
You have the right to inspect and copy medical information used to make
decisions about your care. This
right does not apply to a very narrow category of medical information referred
to as “psychotherapy notes”.
If
you request a copy of your medical information, we may charge a fee of
$1.00 for the first page and 50 cents for each additional page.
We may deny your request to inspect and/or copy your medical information
in certain circumstances. If you are denied access, you may request that the
denial be reviewed. A licensed
health care professional chosen by us will review your request and the denial.
The person conducting the review will not be the person who denied your
original request. We will comply
with the outcome of the review.
Right
to Amend.
If you feel that medical information that we created is incorrect or
incomplete, you may submit a request for an amendment for as long as we maintain
the information. You must provide a reason that supports your amendment
request.
We
may deny your request for an amendment if it is not in writing or does not
include a reason to support the request. In
addition, we may deny your request if you ask to amend information that:
►We
did not create, unless the person or entity that created the information is not
available to make the amendment;
►Is
not part of the medical information that we maintain;
►Is
not part of the information that you would be permitted to inspect and copy; or
►Is
accurate and complete.
Right
to an Accounting of Disclosures.
You have the right to request one free
“accounting of disclosures” every 12 months.
This is a list of certain disclosures
we made of your medical information. There
are several categories of disclosures that we are not required to list in
the accounting. For example, we do
not have to keep track of disclosures made for treatment, payment or health care
operations or for those disclosures that are authorized. Your request
must state a time period, which may not be longer than 6 years and may not
include dates before April 14, 2003.
If
you request more than 1 accounting in a 12-month period, we may charge you for
the costs of providing the list. We
will notify you of the cost involved and you may choose to withdraw or modify
your request at that time before any costs are incurred.
Right
to Request Restrictions.
You have the right to request a restriction or limitation on the
medical information we use or disclose about you unless our use and/or
disclosure is required by law. You
also have the right to request a limit on the medical information 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 may want to pay cash for certain services instead of having
information submitted to your insurance company for payment.
We
are not required to agree to your request.
If we agree, we will comply with your request unless the
information is needed to provide emergency treatment to you.
In
your request, you must indicate:
►The
type of restriction you want and the information you want restricted; and
►To
whom you want the limits to apply, for example, your spouse.
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.
We
will accommodate all reasonable requests. Your request must specify how or where
you wish to be contacted.
Right
to a Paper Copy of This Notice.
You have the right to a paper copy of this notice.
Copies of this notice always will be available in our medical records
department. You also may obtain a
copy of this notice at the following website address:
www.mhtcguymon.org
Can
you change this notice?
We
reserve the right to change this notice. We
reserve the right to make the revised or changed notice effective
for medical information we already have about you as well as any
information we receive in the future. Copies
of the current notice will be posted at the Hospital and will be available for
you to pick up on each visit to the Hospital.
What
if I have questions or need to report a problem?
If
you believe your privacy rights have been violated, you may file a complaint
with us or with the Secretary of the Department of Health and Human Services.
To
file a complaint with us, or if you would like more information about our
privacy practices, contact our Privacy Official.
The Privacy Official's Phone number is:
(580)338-6515 ext. 2005.
The Privacy Official’s E-Mail address is:
The
Privacy Official’s mailing address is:
Memorial
Hospital of Texas County
Attn: Privacy Officer
520 Medical Drive
Guymon, OK 73942
To file a complaint with the Secretary of the Department of Health and Human Services, you must submit the complaint within 180 days of when you knew or should have known of the circumstance that led to the complaint. The complaint must be submitted in writing. Our Privacy Official can provide you with current contact information. You will not be penalized for filing a complaint.