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.
You have the right to obtain a paper copy of this Notice upon request.
Notice describes the privacy practices of Henry County Medical Center
and the health care professionals who provide services to patients at the Medical
Patient health information
federal law, your patient health information is protected and confidential.Patient
health information includes information about your symptoms, test results,
diagnosis, treatment and related medical information. Your health information
also includes payment, billing and insurance information.
How we use your
patient health information
We use health information about
you for treatment, to obtain payment and for health care operations,
including administrative purposes and evaluation of the quality of care
that you receive. Under
some circumstances, we may be required to use or disclose the information
even without your permission.
Examples of treatment, payment
and health care operations
will use and disclose your health information to provide you with medical
treatment or services. For example, nurses, physicians and other members
of your treatment team will record information in your record and use
it to determine the most appropriate course of care. We may also disclose
the information to other health care providers who are participating
in your treatment, to pharmacists who are filling your prescriptions
and to family members who are helping with your care.
Payment. We will use
and disclose your health information for payment purposes. For example,
we may need to obtain authorization from your insurance company before
providing certain types of treatment. We will submit bills and maintain
records of payments from your health plan. If you have a legal claim
against a third party for causing your injuries, we may file a hospital
lien in court to collect payment from them.
care operations. We
will use and disclose your health information to conduct our standard
internal operations, including proper administration of records, evaluation
of the quality of treatment and to assess the care and outcomes of your
case and others like it.
We may use your information
to contact you with appointment reminders. We may also contact
you to provide information about treatment alternatives or other health-related
benefits and services that may be of interest to you.
Other uses and disclosures
We may use or disclose identifiable
health information about you for other reasons, even without your consent.
Subject to certain requirements, we are permitted to give out health
information without your permission for the following purposes:
by law. We may be required by law to report
gunshot wounds, suspected abuse or neglect or similar injuries and
health activities. As required by law, we may
disclose vital statistics, diseases, information related to recalls
of dangerous products and similar information to public health authorities.
oversight. We may be required to disclose information
to assist in investigations and audits, eligibility for government
programs and similar activities.
and administrative proceedings. We may disclose
information in response to an appropriate subpoena or court order.
enforcement purposes. Subject to certain restrictions,
we may disclose information required by law enforcement officials.
- Deaths. We
may report information regarding deaths to coroners, medical examiners,
funeral directors and organ donation agencies.
threat to health or safety. We may use and disclose
information when necessary to prevent a serious threat to your health
and safety or the health and safety of the public or another person.
and special government functions. If you are
a member of the armed forces, we may release information as required
by military command authorities. We may also disclose information to
correctional institutions or for national security purposes.
- Research. We
may use or disclose information for approved medical research.
compensation. We may release information about
you to workers compensation agencies and your employer to provide benefits
for work-related injuries or illness.
- Fund raising. We
may contact you, or allow an institutionally-related foundation to
contact you, for fund raising purposes. We may also ask if we can disclose
limited information about you to clergy or include it in the patient
- Under limited circumstances, we may disclose
information to notify or locate your relatives or to assist disaster
relief agencies. In any other situation, we will ask for your written
authorization before using or disclosing any identifiable health
information about you. If you choose to sign an authorization to
disclose information, you can later revoke that authorization to
stop any future uses and disclosures.
You have the following rights
with regard to your health information. Please contact the person listed
below to obtain the appropriate form for exercising these rights.
restrictions. You may request restrictions on
certain uses and disclosures of your health information. We are not
required to agree to such restrictions, but if we do agree, we must
abide by those restrictions.
- Confidential communications. You
may ask us to communicate with you confidentially by, for example,
sending notices to a special address or not using postcards to remind
you of appointments.
- Inspect and obtain copies. In
most cases, you have the right to look at or get a copy of your health
information. There may be a small charge for the copies.
information. If you believe that information
in your record is incorrect, or if important information is missing,
you have the right to request that we correct the existing information
or add the missing information.
of disclosures. You may request a list of
instances where we have disclosed health information about you for
reasons other than treatment, payment or health care operations.
Our legal duty
We are required by law to protect
and maintain the privacy of your health information, to provide this
Notice about our legal duties and privacy practices regarding protected
health information and to abide by the terms of the Notice currently
Changes in privacy practices
We may change our policies
at any time. Before we make a significant change in our policies,
we will change our Notice and post the new Notice in the admissions area. You
can also request a copy of our Notice at any time. For more information
about our privacy practices, contact the person listed below.
If you are concerned that we
have violated your privacy rights, or if you disagree with a decision
we made about your records, you may contact the person listed below.
You also may send a written complaint to the U.S. Department of Health
and Human Services. The person listed below will provide you with
the appropriate address upon request. You will not be penalized
in any way for filing a complaint.
If you have any questions,
requests, or complaints, please contact: Privacy Officer Health
Information Management Department (731) 644-8562.
Henry County Medical Center
and the physicians who practice here are independent contractors and
do not hereby assume any liability for the services or conduct of the
The effective date of this
Notice is April 14, 2003.