Lawrence Memorial Hospital and Lawrence Hall Health and Rehabilitation
Notice of Privacy Practices
Effective; April 14, 2003
Revised: March 26, 2013;
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.
If you have any questions about this notice, please contact the Privacy Officer of the hospital (see the bottom of this Notice for contact details of the Privacy Officer). This notice will tell you how we may use and disclose protected health information about you.
Protected health information means any health information about you that identifies you or for which there is a reasonable basis to believe the information can be used to identify you. In this notice, we refer to the protected health information as “medical information.”
This notice will also tell you about your rights and our duties with respect to medical information about you. In addition, it will describe how you can file a complaint if you believe we have violated your privacy rights.
WHO WILL FOLLOW THIS NOTICE
This Notice of Privacy Practices describes the practices of Lawrence Healthcare and that
We all will follow the terms of this notice. In addition, we may share medical information with each other for treatment, payment or hospital operations purposes described in this notice.
OUR PLEDGE REGARDING MEDICAL INFORMATION:
We understand that medical information about you and your health is personal and we are committed to protecting it. Your medical information consists of records of the care and services you receive at the hospital. We need this record to provide you with quality care and to comply with certain legal requirements. This notice applies to all medical information, whether created by hospital personnel or your personal doctor. Your personal doctor may have different policies or notices regarding the doctor’s use and disclosure of your medical information created in the doctor’s office or clinic.
We are required by law to:
• make sure that medical information that identifies you is kept private;
• Give you this notice of our legal duties and privacy practices with respect to medical
information about you; and
• follow the terms of the notice that is currently in effect.
HOW WE MAY — USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU.
We will share your medical information as necessary to carry out treatment, payment, or our health care operations. The following categories describe different ways that we use and disclose medical information. For each category of uses or disclosures, we will explain what we mean and try to give some examples. Not every use or disclosure in a category will be listed. However, all of the ways we are permitted to use and disclose information will fall within one of For Treatment. We may use medical information about you to provide you with medical treatment or services. We may disclose medical information about you to doctors, nurses, technicians, medical students, or other hospital personnel who are involved in taking care of you at the hospital. For example, a doctor treating you for a broken leg may need to know if you have diabetes because diabetes may slow the healing process. Different departments of the hospital also may share medical information about you in order to coordinate the different things you need, such as prescriptions, lab work, and x-rays. We may consult or refer you to other health care providers and share your medical information with them. We also may disclose medical information about you to people outside the hospital who may be involved in your medical care after you leave the hospital, such as family members, or others we use to provide services that are part of your care.
For Payment. We may use and disclose medical information about you so that the treatment services you receive at the hospital may be billed to and payment may be collected from you, an insurance company, or a third party. We also may need to provide your insurance company or a government program, such as Medicare or Medicaid, with information about your medical condition and the health care you need to receive.
For Health Care Operations. We may use and disclose medical information 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 medical information to review our treatment and services and to evaluate the performance of our employees in
DISCLOSURES TO WHICH YOU HAVE THE OPPORTUNITY TO OBJECT OR AGREE
We will include your name, location in the hospital; condition described in general terms (e.g., fair, stable, etc.) on our facility census sheet while you are a patient at the hospital. This information may be released to people who ask for you by name. Your religious affiliation may be given to members of the clergy, 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 this information released you must notify the Privacy Officer or Administration of the hospital of your objection.
Individuals Involved in Your Care or Payment for Your Care. We may disclose medical information about you to family members, other relatives, a close personal friend, or any other person identified by you who is involved in your medical care or payment related to your care. We may also give information to someone who helps pay for your care. If there is a family member, other relative, or close personal friend that you do not want to disclose medical information about you, please notify the Privacy Officer/Medical Records Department of the hospital, or tell our staff member who is providing care to you.
— USES AND DISCLOSURES THAT MAY BE MADE WITHOUT YOUR AUTHORIZATION OR OPPORTUNITY TO OBJECT
Disaster Relief. We may use or disclose medical information about you to an entity assisting in a disaster relief effort so that your family member, other relative, or close personal friend can be notified about your condition, status, and location.
As Required by Law. We may use or disclose medical information about you when we are required to do so by federal, state, or local law.
Public Health Activities. We may disclose medical information about you for public health activities and purposes. These activities generally include the following:
• to prevent or control disease, injury or disability;
• to report births and deaths;
• to report child abuse or neglect;
• to report reactions to medications or problems with products;
• to notify people of recalls of products they may be using;
• to notify a person who may have been exposed to a disease or may be at risk for contracting
or spreading a disease or condition.
Reporting Victims of Abuse, Neglect or Domestic Violence. We may disclose medical information about you to notify an appropriate government authority if we believe you are a victim of abuse, neglect, or domestic violence. We will only make this disclosure if you agree or when required or authorized by law.
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, licensure or disciplinary actions. These activities are necessary for the government to monitor the health care system, government programs, and compliance with civil rights laws.
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. We may also disclose medical information about you in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute, but only if efforts have been made to tell 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 a law enforcement
• In response to a court order, subpoena, warrant, summons, or similar process;
• To identify or locate a suspect, fugitive, material witness, or missing person;
• About an actual or suspected victim of a crime and that person agrees to the disclosure. If
we are unable to obtain that person’s agreement, in limited circumstances, the information
may still be disclosed.
• About a death we believe may be the result of criminal conduct;
Lawrence Memorial Hospital and Lawrence Hall Health and Rehabilitation
• 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 may also release medical information about patients of the hospital to funeral directors as necessary to carry out their duties. Organ, Eye or 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.
To Avert Serious Threat to Health or 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, however, would only be to someone able to help prevent the threat. Military. If you are a member of the armed forces, we may release medical information about you as required by military command authorities. We may also release medical information about foreign military personnel to the appropriate foreign military authority. National Security and Intelligence. We may release medical information about you to
authorized federal officials for the conduct of intelligence, counter-intelligence, 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 to provide protection to the President of the United States, certain other federal officials, or foreign heads of state.
Inmates, Persons in Custody. If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may release medical information about you to the correctional institution or law enforcement official. This release would be necessary (1) for the 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.
Workers Compensation. We may release medical information about you for workers’ compensation or similar programs. These programs provide benefits for work-related injuries or OTHER — USES AND DISCLOSURES BASED UPON YOUR AUTHORIZATION.
Disclosures will be made only with your written authorization such as marketing, sale of PHI, psychotherapy notes, and other uses and disclosures not described in the Notice of Privacy Practices. You may revoke such an authorization at any time by notifying the Privacy Officer of the hospital (see last page for contact details of the Privacy Officer), in writing of your desire to revoke it. However, if you revoke such an authorization, it will not have any affect on actions taken by us in reliance on it.
HOW WE WILL CONTACT YOU. Unless you tell us otherwise in writing, we may contact you by either telephone or by mail at either your home or your office. At either location, we may leave messages for you on the answering machine or voice mail. If you want to request that we communicate to you in a certain way or at a certain location, see “Right to Request Confidential Communications” section of this Notice. Health Related Benefits and Services We may use and disclose medical information about you to tell you about health-related benefits and services that may be of interest to you. You have the right to request not to receive such notifications by calling the hospital Administration or Privacy Officer (see last page for contact details of the Privacy Officer and Administration).
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You have the following rights regarding medical information that we maintain about you. Right to Inspect and Copy. You have the right to inspect and copy medical information that may be used to make decisions about your care. Usually, this includes medical and billing records, but does not include psychotherapy notes. To inspect and copy medical information, you must submit your request in writing to the Privacy Officer of the hospital). If you request a copy of the information, there will be a reasonable fee for the costs of copying and other supplies associated with your request. We will act on your request within thirty (30) business days after we receive your request. If we grant your request, in whole or in part, we will inform you of our acceptance of your request and provide access and copying. Upon completion of transfer to an electronic health record system at Lawrence Memorial Hospital, an individual can request to receive PHI in an We may deny your request to inspect and copy in certain very limited circumstances. If you are denied access to medical information, 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. Right to Amend. If you feel that medical information we have about you is incorrect or incomplete, you may ask us to amend the information. You have this right for so long as we maintain the medical information. To request an amendment, your request must be made in writing and submitted to the Privacy Officer of the hospital. Your request must state the amendment desired and provide a reason in support of that amendment. We will act on your request within thirty (30) business days after we receive your request. If we grant the request, we will make the appropriate amendment to the medical information by appending or otherwise providing a link to the amendment. We will also inform the entities authorized by you to receive a copy of the amendment.
We may deny your request for an amendment if it is not in writing or does not include a reason to support the request. If we deny your request for this or other reasons, we will inform you of the basis for the denial. You will have the right to submit a statement of disagreement with our denial. We may prepare a rebuttal to that statement. All of this will then be included with any subsequent disclosure of the information, or, at our election, we may include a summary of any of that information. If you do not submit a statement of disagreement, you may ask that we include your request for amendment and our denial with any future disclosures of the information. We will include your request for amendment and our denial (or a summary of that information) with any subsequent disclosure of the medical information involved. You also will have the right to complain about our denial of your request. Right to an Accounting of Disclosures. You have the right to request an “accounting of disclosures”, that is, the disclosures we made of medical information about you. The accounting may be for up to six (6) years prior to the date on which you request the accounting but not before April 14, 2003. Under certain circumstances your right to an accounting of disclosures may be suspended for disclosures to a health oversight agency or law enforcement official. To request an accounting of disclosures, you must submit your request in writing to the Privacy Officer of the hospital. Usually, we will act on your request within thirty (60) business days after we receive your request. Within that time, we will either provide the accounting of disclosures to you or give you a written statement of when we will provide the accounting and why the delay is necessary. The first list you request within a twelve (12) month period will be free. For additional lists, 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 the 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 for treatment, payment, or health care operations. You also have the right to request that we restrict the uses or disclosures we make to: (a) a family member, other relative, a close personal friend or any other person identified by you; or, (b) for to public or private entities for disaster relief efforts. For example, you could ask that we not use or disclose information about a surgery you had to your brother or sister. You have the right to restrict disclosures of PHI to health plans, if the requested service has been paid in full prior to the procedure being performed. To request restrictions, you must make your request in writing to the Privacy Officer of the hospital. 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, for example, disclosures to your spouse. We are not required to agree to any requested restriction. However, if we do agree, we will follow that restriction unless the information is needed to provide emergency treatment. Even if we agree to a restriction, either you or we can later terminate the restriction. Right to Opt Out of Fundraising Communication. You have the right to opt out of fundraising communications either by contacting Administration at 870-886-1265 or email email@example.com. 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. If you want to request confidential communication, you must do so in writing to the Privacy Officer of the hospital. Your request must state how or where you wish to be contacted. We will accommodate all reasonable requests. Right to Notification in the Event of a Breach. You will be contacted in writing in the event a breach of your PHI occurs.
Right to a Paper Copy of This Notice. You have the right to a paper copy of our Notice of Privacy Practices. To obtain a paper copy of this notice, contact Terry Webster, RHIT, Health Information Management Director, (870) 886-1243, (870) 886-5534 (fax), 1309 West Main, PO Box 839, Walnut Ridge, AR 72476.
You may also obtain a copy of this notice at our website, http://www.lawrencememorial.info.
Our Right to Change Notice of Privacy Practices. 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. Complaints. You may complain to us and to the Secretary of Health and Human Services if you believe your privacy rights have been violated by us. You may submit a complaint to us, in writing, to Terry Webster, RHIT, Health Information Management Director, (870) 886-1243, (870) 886-5534 (fax), 1309 West Main, PO Box 839, Walnut Ridge, AR 72476. To file a complaint with the Secretary of Health and Human Services, send your complaint to him or her in care of: Office for Civil Rights, U.S. Department of Health and Human Services, 200 Independence Avenue SW, Washington, D.C. 20201.
You will not be penalized for filing a complaint.
Questions and Information. If you have any questions or want more information concerning this Notice of Privacy Practices, please contact the Privacy Officer of the hospital.
Contact details of the Privacy Officer Terry Webster, RHIT, Health Information Management Director, (870) 886-1243,
(870) 886-5534 (fax), 1309 West Main, PO Box 839, Walnut Ridge, AR 72476.
Contact details of the Health Information Management Department Health Information Management, (870) 886-1243, (870) 886-5534 (fax), 1309 West Main,
PO Box 839, Walnut Ridge, AR 72476.
Lawrence Memorial Hospital and Lawrence Hall Health and Rehabilitation