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.

FLOYD MEMORIAL MEDICAL GROUP, FLOYD MEMORIAL HOSPITAL AND HEALTH SERVICES AND ASSOCIATED HEALTH CARE PRACTITIONERS HAS A LEGAL DUTY TO SAFEGUARD YOUR PROTECTED HEALTH INFORMATION. All employees, volunteers, staff, doctors, health professionals and other personnel are legally required to and must abide by the policies set forth in this notice, and to protect the privacy of your health information.

This “protected health information,” or PHI for short, includes information that can be used to identify you. We collect or receive this information about your past, present or future health condition to provide health care to you, or to receive payment for this health care. We must provide you with this notice about our privacy practices that explains how, when and why we use and disclose your PHI.  We will follow the terms of our current notice.  With some exceptions, we may not use or disclose any more of your PHI than is necessary to accomplish the need for the information.  We also are required to notify you following a breach of your unsecured PHI.

We reserve the right to change the terms of this notice and our privacy policies at any time.  Any changes to this notice will apply to the PHI already in existence.  Before we make any change to our policies, we will promptly change this notice and post a new notice in our lobby.  You can also request a copy of this notice from the contact person listed at the end of this notice at any time and can view a copy of the notice on our Web site at www.floydmemorial.org.

WE MAY USE AND DISCLOSE YOUR PROTECTED HEALTH INFORMATION for many different reasons. For some of these reasons, we will need your permission or a specific, signed authorization. Below, we describe the different categories of when we use and disclose your PHI and give you some examples of each category.

A. WE MAY USE, OR DISCLOSE YOUR PROTECTED HEALTH INFORMATION FOR TREATMENT, PAYMENT, OR HEALTH CARE OPERATIONS.

1.  For treatment.  We may disclose your PHI to physicians, nurses, medical students, and other health care personnel and agencies who provide or are involved in your health care.  For example, if you are being treated for a knee injury, we may disclose your PHI to the physical rehabilitation department in order to coordinate your care.  In some cases the sharing of your PHI with other healthcare providers may be done electronically, including through an electronic health information exchange.

2.  To obtain payment for treatment.  We may use and disclose your PHI in order to bill and collect payment for services provided to you.  It is important that you provide us with correct and up-to-date PHI.  For example, we may disclose portions of your PHI to our billing department and your health plan to get paid for the health care services we provided to you.  We may also disclose your PHI to our business associates, such as billing companies, claims processing companies and others that process our health care claims.

3.  To operate our health care business.  We may disclose your PHI in order to operate our facility in compliance with healthcare regulations.  For example, we may use your PHI to review the quality of our services and to evaluate the performance of our staff in caring for you.

B. WE ALSO DO NOT REQUIRE YOUR CONSENT TO USE OR DISCLOSE YOUR PHI:

1.  When requested by federal, state, or local law; judicial or administrative proceedings; or law enforcement agencies.  We will disclose your PHI when a law requires that we report information to government agencies and law enforcement personnel, for example, about victims of abuse, neglect, or domestic violence; when dealing with gunshot and other wounds; or when ordered in a judicial or administrative proceeding. We may also disclose your PHI in response to a subpoena, discovery request, or other lawful process, but only if efforts have been made to notify you and give you an opportunity to object to the request, or to obtain a protective order for the PHI.

2.  For public health activities.  We report information about births, deaths, and various diseases to government officials in charge of collecting that information and we provide coroners, medical examiners and funeral directors necessary information relating to an individual’s death.

3.  For purposes of organ donation.  For patients that have previously agreed to organ donation, we may notify organ procurement organizations to assist them in organ, eye or tissue donation and transplants.

4.  To avoid harm.  In order to avoid a serious threat to health or safety of a person or the public, we may provide your demographic PHI to law enforcement personnel or persons able to prevent or lessen such harm.

5.  For worker’s compensation purposes.  We may disclose your PHI in order to comply with worker’s compensation laws. If you do not want worker’s compensation notified, alternate insurance or payment information must be supplied.

6.  For appointment reminders and health-related benefits and services.  We may use your demographic PHI to contact you as a reminder that you have an appointment or to recommend possible treatment options or alternatives that may be of interest to you.

7.  For fundraising activities.  We may use your PHI to communicate with you to raise funds for our healthcare system.  We may disclose your PHI to a foundation related to Floyd Memorial Hospital and Health Services so that the foundation may contact you to raise money for us.  The money raised through these activities is used to expand and support the health care services and educational programs we provide to the community.  In these cases, we would use or disclose only your name, address and phone number, age, gender, and the dates and departments of service.  If you do not wish to be contacted as part of our fundraising efforts, please contact the person listed at the end of this notice.

8.  Communications About Programs or Products.  Most uses and disclosures of PHI for marketing purposes will be made only with your written authorization. We may use PHI to communicate to you about a product or service if the communication occurs face-to-face, involves a gift of nominal value, or is for a drug refill. We may use and disclose your PHI to communicate with you about a health-related product or service we offer. In addition, we may use or disclose your PHI to tell you about products or services related to your treatment, case management or care coordination, or alternative treatments, therapies, providers or settings of care for you.

9.  Health Oversight Activities.  We may disclose your PHI to a health oversight agency for activities authorized by law. These oversight activities may include audits, investigations, and inspections. These activities are necessary for the government to monitor the health care system, government benefit programs, and compliance with civil rights laws.

10.  Research.  Under certain circumstances, we may use and disclose PHI about you for research purposes. All research projects are subject to a special approval process and information disclosed is only done so with your consent or with appropriate authority as permitted by law.

11.  Military and Veterans.  If you are an member of the armed forces, we may disclose your PHI as required by military command authorities. We may also disclose PHI about foreign military personnel to the appropriate foreign military authority.

12.  National Security and Intelligence Activities.  We may disclose your PHI to authorized federal officials for lawful intelligence, counterintelligence, and other national security activities authorized by law. We may disclose your PHI to authorized federal officials so they may provide protection to the President, other authorized persons or foreign heads of state or for the conduct of special investigations.

13.  Inmates.  We may disclose your PHI to correctional institutions or law enforcement officials if you are an inmate or under the custody of a law enforcement official. Disclosure for these purposes would be necessary: (a) for the institution to provide health care services to you, (b) for the safety and security of the institution, and/or (c) to protect your health and safety or the health and safety of other individuals.

C. YOU HAVE THE OPPORTUNITY TO AGREE TO OR OBJECT TO THE FOLLOWING:

1.  Patient Directories.  We may include your name, location in our facility, and your general condition in our patient directory, to direct visitors who ask for you by name. We may also include your religious affiliation for use by clergy even if they don’t ask for you by name, unless you object in whole or in part. If you do not wish to be included in the facility directory, you may opt out at any time.

2.  Information shared with family, friends or others.  We may disclose your PHI to a family member, friend, or other person that you indicate is involved in your care or the payment for your health care, unless you object in whole or in part.  Your choice to object may be made at any time.

D. YOUR PRIOR WRITTEN AUTHORIZATION IS REQUIRED FOR ANY USES AND DISCLOSURES OF YOUR PROTECTED HEALTH INFORMATION NOT INCLUDED ABOVE.

Except as described above or permitted by law, we will ask for your written authorization before using or releasing any of your PHI. If you choose to sign an authorization to disclose your PHI, you may later revoke that authorization in writing, except to the extent that we have taken action in reliance on the authorization. This will stop any future disclosure of your PHI for the purposes you previously authorized.


YOUR RIGHTS REGARDING YOUR PROTECTED HEALTH INFORMATION

A. You Have the Right to Request Limits on How We Use and Disclose Your PHI.

You have the right to request a restriction in our use or disclosure of your PHI for treatment, payment or health care operations. Additionally, you have the right to request that we restrict our disclosure of your PHI to only certain individuals involved in your care or the payment for your care, such as family members and friends. For any services for which you paid out-of-pocket in full, we will honor your request to not disclose information about those services to your health plan, provided that such disclosure is not necessary for your treatment. In all other circumstances, we are not required to agree to your request; however, if we do agree, we are bound by our agreement except when otherwise required by law, in emergencies, or when the information is necessary to treat you. In order to request a restriction in your use or disclosure of your PHI, you must make your request in writing to the contact person listed in this notice.

C. You Have the Right to See and Get Copies of Your PHI.

You have the right to inspect and obtain a copy of the PHI that may be used to make decisions about you, including patient medical records and billing records, but not including psychotherapy notes. If we maintain health information about you in electronic format, you also have the right to obtain a copy of such information in a readily producible electronic format and to direct us to transmit such information directly to an entity or person clearly, conspicuously, and specifically designated by you. You must submit your request in writing to the contact person listed in this notice in order to inspect and/or obtain a copy of your PHI. We will respond to you within 30 days after receiving your written request. In certain situations, we may deny your request. If we do, we will tell you, in writing, why we denied your request. You have the right to have the denial reviewed. We will choose another licensed healthcare professional to review your request and the denial. The person conducting the review will not be the person who denied your first request. You can request a summary or a copy of the entire medical record as long as you agree to the cost in advance. If your request to see the medical information is approved, we will arrange this in accordance with established hospital policy. We may charge a fee for the costs of copying, mailing, labor and supplies associated with your request. Please submit all requests for this information to: Floyd Memorial Medical Group (812) 949-5740.

D. You Have the Right to Get a List of Instances of When and to Whom We Have Disclosed Your PHI.

You have the right to request an “accounting of disclosures.” An “accounting of disclosures” is a list of certain non-routine disclosures we have made of your PHI. This list will not include uses you have already authorized, or those for treatment payment or operations. This list will not include psychotherapy notes, or uses made for national security purposes, or to corrections or law enforcement personnel. We will respond within 60 days of receiving your request. The list we provide will include the last six years of activity unless you request a shorter time. The list will include dates when your PHI was disclosed and why, with whom your PHI was disclosed (including their address if known), and a description of the information disclosed. The first list you request within a 12-month period will be free. You will be charged a reasonable fee for additional lists within that time frame. Please submit all requests for this information to: Floyd Memorial Medical Group (812) 949-5740.

E. You Have the Right to Correct or Update Your PHI.

If you believe that there is a mistake in your PHI or that a piece of important information is missing, you have the right to request that we amend the information. We can do this for as long as the information is retained by our facility. You must provide the request and your reason for the request in writing. We will respond within 60 days of receiving your request. If we deny your request, our written denial will state our reasons and explain your right to file a written statement of disagreement. If you do not file a written statement of disagreement, you have the right to request that your request and our denial be attached to all future uses or disclosures of you PHI. If we approve your request, we will make the change to your PHI, tell you that we have done it, and tell others that need to know about the change or amendment to your PHI. Please submit all requests for this information to: Floyd Memorial Medical Group (812) 949-5740.

F. You Have the Right to Request a Copy of This Privacy Notice.

Even if you have agreed to receive notice via e-mail, you also have the right to request a paper copy of this notice. Please submit this request to: FMMG Compliance Specialist – (812) 949-5740.


HOW TO VOICE YOUR CONCERNS ABOUT OUR PRIVACY PRACTICES: If you think that we may have violated your privacy rights, or you disagree with a decision we made about access to your PHI, you may file a complaint with the person listed at the end of this notice. You also may send a written complaint to the Secretary of the Department of Health and Human Services at:

200 Independence Avenue, SW
Washington, D.C. 20201

You will not be penalized for filing a complaint.


PERSON TO CONTACT FOR INFORMATION ABOUT THIS NOTICE OR TO VOICE YOUR CONCERNS ABOUT OUR PRIVACY PRACTICES:

FMMG Compliance Specialist
(812) 949-5740.


EFFECTIVE DATE OF THIS NOTICE
This notice is effective as of September 23, 2013.

 

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