Privacy Policy
THIS NOTICE DESCRIBES HOW INFORMATION ABOUT YOU MAY BE
USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION.
PLEASE REVIEW IT CAREFULLY.
Printable Version (PDF)
Understanding Your Health Record/Information
Each time you visit a hospital, physician, or other healthcare
provider, a record of your visit is made. Typically, this record
contains your symptoms, examination and test results, diagnoses,
treatment, and a plan for future care or treatment.
Understanding what is in your record and how your health information
is used helps you to:
- ensure its accuracy
- better understand who, what, when, where and why others may
access your health information
- make more informed decisions when authorizing disclosure to
others.
Your Health Information Rights
Although your health record is the physical property of the healthcare
practitioner or facility that compiled it, the information belongs
to you. You have the right to:
- request a restriction on certain uses and disclosures of your
information as provided by 45 CFR 164.522
- obtain a paper copy of the notice of information practices
upon request
- inspect and copy your health record as provided for in 45
CFR 164.524
- amend your health record as provided in 45 CFR 164.528
- obtain an accounting of disclosures of your health information
as provided in 45 CFR 164.528
- request communications of your health information by alternative
means or at alternative locations
- revoke your authorization to use or disclose health information
except to the extent that action has already been taken.
Our Responsibilities
Rolling Plains Memorial Hospital is required by law to:
- maintain the privacy of your health information
- provide you with a notice as to our legal duties and privacy
practices with respect to information we collect and maintain
about you
- abide by the terms of this notice
- notify you if we are unable to agree to a requested restriction
- accommodate reasonable requests you may have to communicate
health information by alternative means or at alternative locations.
Rolling Plains Memorial Hospital reserves the right to change
our practices and to make the new provisions effective for all
protected health information we maintain. Revised notices will
be posted and a copy of the current notice offered upon registration
or available in prominent areas within the hospital.
We will not use or disclose your health information without your
written authorization, except as described in this notice. You
may revoke your authorization to disclose protected health information
at any time except for that information disclosed on reliance
on the authorization by presenting your written revocation to
the Health Information Management Department of Rolling Plains
Memorial Hospital.
For More Information or to Report a Problem
If you have additional questions and would like additional information,
you may contact Patient Registration and/or the Privacy Officer
(325) 235-1701.
If you believe your privacy rights have been violated, you can
file a complaint with the Privacy Officer or with the Secretary
of Health and Human Services. There will be no retaliation for
filing a complaint.
Examples of Disclosures for Treatment, Payment and Health Operations
We will use your health information for treatment. For example: Your
health information may be used by staff members or disclosed to
other healthcare professionals for the purpose of evaluating your
health, diagnosing medical conditions, and providing treatment.
For example, results of laboratory tests and procedures will be
available in your medical record to all health professionals who
may provide treatment or who may be consulted by staff members.
We will also provide your physician or a subsequent healthcare
provider with copies of various reports that should assist him/her
in treating you once you're discharged from Rolling Plains Memorial
Hospital.
We will use your health information for payment. For example: A
bill may be sent to you or a third party payer. The information
on or accompanying the bill may include information that identifies
you, as well as your diagnosis, procedures and supplies used.
We will use your health information for regular health operations.
For example: Members of the medical staff, the risk or
quality improvement manager, or members of the quality improvement
team may use information in your health record to assess the
care and outcomes in your case and others like it. This information
will then be used in an effort to continually improve the quality
and effectiveness of the healthcare and service we provide.
Other Uses or Disclosures
Business Associates: There are some services provided
in our organization through contacts with business associates.
When these services are contracted, we may disclose your health
information to our business associate so that they can perform
the job we've asked them to do and bill you or your third party
payer for services rendered. So that your health information is
protected, however, we require the business associate to appropriately
safeguard your information.
Directory: Unless you notify us that you object, we
will use your name, location in the facility, general condition,
and religious affiliation for directory purposes. This information
may be provided to members of the clergy and, except for religious
affiliation to other people who ask for you by name.
Notification: We may use or disclose information to
notify or assist in notifying a family member, personal representative,
or another person responsible for your care, your location, and
general condition.
Communication with Family: Health professionals, using
their best judgement, may disclose to a family member, other relative,
close personal friend or any other person you identify, health
information relevant to that person's involvement in your care
or payment related to your care.
Research: We may disclose information to researchers
when their research has been approved by an Institutional Review
Board that has reviewed the research proposal and established
protocols to ensure the privacy of your health information.
Funeral Directors: We may disclose health information
to funeral directors consistent with applicable law to carry out
their duties.
Organ Procurement Organizations: Consistent with applicable
law, we may disclose health information to organ procurement organizations
or other entities engaged in the procurement, banking, or transplantation
of organs for the purpose of tissue donation and transplant.
Marketing: We may contact you to provide appointment
reminders or information about treatment alternatives or other
health related benefits and services that may be of interest to
you.
Fund Raising: We may contact you as part of a fund-raising
effort.
Food and Drug Administration (FDA): We may disclose
to the FDA 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 replacement.
Workers Compensation: We may disclose health information
to the extent authorized by and to the extent necessary to comply
with laws relating to workers compensation or other similar programs
established by law.
Public Health: As required by law, we may disclose your
health information to public health or legal authorities charged
with preventing or controlling disease, injury or disability.
Law Enforcement: We may disclose health information
for law enforcement purposes as required by law, or in response
to a valid subpoena.
Federal law makes provision for your health information to be
released to an appropriate health oversight agency, public health
authority or attorney, provided that a workforce member or business
associate believes in good faith that we have engaged in unlawful
conduct or have otherwise violated professional or clinical standards
and are potentially endangering one or more patients, workers
or the public.
Method of Disclosure
Your information may be communicated to other users or disclosed
to others in various formats. These formats may include, but not
be limited to, facsimile (fax), telephone, mail, e-mail, electronic,
verbal, or other means.
Effective Date
The effective date of this Notice of Privacy Practices is April
14, 2003.
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