OUR COMMITTEMENT REGARDING YOUR PERSONAL HEALTH INFORMATION
McCurtain Memorial Hospital is committed to maintaining and protecting
the confidentiality of our employees’ personal information. This Notice
of Privacy Practices applies to McCurtain Memorial Hospital, our
insurance providers, and prescription provider (collectively, the
Plans). The Plans are required by federal and state law to protect the
privacy of your individually identifiable health information and other
personal information. We are required to provide you with this Notice
about our policies, safeguards and practices. When the Plans use or
disclose your PHI, the Plans are bound by the terms of this Notice, or
the revised Notice, if applicable.
HOW WE MAY USE AND DISCLOSE MEDICAL
INFORMATION ABOUT YOU
HIPAA Notice of
Effective Date: January 6, 2014
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 Jahni Tapley,
Interim CEO, Risk Manager at 580-208-3100.
We are required by law to:
Maintain the privacy of protected health information
Give you this notice of our legal duties and privacy practices
regarding health information about you
Follow the terms of our notice that is currently in effect
HOW WE MAY USE AND
DISCLOSE HEALTH INFORMATION:
The following describes the ways we may use and disclose health
information that identifies you (“Health Information”). Except
for the purposes described below, we will use and disclose Health
Information only with your written permission. You may revoke
such permission at any time by writing to our practice Privacy Officer.
For Treatment. We may use and disclose Health Information for your
treatment and to provide you with treatment-related health care
services. For example, we may disclose Health Information to
doctors, nurses, technicians, or other personnel, including people
outside our office, who are involved in your medical care and need the
information to provide you with medical care.
For Payment. We may use and disclose Health Information so that we
or others may bill and receive payment from you, an insurance company
or a third party for the treatment and services you received. For
example, we may give your health plan information about you so that
they will pay for your treatment.
For Health Care Operations.
We may use and disclose Health Information for health care operations
purposes. These uses and disclosures are necessary to make sure
that all of our patients receive quality care and to operate and manage
our office. For example, we may use and disclose information to
make sure the obstetrical or gynecological care you receive is of the
highest quality. We also may share information with other
entities that have a relationship with you (for example, your health
plan) for their health care operation activities.
Appointment Reminders, Treatment Alternatives and Health
Related Benefits and Services. We may use and disclose Health Information to contact
you to remind you that you have an appointment with us. We also
may use and disclose Health Information to tell you about treatment
alternatives or health-related benefits and services that may be of
interest to you.
Individuals Involved in Your Care or Payment for Your Care.
When appropriate, we may share Health Information with a person who is
involved in your medical care or payment for your care, such as your
family or a close friend. We also may notify your family about
your location or general condition or disclose such information to an
entity assisting in a disaster relief effort.
Research. Under certain circumstances, we may use and disclose
Health Information for research. For example, a research project
may involve comparing the health of patients who received one treatment
to those who received another, for the same condition. Before we
use or disclose Health Information for research, the project will go
through a special approval process. Even without special
approval, we may permit researchers to look at records to help them
identify patients who may be included in their research project or for
other similar purposes, as long as they do not remove or take a copy of
any Health Information.
As Required by Law. We will disclose Health Information when
required to do so by international, federal, state or local law.
To Avert a Serious Threat to Health or Safety.
We may use and disclose Health Information when necessary to prevent a
serious threat to your health and safety or the health and safety of
the public or another person. Disclosures, however, will be made
only to someone who may be able to help prevent the threat.
Business Associates. We may disclose Health Information to our
business associates that perform functions on our behalf or provide us
with services if the information is necessary for such functions or
services. For example, we may use another company to perform
billing services on our behalf. All of our business associates
are obligated to protect the privacy of your information and are not
allowed to use or disclose any information other than as specified in
Organ and Tissue Donation.
If you are an organ donor, we may use or release Health Information to
organizations that handle organ procurement or other entities engaged
in procurement, banking or transportation of organs, eyes or tissues to
facilitate organ, eye or tissue donation and transplantation.
Military and Veterans. If you are a member of the armed forces, we
may release Health Information as required by military command
authorities. We also may release Health Information to the
appropriate foreign military authority if you are a member of a foreign
Workers’ Compensation. We may release Health Information for workers’
compensation or similar programs. These programs provide benefits
for work-related injuries or illness.
Public Health Risks. We may disclose Health Information for public
health activities. These activities generally include disclosures
to prevent or control disease, injury or disability; report births and
deaths; report child abuse or neglect; report reactions to medications
or problems with products; notify people of recalls of products they
may be using; a person who may have been exposed to a disease or may be
at risk for contracting or spreading a disease or condition; and the
appropriate government authority if we believe a patient has been the
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 Health 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
Data Breach Notification Purposes.
We may use or disclose your Protected Health Information to provide
legally required notices of unauthorized access to or disclosure of
your health information.
Lawsuits and Disputes. If you are involved in a lawsuit or a dispute,
we may disclose Health Information in response to a court or
administrative order. We also may disclose Health Information 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
Law Enforcement. We may release Health Information if asked by a law
enforcement official if the information is: (1) in response to a court
order, subpoena, warrant, summons or similar process; (2) limited
information to identify or locate a suspect, fugitive, material
witness, or missing person; (3) about the victim of a crime even if,
under certain very limited circumstances, we are unable to obtain the
person’s agreement; (4) about a death we believe may be the result of
criminal conduct; (5) about criminal conduct on our premises; and (6)
in an emergency 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 Health 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 Health
Information to funeral directors as necessary for their duties.
National Security and Intelligence Activities.
We may release Health Information to authorized federal officials for
intelligence, counter-intelligence, and other national security
activities authorized by law.
Protective Services for the President and Others.
We may disclose Health Information to authorized federal officials so
they may provide protection to the President, other authorized persons
or foreign heads of state or to conduct special investigations.
Inmates or Individuals in Custody.
If you are an inmate of a correctional institution or under the custody
of a law enforcement official, we may release Health Information to the
correctional institution or law enforcement official. This
release would be if 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) the safety and security of the
USES AND DISCLOSURES THAT REQUIRE US TO GIVE YOU AN
OPPORTUNITY TO OBJECT AND OPT
Individuals Involved in Your Care or Payment for Your Care.
Unless you object, we may disclose to a member of your
family, a relative, a close friend or any other person you identify,
your Protected Health Information that directly relates to that
person’s involvement in your health care., If you are unable to
agree or object to such a disclosure, we may disclose such information
as necessary if we determine that it is in your best interest based on
our professional judgment.
Disaster Relief. We may disclose your Protected Health Information to
disaster relief organizations that seek your Protected Health
Information to coordinate your care, or notify family and friends of
your location or condition in a disaster. We will provide you
with an opportunity to agree or object to such a disclosure whenever we
practically can do so.
YOUR WRITTEN AUTHORIZATION IS REQUIRED FOR OTHER USES AND
The following uses and disclosures of your Protected Health Information
will be made only with your written authorization:
Uses and disclosures of Protected Health Information for marketing
Disclosures that constitute a sale of your Protected Health
Other uses and disclosures of Protected Health Information not covered by
this Notice or the laws that apply to us will be made only with your
written authorization. If you do give us an authorization, you
may revoke it at any time by submitting a written revocation to our
Privacy Officer and we will no longer disclose Protected Health
Information under the authorization. But disclosure that we made
in reliance on your authorization before you revoked it will not be
affected by the revocation.
the following rights regarding Health Information we have about you:
Right to Inspect and Copy.
You have a right to inspect and copy Health Information that may be
used to make decisions about your care or payment for your care.
This includes medical and billing records, other than psychotherapy
notes. To inspect and copy this Health Information, you must make
your request, in writing, to Sarah Hopson, RHIA. We have up to 30
days to make your Protected Health Information available to you and we
may charge you a reasonable fee for the costs of copying, mailing or
other supplies associated with your request. We may not charge
you a fee if you need the information for a claim for benefits under
the Social Security Act or any other state of federal needs-based
benefit program. We may deny your request in certain limited
circumstances. If we do deny your request, you have the right to
have the denial reviewed by a licensed healthcare professional who was
not directly involved in the denial of your request, and we will comply
with the outcome of the review.
Right to an Electronic Copy of Electronic Medical Records.
If your Protected Health Information is maintained in an electronic
format (known as an electronic medical record or an electronic health
record), you have the right to request that an electronic copy of your
record be given to you or transmitted to another individual or entity.
We will make every effort to provide access to your Protected Health
Information in the form or format you request, if it is readily
producible in such form or format. If the Protected Health
Information is not readily producible in the form or format you request
your record will be provided in either our standard electronic format
or if you do not want this form or format, a readable hard copy form.
We may charge you a reasonable, cost-based fee for the labor associated
with transmitting the electronic medical record.
Right to Get Notice of a Breach.
You have the right to be notified upon a breach of any of your
unsecured Protected Health Information.
Right to Amend. If you feel that Health Information we have is
incorrect or incomplete, you may ask us to amend the information.
You have the right to request an amendment for as long as the
information is kept by or for our office. To request an
amendment, you must make your request, in writing, to Sarah Hopson,
Right to an Accounting of Disclosures.
You have the right to request a list of certain disclosures we made of
Health Information for purposes other than treatment, payment and
health care operations or for which you provided written authorization.
To request an accounting of disclosures, you must make your request, in
writing, to Sarah Hopson, RHIA.
Right to Request Restrictions.
You have the right to request a restriction or limitation on the Health
Information we use or disclose for treatment, payment, or health care
operations. You also have the right to request a limit on the
Health Information we disclose to someone involved in your care or the
payment for your care, like a family member or friend. For
example, you could ask that we not share information about a particular
diagnosis or treatment with your spouse. To request a
restriction, you must make your request, in writing, to Sarah Hopson,
RHIA. We are not
required to agree to your request unless you are asking us to
restrict the use and disclosure of your Protected Health Information to
a health plan for payment or health care operation purposes and such
information you wish to restrict pertains solely to a health care item
or service for which you have paid us “out-of-pocket” in full. If we
agree, we will comply with your request unless the information is
needed to provide you with emergency treatment.
If you paid out-of-pocket (or in other words, you have requested that
we not bill your health plan) in full for a specific item or service,
you have the right to ask that your Protected Health Information with
respect to that item or service not be disclosed to a health plan for
purposes of payment or health care operations, and we will honor that
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 by mail or at work.
To request confidential communications, you must make your request, in
writing, to Wanda Adams. Your request must specify how or where
you wish to be contacted. We will accommodate reasonable
Right to a Paper Copy of This Notice.
You have the right to a paper copy of this notice. You may ask us
to give you a copy of this notice at any time. Even if you have
agreed to receive this notice electronically, you are still entitled to
a paper copy of this notice. You may obtain a copy of this notice
at our web site, www.mmhok.com. To obtain a paper copy of this
notice, contact Wanda Adams.
CHANGES TO THIS NOTICE:
We reserve the right to change this notice and make the new notice apply
to Health Information we already have as well as any information we
receive in the future. We will post a copy of our current notice
at our office. The notice will contain the effective date on the
first page, in the top right-hand corner.
believe your privacy rights have been violated, you may file a
complaint with our office or with the Secretary of the Department of
Health and Human Services. To file a complaint with our office,
contact Jahni S. Tapley. All complaints must be made in writing.
You will not be penalized for filing a complaint.
You may contact our office and the above listed people
McCurtain Memorial Hospital
1301 East Lincoln Rd
Idabel, OK 74745
The Plans may change the terms of this Notice at any time. If the Plans
change this Notice, the Plans may make the new Notice terms effective
for all of your PHI that the Plans maintain, including any information
the Plans created or received before we issued the new Notice. If the
Plans change this Notice, the Plans will make it available to you.