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
Assistant Administrator, 311 N. Morrow, Mena, AR 71953 or 479-394-6100.
The terms of this Privacy Notice applies to Protected Health Information
(defined below) associated with the Hospital (defined below). This
Notice describes how Hospital may use and disclose Protected Health
Information ("PHI") to carry out treatment, payment and
health care operations, and for other purposes that are permitted
or required by law.
DEFINITIONS
For purposes of this Notice, the following definitions apply:
"HIPAA" means Health Insurance Portability and Accountability
Act of 1996
"Hospital" means, for purposes of this Notice;
• All departments and units of Hospital.
• Any member of a volunteer group we allow to help you while
you are in Hospital.
• All employees, staff and other Hospital personnel.
• Any health care professional authorized to enter information
in your Hospital chart.
• All Hospital remote sites and locations.
"Protected Health Information" ("PHI") means
individually identifiable health information, as defined by HIPAA,
that is created or received by Hospital as it relates to the past,
present or future physical or mental health or condition of an individual;
the provision of health care to an individual; or the past, present
or future payment for the provision of health care to an individual;
and that identifies the individual or for which there is a reasonable
basis to believe information can be used to identify the individual.
PHI includes information of persons living or deceased.
OUR PLEDGE REGARDING MEDICAL INFORMATION
We understand that medical information about you and your health
is personal. We are committed to protecting your PHI. We create
a record of the care and services you receive at Hospital. We need
this record to provide you with quality care and to comply with
certain legal requirements. This notice applies to all PHI generated
by the Hospital, whether made 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.
This Notice will tell you about the ways in which
we may use and disclose your PHI. We also describe your rights and
certain obligations we have regarding the use and disclosure of
your PHI.
We are required by law to:
• make sure that your PHI is kept private;
• give you this notice of our legal duties and privacy practices
with respect to PHI; and
• follow the terms of the notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE YOUR PHI
The following categories describe different ways that we use and
disclose PHI. 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 the categories.
• Uses and Disclosures for Treatment. We may use your PHI
to provide you with medical treatment or services. We may disclose
your PHI 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. In addition, the doctor may need to tell the dietitian
if you have diabetes so that we can arrange for appropriate meals.
Different departments of the Hospital also may share your PHI in
order to coordinate the different things you need, such as prescriptions,
lab work and x-rays. We also may disclose your PHI to people outside
Hospital who may be involved in your medical care after you leave
the Hospital, such as family members, clergy or others we use to
provide services that are part of your care.
• Uses and Disclosures For Payment. We may use and disclose
your PHI so that the treatment and services you receive at the Hospital
may be billed to and payment may be collected from you, an insurance
company or a third party. For example, we may need to give your
health plan information about surgery you received at the Hospital
so your health plan will pay us or reimburse you for the surgery.
We may also tell your health plan about a treatment you are going
to receive to obtain prior approval or to determine whether your
plan will cover the treatment.
• Uses and Disclosures For Health Care Operations. We may
use and disclose your PHI 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
your PHI to review our treatment and services and to evaluate the
performance of our staff in caring for you. We may also combine
PHI about many Hospital patients to decide what additional services
the Hospital should offer, what services are not needed, and whether
certain new treatments are effective. We may also disclose your
PHI to doctors, nurses, technicians, medical students, and other
Hospital personnel for review and learning purposes. We may also
combine your PHI with medical information from other Hospitals to
compare how we are doing and see where we can make improvements
in the care and services we offer. We may remove information that
identifies you from this set of medical information so others may
use it to study health care and health care delivery without learning
who the specific patients are.
• Appointment Reminders. We may use and disclose your PHI
to contact you as a reminder that you have an appointment for treatment
or medical care.
• Treatment Alternatives. We may use and disclose your PHI
to tell you about or recommend possible treatment options or alternatives
that may be of interest to you.
• Health-Related Benefits and Services. We may use and disclose
your PHI to tell you about health-related benefits or services that
may be of interest to you.
• Fundraising Activities. We may disclose medical information
to the Mena Regional Support Foundation which is related to the
Hospital so that the Foundation may contact you in an effort to
raise money for Hospital. We only will release contact information,
such as your name, address and phone number and the dates you received
treatment or services at the Hospital. If you do not want the Hospital
or Foundation to contact you for fundraising efforts, you must notify
the Chair of the support Foundation, Sue Cavner, 311 N. Morrow Avenue,
Mena, AR 71953, or 479-243-5844 in writing.
• Individuals Involved in Your Care or Payment for Your Care.
We may release your PHI to a friend or family member who is involved
in your medical care. We may also give your PHI to someone who helps
pay for your care. We may also tell your family or friends your
general condition and that you are in the Hospital. In addition,
we may disclose your PHI to an entity assisting in a disaster relief
effort so that your family can be notified about your condition,
status and location.
• Business Associates. Certain aspects and components of our
services are performed through contracts with outside persons or
organizations. At times it may be necessary for us to provide certain
of your PHI to one or more of these outside persons or organizations.
• Research. Under certain circumstances, we may use and disclose
your PHI for research purposes. For example, a research project
may involve comparing the health and recovery of all patients who
received one medication to those who received another, for the same
condition. All research projects, however, are subject to a special
approval process. This process evaluates a proposed research project
and its use of PHI, trying to balance the research needs with patients’
need for privacy of their PHI. Before we use or disclose PHI for
research, the project will have been approved through this research
approval process, but we may, however, disclose your PHI to people
preparing to conduct a research project, for example, to help them
look for patients with specific medical needs, so long as the medical
information they review is not removed from the Hospital. We will
almost always ask for your specific permission if the researcher
will have access to your name, address or other information that
reveals who you are, or will be involved in your care at Hospital.
• As Required By Law. We will disclose your PHI when required
to do so by federal, state or local law.
• To Avert a Serious Threat to Health or Safety. We may use
and disclose your PHI 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.
Special Situations
• Organ and Tissue Donation. We may release your PHI 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.
• Military and Veterans. If you are a member of the armed
forces, we may release your PHI as required by military command
authorities. We may also release PHI about foreign military personnel
to the appropriate foreign military authority.
• Workers’ Compensation. We may release your PHI for
workers’ compensation or similar programs. These programs
provide benefits for work-related injuries or illness.
• Public Health Risks. We may disclose your PHI for public
health activities. These activities generally include the following:
o to prevent or control disease, injury or disability;
o to report births and deaths;
o to report child abuse or neglect;
o to report adverse events, product defects, or problems;
o to notify people of recalls of products they may be using;
o 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;
o to notify 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 your PHI 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 laws.
• Lawsuits and Disputes. If you are involved in a lawsuit
or a dispute, we may disclose your PHI in response to a court or
administrative order. We may also disclose your PHI in response
to a subpoena, discovery request, or other lawful process by someone
else involved in the dispute, but only if reasonable efforts have
been made to tell you about the request or to obtain an order protecting
the information requested.
• Law Enforcement. We may release your PHI if asked to do
so by a law enforcement official:
o In response to a court order, subpoena, court-ordered warrant,
summons or similar process;
o To identify or locate a suspect, fugitive, material witness, or
missing person;
o About the victim of a crime if, under certain limited circumstances,
we are unable to obtain the person’s agreement;
o About a death we believe may be the result of criminal conduct;
o About criminal conduct occurring on the premises of the Hospital;
and
o In emergency circumstances to report the commission and nature
of 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 your PHI to a coroner or medical examiner for purposes of
identifying a deceased person or determine the cause of death. We
may also release PHI about patients of the Hospital to funeral directors
as necessary to carry out their duties.
• National Security and Intelligence Activities. We may release
your PHI to authorized federal officials for intelligence, counterintelligence,
and other national security activities authorized by law.
• Protective Services for the President and Others. 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 conduct special investigations.
• Security Clearances. We may use your PHI to make decisions
regarding your medical suitability for a security clearance or service
abroad. We may also release your medical suitability determination
to the officials in the Department of State who need access to that
information for these purposes.
• Inmates. If you are an inmate of a correctional institution
or under the custody of a law enforcement official, we may release
your PHI to the correctional institution or law enforcement official.
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) for the safety and security of the correctional
institution.
• Video Surveillance. Some of our treatment areas and patient
rooms are equipped with video surveillance equipment, which may
be used in some circumstances. Should it be needed in the course
of your care, our staff will notify you before the camera is turned
on.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You have the following rights regarding your PHI we maintain about
you:
• Right to Inspect and Copy. You have the right to inspect
and copy your PHI that we maintain. Usually, this includes medical
and billing records, but does not include psychotherapy notes, information
compiled in reasonable anticipation for use in a civil, criminal
or administrative proceeding and PHI maintained by Hospital that
is subject to Clinical Laboratory Improvements Amendments.
To inspect and copy medical information that
may be used to make decisions about you, you must submit your request
in writing to the Hospital's Medical Records Department. If you
request a copy of the information, we may charge a fee for the costs
of copying, mailing or other supplies associated with your request.
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.
• Right to Amend. If you feel that your PHI 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 the Hospital.
o To request an amendment, your request must be made in writing
and submitted to the Assistant Administrator, 311 N. Morrow, Mena,
AR 71953. In addition, you must provide a reason that supports your
request.
o We may deny your request for an amendment if it is not in writing
or does not include a reason to support the request. In addition,
we may deny your request if you ask us to amend information that:
o Was not created by us, unless the person or entity that created
the information is no longer available to make the amendment;
o Is not part of the medical information kept by or for the Hospital;
o Is not part of the information which you would be permitted to
inspect and copy; or
o Is accurate and complete.
• Right to an Accounting of Disclosures. You have the right
to request an "accounting of disclosures of your PHI."
This is a list of the disclosures we made of your PHI, except for
certain matters for which we are not required to disclose.
Your request must state a time period which may
not be longer than six years prior to the date of your request.
Your request should indicate in what form you want the list (for
example, on paper, electronically). The first list you request within
a 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 that time before any costs are incurred.
• Right to Request Restrictions. You have the right to request
a restriction or limitation on the PHI we use or disclose about
you for treatment, payment or health care operations. You also have
the right to request a limit on the PHI we disclose about you to
someone who is involved in your care or the payment for your care,
like a family member or friend. For example, you could ask that
we not use or disclose information about a surgery you had.
We are not required to agree to your request.
If we do agree, we will comply with your request unless the information
is needed to provide your emergency treatment.
To request restrictions, you must make
your request in writing to the Assistant Administrator at 311 N.
Morrow, Mena, AR 71953. 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.
• 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 at work or by mail.
• To request confidential communications, you must make your
request in writing to the Assistant Administrator, 311 N. Morrow,
Mena, AR 71953. We will not ask you the reason for your request.
We will accommodate all reasonable requests. Your request must specify
how or where you wish to be contacted.
• 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.
CHANGES TO THIS NOTICE
• We reserve the right to change this Notice. We reserve the
right to make the revised or changed Notice effective for PHI we
already have about you as well as any information we receive in
the future. We will post a copy of the current notice in the Hospital.
The effective date of the notice will be shown on the first page,
in the top right-hand corner, of the Notice. In addition, each time
you register at or are admitted to the Hospital for treatment or
health care services as an inpatient or outpatient, we will make
available upon request a copy of the current Notice in effect.
COMPLAINTS
If you believe your privacy rights have been violated, you may file
a complaint with the Hospital or with the Secretary of the Department
of Health and Human Services. To file a complaint with the Hospital,
contact the Assistant Administrator at 311 N. Morrow, Mena, AR 71953.
All complaints must be submitted in writing.
You will not be penalized for filing a complaint.
OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of PHI covered by this Notice or the
laws that apply to us will be made only with your written authorization.
If you provide us authorization to use or disclose your PHI, you
may revoke that permission, in writing, at any time. If you revoke
your authorization, we will no longer use or disclose you PHI for
the reasons covered by your written authorization. You understand
that we are unable to take back any disclosures we have already
made with your authorization, and that we are required to retain
our records of the care that we provided to you
