Drew Memorial Hospital

	Privacy Policy

NOTICE OF PRIVACY PRACTICES

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.

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, diagnosis(es), treatment(s), and a plan for future care or treatment. This information, often referred to as your health or medical record, serves as a:

Basis for planning your care and treatment
Means of communication among the many health professionals who contribute to your care
Legal document describing the care you received
Means by which you or a third-party payer can verify that services billed were actually provided
A tool in educating health professionals
A source of data for medical research
A source of information for public health officials charged with improving the health of the nation
A source of data for facility planning and marketing
A tool with which we can assess and continually work to improve the care we render and the outcomes we achieve

Your hospital, physician or healthcare provider will also maintain information concerning the charges to your account for the healthcare services rendered to you, any third parties who may have a financial obligation for payment of the charges (e.g. insurance companies) and the status of your account.

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:

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 a limit on the medical information we disclose about you to someone who is involved in your care or the payment of 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 you emergency treatment. To request restrictions, you must make your request in writing to the Privacy Officer. 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 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 that may be used to make decisions about you, you must submit your request in writing to the Drew Memorial Hospital, 778 Scogin Drive, Monticello, AR 71655. 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. 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 the right to request an amendment for as long as the information is kept by or for the hospital.

To request an amendment, your request must be made in writing and submitted to Drew Memorial Hospital, 778 Scogin Drive, Monticello, Arkansas 71655. In addition, you must provide a reason that supports your request.

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:

Was not created by us, unless the person or entity that created the information is no longer available to make the amendment;
Is not part of the medical information kept by or for the hospital;
Is not part of the information which you would be permitted to inspect and copy; or
Is accurate and complete.

Right to an Accounting of Disclosures: You have the right to request an "accounting of disclosures." This is a list of the disclosures we made of medical information about you. To request this list or accounting of disclosures, you must submit your request in writing to Drew Memorial Hospital, 778 Scogin Drive, Monticello, Arkansas 71655. Your request must state a time period which may not be longer than six years and may not include dates before April 14, 2003. Your request should indicate in what form you want the list (for example, on paper or electronically). 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 that time before any costs are incurred.

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 Privacy Officer. 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. 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 website, www.drewmemorial.org. To obtain a paper copy of this notice, inquire at the hospital admissions desk.

Our Responsibilities

This organization is required 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 the notice currently in effect
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

We reserve the right to change our practices and to make the new provisions effective for all protected health information we maintain. If revised, copies of the revised "Notice of Privacy Policies" will be available via our web site www.drewmemorial.org or by contacting either the Hospital's admissions office or Privacy Officer.

We will not use or disclose your health information without your written authorization, except as described in this notice. If you provide us with permission to use of disclose medical information about you, you may revoke the permission, in writing, at any time and we will no longer use or disclose medical information about you 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 permission and that we are required to retain our records of the care that we provided to you.

How We May Disclose Medical Information About You

Treatment Purposes: We may use medical information about you to provide you with medical treatment or services. For example: Information obtained by a nurse, physician, or other member of your healthcare team will be recorded in your medical record and used to determine the course of treatment that should work best for you.

Payment Purposes: We may use and disclose medical information about you 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: A bill will be sent to you or third-party payer.

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: Members of the medical staff, the risk manager or members of the quality improvement team may use information in your health record for quality improvement purposes.

Business Associates: There are some services provided in our organization through contract with business associates. Examples include but are not limited to physician services in the emergency department, anesthesia, radiology and certain laboratory tests. We may disclose your health information to our business associate so that they can perform their job and bill you or your third-party payer for services rendered. These business associates are required to appropriately safeguard your information.

Appointment Reminders: We may use and disclose medical information to contact you as a reminder that your have an appointment for treatment or medical care at the hospital.

Treatment Alternatives: We may use and disclose medical information to tell you about or recommend possible alternative treatment options or alternatives that may be of interest to you.

Health Related Benefits and Services: We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.

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 while you are a patient at the hospital. 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 of your location and general condition.

Communication with Family: Health professionals, using their best judgment, may disclose to a family member or any other person you identify, health information relevant to that person's involvement in your care or payment related to your care.

Fund Raising: We may contact you as part of a fund-raising effort for the hospital or an organization related to the hospital. We only would 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 to contact you for fundraising efforts, you must notify Drew Memorial Hospital in writing at 778 Scogin Drive, Monticello, Arkansas 71655.

Research: We may disclose information to researchers when their research has been approved by an institutional review board and privacy protocols have been established.

As Required By Law: We will disclose medical information about you 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 medial information about you when necessary to prevent a serious threat to your health or safety or the health or safety of the public or another person.

Coroners, Medical Examiners, and Funeral directors: We may disclose health information to coroners, medical examiners or funeral directors consistent with applicable law to allow these individuals to carry out their duties.

Organ Procurement Organizations: Consistent with applicable law, we may disclose health information to organ procurement organizations for the purpose of tissue donation and transplant.

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 law 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.

Correctional Institution: Should you be an inmate of a correctional institution, we may disclose to the institution or agents thereof health information necessary for your health and the health and safety of other individuals.

Law Enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.

Military and Veterans: If you are or have been a member of the armed forces, we may release medical information about you as required by military command authorities.

Health Oversight Activities: We may disclose medical information to a health oversight agency for activities authorized by law, including, for example, audits, investigations, inspections and licensure.

Lawsuits and Disputes: If you are involved in a lawsuit or 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.

National Security and Intelligence Activities: We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities authorized by law.

For More Information or to Report a Problem

If you we have questions and would like additional information, you may contact the Privacy Officer at 870-367-2411.

If you believe your privacy rights have been violated, you can file a complaint with the Privacy Officer of the hospital or the Department of Health and Human Services. All complaints must be submitted in writing. You will not be penalized and no adverse actions will be taken against you for filing a complaint

Effective Date: 10-11-01