Privacy
Statement
(click here for a printable
version of this notice)
THIS
NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE READ
IT CAREFULLY. (If you have questions about this notice, please contact
the Privacy Officer.)
WHO
WILL FOLLOW THIS NOTICE:
This
notice describes Memorial Medical Center practices and that of:
- Any health
care professional authorized to enter information into your chart.
- All departments
and units of Memorial Medical Center.
- Any member
of a volunteer group we allow to help you while you are in the care
of Memorial Medical Center.
- All employees,
staff and other Memorial Medical Center personnel.
OUR
PLEDGE REGARDING MEDICAL INFORMATION:
We
understand that medical information about you and your health is personal.
We are committed to protecting medical information about you. We create
a record of the care and services you receive from Memorial Medical
Center. We need this record to provide you with quality care and to
comply with certain legal requirements. This notice applies to all
of the records of your care generated by Memorial Medical Center,
whether made by Memorial Medical Center or another provider that you
were referred to. Other physicians you may see in the course of your
treatment 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 medical information
about you. We also describe your rights and certain obligations we
have regarding the use and disclosure of medical information.
Law requires us
to:
- Make sure that
medical information that identifies you is kept private;
- Give you this
notice of our legal duties and privacy practices with respect to
medical information about you; and
- Follow the
terms of the notice that is currently in effect.
HOW
WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU
The following categories describe different ways that we
use and disclose medical information. 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.
FOR TREATMENT
- We may use medical information about you to provide you with medical
treatment or services. We may disclose medical information about you
to doctors, nurses, technicians, medical students, or other hospital
personnel who are involved in taking care of your service. 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 medical information about you in order
to coordinate the different things you need, such as prescriptions,
lab work and x-rays. We also may disclose medical information about
you to people outside the 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.
FOR PAYMENT
- We may use and disclose medical information about you so that the
treatment and services you receive at Memorial Medical Center 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 care
information about treatment you received at the Memorial Medical Center
so your health plan will pay us or reimburse you for the care. We
may also tell your health plan about a treatment or service you are
going to receive to obtain prior approval or to determine whether
your plan will cover the treatment.
FOR HEALTH
CARE OPERATIONS - We may use and disclose medical information
about you for Memorial Medical Center operations. These uses and disclosures
are necessary to run Memorial Medical Center and make sure that all
of our patients receive quality care. For example, we may use medical
information to review our treatment and services and to evaluate the
performance of our staff in caring for you. We may also combine medical
information about many patients to decide what additional services
the Memorial Medical Center should offer, what services are not needed,
and whether certain new treatments are effective. We may also disclose
information to doctors, nurses, technicians, medical students, and
other Memorial Medical Center personnel for review and learning purposes.
We may also combine the medical information we have with medical information
from other health providers 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 medical information to contact
you as a reminder that you have an appointment for medical care.
TREATMENT
ALTERNATIVES - We may use and disclose medical information 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 medical information
to tell you about health-related benefits or services that may be
of interest to you.
FUNDRAISING
ACTIVITIES - We may use medical information about you to contact
you in an effort to raise money for Memorial Medical Center and its
operations. We may disclose medical information to a foundation related
to the Memorial Medical Center so that the foundation may contact
you in raising money for Memorial Medical Center. We only would release
contact information; such as your name, address and phone number and
the dates you received treatment or services at Memorial Medical Center.
If you do not want the Memorial Medical Center to contact you for
fundraising efforts, you must notify the Privacy Officer in writing.
INDIVIDUALS
INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE - We may release
medical information about you to a friend or family member who is
involved in your medical care. We may also give information to someone
who helps pay for your care. In addition, we may disclose medical
information about you to an entity assisting in a disaster relief
effort so that your family can be notified about your condition, status
and location.
RESEARCH
- Under certain circumstances, we may use and disclose medical information
about you 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 medical information, trying to balance the research needs with
patients' need for privacy of their medical information. Before we
use or disclose medical information for research, the project will
have been approved through this research approval process, but we
may, however, disclose medical information about you 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 does not leave the Memorial Medical Center. 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 with Memorial Medical Center.
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 medical
information about you 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 - If you are an organ donor, we may
release medical information 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.
WORKERS' COMPENSATION
- We may release medical information about you for workers' compensation
or similar programs. These programs provide benefits for work-related
injuries or illness.
PUBLIC HEALTH
RISKS - We may disclose medical information about you for public
health activities. These activities generally include the following:
- To prevent
or control disease, injury or disability;
- To report births
and deaths;
- To report child
abuse or neglect;
- To report reactions
to medications or problems with products;
- To notify people
of recalls of products they may be using;
- 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;
- 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 medical 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
laws.
LAWSUITS AND
DISPUTES - If you are involved in a lawsuit or a 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.
LAW ENFORCEMENT
- We may release medical information if asked to do so by a law enforcement
official:
- In response
to a court order, subpoena, warrant, summons or similar process;
- To identify
or locate a suspect, fugitive, material witness, or missing person;
- About the victim
of a crime if, under certain limited circumstances, we are unable
to obtain the person's agreement;
- About a death
we believe may be the result of criminal conduct;
- About criminal
conduct at Memorial Medical Center; and
- In emergency
circumstances 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 medical 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
may also release medical information about patients of MEMORIAL MEDICAL
CENTER to funeral directors as necessary to carry out their duties.
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.
PROTECTIVE
SERVICES FOR THE PRESIDENT AND OTHERS - We may disclose medical
information about you to authorized federal officials so they may
provide protection to the President, other authorized persons or foreign
heads of state or conduct special investigations.
INMATES If you are an inmate of a correctional institution or under
the custody of a law enforcement official, we may release medical
information about you to the correctional institution or law enforcement
official. This release would be 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.
YOUR
RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU
You
have the following rights regarding medical information we maintain
about you:
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 Privacy Officer.
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 Memorial Medical Center 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 Memorial Medical Center.
To request an amendment, your request must be made in writing and
submitted to the Privacy Officer. 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 Memorial Medical Center;
- 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 the Privacy Officer. 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, 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 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 for your
care, like a family member or friend. For example, you could ask that
we not use or disclose information about care 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 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.mmcportlavaca.com.
To obtain a paper
copy of this notice, Memorial Medical Center, Attn: Privacy Officer,
815 N. Virginia Street, Port Lavaca, Texas 77979.
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 medical information 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 waiting room. The notice
will contain on the first page, in the top right-hand corner, the
effective date. In addition, each time you register at the front desk
for treatment or health care services as an inpatient or outpatient,
we will offer you 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 Memorial Medical Center or with the Secretary of the Department
of Health and Human Services. To file a complaint with the Memorial
Medical Center, contact Lynne Voskamp, Director Clinical Services,
361-552-0437 or Becky Malone, Director Health Information/Privacy
Officer, 361-552-0244. 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 medical information not covered by this notice
or the laws that apply to us will be made only with your written permission.
If you provide us permission to use or disclose medical information
about you, you may revoke that permission, in writing, at any time.
If you revoke your permission, 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.
***************
The final HIPPA privacy rules prohibit the notice and
consent from being combined into a single document.
