Notice of Privacy Practices

Joint Notice of Privacy Practices
(Puede obtener una copia de este formulario en Espanol, si la pide.)
Effective Date: August 20, 2012

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.

1. Purpose: Wadley Regional Medical Center, LP, and its professional staff, employees, and volunteers and all of its affiliated entities (referred to collectively as Hospital) follow the privacy practices described in this Notice. The Hospital is required by law to maintain the privacy of your medical information. This Notice describes how we may use and disclose your medical information. Not every use and disclosure in a category will be listed.
    
2. Organized Health Care Arrangement. The Hospital and its medical staff participate together in an organized health care arrangement to provide health care to you at the Hospital. This Notice applies to physicians and other members of the Medical Staff who have agreed to abide by its terms concerning the services they perform at the Hospital. This Notice does not create an agency relationship, a joint venture, or any other legal relationship between those covered by this Notice. Under this arrangement, the Hospital may share your medical information as necessary for treatment, payment and health care operations relating to the organized health care arrangement.
    
3. Uses and Disclosures for Treatment, Payment, and Health Care Operations. We will use and disclose your medical information for treatment, payment and health care operations. Treatment involves providing and coordinating your care. For example, we may disclose your information to a specialist to help diagnose or treat you. Payment involves uses and disclosures to assist in obtaining payment for our services. For example, we may disclose your information to health plans or other payors to determine whether you are enrolled with the payor or eligible for health benefits, submit claims for payment, and provide information to entities that help us submit bills and collect amounts owed. Health care operations involves our standard internal operations, such as quality assurance activities, peer review, arranging for legal services, and training. Your protected health information is subject to electronic disclosure.
    
4. Other Uses and Disclosures Not Requiring an Authorization. Your medical information may be used and disclosed as described below:
    
    
   • Hospital directory (which may include your name, general condition, and your location in the Hospital).
   • Religious affiliation and directory information to a hospital chaplain or member of the clergy.
   • Family members or close friends involved in your care or payment for your treatment.
   • A government disaster relief agency if you are involved in a disaster relief effort.
   • To provide appointment reminders to you.
   • To inform you of treatment alternatives or benefits or services related to your health. If we receive anything of value for making these communications, we will notify you of this fact, and you will have an opportunity to opt out of future communications.
   • To contact you to raise funds for the Hospital, but information disclosed to a third party assisting us with fundraising will be limited to your name, address, phone number, and the dates you received services at the Hospital. You will have the opportunity to opt out of receiving fundraising communications.
   • As required by law.
   • Public health activities, including disease prevention, injury or disability; reporting births and deaths; reporting child abuse or neglect; reporting reactions to medications or product problems; notification of recalls; infectious disease control; notifying government authorities of suspected abuse, neglect or domestic violence (if you agree or as required by law).
   • Health oversight activities (e.g., audits, inspections, investigations, and licensure activities).
   • Lawsuits and disputes (e.g., as required by a court or administrative order, or in response to a subpoena or other legal process).
   • Law enforcement (e.g., in response to legal process or as required or allowed by law).
   • Coroners, medical examiners, and funeral directors.
   • Organ and tissue donation organizations.
   • Certain research projects as approved by an Institutional Review Board or if certain conditions are met.
   • To prevent a serious threat to health or safety.
   • To military authorities if you are a member of the armed forces.
   • National security and intelligence activities.
   • Protection of the President or other authorized persons or foreign heads of state, or to conduct special investigations.
   • Inmates or others in custody to a correctional institution or law enforcement
   • Workers’ Compensation (in compliance with applicable laws).
   • To business associates (individuals or entities that perform functions on our behalf) (e.g., to install a new computer system) provided they agree to safeguard the information.
      
5. Substance Abuse Information. Alcohol and drug abuse information has special privacy protections. The Hospital will not disclose any information identifying an individual as being a substance abuse patient or provide any medical information relating to the patient’s substance abuse treatment unless (i) the patient consents in writing; (ii) a court order requires disclosure of the information; (iii) medical personnel need the information to meet a medical emergency; (iv) qualified personnel use the information for the purpose of conducting scientific research, management audits, financial audits, or program evaluation; or (v) it is necessary to report a crime of a threat to commit a crime, or to report abuse or neglect as required by law.
    
6. Your Authorization Is Required for Other Uses and Disclosures. Except as described above, we will not use or disclose your medical information unless you authorize (permit) the Hospital in writing to use or disclose your information. For example, we will not disclose psychotherapy notes, use or disclose your medical information for marketing purposes or sell your medical information unless you have signed an authorization or applicable law permits the use or disclosure. You may revoke your authorization, and thereby stop any future uses and disclosures, by notifying us in writing.
    
7. You Have Rights Regarding Your Medical Information. You have the following rights regarding your medical information, provided that you make a written request to invoke the right on the form provided by the Hospital:
   
   
   • Right to request restriction. You may request limitations on your medical information we use or disclose for health care treatment, payment, or operations (e.g., you may ask us not to disclose that you have had a particular surgery). We are not required to agree to your request, except for requests to restrict disclosures to a health plan when you have paid in full out-of-pocket for your care. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment.
   • Right to confidential communications. You may request communications in a certain way or at a certain location, but you must specify how or where you wish to be contacted.
   • Right to inspect and copy. You have the right to look at and obtain a copy of your medical records, billing records, and other records used to make decisions about your care. We may charge you a fee for our costs to copy the information. Under limited circumstances, your request may be denied and you may request review of the denial by another licensed health care professional chosen by the Hospital. The Hospital will comply with the outcome of the review. If your information is stored electronically and you request an electronic copy, we will provide it to you in a readable electronic form and format.
   • Right to request amendment. If you believe that the medical information we have about you is incorrect or incomplete, you have the right to request that your records be amended. Under limited circumstances, the Hospital may deny your request for amendment. If denied, you will receive an explanation for the decision and information explaining your options.
   • Right to accounting of disclosures. You may request a list of instances where we have disclosed your medical information for certain types of disclosures. The accounting will not include disclosures that we are not required to record, such as disclosures made pursuant to an authorization. The first accounting you request within a 12-month period is free, but we will charge a fee for any additional lists requested within the same 12-month period.
   • Right to a copy of this Notice. You may request a paper copy of this Notice at any time, even if you have been provided with an electronic copy. You may obtain an electronic copy of this Notice at our website, www.wadleyhealth.com
      
8. Requirements Regarding This Notice. The Hospital is required by law to provide you with this Notice. We will be governed by this Notice for as long as it is in effect and are also required to comply with any federal or state laws that impose stricter standards than those described in this Notice. The Hospital may change this Notice at any time and these changes will be effective for medical information we have about you as well as any information we receive in the future. Each time you register at the Hospital for health care services as an inpatient or outpatient, you may receive a copy of the Notice in effect at the time.
    
9. Complaints. If you believe your privacy rights have been violated, you may file a complaint with the Hospital or with the Secretary of the United States Department of Health and Human Services. You will not be penalized or retaliated against in any way for making a complaint to the Hospital or the Department of Health and Human Services. If we discover a breach by us or our business associates involving your medical information that is not encrypted or meets other security requirements, we will notify you of the breach by letter or other method permitted by law.
    
   Contact the Hospital’s Regional Compliance and Privacy Officer at (903) 798-8086 if:
   
   
   • You have a complaint;
   • You have any questions about this Notice; or
   • You wish to obtain a form to exercise your individual rights described in section 7 of this Notice.