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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.
Uses and Disclosures of Protected Health Information
Your Rights
Complaints
This notice of Privacy Practices describes how we may use and disclose your protected health information (PHI) to carry out treatment, payment or health care operations (TPO) and for other purposes that are permitted or required by law. It also describes your right to access and control your protected health information. "Protected health information" is information, including demographic information, that may identify you and that relates to your past, present or future physical or mental health or condition and related health care services.
Johns Community Hospital and the Health Center are required by law to make sure that medical information that identifies you is kept private, to give you this notice of our legal duties and privacy practices with respect to your medical information and to follow the terms of this Notice as long as it is currently in effect. If we revise this Notice, we will follow the terms of the revised Notice.
Your protected health information may be used and disclosed by Johns Community Hospital, your physician, our office staff and others outside of our Hospital and Health Center who are involved in your care and treatment for the purpose of providing health care services to you, to pay your health care bills, to support the operation of the hospital, and any other use required by law.
Treatment: We will use and disclose your protected health information to provide, coordinate, or manage your health care and any related services. This includes the coordination or management of your health care with a third party. For example, your protected health information may be provided to a physician to whom you have been referred or to a radiologist or other consultants to ensure that the hospital or physician has the necessary information to diagnose or treat you.
Payment: Your protected health information will be used, as needed, to obtain payment for your health care services. For example, obtaining approval for a hospital stay may require that your relevant protected health information be disclosed to a health plan or insurance company to obtain approval for the hospital admission.
Healthcare Operations: We may use or disclose, as needed, your protected health information in order to support the business activities of Johns Community Hospital or Health Center. These activities include, but are not limited to, quality assessment and review, training of medical students, licensing, and contacting you to remind you of your appointment.
We may use or disclose your protected health information in the following situations without your authorization as Required by Law: Public Health Activities (disease prevention, injury or disability, reporting of births and deaths, reporting abuse, neglect or domestic violence, reporting reactions to medications or medical products, notification of recalls, Food and Drug Administration requirements, and infectious disease control); Health Oversight Activities (or activities authorized by law such as audits, investigations, inspections, and licensure which are necessary for the government to monitor the health care system, government programs and compliance with civil rights laws); Coroners, Medical Examiners and Funeral Directors; Organ and Tissue Donation (We may release medical information to organizations that handle organ procurement or organ, eye or tissue transplantation or to an organ donation bank to facilitate organ or tissue donation or transplantation); Research; Governmental Disclosures (Criminal Activity, Investigation of crimes, about inmates to correctional institutions or law enforcement officials, Armed Forces and National Security); Workers' Compensation; Disaster Relief Agencies; and when required by the Secretary of the Department of Health and Human Services to investigate or determine our compliance with the Health Insurance Portability and Accountability Act.
We may also include your name and location in the hospital on the Hospital Census sheet. If you do not want us to list this information in our directory, you must tell us that you object. We may release your religious affiliation to the members of the clergy. If you do not want us to share this information with the clergy, you must tell us that you object. We may release medical information about you to family members, other relative or close personal friend who is involved in your medical care or payment for your treatment. If you are able and available to agree or object, we will give you the opportunity to object prior to disclosing any information. If you are unable or unavailable to agree or object, our health professionals will use their best judgment in communicating with your family and others.
Your Authorization is required for other disclosures. Except as described above, we will not use or disclose your medical information unless you authorize Johns Community Hospital in writing to disclose your information. You may revoke your authorization, which will be effective only after the date of receipt of your written revocation.
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You have the following rights regarding medical information we maintain about you:
You have the Right to Inspect and Copy your Medical Information. Johns Community Hospital and The Health Center will charge a fee for copying and mailing. We may deny your request to inspect and copy in certain limited circumstances, such as psychotherapy notes, information compiled in a reasonable anticipation of, or use in, a civil, criminal, or administrative action or proceeding, and protected health information that is subject to law that prohibits access to protected health information.
You have the Right to Request Restriction. You may request limitations on your medical information we use or disclose for health care treatment, payment or operations, but we are not required to agree to your request. If we agree, we will comply with your request unless the information is needed to provide you with emergency treatment. You may also request that any part of your protected health information not be disclosed to family members or friends who may be involved in your care or for notification purposes as described in this Notice of Privacy Practices. Your request must state the specific restriction requested and to whom you want the restriction to apply.
You have the Right to Request Confidential Communication. You have the right to request that we communicate with you about medical matters in a certain way or in a certain location. For example, you can ask that we only contact you by telephone at work or that we only contact you by mail at home. Your request must specify how or where you wish to be contacted.
You have the Right to Request Amendment. If you believe that the medical information we have about you is incorrect or incomplete, you may request an amendment. Johns Community Hospital and the Health Center are not required to accept the amendment. If we deny your request for amendment, you have the right to file a statement of disagreement with us and we may prepare a rebuttal to your statement and will provide you with a copy of any such rebuttal.
You have the Right to an Accounting of Disclosures. You may request a list of the disclosure of your medical information that have been made to persons or entities other than for treatment, payment or operations.
You have the Right to a Copy of this Notice. You have a right to a paper copy of this notice. You may ask us to give you a copy of this Notice at any time. You may obtain an electronic copy of this Notice at our web site, http://www.johnscommunityhospital.org. Paper copies of this notice will be available at the Health Center desks and Johns Community Hospital admission and registration areas.
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If you believe that your privacy rights have been violated, you may file a complaint with Johns Community 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 with Johns Community Hospital or the Department of Health and Human Services. If you have a complaint, contact Ernest Balla, CEO, Johns Community Hospital, 305 Mallard Lane, Taylor, Texas 76574.
To file a complaint with the Department of Health and Human
Services:
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file online at:
www.hhs.gov/ocr/hipaa/
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or mail your complaint to HIPAA
Complaint, Office for Civil Rights, Region VI U.S. Dept.
Health & Human Services, 1301 Young St., Suite 1169, Dallas
Texas 75202
For further information about this Privacy Notice, please contact
Tim Tarbell, Assistant Administrator of Support Services at
512-352-7611, ext. 282.
Effective April 14, 2003
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