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Privacy Notice
Jackson Parish Hospital
165 Beech Springs
Rd.
Jonesboro, LA 71251
(318)
259-4435
An Affiliate of St. Francis Medical
Center
Privacy Notice
I.
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. You should
read this Notice before signing the Consent that authorizes the use
and disclosure of health information for treatment, payment, and
health care operations.
II.
Our duty to
Safeguard Your Protected Health
Information
Individually
identifiable information about your past, present or future health
or condition, the provision of health care to you, or payment for
the health care is considered “Protected Health Information”
(“PHI”). We are
required to extend certain protections to your PHI, and to give you
this notice about our privacy practices that explains how, when and
why we may use or disclose your PHI. Except in specified
circumstances, we must use or disclose only the minimum necessary
PHI to accomplish the purpose of the use or
disclosure.
We are required to
follow the privacy practices described in this Notice, though we
reserve the right to change our privacy practices and the terms of
this Notice at any time.
If we do so, we will post a new notice in the
Emergency Department and the hospital
Lobby. You may
request a copy of the new notice from the Administrative
Assistant.
III.
How We May Use
and Disclose Your Protected Health
Information
We use and disclose PHI
for a variety of reasons.
For most uses/disclosures, we must obtain your consent. With your consent we can
release your information for treatment, payment and healthcare
operations. For others,
we must have your written authorization. With authorizations, we can
release your information to anyone you specify on the
authorization. If we
disclose your PHI to an outside entity in order for that entity to
perform a function on our behalf, we must have in place an agreement
with the outside entity that it will extend the same degree of
privacy protection to your information as we must apply to your
PHI. However, the law
provides that we are permitted to make some uses/disclosures without
your consent or authorization. The following offers more description
and examples of our potential uses/disclosures of your
PHI.
¨
Uses and
Disclosures Relating to Treatment, Payment, or Health Care
Operations. Generally,
we must have your consent to use/disclose your PHI. With that consent, we may
use or disclose your PHI as follows:
For
Treatment: We may disclose your PHI to
doctors, nurses, and other health care personnel who are involved in
providing your health care.
For example, your PHI will be shared among members of your
treatment team, or with our pharmacy staff. Your PHI may also be shared
with outside entities performing ancillary services relating to your
treatment, such as lab work or x-rays.
To Obtain
Payment: We may use/disclose your PHI
in order to bill and collect payment for your health care
services. For example,
we may contact your employer to verify employment status, and/or
release portions of your PHI to the Medicare program, and/or private
insurer to receive payment for services that were delivered to
you.
For Health Care
Operations: We may use/disclose your PHI
in the course of operation of our facility. For example, use your PHI in
evaluating the quality of services provided, or disclose your PHI to
our attorney for audit purposes. Release of your PHI to state
agencies might also be necessary to determine your eligibility for
publicly funded services.
Appointment
Reminders: Unless you provide us with
alternative instructions, we may send appointment reminders and
other similar materials to your home.
Exceptions:
Although your consent is usually required for the
use/disclosure of your PHI for the activities describe above, the
law allows us to use/disclose your PHI without consent in certain
situations. For
example, we may disclose your PHI if needed for emergency treatment
if it is not reasonably possible to obtain your consent prior to the
disclosure and we think that you would give consent if able. Also, if we are required by
law to provide your treatment, we may use/disclose your PHI for
treatment, payment and operations without obtaining your prior
consent.
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Uses and
Disclosures Requiring Authorization
For uses and disclosures
beyond treatment, payment and operations purposes we are required to
have your written authorization, unless the use or disclosure falls
within one of the exceptions described below. Like consents,
authorizations can be revoked at any time to stop future
uses/disclosures except to the extent that we have already
undertaken an action in reliance upon your
authorization.
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Uses and
Disclosures Not Requiring Consent or
Authorization
When Required By
Law: We may disclose PHI when a
law requires that we report information about suspected abuse,
neglect or domestic violence, or relating to suspected criminal
activity, or in response to a court order. We must also disclose PHI to
authorities that monitor compliance with these privacy
requirements.
For Public Health
Activities:
We may disclose
PHI when we are required to collection information about disease or
injury, or to report vital statistics to the public health
authority.
For Health Oversight
Activities:
We may disclose PHI
to protection and advocacy agencies or other agencies responsible
for monitoring the health care system for such purposes as reporting
or investigation of unusual incidents.
Relating To
Decedents: We may disclose
PHI relating to an individual to the coroners, medical examiners or
funeral directors, and to organ procurement organizations relating
to organ, eye, or tissue donations or
transplants.
For Research
Purposes: In certain circumstances,
and under supervision of a privacy board, we may disclose PHI to
agencies for research purposes.
To Avert Threat to
Health or Safety: In order to avoid serous
threat to health or safety, we may disclose PHI as necessary to law
enforcement or other persons who can reasonably prevent or lessen
the threat of harm.
For Specific
Government Functions: We may disclose PHI of
military personnel and veterans in certain situations, to
correctional facilities in certain situations, to government
programs relating to eligibility and enrollment, and for national
security reasons, such as protection of the
President.
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Uses and
Disclosures of PHI from Alcohol or Other Drug records not Requiring
Consent or Authorization: The law provides that we may use/disclose
your PHI from alcohol and other drug records without consent or
authorization in the following
circumstances:
When Required By
Law: We may disclose PHI
when a law requires that we report information about suspected child
abuse and neglect, or when a crime has been committed on the
hospital premises or against hospital personnel, or in response to a
court order.
Relating To
Decedents: We may disclose
PHI relating to an individual’s death if state or federal law
requires the information for collection of vital statistics or
inquiry into cause of death.
For Research, Audit,
Or Evaluation Purposes:
In certain
circumstances, we may disclose PHI for research, audit or evaluation
purposes.
To Avert Threat to Health or Safety: In order to avoid a
serious threat to health or safety, we may disclose PHI to law
enforcement when a threat is made to commit a crime on the hospital
premises or against hospital
personnel.
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Uses and
Disclosures Requiring You to Have an Opportunity to Object: In the following situations,
we may disclose your PHI if we inform you about the disclosure in
advance and you do not object, as long as the disclosure is not
otherwise prohibited by law.
However, if there is an emergency situation and you cannot be
given the opportunity to object, disclosure may be made if it is
consistent with any prior expressed wishes and disclosure is
determined to be in your best interests. You must be informed and
given an opportunity to object to further disclosure as soon as you
are able to do so.
Patient
Directories:
Your name, location,
and general condition may be put into our patient directory for
disclosure to callers or visitors who ask for you by name. Additionally, your religious
affiliation may be shared with clergy.
To Families, Friends
or Others Involved in Your Care: We may share with these people information
directly related to their involvement in your care, or payment for
your care. We may also
share PHI with these people to notify them about your location,
general condition, or death.
IV.
Your Rights
Regarding Your Protected Health Information. You have the following
rights relating to your protected health
information:
To Request
Restriction on Uses/Disclosures: You have the right to ask that we limit how
we use or disclose your PHI.
We will consider your request, but are not legally bound to
agree to the restriction.
To the extent that we do agree to any restrictions on our
use/disclosure of your PHI, we will put the agreement in writing and
abide by it except in emergency situations. We cannot agree to limit
use/disclosures that are required by law. Please contact the Medical
Records Department Monday through Friday 8:00
.am. -
4:30 p.m.
To Choose How We
Contact You:
You have the right
to ask that we send you information at an alternative address or by
an alternative means.
We must agree to your request as long as it is reasonably
easy for us to do so.
Please contact the Business Office Monday through Friday
8:00 a.m. - 4:30 p.m.
To Inspect and Copy
Your Bill:
Unless your access
is restricted for clear and documented treatment reasons, you have a
right to see your protected health information if your put your
request in writing. We
will respond to your request within 30 days. If we deny your access, we
will give you written reasons for the denial and explain any right
you have to have the denial reviewed. If you want copies of your
PHI, a charge for copying may be imposed, depending on your
circumstances. You have
a right to choose what portions of your information you want copied
and to have prior information on the cost of copying. Please contact the Medical
Records Department Monday through Friday 8:00 a.m. – 4:30
p.m.
To Request Amendment
of Your PHI:
If you believe that
there is a mistake or missing information in our record of your PHI,
you may request, in writing, that we correct or add to the
record. We will respond
within 60 days of receiving your request. We may deny the request if
we determine that the PHI is (i) correct and complete; (ii) not
created by us and/or not part of our records, or; (iii) not
permitted to be disclosed.
Any denial will state the reasons for denial and explain your
rights to have the request and denial, along with any statement in
response that you provide, appended to your PHI. If we approve the request
for amendment, we will change the PHI and so inform you, and tell
others that need to know about the change in the PHI. Please contact the Medical
Records Department Monday through Friday 8:00 a.m. – 4:30
p.m.
To Find Out What
Disclosures Have Been Made:
You have the right
to get a list of when, to whom, for what purpose, and what content
of your PHI has been released other than instances of disclosure for
which you gave consent ( i.e. for treatment, payment, operations, to
you, your family, or the facility directory). The list also will not
include any disclosures made for national security purposes, to law
enforcement officials or correctional facilities. We will respond to your
written request for such a list within 60 days of receiving it. Your request can relate to
disclosures going as far back as six years. There will be no charge
for up to one such list each year. There may be a charge for
more frequent requests.
Please contact the Medical Records Department Monday through
Friday 8:00 a.m. – 4:30 p.m.
To Receive This
Notice: You have a right to
receive a paper copy of this notice and/or an electronic copy by
email upon request.
Please contact Administration during normal operating
hours.
V.
How To
Complain About Our Privacy
Practices
If you think we may have
violated your privacy rights, or you disagree with a decision we
made about access to your PHI, you may file a complaint with the
person listed in Section VI below. You also may file a written
complaint with the Secretary of the U.S. Department of Health and
Human Services. We will
take no retaliatory action against you if you make such
complaints.
VI.
Contact Person
for Information or to Submit a
Complaint:
If have questions about
this notice or any complaints about our privacy practices please
contact: Privacy Officer, (318)
395-4100.
VII.
Areas of Service
Affected by this Notice
This notice
applies to the following areas of
Jackson
Parish
Hospital:
A.
Jackson
Parish
Hospital
B.
Jackson
Parish
Hospital Emergency
Room
C.
Jackson
Parish
Hospital Clinical
Support Services/Diagnostic Center
D.
Jackson Parish
Hospital Clinics (including Walk-In and Physician
clinics)
E.
Any other entity
owned or operated by Jackson
Parish
Hospital
Version 5 July 16,
2003
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