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Sumter
Regional Hospital and Affiliates
NOTICE OF
PRIVACY PRACTICES
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.
Healthcare
Providers make and keep records of medical information.
While you are a patient here, we will use and
disclose your medical information
-
To provide treatment to you
and to keep a record describing your care
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To receive payment for the
care we provide
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To administer the hospital
properly
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To comply with law
This Notice summarizes the ways we may use and
disclose medical information about you. It also
describes your rights and our duties regarding
the use and disclosure of your medical information.
This Notice applies to all records of your care
at the Hospital, whether made by Hospital personnel
or by your personal doctor. Your doctor and other
health care providers may use a different Notice
and policy regarding the use and disclosure of
your medical information in their offices.
When we use
the word “we” or “Hospital”
we mean the Sumter Regional Hospital, its affiliates,
medical professionals and other parties who assist
us in our business.
We are required
by law:
-
To keep your medical information
confidential in accordance with legal requirements,
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To give you this Notice of
our legal duties and
privacy practices with respect to your medical
information, and
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To follow the terms of the
Notice that is currently in effect.
PERSONS COVERED BY THIS NOTICE
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All employees, staff and other
Hospital personnel,
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The following entities, sites
and locations: Sumter Regional Hospital, Ideal
Health Care Center, Hospice of Americus and
Sumter County, Ellaville Primary Medicine
Center, Ellaville Pediatrics Medicine Center,
Ellaville Internal Medicine Center, Buena
Vista Internal Medicine Center, and the Organized
Health Care Arrangement comprised of the Sumter
Regional Hospital, Medical Staff and the Provider
Hospital Organization (PHO). In addition,
these entities, sites and locations may share
medical information with each other for the
treatment, payment and administrative purposes
described in this Notice,
-
Persons or entities performing
services for the Hospital under agreements
containing privacy protections or to which
disclosure of medical information is permitted
by law,
-
Persons or entities with whom
the Hospital participates in managed care
arrangements,
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Our volunteers and medical,
nursing and other health care students, and
-
Members of the Hospital Medical
Staff and other medical professionals involved
in your care or performing peer review, quality
improvement, medical education and other services
for the Hospital.
USES
AND DISCLOSURES OF YOUR MEDICAL INFORMATION
We use and
disclose medical information in the ways described
below.
Treatment.
We may use your medical information to provide
medical treatment or services to you. We may disclose
medical information about you to doctors, nurses,
technicians, medical, nursing or other health
care students, or other personnel taking care
of you. 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 you can have appropriate
meals. Departments of the Hospital may share your
medical information to schedule the tests and
procedures you need, such as prescriptions, laboratory
tests and x-rays. We also may disclose your medical
information to health care facilities if you need
to be transferred from the Hospital to another
hospital, a nursing home, a home health provider
or a rehabilitation center. We also may disclose
your medical information to people outside the
Hospital who are involved in your care after you
leave the Hospital such as family members or pharmacists.
Payment.
We may use and disclose your medical information
so that the treatment and services you receive
can be billed and collected from you, an insurance
company or another third party. For example, we
may give your health plan information about surgery
you received so your health plan will pay us for
the surgery. We also may tell your health plan
about a treatment you are going to receive in
order to obtain prior approval from your plan
to cover payment for the treatment.
Health
Care Operations. We may use and disclose
your medical information for Hospital operations,
such as for peer review, performance improvement,
risk management, and our compliance with licensure,
accreditation or certification requirements. For
example, we may disclose your medical information
to physicians on our Medical Staff who review
treatment of patients. We may disclose information
to doctors, nurses, technicians, medical, nursing
or other health care students, and Hospital personnel
for teaching. We may combine medical information
about many patients to decide what services the
Hospital should offer, and whether new services
are cost-effective and how we compare with other
hospitals. Sometimes, we may remove identifying
information from this medical information so others
may use it to study health care and health care
delivery without learning who you are. We may
disclose information to other health care providers
involved in your treatment to permit them to carry
out the work of their facility or to get paid.
For example, we may provide information about
your treatment to an ambulance company that brought
you to the Hospital so that the ambulance company
can get paid for their services.
Activities
of Our Affiliates. We may disclose your
medical information to our affiliates in connection
with your treatment or other hospital activities.
Activities
of Organized Health Care Arrangements in Which
We Participate. For certain activities,
the Hospital, members of its Medical Staff and
other independent professionals are called an
Organized Health Care Arrangement. We may disclose
information about you to health care providers
participating in our Organized Health Care Arrangements,
such as a managed care or physician-hospital organization.
Such disclosures would be made in connection with
our services, your treatment under a health plan
arrangement, and other activities of the Organized
Health Care Arrangement.
IMPORTANT NOTICE
The
Hospital may share your medical information with
members of the Hospital Medical Staff and other
independent medical professionals in order to
provide treatment and perform other activities
such as peer review, quality improvement, medical
education and other services for the Hospital.
While those professionals may follow this Notice
and otherwise participate in the privacy program
of the Hospital, they are independent professionals
and the Hospital expressly disclaims any responsibility
or liability for their acts or omissions.
Health Services, Treatment Alternatives and Health-Related
Benefits. We may use and disclose your medical
information to tell you about (i) health-related
products or services that we offer, (ii) other
providers participating in a health care network
that we participate in, (iii) possible treatment
options or alternatives, or (iv) health-related
benefits or services that may be of interest to
you. We also may use that information to communicate
with you to coordinate your care. We may use and
disclose your medical information to contact and
remind you of an appointment for treatment or
medical care.
Fundraising.
We may use your medical information to raise money
for the Hospital. We may disclose information
such as your name, address, telephone number,
gender, age and the dates you received treatment
at the Hospital to our fundraising foundation
so that it may contact you. If you do not want
the Hospital to contact you for fundraising, please
notify the Contact Person listed below in writing.
Hospital
Directory. We may include certain information
about you in the Hospital Directory while you
are a patient in the Hospital. This information
may include your name, your room number, your
general condition (fair, stable, etc.) and your
religious affiliation. Your religious affiliation
may be given to a member of the clergy, such as
a priest or rabbi, even if they don’t ask
for you by name. Disclosure of your room will
not reveal that you are in a specific unit or
area of the Hospital, if such information would
reveal that you are at the Hospital for treatment
of rape or attempted rape, HIV/AIDS, or alcohol/drug
abuse. Directory information, except for your
religious affiliation, may be released to people
who ask for you by name. This is so your family,
friends and clergy can visit you in the Hospital
and generally know how you are doing. If you do
not want this information given out, please tell
the registration clerk.
Individuals
Involved in Your Care or Payment for Your Care.
We may release your medical information to the
person you named in your Durable Power of Attorney
for Health Care (if you have one), or to a friend
or family member who is your personal representative
(i.e., empowered under state or other law to make
health-related decisions for you). We may give
information to someone who helps pay for your
care. In addition, we may disclose your medical
information to an entity assisting in disaster
relief efforts so that your family can be notified
about your condition.
Research.
We may use and disclose your medical information
for research purposes. Most research projects,
however, are subject to a special approval process.
Most research projects require your permission
if a researcher will be involved in your care
or will have access to your name, address or other
information that identifies you. However, the
law allows some research to be done using your
medical information without requiring your authorization.
Required
By Law. We will disclose your medical
information when federal, state or local law requires
it. For example, the Hospital must comply with
child abuse reporting laws and laws requiring
us to report certain diseases or injuries to state
or federal agencies.
Serious
Threat to Health or Safety. We may use
and disclose your medical information when necessary
to prevent a serious threat to your health and
safety or the health and safety of the public
or another person.
Note:
Georgia and Federal Law provide protection for
certain types of health information, including
information about alcohol or drug abuse, mental
health and AIDS/HIV, and may limit whether and
how we may disclose information about you to others.
SPECIAL
SITUATIONS
Organ
and Tissue Donation. If you are an organ
donor, we may release your medical information
to organizations that handle organ procurement
or organ, eye or tissue transplantation or to
an organ donation bank, as necessary to aid in
its organ or tissue donation and transplantation
process.
Military
and Veterans. If you are a member of
the U.S. or foreign armed forces, we may release
your medical information as required by military
command authorities.
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.
Minors.
If you are a minor (under 18 years old), the Hospital
will comply with Georgia law regarding minors.
We may release certain types of your medical information
to your parent or guardian, if such release is
required or permitted by law.
Public
Health Risks. We may disclose your medical
information for public health purposes:
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To prevent or control disease,
injury or disability,
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To report births and deaths,
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To report child or adult abuse,
neglect or violence,
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To report reactions to medications
or problems with products,
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To notify people of recalls
of products they may be using, and
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To notify a person who may
have been exposed a disease or may be at risk
for getting or spreading a disease or condition.
Health
Oversight Activities. We may disclose
your medical information to a federal or state
agency for health oversight activities such
as audits, investigations, inspections, and
licensure of the Hospital and of the providers
who treated you at the Hospital. These activities
are necessary for the government to monitor
the health care system, government programs,
and compliance with laws.
Lawsuits
and Disputes. We may disclose your
medical information to respond to a court or
administrative order or a search warrant. We
also may disclose your medical information in
response to a subpoena, discovery request, or
other lawful process by someone else involved
in a dispute, but only if efforts have been
made to tell you about the request and you have
been provided an opportunity to object or to
obtain an appropriate court order protecting
the information requested.
Law
Enforcement. Subject to certain conditions,
we may disclose your medical information for
a law enforcement purpose upon the request of
a law enforcement official.
Medical
Examiners and Funeral Directors. We
may disclose your medical information to a medical
examiner or funeral director so they may carry
out their duties.
National
Security. We may disclose your medical
information to authorized federal officials
for national security activities authorized
by law.
Protective
Services. We may disclose your medical
information to authorized federal officials
so they may provide protection to the President
and other persons.
Inmates.
If you are an inmate of a correctional institution
or under the custody of a law enforcement officer,
we may release your medical information to the
correctional institution or a law enforcement
officer. This release would be necessary for
the Hospital to provide you with health care,
to protect your health and safety or the health
and safety of others, or for the safety and
security of the law enforcement officer or the
correctional institution.
YOUR
PRIVACY RIGHTS
Right
to Review and Right to Request a Copy.
You have the right to review and copy medical
information in your medical and billing records.
The Health Information Management (HIM) Department
has a request form you can fill out to review
or copy your medical information, and to tell
you how much it will cost. The Hospital will tell
you if it cannot fulfill your request. If you
are denied the right to see or copy your medical
information, you may ask us to reconsider our
decision. Depending on the reason for the decision,
we may ask a licensed health care professional
to review your request and its denial. We will
comply with this person’s decision.
Right
to Amend. If you feel your medical information
in our records is incorrect or incomplete, you
may ask us in writing to amend the information.
You must provide a reason to support your requested
amendment. We will tell you if we cannot fulfill
your request. The Contact Person listed below
can help you with your request.
Right
to an Accounting of Disclosures. You
have the right to make a written request for a
list of certain disclosures the Hospital has made
of your medical information. This list is not
required to include all disclosures we make. Disclosure
for treatment, payment, or Hospital administrative
purposes, disclosures made before April 14, 2003,
disclosures made to you or which you authorized,
and other disclosures are not required to be listed.
The Contact Person listed below can help you with
this process, if needed, and can tell you how
much it will cost.
Right
to Request Restrictions on Disclosures.
You have the right to make a written request to
restrict or put a 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 your medical information
that we disclose to someone involved in your care
or the payment for your care, like a family member
or friend.
We
are not required to agree to your request.
However, if we do agree, we will comply with your
request unless the information is needed to provide
you with emergency treatment or to make a disclosure
that is required under law. 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
adult children.
Right
to Request Confidential Communications.
You have the right to make a written 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 contact you only
at work or by mail. 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. The Contact Person listed
below can help you with these requests if needed.
Right
to a Paper Copy of This Notice. You have
the right to receive a paper copy of this Notice
at any time even if you have agreed to receive
this Notice electronically. You may obtain a copy
of this Notice at our website, www.sumterregional.org
or a paper copy from the Contact Person listed
below.
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 for any information we receive
in the future. We will post the current Notice
in the Hospital and on the Hospital’s website.
COMPLAINTS
If you believe
your privacy rights have been violated, you may
file a written complaint with the Hospital or
with the Secretary of the Department of Health
and Human Services or HHS. Generally, a complaint
must be filed with HHS within 180 days after the
act or omission occurred, or within 180 days of
when you knew or should have known of the action
or omission. To file a complaint with the Hospital,
contact the Director of Health Information Management
at 100 Wheatley Drive, Americus, Georgia 31709.
You will not be denied care or discriminated against
by the Hospital for filing a complaint.
OTHER
USES OF MEDICAL INFORMATION
Other uses and disclosures of your medical information
not covered by this Notice or the laws and regulations
that apply to the Hospital will be made only with
your written permission. If you give 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 your medical information
for the reasons covered by your written authorization,
but the revocation will not affect actions we
have taken in reliance on your permission. You
understand that we are unable to take back any
disclosures we have already made with your permission,
we still must continue to comply with laws that
require certain disclosures, and we are required
to retain our records of the care that we provided
to you.
If
you have any questions about this Notice, please
contact the Privacy Officer.
Effective
Date: [April/14/2003]
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