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notice is intended to inform you about our practices
related to the protection of the privacy of your
medical records. Generally, we are required by
law to ensure that medical information that identifies
you is kept private. Further, we must give you
this information related to our legal duties and
privacy practices with respect to any medical
information we create or receive about you. We
are required by law to follow the terms of the
notice that is currently in effect.
This notice will explain how we may use and disclose
your medical information and your rights related
to any medical information that we have about
you. This notice applies to the medical records
that are generated in or by this hospital, whether
made by hospital personnel or your personal doctor.
Your personal doctor 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.
With few exceptions, we are required to obtain
your authorization for the use or disclosure of
the information. We have listed some of the reasons
why we might use or disclose your medical information
and some examples of the types of uses or disclosures
below. Not every use or disclosure is covered,
but all of the ways that we are allowed to use
and disclose information will fall into one of
these categories.
If you have any questions about the content of
this Notice of Privacy Practices, please contact
the Hospital’s Privacy Officer at
573-651-5500.
In addition to hospital departments, employees,
staff and other hospital personnel, the following
persons will also follow the practices described
in this Notice of Privacy Practices:
- Any health care professional who is authorized
to enter information in your medical record
- Any member of a volunteer group that we will
allow to help you while you are in the hospital
- The employees and staff of Southeast Home
Health, Southeast Hospice, Southeast Outpatient
Rehab, Southeast Medical Equipment, Southeast
Missouri Hospital Physicians LLC, Cardiac and
Vascular Surgeons, Southeast Missouri Hospital
Pharmacy, Southeast Missouri Hospital Retail
Pharmacy and Main Street Fitness will follow
this Notice of Privacy Practices.
- In addition, these other entities may share
medical information for treatment, payment or
health care operations as they are described
in this Notice of Privacy Practices. These other
entities are hereinafter referred to collectively
with the hospital as “Hospital.”
- Students and faculty of Southeast Missouri
Hospital College of Health Sciences and other
educational facilities for which the hospital
provides practice sites.
Uses and Disclosures of Medical Information
That Do Not Require Your Authorization:
We can use or disclose medical information about
you regarding your treatment, payment for services
or for hospital operations without your authorization.
For Treatment: To provide you with medical treatment
or services, we may need to use or disclose information
about you to doctors, nurses, technicians, medical
students or other hospital personnel who are involved
in your treatment. For example, a doctor may need
to know what drugs you are allergic to before
prescribing medications. Departments within the
hospital may share medical information about you
to coordinate your care. For instance, the laboratory
may request information to complete lab work.
We may also disclose medical information about
you to people who may be involved in your medical
care after you leave the hospital, such as home
health agencies, your family and clergy members.
For Payment: We may use and disclose
your medical information for the hospital to bill
and receive payment for the treatment that you
received here. For example, we may use or disclose
your medical information to your insurance company
so that your insurance company can pay us or reimburse
you for services received at the hospital. We
may also ask your insurance company for prior
authorization for a service to determine whether
the insurance company will cover it.
For Health Care Operations: We
can use and disclose medical information about
you for hospital operations. These include uses
and disclosures that are necessary to run the
hospital and make sure that our patients receive
quality care. For example, we may use or disclose
medical information about you to evaluate our
staff’s performance in caring for you. Medical
information about you and other hospital patients
may also be combined to allow us to evaluate whether
the hospital should offer additional services
or discontinue other services and whether certain
treatments are effective. We may also compare
this information with other hospitals to evaluate
whether we can make improvements in the care and
services that we offer. To best protect your privacy
when we are comparing medical information with
that of other hospitals, we will remove information
that identifies you.
Other Permitted Uses and Disclosures of
Your Medical Information:
We can use or disclose health information about
you without your authorization when there is an
emergency, when we are required by law to treat
you, when we are required by law to use or disclose
certain information or when there are substantial
communication barriers to obtaining consent from
you.
Further, we may use or disclose your health information
without your consent or authorization in any of
the following circumstances:
When it is required by law;
- When it involves use and disclosure for public
health activities, such as mandated disease
reporting, etc;
- When reporting information about victims of
abuse, neglect or domestic violence;
- When disclosing information for the purpose
of health oversight activities, such as audits,
investigations, licensure, or disciplinary actions
or legal proceedings or actions;
- When disclosing information for judicial and
administrative proceedings in accordance with
state and/or federal law, for instance, in response
to a court order, such as a court-ordered subpoena;
- When disclosing information for law enforcement
purposes, for instance, to locate or identify
a suspect, fugitive, witness or missing person;
regarding a victim of a crime who cannot give
consent or authorization because of incapacity;
regarding a death believed to be the result
of criminal conduct or regarding suspected criminal
conduct at the hospital;
- When disclosing information about deceased
persons to medical examiners, coroners and funeral
directors;
- When disclosing or using information for organ
and tissue donation purposes;
- When disclosing information related to a research
project when a waiver of authorization has been
approved by the Institutional Review Committee.
- For more information about this right, see
45 Code of Federal Regulations (C.F.R.) §164.512
(i);
- When we believe in good faith that the disclosure
is necessary to avert a serious health or safety
threat to you or to the public;
- When disclosure is necessary for specialized
government functions, such as military service,
for the protection of the President or for national
security and intelligence activities;
- When required by military command authorities,
if you are a member of the armed forces (or
if foreign military personnel, to appropriate
foreign military authorities);
- In the case of a prison inmate, information
can be released to the correctional facility
in which he or she resides for the following
purposes: (1) for the institution to provide
the inmate with health care; (2) to protect
the health and safety of the inmate or the health
and safety of others; (3) for the safety and
security of the correctional facility; and
When disclosure is necessary to comply with
worker’s compensation laws or purposes.
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We
may use or disclose your health information to
contact and remind you that you have an appointment
for treatment or medical care.
We may use or disclose your health information
to provide you with information about or recommendations
of possible treatment options or alternatives
that may interest you.
We may use or disclose your health information
to inform you about health benefits or services
that may interest you.
We may use or disclose your health information
in order to include you in the Hospital’s
patient directory. Directory information includes
your name, location in the Hospital and your general
condition. We may disclose information to people
that ask for you by name. In addition, a member
of clergy may obtain your religious affiliation,
even if they do not ask for you by name.
We may use health information about you to contact
you in an effort to raise money for the hospital.
Southeast Missouri Hospital Foundation may receive
contact information, which includes name, address,
phone number and the dates that you received services
from the hospital.
We may release health information about you to
a friend and/or family member who is involved
in your care. We can tell your family and/or friends
of your condition and that your are in the hospital
for treatment or services. We can also give this
information to someone who will help or is helping
to pay for your care.
We can disclose health information about you to
a public or private entity that is authorized
by law or its charter to assist in disaster relief
efforts, i.e., the American Red Cross, for the
purpose of notification of family and/or friends
of your whereabouts and condition.
Other Uses or Disclosures Not Covered
by This Notice:
Uses or disclosures not covered in this Notice
of Privacy Practices will not be made without
your written authorization. If you provide us
written authorization to use or disclose information,
you can change your mind and revoke your authorization
at any time, in writing. If you revoke your authorization,
we will no longer use or disclose the information.
However, we will not be able to take back any
disclosures that we have made pursuant to your
previous authorization.
Your Rights with Respect to Health Information:
Although your medical information record is the
physical property of the hospital, the information
in our medical information record belongs to you.
You have the following rights:
Right to Request Restrictions:
You have the right to request that we restrict
any use or disclosure of your health information.
We are not required to agree to any restriction
that you request. If we do agree to adhere to
your restrictions, we will comply with your request
unless the information is needed to provide you
treatment. Any request to restrict uses or disclosures
must be made in writing to the hospital’s
Privacy Officer. Your request must indicate (1)
what information you want limited; (2) whether
you want to limit our use, disclosure or both;
and (3) to whom you want the limits to apply.
For more information about this right, see 45
Code of Federal Regulations (C.F.R.) § 164.522(a).
Right to Receive Information in Certain Form and
Location: You have the right to receive information
about your health in a certain form and location.
For instance, you can request that we not contact
you at your work. To request confidential communications,
you must make your request in writing to the hospital’s
Privacy Officer. The request must tell us how
and/or where you want to receive the information.
We will accommodate reasonable requests.
For more information about this right, see 45
C.F.R. § 164.522(b).
Right to Inspect and Copy Protected Health
Information: You have the right to inspect
and copy your health information that may be used
to make decisions about your care, with the exception
of psychotherapy notes. If you want to see or
copy your medical information, you must submit
a request in writing to the hospital’s Medical
Records Department. If you request copies of information,
we may charge a fee for any costs associated with
your request, including the cost of copies, mailing
or other supplies.
In limited circumstances we can deny access to
your health information. If access is denied,
you can request that the denial be reviewed. A
licensed health care professional chosen by the
Hospital will review your request and the denial.
We will adhere to the decision of the reviewer.
For more information about this right, see 45
C.F.R. §164.524.
Right to an Accounting of Disclosures:
You have the right to an accounting of disclosures
of medical information that we have made, with
some exceptions. You must submit your request
in writing to the hospital’s Privacy Officer.
Your request must state a time period that may
not be longer than six (6) years and may not include
date before April 14, 2003. You should include
how you want the information reported to you,
i.e., by paper, electronically, etc. You have
the right to an accounting every twelve (12) months.
If you request more than one (1) accounting in
a twelve (12) month period, we may charge you
a reasonable fee for the cost of providing the
accounting. We will notify you of the charge for
such a request and you can choose to withdraw
or change your request before any costs are incurred.
For more information about this right,
see 45 C.F.R. §164.528.
Right to Request Amendment to Protected
Health Information: You have a right
to request that your health information be changed
if you believe that it is incorrect or incomplete.
You have a right to request a change for as long
as the information is kept by the hospital. To
request a change in your information, you must
submit it in writing to the hospital’s Privacy
Officer; you must give the reason that you want
the information changed, including why you think
the information is incorrect or incomplete.
We can deny your request if it is not in writing
or does not include a reason why the information
should be changed. We can also deny your request
for the following reasons: (1) the information
was not created by the Hospital, unless the person
or entity that did create the information is no
longer available; (2) the information is not part
of the medical record kept by or for the Hospital;
(3) the information is not part of the information
that you would be permitted to inspect or copy;
or (4) we believe the information is accurate
and complete.
For more information about this right,
see 45 C.F.R. §164.526.
Right to Receive a Copy of this Notice
of Privacy Practices: You have the right
to a paper copy of this Notice of Privacy Practices.
Even if you have agreed to receive this notice
in another form, you can still have a paper copy
of this notice. To obtain a paper copy of this
notice, contact the Privacy Officer. You can obtain
a copy of this notice at our Web site, www.southeastmissourihospital.com.
Complaints
If you believe that we have violated any of your
privacy rights or have not adhered to the information
contained in this Notice of Privacy Practices,
you can file a complaint by putting it in writing
and sending it to the Hospital’s Privacy
Officer.
You may also file a complaint with the Secretary
of the U.S. Department of Health and Human Services.
You will not be retaliated against for filing
a complaint with either the hospital or the U.S.
Department of Health and Human Services.
Changes to This Notice of Privacy Practices
We reserve the right to change or modify the information
contained in this Notice of Privacy Practices.
Any changes that we make can be effective for
any health information that we have about you
and any information that we might obtain. Each
time you receive services from the hospital, we
will provide the most current copy of our Notice
of Privacy Practices. The most recent version
of the Privacy Practices will be posted in our
building. Also, you can call or write our contact
person, whose information is included on the first
page of this Notice of Privacy Practices, to obtain
the most recent version of this notice.
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