Patient Privacy Statement
In accordance with Title VI and VII of the Civil Rights Acts of 1964 and
their implementing regulations, Ashley County Medical Center will directly
or through contractual or other arrangements admit and treat all persons
without regard to race, color, creed, religion, sex or national origin
in its provision of services and benefits, including assignments or transfers
within the facility and referrals to or from the facility.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND
DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW CAREFULLY
If you have questions about this notice, please contact Kayla Hill, RHIA,
Health Information Department Director/Privacy Officer at 870-364-1242.
WHO WILL FOLLOW THIS NOTICE:
- This notice describes our hospital’s practices and that of:
- Any health care professional authorized to enter information into your
- All departments and units of the hospital.
- Any member of a volunteer group we allow to help you while you are in the hospital.
- All employees, staff, and other hospital personnel.
OUR PLEDGE REGARDING MEDICAL INFORMATION:
We understand that medical information about you and your health is personal.
We are committed to protecting medical information about you. We create
a record of the care and services you receive at the hospital. We need
this record to provide you with quality care and to comply with certain
legal requirements. This notice applies to all of the records of your
care generated by the 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.
This notice will tell you about the ways in which we may use and disclose
medical information about you. We also describe your rights and certain
obligations we have regarding the use and disclosure of medical information.
We are required by law to:
- Make sure that medical information that identifies you is kept private;
- Give you this notice of our legal duties and privacy practices with respect
to medical information about you; and
- Follow the terms of the notice that is currently in effect.
HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU.
The following categories describe different ways that we use and disclose
medical information. For each category of uses or disclosures, we will
explain what we mean and try to give some examples. Not every use or disclosure
in a category will be listed. However, all of the ways we are permitted
to use and disclose information will fall within one of the categories.
We may disclose medical information about you to provide you with medical
treatment or services. We may disclose medical information about you to
doctors, nurses, technicians, medical students, or other hospital personnel
who are involved in taking care of you at the hospital. 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 tell the dietitian if you have diabetes so that we can arrange for
appropriate meals. Different departments of the hospital also may share
medical information about you in order to coordinate the different things
you need such as prescriptions, lab work, and x-rays. We also may disclose
medical information about you to people outside the hospital who may be
involved in your medical care after you leave the hospital, such as family,
clergy, or others we use to provide services that are part of you care.
We may use and disclose medical information about you so that the treatment
and services you receive at the hospital may be billed to and payment
may be collected from you, an insurance company, or a third party. For
example, we may need to give your health plan information about surgery
you received at the hospital so your health plan will pay us or reimburse
you for the surgery. We may also tell your health plan about a treatment
you are going to receive to obtain prior approval or to determine whether
your plan will cover the treatment.
FOR HEALTH CARE OPERATIONS:
We may use and disclose medical information about you for hospital operations.
These uses and disclosures are necessary to run the hospital and make
sure that all of our patients receive quality care. For example, we may
use medical information to review our treatment and services and to evaluate
the performance of our staff in caring for you. We may also combine medical
information about many hospital patients to decide what additional services
the hospital should offer, what services are not needed, and whether certain
new treatments are effective. We may also disclose information to doctors,
nurses, technicians, medical students, and other hospital personnel for
review and learning purposes. We may also combine the medical information
we have with medical information from other hospitals to compare how we
are doing and see where we can make improvements in the care and services
we offer. We may remove information that identifies you from this set
of medical information so others may use it to study health care and health
care delivery without learning who the specific patients are.
We may use and disclose medical information to contact you as a reminder
that you have an appointment for treatment or medical care at the hospital.
We may use and disclose medical information to tell you about or recommend
possible treatment options or alternatives that may be of interest to you.
We may use information about you to contact you in an effort to raise
money for the hospital and its operations. We may disclose information
about you to a foundation related to the hospital so that the foundation
may contact you in raising money for the hospital. We only would release
contact information, such as your name, address, and phone number and
the dates you received treatment or services at the hospital. If you do
not want the hospital to contact you for fundraising efforts, you must
notify Pam Weatherly, Marketing/Public Relations Director at 870-364-1409
or Kayla Hill, RHIA, Health Information Department Director/Privacy Officer
at 870-364-1242 in writing.
We may include certain limited information about you in the hospital directory
while you are a patient in the hospital unless you are in our Generations
Unit where law prohibits us from releasing this information. This information
may include your name, location in the hospital, and your religious affiliation.
The directory information, except your religious affiliation and Generations
patient information may also 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. To request your information
excluded from our directory, please inform the Admissions Representative
in writing when you are registered.
INDIVIDUALS INVOLVED IN YOUR CARE OR PAYMENT FOR YOUR CARE:
We may release medical information about you to a friend or family member
who is involved in your medical care. We may also give information to
someone who helps pay for your medical care. We may also tell your family
or friends your condition and that you are in the hospital. In addition,
we may disclose medical information about you to an entity assisting in
a disaster relief effort so that your family can be notified about your
condition, status, and location.
Under certain circumstances, we may use and disclose medical information
about you for research purposes. For example, a research project may involve
comparing the health and recovery of all patients who received one medication
to those who received another, for the same condition. All research projects,
however, are subject to a special approval process. This process evaluates
a proposed research project and its use of medical information, trying
to balance the research needs with patients’ need for privacy of
their medical information. Before we use or disclose medical information
for research, the project will have been approved through this research
approval process, but we may, however, disclose medical information about
you to people preparing to conduct a research project, for example, to
help them look for patients with specific medical needs, as long as the
medical information they review does not leave the hospital. We will almost
always ask for your specific permission if the researcher will have access
to your name, address, or other information that reveals who you are,
or will be involved in your care at the hospital.
AS REQUIRED BY LAW:
We will disclose medical information about you when required to do so
by federal, state, or local law (i.e. including but not limited to Discharge
Data to Arkansas Department of Health, Arkansas Cancer Registry, HIV,
Birth Defects, etc.)
TO AVERT A SERIOUS THREAT TO HEALTH OR SAFETY:
We may use and disclose medical information about you when necessary to
prevent a serious threat to your health and safety or the health and safety
of the public or another person. Any disclosure, however, would only be
to someone able to help prevent the threat.
ORGAN AND TISSUE DONATION:
We, as required by law, will use and disclose medical information to organizations
that handle organ procurement or organ, eye, or tissue transplantation
or to an organ donation bank, as necessary to facilitate organ or tissue
donation and transplantation.
MILITARY AND VETERANS:
If you are a member of the armed forces, we may release medical information
about you as required by military command authorities. We may also release
medical information about foreign military personnel to the appropriate
foreign military authority.
We may release medical information about you for Workers’ Compensation
or similar programs. These programs provide benefits for work-related
injuries or illnesses.
PUBLIC HEALTH RISKS:
We may disclose medical information about you for public health activities.
These activities generally include the following:
HEALTH OVERSIGHT ACTIVITIES:
- to prevent or control disease, injury or disability;
- to report births and deaths;
- to report child/adult abuse or neglect;
- to report reactions to medications or problems with products;
- to notify people of recalls of products they may be using;
- to notify a person who may have been exposed to a disease or may be at
risk for contracting or spreading a disease or condition;
- to notify the appropriate government authority if we believe a patient
has been the victim of abuse, neglect, or domestic violence. We will only
make this disclosure if you agree or when required or authorized by law.
We may disclose medical information to a health oversight agency for activities
authorized by law. These oversight activities include, for example, audits,
investigations, inspections, and licensure. These activities are necessary
for the government to monitor the health care system, government programs,
and compliance with civil rights laws.
LAWSUITS AND DISPUTES:
If you are involved in a lawsuit or a dispute, we may disclose medical
information about you in response to a court or administrative order.
We may also disclose medical information about you in response to a subpoena,
discovery request, or other lawful process by someone else involved in
the dispute, i.e. Hospital Attorney acting as legal representative for
We may release medical information if asked to do so by a law enforcement
CORONERS, MEDICAL EXAMINERS AND FUNERAL DIRECTORS:
- In response to a court order, subpoena, warrant, summons, or similar process;
- To identify or locate a suspect, fugitive, material witness, or missing person;
- About the victim of a crime if, under certain limited circumstance, we
are unable to obtain the person’s agreement;
- About a death we believe may be the result of criminal conduct;
- In emergency circumstances to report a crime; the location of the crime
or victims; or the identity, description, or location of the person who
committed the crime.
We may release medical information to a coroner or medical examiner. This
may be necessary, for example, to identify a deceased person or determine
the cause of death. We may also release medical information about deceased
patients to funeral directors as necessary to carry out their duties.
NATIONAL SECURITY AND INTELLIGENCE ACTIVITIES:
We may release medical information about you to authorized federal officials
for intelligence, counterintelligence, and other national security authorized by law.
PROTECTIVE SERVICES FOR THE PRESIDENT AND OTHERS:
We may disclose medical information about you to authorized federal officials
so they may provide protection to the President, other authorized persons,
or foreign heads of state or conduct special investigations.
If you are an inmate of a correctional institution or under the custody
of a law enforcement official, we may release medical information about
you to the correctional institution or law enforcement official. This
release would be necessary (1) for the institution to provide you with
health care; (2) to protect your health and safety or the health and safety
of others; or (3) for the safety and security of the correctional institution.
YOUR RIGHTS REGARDING MEDICAL INFORMATION ABOUT YOU.
You have the following rights regarding medical information we maintain
RIGHT TO INSPECT AND COPY:
You have the right to inspect and copy medical information that may be
used to make decisions about your care. Usually, this includes medical
and billing records, but does not include psychotherapy notes.
To inspect and copy medical information that may be used to make decisions
about you, you must submit your request in writing to the Health Information
Department. If you request a copy of the information, we may charge a
fee for the costs of copying and mailing or other supplies associated
with your request.
We may deny your request to inspect and copy in certain very limited circumstances.
If you are denied access to medical information, you may request that
the denial be reviewed. Another licensed health care professional chosen
by the hospital will review your request and the denial. The person conducting
the review will not be the person who denied your request. We will comply
with the outcome of the review.
RIGHT TO AMEND:
If you feel that medical information we have about you is incorrect or
incomplete, you may ask us to amend the information. You have the right
to request an amendment for as long as the information is kept by or for
We may deny your request for an amendment if it is not in writing or does
not include a reason to support the request. In addition, we may deny
your request if you ask us to amend information that:
RIGHT TO AN ACCOUNTING OF DISCLOSURES:
- Was not created by us, unless the person or entity that created the information
is no longer available to make the amendment;
- Is not part of the medical information kept by or for the hospital;
- Is not part of the information which you would be permitted to inspect
and copy; or
- Is accurate and complete.
You have the right to request an “accounting of disclosures.”
This is a list of the disclosures we made of medical information about you.
To request this list or accounting of disclosures, you must submit your
request in writing to the Health Information Department. Your request
must state a time period, which may not be longer than six years and may
not include dates before
February 26, 2003
. Your request should indicate in what form you want the list (for example,
on paper, electronically). The first list you request within a 12-month
period will be free. For additional lists, we may charge you for the costs
of providing the list. We will notify you of the cost involved and you
may choose to withdraw or modify your request at that time before any
costs are incurred.
RIGHT TO REQUEST RESTRICTIONS:
You have the right to request a restriction or 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 the medical
information we disclose about you to someone who is involved in your care
or the payment for your care, like a family member or friend. For example,
you could ask that we not use or disclose information about a surgery you had.
We are not required to agree with your request.
If we do agree, we will comply with your request unless the information
is needed to provide you emergency treatment.
To request restrictions, you must make your request in writing to Kayla
Hill, RHIA, Health Information Department Director/Privacy Officer at
870-364-1242. 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 spouse.
RIGHT TO REQUEST CONFIDENTIAL COMMUNICATIONS:
You have the right to 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 only contact you at work or by mail.
To request confidential communications you must make your request in writing
to ?. 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.
RIGHT TO PAPER COPY OF THIS NOTICE:
You have the right to a paper copy of this notice. You may ask us to give
you a copy of this notice at any time. Even if you have agreed to receive
this notice electronically, you are still entitled to a paper copy of
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 any information we receive in the future. We
will post a copy of the current notice in the hospital. The notice will
contain, on the first page in the top right-hand corner, the effective
date. In addition, each time you register or are admitted to the hospital
for treatment or health care services as an inpatient or outpatient, we
will offer you a copy of the current notice in effect.
If you believe you privacy rights have been violated, you may file a complaint
with the hospital or with the Secretary of the Department of Health and
Human Services. To file a complaint with the hospital, contact Donna White,
RN, QI/RM, Compliance Officer at 870-364-1232 or Kayla Hill, RHIA, Health
Information Department Director/Privacy Officer at 870-364-1242. All complaints
must be submitted in writing.
You will not be penalized for filing a compliant.
OTHER USES OF MEDICAL INFORMATION
Other uses and disclosures of medical information not covered by this
notice or the laws that apply to us will be made only with your written
permission. If you provide 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 medical
information about you for the reasons covered in your written revocation.
You understand that we are unable to take back any disclosures we have
already made with your permission, and that we are required to retain
our records of the care that we provided to you.