Effective 9/23/2013

This Notice describes how medical information about you may be used and disclosed, your rights to this information and how you can get access to this information. PLEASE REVIEW CAREFULLY.

If you have any questions please contact the privacy office:
Nancy Edwards
130 Medical Circle
Nashville, AR 71852
870-845-6992
nancye@howardmemorial.com

Our pledge to you:

We understand that medical, billing and personal information is important, and we are committed to protecting the privacy of that information. We create a record of the care and services you receive to help ensure quality care is provided and to comply with legal requirements. This Notice applies to all of those records of your care that we maintain, whether created by our associates or your personal physician. Your personal physician may have different policies regarding his/her physician office.

We will not sell your medical or personal information for direct or indirect payment without your authorization.

Who will follow this Notice?

Howard Memorial Hospital provides healthcare to our patients, residents and clients in partnership with physicians and other professionals and organizations. The privacy practices information in this Notice will be followed by:

• Any healthcare professional who treats you at any of our locations, including all off-campus units or departments
• All employed associates, staff or volunteers of our organization with whom we may share information, as permitted within our organized healthcare arrangement
• Any business associate or business associate sub-contractor or any affiliate or partner of HMH with whom we share health information

We are required by law to:

• Keep your medical, billing and personal information private
• Give patients this Notice of our legal duties and privacy practices with respect to your protected health information
• Notify you of an authorized disclosure of your unsecured medical, billing or personal information
• Follow the terms of the Notice currently in effect

Changes to this Notice:

We may change our policies and privacy practices at any time. Changes will apply to the protected health information we already have as well as new information obtained after the change occurs. When we make a significant change in our policies, we will change our Notice and post it prominently in waiting areas and online. You can receive a copy of the most current Notice at anytime. You will also be offered a copy of the current Notice each time you register at our facility for treatment. You will be asked to acknowledge your receipt of the Notice in writing.

We may use and disclose your medical, billing and personal information for:

• Treatment (e.g. sending medical information about you to another healthcare provider as part of a referral)
• Obtaining payment for care provided (e.g. sending billing information to your insurance company)

NOTE: if you pay out-of-pocket in full for the care or service provided, you do have the right to restrict the disclosure of that information to your insurance company.

• Supporting our healthcare operations (e.g. comparing patient data to improve treatment methods)

We may use and disclose your medical information without your authorization for:

• Public health purposes
• Abuse or neglect reporting
• Health oversight audits or inspections
• Some research studies
• Funeral arrangements
• Organ donation
• Worker’s compensation
• Emergencies
• A request from law enforcement officials in specific circumstances or other times when required by law
• Valid judicial or administrative orders

 We may contact you without authorization:

• For appointment reminders
• To inform you about possible treatment options, alternatives, health-related benefits or services that may be of interest to you

Use of demographic information without authorization:

We may use certain demographic information without authorization such as name, address, phone number or email address, date of birth, health insurance status, gender, dates of services, department of service, treating physician or outcome information to contact you for the purpose of fundraising for HMH. You have the right to opt-out of receiving future communications with each solicitation; directions for opting-out will be included with each communication.

We may provide your name to our institutionally related foundation. The money raised through the foundation will be used to expand and improve the programs and services we provide to the community. Information on how to opt-out will be contained in each communication.

Your decision to opt-out of any communication from HMH will have no impact on your treatment or payment for services at HMH.

How personal information is used once you are admitted as a patient at HMH:

You have the option of not being listed in the facility patient directory. If you do choose to be listed, the following information may be released to anyone who asks for you by name:

• Your name
• Your location in the facility
• Your general condition—good, fair, guarded, critical, etc.

We may disclose medical and billing information about you to a friend or family member who is involved in your medical care or to disaster relief authorities so that your family can be notified of your location and condition.

Other uses of your medical and billing information:

Other than face-to-face conversations about services and treatment alternatives, we will not use your protected information for marketing purposes without your authorization.

 In any other situation not mentioned in this Notice, we will ask for your written authorization before using or disclosing your medical, billing or personal information (i.e. mental health services and attorney requests). If you choose to authorize the use or disclosure of your medical, billing or personal information, you can later revoke that authorization by notifying us in writing of your decision.

Your rights regarding your medical and billing information:

In most cases, you have the right to look at or obtain a copy of the medical and billing information contained in the designated record set used to make decisions about your care. You may request this information in a printed format, or if the information is maintained electronically, you may request an electronic copy. There may be a fee charged for the cost of supplies and labor for creating the copies.

If you believe information in your designated record set is incorrect or missing, you have the right to request that we correct the records. Your request must be submitted in writing and include the reason why you are requesting the change. We can deny your request to change a record if the information you are requesting:

• Was not created by us
• Is not part of the medical or billing information maintained by us
• Is deemed accurate

You may appeal, in writing, a decision by us not to amend a record.

You have the right to a list of all instances when we have disclosed your medical, billing and personal information without authorization for reasons other than treatment, payment or healthcare operations. Your written request must identify a time period, which must be less than a 6-year time frame and occur after April 14, 2003. You may receive the list in a printed format, or if available, electronically. There may be costs associated with your request that will be discussed before any charges are incurred.

If you initially receive a privacy practices Notice electronically, you have the right to a paper copy.

You have the right to request that your medical and billing information be communicated to you in a confidential manner, such as sending mail to an address other than your home. You must notify us in writing of the specific manner or location for us to use to communicate with you.

You may request, in writing, that we not use or disclose your medical, billing or personal information for treatment, payment or healthcare operations to persons involved in your care except when specifically authorized by you, when required by law or in an emergency. We will consider your request, but we are not legally required to honor it.

You may pay for a service out-of-pocket in full and request that the encounter not be disclosed to your insurer.

You may designate someone to act on your behalf and be included in your care. 

Complaints:

If you are concerned that your privacy rights may have been violated or if you disagree with a decision made about access to your records, you may contact:

• The HMH Privacy Office –Nancy Edwards, 870-845-6992 or nancye@howardmemorial.com
• The US Department of Health and Human Services of Civil Rights (OCR)

*If you need help filing a compliant or have a question about the complaint or consent forms, you may email OCR at OCRMail@hhs.gov or request help from the HMH Privacy Office.