NOTICE OF INFORMATION PRACTICES
Effective Date: April 14, 2003
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.
If you have any questions about this notice, please contact the Privacy Officer.
DE QUEEN MEDICAL CENTER
PRIVACY NOTICE FOR HEALTH INFORMATION PRACTICES
UNDERSTANDING YOUR HEALTH RECORD/INFORMATION:
Each time you visit a hospital, a physician, or other health care provider, a record of your visit is made. This record typically contains your symptoms, examination, test results, diagnosis, treatment, and a plan for future care or treatment. The information that is kept is often referred to as your health or medical record and serves as:
basis for planning your care and treatment
means of communication between the many health care professionals who contribute to your care
a legal document describing the care that was received
the means by which you or a third-party payer can verify services that were billed were actually provided
a tool for educating health care professionals
a source of data for medical research
a source of information for public health officials who are charged with improving the health of our nation
a source of data for facility planning and marketing
a tool for assessing and continually working to improve the care we give and the outcomes that are achieved
Understanding your health information in your medical record and how it may be used will help you to understand:
who, what, when, where, and why others may have access to your health information.
how to make a more informed decision when authorizing the disclosure of your health information to others
and ensure the accuracy of your health information
YOUR HEALTH INFORMATION RIGHTS:
The information that is compiled by the health care practitioner or facility belongs to you, the patient. The health/medical record is the physical property of the health care practitioner or facility that rendered the services. You have the right to:
request a restriction on certain uses and disclosures of your information
obtain a paper copy of the Privacy Notice of Health Information Practices
inspect and obtain a copy of your health/medical record
amend your health/medical record
obtain an accounting of disclosures of your health/medical record information
request communications of your health information by alternative means or at alternative locations
revoke your authorization to use or disclose health information except to the extent that action has already been taken
This health care institution is required to:
maintain the privacy of your health information
provide you with a Privacy Notice for Health Information Practices as to our legal duties and privacy practices with respect to the information we collect and maintain
abide by the terms of the Privacy Notice for Health Information Practices
notify you if we are unable to agree with a requested restriction
accommodate a reasonable request to communicate health information by alternative means or alternative locations
We reserve the right to change our practices and to make new provisions effective for all protected health information we maintain. Should our health information practices change, we will notify you via a public notice.
We will not use or disclose your health information without your authorization, except as described in this notice.
DISCLOSURE FOR TREATMENT, PAYMENT AND HEALTH CARE OPERATIONS:
We will use your health information for treatment. Health information will be provided to any member of your health care team (i.e. nurses, physicians, or others) for continuation of treatment. Your physician or any subsequent health care provider will be provided with copies of pertinent information to assist the provider in treating you once you are discharged from our hospital.
We will use your health information for payment. A bill may be sent to you or a third-party payer. The information on the bill or accompanying the bill may include information that will identify you, as well as the treatment rendered and the associated diagnoses.
We will use our health information for regular health care operations.
Members of the local medical staff, employees of the hospital who are involved in the risk or quality improvement areas may use the information in your health/medical record to assess the care and outcomes of your hospitalization and others like it. The information obtained will be utilized to improve the quality and effectiveness of care that we provide.
Business Associates are services that are provided outside of the hospital by agreement. Such as ER physician services, radiologist services, certain laboratory tests, billing agencies and collection services. When these services are agreed upon and contracted, we may disclose certain health information to these business associates so they can carry out their agreement for us on our behalf. To protect your health information, a written agreement has been signed and we require that they appropriately safeguard the information provided to them.
Hospital Census: You will be asked upon admission to the hospital if you would like your name to be placed on the hospital census. Doing so will allow us to place your name on the census and will give us the authority to allow people who ask for you by name to know your location in the hospital. If you wish not to have your information published on the census, people who ask for you by name will be instructed that you are NOT a patient within our hospital.
Notification: We may use or disclose information to notify or assist in notifying a family member, personal representative, or another person responsible for your care, your location and general condition.
Communication with family: Health professionals may disclose to a family member, other relative, close personal friend and any other person you identify, relevant health information to that person's involvement in your care or payment related to your care.
Research: We may disclose health information to researchers when the research has been approved by an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information.
Funeral Directors: Health Information may be disclosed to funeral directors consistent with the applicable laws to carry out their duties.
Organ procurement organizations: We may disclose health information to organ procurement organizations or other entities that may engage in procurement, banking, or transplantation of organs for the purpose of tissue donation or transplant as provided by applicable laws.
Marketing: We may contact you to provide appointment reminders or information about treatment alternatives or other health-related benefits and services that may be of interest to you.
Fund Raising: We may contact you about a fund raising effort.
Food and Drug Administration (FDA): We may disclose to the FDA health information relative to an adverse event with respect to food, supplements, product and product defects, or post marketing surveillance information in order to enable product recalls, repairs, or replacements.
Worker's compensation: Health Information may be disclosed to worker's compensation or other similar programs to the extent authorized by and to the extent necessary to comply with laws relating to worker's compensation.
Public Health: As required by law, we may disclose health information to authorities charge with preventing or controlling diseases, injury or disability.
Correctional Institutes: If you are an inmate of a correctional institution or under the custody of a law enforcement official, we may disclose to the institution or the official health information necessary for your health and the health and safety of other individuals.
Law Enforcement: We may disclose health information for law enforcement purposes as required by law or in response to a valid subpoena.
Health Oversight Activities: Health information may be disclosed to a health oversight agency for activities authorized by law. These agencies may include audits, investigations, inspections, and licensure. These agencies are necessary for the government to monitor the health care system, government programs and compliance with civil rights.
Lawsuits and Disputes: If you are involved in a lawsuit or dispute, health information may be disclosed in response to a subpoena, discovery request, or other lawful process by someone else involved in the dispute but only if efforts have been made to tell you about the request or to obtain an order protecting the information requested.
Federal law makes the provision for your health information to be disclosed to an appropriate health oversight agency, public health authority or attorney, provided that the workforce member or business associate believes in good faith that we have engaged in unlawful conduct or have otherwise violated professional or clinical standards and are potentially endangering one or more patients, employees or the public.
FOR MORE INFORMATION OR TO REPORT A PROBLEM:
If you have questions and would like additional information, you may contact DMC's Privacy Officer at 870-642-7572, ext. 224.
TO FILE A PRIVACY COMPLAINT:
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. To file a written complain with the hospital, contact the PRIVACY OFFICER, DE QUEEN MEDICAL CENTER, 1306 W. COLLIN RAYE DR., DE QUEEN, AR 71832. Or you may contact the Health and Human Services Office for Civil Rights at: Ralph House, Regional Manager, Office of Civil Rights, U. S. Dept. of Health and Human Services, Dallas, Texas 75202. Phone: (214)767-4056, Fax: (214)767-0432 or TDD (214)767-8940.
Any objections to the use of this information may be documented on the consent or condition for treatment form.