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.
If you have any questions, please contact our Privacy Office at the address or telephone number.
Who will follow this notice
Jackson Hospital & Clinic provides health care to our patients in partnership with physicians and other professionals and organizations. The information privacy practices in this Notice will be followed by all departments and units of our organization, including all off-campus units or departments, and all employed associates, staff or volunteers of our organization, including staff at Jackson Hospital Owned Physician Offices.
In addition, we are a clinically integrated care setting, and we have many doctors and other providers giving care to patients in our Hospital. For convenience of our patients, we are giving one Notice of Privacy Practices to each patient, instead of notices from multiple physicians and other caregivers. This Notice serves as the notice required under Federal law to be given to patients by this Hospital, all members of our Hospital medical staff and all other health care professionals who treat you at any of our locations. The health care providers covered by this “organized health care arrangement” (“OHCA”) will share protected health information with each other, as necessary to carry out your treatment, payment for treatment, and health care operations relating to the OHCA. This arrangement does not mean that the persons participating in the OHCA are involved in a joint business arrangement, or that they are responsible for the acts of one another.
Our pledge to you
As a patient at Jackson Hospital, you have the right to privacy concerning your medical plan of care. Medical record information and your relationship with your physician are considered private. Your diagnosis and course of treatment are available only to those directly involved with your care. Unless you tell us otherwise, we will make every effort to give your family continuous updates on your condition. We create a record of the care and services you receive to provide quality care and to comply with legal requirements. This Notice applies to all of the records of your care that we maintain, whether created by facility staff or your 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. We are required by law to:
- Keep medical information about you private.
- Give you this Notice of our legal duties and privacy practices with respect to medical information about you.
- Follow the terms of the Notice that is currently in effect.
Changes to this notice
We reserve the right change the terms of this Notice at any time. Changes will apply to medical information we already hold, as well as new information we receive after the change occurs. If we change our Notice, we will post the new Notice in waiting areas, patient rooms, and on our Web site at www.jackson.org. You can receive a copy of the current Notice at any time. The effective date is listed just below the title above. You will be offered a copy of the current Notice each time you register at a facility for treatment. You will also be asked to acknowledge in writing your receipt of this Notice on our General Consent for Treatment form.
How we may use and disclose medical information about you
We may use and disclose medical information about you for treatment (such as sending medical information about you to a specialist as part as a referral); to obtain payment for treatment (such as sending billing information to your insurance company or Medicare); and to support our health care operations (such as comparing patient data to improve treatment methods). We may disclose medical information to “business associates” who provide contracted services such as accounting, legal representation, claims processing, accreditation, and consulting. If we do disclose medical information to a business associate, we will do so subject to a contract that provides that the information will be kept confidential, within the timeframes required by HIPAA.
We may use or disclose information about you without your prior authorization for several other reasons. Subject to certain requirements, we may give out medical information about you without prior authorization for public health purposes (such as reports of communicable diseases, births and deaths), abuse or neglect reporting, government health oversight audits or inspections, research studies (under some circumstances), funeral arrangements and organ donation, workers’ compensation purposes, and emergencies. We will also disclose medical information when required by law, such as in response to a request from law enforcement in specific circumstances, or in response to valid judicial or administrative orders.
We also may contact you for appointment reminders, to tell you about or recommend possible treatment options, alternatives, health-related benefits or services that may be of interest to you, or to raise funds for the Hospital.
If you are admitted as a patient, unless you tell us otherwise, we will list in the patient directory your name, location in the hospital, your general condition (good, fair, etc.) and your religious affiliation, and will release all but your religious affiliation to anyone who asks about you by name. Your religious affiliation may be disclosed to a clergy member, even if they do not ask for you by name.
If you do not object, we may disclose medical information about you to a friend or family member who is involved in your medical care. We may also release information to disaster relief authorities, so that your family can be notified of your location and condition.
Other uses of medical information
In any other situation not covered by this Notice or the laws that apply to us, we will ask for your written authorization before using or disclosing medical information about you. If you authorize a use or disclosure, you can revoke that authorization at any time by notifying us in writing of your decision. If you revoke your permission, we will no longer use or disclose medical information about you for the reasons covered by your written authorization. You understand that we are unable to take back any disclosures we have already made with your permission.
Your rights regarding medical information about you
In most cases, you have the right to look at or get a copy of medical information that we use to make decisions about your care, when you submit a written request. If you request copies, we may charge a fee for the cost of copying, mailing or other related supplies. If we deny your request to review or obtain a copy, you may submit a written request for a review of that decision.
If you believe that information in your records is incorrect or incomplete, you have the right to request that we amend the records, by submitting a request in writing that provides your reason for requesting the amendment. We may deny your request. You may appeal, in writing, a decision by us not to amend a record.
You have the right to a list of those instances where we have disclosed medical information about you, other than for treatment, payment, health care operations or in some circumstances where you specifically authorized a disclosure, when you submit a written request. The request must state the time period desired for the accounting, which must be less than a 6-year period and starting after April 14, 2003. You may receive the list in paper or electronic form. The first disclosure list request in a 12-month period is free; other requests will be charged according to our cost of producing the list. We will inform you of the cost before you incur any costs.
If this Notice was sent to you electronically, you have the right to a paper copy of this Notice.
You have the right to request that medical information about you be communicated to you in a confidential manner, such as sending mail to an address other then your home, by notifying us in writing of the specific way or location for us to use to communicate with you.
You may request, in writing, that we do not use or disclose medical information about you, for treatment, payment or healthcare operations or 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 accept it. We will inform you of our decision on your request. All written requests or appeals should be submitted to our Privacy Office listed at the bottom of this notice.
Complaints
If you are concerned that your privacy rights may have been violated, or you disagree with a decision we made about access to your records, you may contact our Privacy Office at this address:
Jackson Hospital Privacy Office
1725 Pine Street, Montgomery, AL 36106
Telephone: 334-293-8799
All complaints must be submitted in writing. You may also send a written complaint to the U.S. Department of Health and Human Services Office of Civil Rights. Our Privacy Office can provide you the address. Under no circumstances will you be penalized or retaliated against for filing a complaint.
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