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

CONTACT PERSON. If you have any questions about this Notice, please contact:
Betty Woodard, Privacy Officer at extension 325-574-7446, or 
Administration at 325-574-7437.

Who Will Follow This Notice.  This Notice describes D.M. Cogdell Memorial Hospital’s (the “Hospital's”) privacy practices, as well as the privacy practices of: (a) any health care professional authorized to enter information into your Hospital chart; (b) all departments, sections, and units of the Hospital; (c) any member of a volunteer group we allow to help you while you are in the Hospital; and (d) all employees, staff and other Hospital personnel.  All of these entities, sites and locations follow the terms of this Notice.  In addition, these entities, sites and locations may share medical information with each other for the treatment, payment and health care operations activities described in this Notice.

PURPOSE OF THIS NOTICE. We are required by law to maintain the privacy of your medical information.  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 the care and services you received at the Hospital, whether made by Hospital employees or your personal physician.  This Notice will tell you about the ways in which we may use and disclose medical information about you.  This Notice also describes your rights and certain obligations we have regarding the use and disclosure of your medical information.

OUR DUTIES. 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 your medical information; and
 - Follow the terms of this Notice as long as it is currently in effect.  If we revise this Notice, we will follow the terms of the revised Notice as long as it is currently in effect.

HOW WE MAY USE AND DISCLOSE MEDICAL INFORMATION ABOUT YOU. The following categories (listed underlined below) describe different ways that we use and disclose medical information.  For each category of uses or disclosures, we will explain what we mean and give you 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 following underlined categories.

For Treatment.  We may use 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 need to tell the dietician 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 services that you need, such as lab work, X-rays, and prescriptions.  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 physicians who will provide follow-up care, physical therapy organizations, medical equipment suppliers, and skilled nursing facilities.

For Payment.  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) your 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 also may 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 to 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 also may disclose information to doctors, nurses, technicians, students, and other Hospital personnel to conduct training programs.  We also may 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 also may remove all information that identifies you from this set of medical information so that others may use that information to study health care and health care delivery without learning whom the specific patients are.

To Business Associates For Treatment, Payment, and Health Care Operations.  We may disclose medical information about you to one of our business associates in order to carry out treatment, payment, or health care operations.  For example, we may disclose medical information about you to a company who bills insurance companies on the Hospital’s behalf to enable that company to help us obtain payment for the health care services we provide.

Individuals Involved in Your Care or Payment for Your Care.  We may release medical information about you to a family member, other relative, or close personal friend who is involved in your medical care if the medical information released is directly relevant to such person’s involvement with your care.  We also may release information to someone who helps pay for your care.  We also may tell your family or friends that you are in the Hospital and your general condition.  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 location and general condition. 

Appointment Reminders.  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.

Treatment Alternatives.  We may use and disclose medical information to give you information about treatment options or alternatives that may be of interest to you. 

Health-Related Benefits and Services.  We may use and disclose medical information to tell you about health-related benefits or services that may be of interest to you.

Fundraising.  We may use limited medical information about you to contact you in an effort to raise money for the Hospital and its operations.

Marketing Activities. We shall obtain your prior written authorization to use your protected health information for marketing purposes except for a face-to-face encounter or a communication involving a promotional gift of nominal fee. Doctors and other covered entities communicating with you about your treatment options or the Hospital’s own health related products and services are not considered marketing. For example, the hospital can inform you of value-added items and services.

>As Required By Law.  We will disclose medical information about you when required to do so by federal, state, or local law.

>Public Health Activities.  We may disclose medical information about you for public health activities.  Public health activities generally include:

   ~ Preventing or controlling disease, injury or disability;

   ~ Reporting births and deaths;

   ~ Reporting child abuse or neglect;

   ~ Reporting reactions to medications or problems with products;

   ~ Notifying people of recalls of products they may be using;

   ~ Notifying a person who may have been exposed to a disease or may be at risk for contracting or spreading a disease or condition;

   ~ Notifying 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.

>Health Oversight Activities.  We may disclose medical information to a health oversight agency for activities authorized by law such as 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 order to comply with a court order, or under court order or court subpoena. 

>Law Enforcement.  We may release medical information if asked to do so by a law enforcement official:

    ~ In response to a court order, subpoena, warrant, summons or similar process;

    ~ To identify or locate a suspect, fugitive, material witness, or missing person, but only if limited information (e.g., name and address, date and place of birth, social security number, blood type and RH factor, type of injury, date and time of treatment, and date and time of death, if applicable) is disclosed;

    ~ About the victim of a crime if, under certain limited circumstances, we are unable to obtain the person's agreement;

    ~ About a death we believe may be the result of criminal conduct;

    ~ About criminal conduct we believed occurred on the premises of the Hospital; and

    ~ 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.

>Coroners, Medical Examiners and Funeral Directors.  We may release medical information about patients of the Hospital to a coroner or medical examiner to identify a deceased person or to determine the cause of death.  We may also release medical information about patients of the Hospital to funeral directors as necessary to carry out their duties.

>Organ and Tissue Donation.  Consistent with applicable law, we may disclose health information to organ procurement organizations or other entities engaged in the procurement, banking, or transplantation of organs for the purpose of tissue donation and transplant.

>Research.  We may disclose information to researchers when an institutional review board that has reviewed the research proposal and established protocols to ensure the privacy of your health information has approved their research. 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. 

>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 who is able to help prevent the threat. 

>Armed Forces and Foreign Military Personnel.  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.

>National Security and Intelligence Activities.  We may release medical information about you to authorized federal officials for intelligence, counterintelligence, and other national security activities 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 to conduct special investigations. 

>Inmates.  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, for example:  (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.

>Workers' Compensation.  We may release medical information about you for workers' compensation or similar programs to the extent authorized by and to the extent necessary to comply with laws.  These programs provide benefits for work-related injuries or illness.

When Your Authorization Is Required.  Other uses or disclosures of your medical information for other purposes or activities, not listed above, will be made only with your written authorization (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 by your written permission.  However, we are unable to take back any disclosures we have already made with your permission.

YOUR RIGHTS. You have the following rights regarding medical information we maintain about you:

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, such as a family member or friend.  For example, you could ask that we not use or disclose information about a particular surgery that you have had.  We are not required to agree to your request.  If we do agree, we will comply with your request unless the information is needed to provide you with emergency treatment.  To request restrictions, you must make your request in writing to Betty Woodard, Privacy Officer, D.M. Cogdell Memorial Hospital, 1700 Cogdell Blvd, Snyder, Texas 79549.  In your request, you must tell us:  (1) what information you want to limit; (2) whether you want to limit our use or disclosure of the information (or both); and (3) to whom you want the limits to apply (e.g., disclosures to your spouse).  A request form is available in the Hospital’s Health Information Management Department.

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 by telephone at work or that we only contact you by mail at home.  To request confidential communications, you must make your request in writing to Betty Woodard, Privacy Officer, D.M. Cogdell Memorial Hospital, 1700 Cogdell Blvd., Snyder, Texas 79549.  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.  A request form is available in the Hospital’s Health Information Management Department.

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; however, psychotherapy notes may not be inspected and copied.  To inspect and copy medical information that may be used to make decisions about you, you must submit your request in writing to Betty Woodard, Privacy Officer, D.M. Cogdell Memorial Hospital, 1700 Cogdell Blvd., Snyder, Texas 79549.  If you request a copy of the information, we may charge a fee for the costs of copying, 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.  The Administration of 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.  A request form is available in the Hospital’s Health Information Management Department.

Right to an Accounting of Disclosures.  You have the right to request an "accounting of disclosures” by the Hospital of your medical information that occurred in the past six (6) years.  The accounting (or list) of disclosures will include:  (1) the date of the disclosure; (2) the name of the entity or person who received the medical information and, if known, the address; (3) a brief description of the medical information disclosed; and (4) a brief statement of the purpose of the disclosure.  To request this list, you must submit your request in writing to Betty Woodard, Privacy Officer, D.M. Cogdell Memorial Hospital, 1700 Cogdell Blvd., Snyder, Texas 79549.  Your request must state a time period that may not be longer than six (6) years and may not include dates before April 14, 2003; however, the time period certainly may be less than six (6) years.  Your request should indicate in what form you want the list (e.g., whether you want the list on paper, or electronically).  The first list you request within a twelve (12) month period will be free of charge.  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 a 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 this Notice.  To obtain a paper copy of this Notice, contact the Admissions Department at D.M. Cogdell Memorial Hospital, 1700 Cogdell Blvd., Snyder, Texas 79549, 325-574-7354. 

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 at 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. 

COMPLAINTS. If you believe your privacy rights have been violated, you may file a complaint with the Hospital or with the Secretary of the federal Department of Health and Human Services.  You will not be penalized or retaliated against in any way for making a complaint to the Hospital or the Department of Health and Human Services.  To file a complaint with the Hospital, contact Betty Woodard, Privacy Officer, D.M. Cogdell Memorial Hospital, 1700 Cogdell Blvd., Snyder, Texas 79549, 325-574-7446.  All complaints to the Hospital must be submitted in writing